need help with cancer dx

[ccrumpler]

We've just been given a diagnosis of lymph cancer for our dear lab mix. Based on the swollen lymph glands and blindness - which seems to come & go. She ran some blood tests, but said biopsy is not usually done unless we intend to run the full course of chemo, which she didn't recommend based on her experiences with it. I've been searching the net for information, but found little available. Can anyone here offer any suggestions - alternate possibilities (tried antibiotics) or treatment?

[dragondawg]

Normally a needle aspirate is sent off to a Pathology lab for confirmation. A biopsy is usually only done if you wish to pursue immuno-typing it as "T" or "B" type.

Your choices are the following:

1. Do nothing. Lymphoma will rage through the dog and kill it in 4-6 weeks. It can be a painful death. Obviously not a recommended option.

2. Treat pallatively with high doses of Prednisone. This will give you a remission time of 30-60 days. Once the cancer comes back the end usually comes soon there after. However Prednisone is a one way street. If you should decide later to try Chemo, it will be too late. Prednisone induces resistance to multiple front line Chemo drugs (e.g. multiple drug resistance or MDR).

Lymphoma is the most treatable of the cancers with Chemotherapy. There are rare exceptions, but most dogs will respond very well to it. Despite a couple of unexpected set backs my 1/2Lab-1/2 Golden lasted 1 yr 3 days post diagnosis. She underwent a modified LCOPA protocol. In the time of her first remission of 7.5 months she had a high quality of life. The second week after her first treatment a life threatening infection flared up, and the last 24 hrs of her life overnight she was in a Vet hospital sick with a severe infection. Outside of those two times, she seemed content and happy throughout her year of illness.

The only real issue usually with Chemo is how much the owner is willing to spend. Combined with initial diagnostics, blood work, treating a Lymphoma dog with Chemo can be expensive. Back to the options...

3. Treat non-agressively with Chemo using the older COP protocol. Advantage lower cost, and will usually give a 4-6 month remission.

4. Treat agressively with a multiple drug approach. The key being the inclusion of Doxorubicin and Elspar into the protocol. The primary protocols are LCOPA, and the now in vogue Madison-Wisconsin. Remission times can range from 6 months to 1.5 years. Combining the Madison-Wisc with half body radiation is yielding remission times of 2+ years in some cases.

I would urge you to seriously consider Chemo. I would do it all over again, and if I had known of the possible benefits probably would have thrown in the 1/2 body radiation in lieu of the maintanance Chemo treatments after the first remission had been obtained. With proper supportive drugs such as Metoclopromide/Zofran along with an acid blocker such as Cimetidine your dog will probably not experience any nausea. The worst case scenario is if the cancer is already resistant to the drugs, but the only way to find out is to try the Chemo.

I note your location is Coastal NC. I would urge you to get a referral to the Veterinary Specialty Hospital of Carolinas, and make an appointment with Dr. Jerry Waddle.

http://www.vetspechosp.com/vets.cfm

Tell him "Daisy" sent ya. I had mine there in the June 2002-2003 time frame.

It may be some distance from the coast, but it will be worth the trip for you. He will usually want to see the dog the first couple of treatments, but after that he can set things up so that the local Vet of your choice can administer some of the other treatments. Since your current Vet is not too ethusiastic you might want to consider another to partner with the Oncologist.

If you should go to Dr. Waddle ask him about supportive drugs for nausea such as Metoclopromide. He is very accomodating. Since I arrived at his door 3 weeks post diagnosis and 1 Chemo treatment I have no reference point for this, but you should ask him for antibiotics to counter any latent infection. Approx. 70% of Lymphoma puppies have a latent secondary infection at the point of diagnosis which can flare up after the first Chemo treatment. I almost lost mine the week after her first treatment at the local Vet. In fact the road was bumpy before finding the VSH in Cary.

Finally start your puppy on fish oil. Try 3000-4000 twice a day. Worst that might happen if you give too much is a loose stool. If so then cut back. As you might imagine your Lab will just hate to take those fish oil gel caps.

http://www.hillspet.com/media/generalContent/Vet/Clinical/Monographs/en/managementOfCanineCancer_en.pdf

If you have the finances and time, don't give up hope. Try the Chemo. Chances are you will not be disappointed. You potentially still have many months ahead to share with your puppy

[ccrumpler]

I've been thinking about taking him to another vet locally to get a 2nd opinion. My husband has great confidence in this one though - and agrees with her about the chemo. To me, the symptoms seem a little vague to have such a quick and definite dx. I don't know how expensive a biopsy is, but at least then I'd know. This off & on blindness throws me. He had the 1st incident a week ago, then he was fine. Then yesterday he was blind in one eye. Thanks for the information. I still have to digest all this. And while I can find plenty of info on the web for human problems, I'm finding very little for pets. Again, thanks.

[tatsxxx11]

You've gotten some great advice...I too would strongly urge you to consider all of the medical options available for you pup. The most important avenue to pursue now, I believe, is to get a firm, definitive diagnosis. If you're able to have him evaluated by a specialist, an oncologist, I think that would be best and allow you to consider all options realistically. When my Lab Jingles was suffering from liver cancer, she also had periods of blindness My thought and prayers are with you and your beloved pup. Please keep us updated. Sandra

[dragondawg]

Unless the Vet just totally bungles it, a needle aspirate is all that is needed to confirm the diagnosis of Lymphoma.

Given the 4-6 week time frame IF it's Lymphoma you really do not want to procrastinate.

Now to scare you to the Vet... Lymphoma can cause tumors in any organ. The eyes are an organ. That was one of my nightmares when my Daisy went throught this. Also it can infiltrate the nervous system including the brain. The good news - if there is such a thing with Lymphoma, is that when treated not only will your dog have a good quality of life but when it's time to go, they will go fast. For mine it was 24 hrs from tired but not ill, to severely ill.

Tell husband not to be afraid of the Chemo. I know I was initially. The dosage they give dogs is designed to yield a high quality of life, but not a cure. If the approach was to cure as it is in humans, then it would be a lot more toxic. Humans can provide immediate feedback to the Oncologist, dogs can not. The hardest part of Chemo for our dogs is not the side effects, but the owners getting over the precieved phobia of Chemo.

One of the tricks that the Dr. Waddle's of the world play is to administer Elspar and Prednisone initially. The results are dramatic, and the two drugs are the least toxic of the Chemo drugs. It gives the owners (not the dog) the courage to proceed. Get a referral you won't regret it.

[ccrumpler]

Thank you for your help. My husband talked to the vet again, and she's put him back on antibiotics in case it is one of the tick related diseases we have here, and some eye drops. She still doesn't seem to want to to anything to confirm the cancer dx, and I suspect the antibiotics were more to make me feel better. Also recommended the fish oil - you were right about how hard that would be to give him I'm going to push for another vet I think. Actually the one we've taken him to isn't our regular one - he's been on vacation all month so we had to see one of his partners. Maybe I can at least get my husband to take Buddy in when he gets back this week. Or I may take matters into my own hands and take him elsewhere. He's such a handful though. Normally quite well-behaved, and he loves everyone at the vet's office, but if he decides to go somewhere, I can't stop him - he's almost as big as I am, and certainly more muscular

[dragondawg]

Indeed get to another Vet, and have them send a needle aspirate off to a Pathology lab ASAP. If it's Lymphoma you need to act now. If they can't confirm, you still should consider taking the trip to VSH. They have a lab in house for testing, and will be able to confirm Lymphoma, or some other cause such as Leptospirosis.

[ccrumpler]

Thank you. I'm not going to wait for our regular vet to come back, he's going somewhere else. I stopped by PetSmart this weekend to pick up some vitamins (couldn't find any liquid ones like the vet recommended), and found they now have an animal hospital there. Would have talked to someone, but of course they weren't there on Sunday. Had lots of literature out though, and found info on a couple of other diseases with symptoms that include swollen lymph nodes. He may have cancer, but I want to know this for sure. That she doesn't want to confirm it with the aspiration bugs me, and yet she's able to say she's 99% sure it's cancer. Good news is that his appetite seems to have pick up. I've been giving him his vitamin & pill cocktail in a can of food, but now he's going back to eating his dry food. May not mean anything, but it makes me feel better.