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Well, crap. Tell me about canine lymphoma

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  • Original Poster

    #41
    Just a quick update:

    We are starting a modified CHOP protocol today at CSU. They have shortened it to 15 weeks. Hopefully, it will make Riana feel better soon. I think the biggest concern now is Riana's tumor load--the vet mentioned tumor lysis syndrome (I think that's what it was called?) and that she usually recommends hospitalization for dogs like Riana with the first dose of chemo. We agreed I could monitor her at home. Fingers crossed for no nasty reactions.

    Comment


    • #42
      FWIW, tumor lysis syndrome is one of those things that we worry about MUCH more often than it is actually seen...but it does exist. Fingers crossed as well, and jingles that Riana feels better soon -- isn't that what it's all about?

      Comment

      • Original Poster

        #43
        The vet did mention it was one of those rare, off the wall concerns...but I tend to be one of those people who has the bad luck to collect rare, off the wall responses or issues. I will be watching Riana closely, just in case.

        We are waiting for fresh labs to come back, and then she goes back for her vincristine.

        Comment


        • #44
          My assistant trainers dog died this past weekend with this, he was diagnosed just a couple weeks ago. Didn't feel it was fair to make him go thru chemo etc.
          www.shawneeacres.net

          Comment


          • #45
            Originally posted by shawneeAcres View Post
            My assistant trainers dog died this past weekend with this, he was diagnosed just a couple weeks ago. Didn't feel it was fair to make him go thru chemo etc.
            Personal choice, but its a HUGE pet peve of mine when people say they dont think its fair to put their dog through chemo. We have 28 chemo dogs coming in for treatments right now, all happy and not stressed when they come in for chemo treatments. They are all sent home with an anti-nausea and some will occasionally feel a little off for a day post chemo - but for the most part the symptoms are very mild and go away after a few hours. If the chemo does make them ill (and it CAN in some rare cases) you stop treatment.

            Again, I agree that choosing not to do chemo is absolutley fine, but using stress to the animal as a reason to decline treatment is an uneducated decision for the average pet dog. At least at our facility, all the dogs run up to the chemo ward to get their treats and hang out with their attendants for the day!

            If you have a dog who stresses majorly in the car, or in hospital then yes...I can see that a reason not to put the dog through chemo, but people need to understand that they are not shoved in kennels then poked and prauded with huge needles with painful drugs. They are coddled like our own animals, given quality one on one time with their personal caregivers for the day and the chemo treatments often take all of 5 seconds to 30 minutes at most. They are not painful.

            Comment


            • #46
              How much does chemo run. My 16 year old was diagnosed last week. She seems awfully damn peppy for me to just do nothing.
              www.ncsporthorse.com

              Comment

              • Original Poster

                #47
                Riana is fatigued tonight, but interested when stuff happens. We did spend 6 hours at CSU, though, so some tiredness might just be from that. She does not appear to be in pain or feel icky. This morning, she was slow to eat her breakfast (first time since she was diagnosed), and walked away from her dinner a couple times tonight, but still finished--I am unsure if she's just having trouble swallowing due to the enlarged lymph nodes, or if her issues tonight are due to chemo. We'll keep an eye on it.

                I'm really hoping that she will feel significantly better soon!

                And adding, as a couple posts showed up as I was typing:

                Shea'smom: the single drug Doxorubicin protocol runs ~$1500 and the multidrug CHOP protocol runs ~ $4000 at CSU, and that is including all of the bloodwork and take home drugs and doctor visits and whatever. The Dox protocol has a median survival time of 6-8 months and the CHOP has MST of 12ish months. (From what I understand from my conversation today--if I am off, the people in the know here will correct me) CSU offers some trials that will help with the cost of chemo.

                And STB: thank you. I don't think I'm being unfair to Riana. I think I am giving her the best chance to feel BETTER. My #1 reason why I am doing this is that I want her to feel better. When I was at CSU today, the vets really stressed that that is also their goal, and they try very hard to make the experience GOOD for the dog--lots of treats and pets and praise. Riana's vincristine infusion took all of 15 minutes and she came back just as happy and tail-waggy as when she left. They pre-treated her for nausea at my request (I would rather pre-treat and have her not react than not pre-treat and have her feel icky and then treat), and sent me home with nausea drugs and diarrhea drugs. Everyone's goal seems to be to get the dog feeling better with no bad days.

                Comment


                • #48
                  Originally posted by shea'smom View Post
                  How much does chemo run. My 16 year old was diagnosed last week. She seems awfully damn peppy for me to just do nothing.
                  Depends on the protocol for the type of cancer.

                  CBCs and physical exams will need to be done before each treatment - this will generally run $150.

                  Vincristine is a relatively cheap IV chemo that is used in conjunction with several other drugs for lymphoma - this with IV catheter will run you anywhere from $75-$250.

                  Adria will cost slightly more as its a 30 min injection.

                  CCNU is oral and can be anywhere from $35-100.

                  Kidrolase is an IM injection and is around $100.

                  There are many different drugs to use depending on what your oncologist sees appropriate.

                  Pred is a very cheap alternative to chemo...runs about $0.15 per 5mg tablet. Lots of people choose this instead of chemo as its extremely cost efficient, and although life expectancy is shorter it generally does extend life as opposed to no treatment. Side effects to high pred doses however (in my opinion) can be harsher than chemo side effects as often there is pu/pd, extreme hunger, panting and anxiousness and acute liver failure associated with it in high doses.


                  Generally, most protocols are weekly for 6 weeks, then every 2 weeks for 6 weeks, then every 3 weeks for 6 weeks. Then finish, or some people choose to stay on a remission protocol which is vincristine once a month to once every 6 weeks.


                  Rescue protocols will cost more, once your animal comes out of remission.

                  We have a dog now that has just finished his 18 week chemo protocol and it ran him $12,000. Dog is doing great.

                  Comment


                  • #49
                    Originally posted by Simkie View Post
                    Riana is fatigued tonight, but interested when stuff happens. We did spend 6 hours at CSU, though, so some tiredness might just be from that. She does not appear to be in pain or feel icky. This morning, she was slow to eat her breakfast (first time since she was diagnosed), and walked away from her dinner a couple times tonight, but still finished--I am unsure if she's just having trouble swallowing due to the enlarged lymph nodes, or if her issues tonight are due to chemo. We'll keep an eye on it.

                    I'm really hoping that she will feel significantly better soon!

                    I hope she feels better too!!! Did she go home with any cerenia (anti-nausea?) often the day after chemo they can feel a little blah, but generally bounce back pretty quickly the following day. Its rare for them to feel icky for more than 24 hours after their chemo. Jingles for her.

                    Comment

                    • Original Poster

                      #50
                      Originally posted by SquishTheBunny View Post
                      I hope she feels better too!!! Did she go home with any cerenia (anti-nausea?) often the day after chemo they can feel a little blah, but generally bounce back pretty quickly the following day. Its rare for them to feel icky for more than 24 hours after their chemo. Jingles for her.
                      Ayup--she was pre-treated via injectible at the hospital and I have pills too.

                      Comment


                      • #51
                        Well, I guess I won't be spending that much on my old girl. She is on pred already. sigh.
                        www.ncsporthorse.com

                        Comment

                        • Original Poster

                          #52
                          shea'smom, here is my bill from today:

                          Specialty exam: $120
                          Oncology Procedure: $72
                          CBC: $33
                          Diagnostic profile: $45
                          Flow Cytometry: $110
                          Chemo Prep Phaseal: $35
                          Prednisolone: $7.16
                          Tylosin: $20.18
                          Vincristine: $7.11
                          Maropitant: $10.99
                          Maropitant: $10.62

                          The flow cytometry was to determine B cell vs T cell. Prednisolone was one time--i have four weeks worth. Tylosin was the anti-diarrhea med. The Maropitant is the anti-nausea and on there twice because it's the injectible they gave her there and the pills I took home.

                          Bloodwork has to be done weekly for this protocol, and I have arranged to do it next week at my regular vet to reduce the time Riana has to spend at CSU.

                          There are trials at CSU which would reduce the cost of treatment, but I was not interested, as they required general anesthesia for a lymph node biopsy. Perhaps they would be of interest to you? (And--not sure if you saw my previous post, as I edited, but the Doxorubicin protocol comes in at ~$1500 at CSU, pre trial credit. You don't have to spend $12k.)

                          Comment


                          • #53
                            Its certainly not always 12k!! Sometimes dogs dont live the to the end of the protocol, and they always have modified versions to better suit "parents" with financial concerns. I know I wouldnt be able to do the full protocol!!

                            Universities will generally be much cheaper as they are teaching hospitals, I am at a private referral practice so prices are higher.

                            We also probably do more pre-treatments, such as ultrasounds before each doxyrubicin treatment and IV catheters with phaseal systems for allchemo injections. There are certainly ways of doing it cheaper - but again, in private practice we see the majority of animals who come from rediculously wealthy families or have pet insurance.

                            Unfortunatley its extremely unrealistic for most people to pay for that, understandably!

                            Comment

                            • Original Poster

                              #54
                              And, just in case anyone is curious, here is CSU's 15 week CHOP protocol. I haven't seen it anywhere online.

                              Week One:
                              Vincristine 0.7 mg/m2
                              Prednisone 2 mg/kg/d

                              Week Two:
                              Cytoxan 250 mg/m2
                              Prednisone 1.5 mg/kg/d

                              Week Three:
                              Doxorubicin 30 mg/m2
                              Prednisone 1 mg/kg/d

                              Week Four:
                              Prednisone 0.5 mg/kg/d

                              Week Five:
                              Vincristine 0.7 mg/m2

                              Week Six:
                              Cytoxan 250 mg/m2

                              Week Seven:
                              Doxorubicin 30 mg/m2

                              Week Eight:
                              Off

                              Week Nine:
                              Vincristine 0.7 mg/m2

                              Week Ten:
                              Cytoxan 250 mg/m2

                              Week Eleven:
                              Doxorubicin 30 mg/m2

                              Week Twelve:
                              Off

                              Week Thirteen:
                              Vincristine 0.7 mg/m2

                              Week Fourteen:
                              Cytoxan 250 mg/m2

                              Week Fifteen:
                              Doxorubicin 30 mg/m2

                              Comment

                              • Original Poster

                                #55
                                Originally posted by SquishTheBunny View Post
                                Its certainly not always 12k!! Sometimes dogs dont live the to the end of the protocol, and they always have modified versions to better suit "parents" with financial concerns. I know I wouldnt be able to do the full protocol!!

                                Universities will generally be much cheaper as they are teaching hospitals, I am at a private referral practice so prices are higher.

                                We also probably do more pre-treatments, such as ultrasounds before each doxyrubicin treatment and IV catheters with phaseal systems for allchemo injections. There are certainly ways of doing it cheaper - but again, in private practice we see the majority of animals who come from rediculously wealthy families or have pet insurance.

                                Unfortunatley its extremely unrealistic for most people to pay for that, understandably!
                                Okay, since you mention it--wtf is a phaseal system? It's on my bill and I've never heard of it before!

                                Comment

                                • Original Poster

                                  #56
                                  Update today:

                                  Riana is brighter and more engaged today. She was slowish to eat breakfast (compared to normal), but finished and did not walk away. Her lymph nodes seem to be smaller. No nausea or diarrhea.

                                  I think that she's feeling quite a bit better!

                                  Comment


                                  • #57
                                    Originally posted by Simkie View Post
                                    Update today:

                                    Riana is brighter and more engaged today. She was slowish to eat breakfast (compared to normal), but finished and did not walk away. Her lymph nodes seem to be smaller. No nausea or diarrhea.

                                    I think that she's feeling quite a bit better!
                                    YAY!!!! Heres hoping she continues to do better and better!!!

                                    The Phaseal system is a disposable safety system for drawing up chemo drugs, its for the handlers safety so there is no leakage and the chemo is all in a closed system.

                                    Glad she is feeling better. Hopefully those lymph nodes will stay down for a long time

                                    Comment


                                    • #58
                                      Originally posted by Simkie View Post
                                      Okay, since you mention it--wtf is a phaseal system? It's on my bill and I've never heard of it before!
                                      It's the system they use to handle and deliver the chemo safely without exposing the drugs to the patient or the administrator.

                                      http://www.carmelpharma.com/phaseal.html

                                      www.youtube.com/watch?v=o8UG4z2uRAQ

                                      Comment

                                      • Original Poster

                                        #59
                                        Wow, that is very neat. Thanks for the links, especially the video.

                                        Riana has faded a bit this afternoon/evening, but scarfed her dinner with her usual enthusiasm. Not sure if she's feeling lousy or just tired. Nothing about her is overly concerning. Vitals are all normal. I did give her the Cerenia in case her tummy is bothering her, but I haven't really seen any indication that it is. No vomiting or frequent swallowing or drooling or anything.

                                        Lymph nodes are significantly smaller, but her fat right hind limb (lots of edema) has not reduced. No heat and no pain. Vet was not concerned, but--as a horse person!!--it bothers me.

                                        Comment


                                        • #60
                                          Jingles for Riana.
                                          www.ncsporthorse.com

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