Options for lymphoma in an aggressive dog?

RE: Options for lymphoma in an aggressive dog?

Tedders — Thu, 22 Jun 2017 22:59:44 GMT

We had an aggressive dog with lymphoma a few years ago that we had to sedate every week for it's vincristine injection and it did fine for a while. I think we've had to sedate the odd cat too.

RE: Options for lymphoma in an aggressive dog?

Martin Atkinson — Thu, 22 Jun 2017 09:30:37 GMT

[quote user="George Cooper"]Ashley - you've actually answered your own question by mentioning the risk to staff. You have an over-riding responsibility to their safety[/quote]We are talking about a snappy little terrier here not a Rottweiler that is going to take someone's arm off. We have to deal with these every day and manage, whats the difference doing it every 2 weeks when the animal will benefit from it. What's more Ashlea has implied it was much easier to deal with when it came in for it's investigation so why not just give it a try, if its is all too much then give up.

[quote user="vs0u "]I suggest that the vet's role is to help the owner to understand that the dog's welfare may be best served by minimal intervention, and to reassure them that there is absolutely no reason to feel guilty about taking the preds +/- PTS option.[/quote]This is partly true and if everyone is on board making a decision for the right reasons fine but part of this to me seems to be the looking for excuses not to do the chemo.

Clive's last post sums it up.

RE: Options for lymphoma in an aggressive dog?

Thomas Johnson — Thu, 22 Jun 2017 08:58:25 GMT

[quote user="George Cooper"]i would agree with the others who have suggested steroids to effect as opposed to 'side-effect' and then give it a humane ticket one way only.[/quote]

I agree with this, and remember discussing prednisolone dose for palliation of dogs with lymphoma with Gerry Polton a couple of years ago and he suggested starting at 0.5mg/kg sid, and only going higher if you didn't see a response.

RE: Options for lymphoma in an aggressive dog?

vs0u — Wed, 21 Jun 2017 19:18:54 GMT

[quote user="Martin Atkinson"]

[quote user="Ashlea"]He surprised me when he was in for sedation for investigation, he's been almost impossible to sedate before[/quote]

[quote user="Ashlea"]I've used Lomustine before but am I correct in thinking it's hideously expensive? [/quote]

[quote user="Ashlea"] the owner is happy to pay whatever is necessary,

[/quote][quote user="Ashlea"] I think she feels guilty that we're not able to do the same for this one.[/quote] So at risk of angering one star man: why the heck don't you just sedate the dog and get on with COP or CHOP? If it all becomes too much you can stop but at least you've tried. It sounds as though someone is making excuses somewhere along the line to suit their own agenda.

[/quote]

I disagree with this and suggest that the vet's role is to help the owner to understand that the dog's welfare may be best served by minimal intervention, and to reassure them that there is absolutely no reason to feel guilty about taking the preds +/- PTS option. Each animal is different and what was done for the other dog is clearly going to be much more stressful for this one.

What would you do if it was your animal?

RE: Options for lymphoma in an aggressive dog?

Clive Ansell — Wed, 21 Jun 2017 17:20:56 GMT

I agree with Martin, if the owners want to try and are happy to pay for it, do what you would do in a non aggressive dog, on the basis it will have to sedated every visit.

What you are doing is not that invasive or painful, so you may et away with low doses of Dom/Torb and reverse when done

If not the +/- preds +/- PTS

RE: Options for lymphoma in an aggressive dog?

George Cooper — Wed, 21 Jun 2017 16:47:12 GMT

Ashley - you've actually answered your own question by mentioning the risk to staff. You have an over-riding responsibility to their safety and any dog, especially one with life-limiting problems, that compromises that comes second in the priority ratings.

i am also going to comment upon your initial posting which was heavy on "previous" with the owner and her original pet...... As those on this list will aver, I am of the strokey-feeley side of veterinary work, but, where a cancer is involved, and where QOL of dog AND staff are involved, I would suggest that you step back and perhaps let someone less emotionally involved (=blinkered?? LOL) take over the case.

i would agree with the others who have suggested steroids to effect as opposed to 'side-effect' and then give it a humane ticket one way only.

oh - and apologies if this appears to be blunt - I cannot see any other sensible route for this dog, this owner, and this vet (you) in this case. Do what is right.

RE: Options for lymphoma in an aggressive dog?

Martin Atkinson — Wed, 21 Jun 2017 16:15:26 GMT

[quote user="roland bulkyn-rackowe"]Sileo sounds like a good idea to try![/quote]The problem with Sileo is that it has to go under the lips as will not be adsorbed if the dog swallows it so if its trying to bite the end of he syringe off its unlikely to be effective. Maybe still worth a try though.

RE: Options for lymphoma in an aggressive dog?

Roland Bulkyn-Rackowe — Wed, 21 Jun 2017 16:01:10 GMT

I'd consider sedating and epirubicin + pred. I've done this once or twice some years ago. I can't remember the protocol but it was about one infusion every 3 weeks. In house CBC + film examination before each treatment. Sileo sounds like a good idea to try!

RE: Options for lymphoma in an aggressive dog?

Braden Collins — Wed, 21 Jun 2017 14:00:53 GMT

To my mind, if the dog finds a trio to the vet so stressful that the normally happy, well mannered dog becomes aggressive and urinates everywhere, it's not doing the dogs welfare much good to have such a stressful trio each week or fortnightly. I also wouldn't risk my staff for such a case.

I feel the dog's welfare is best served by focusing on maximising quality of life, rather than causing it a great deal of stress.

Lomustine in Australia is quite cheap, but with monitoring involved the price can add up. If you're not monitoring cell counts, you'd need to be very conservative on dosing which would likely affect duration of activity.

RE: Options for lymphoma in an aggressive dog?

Martin Atkinson — Wed, 21 Jun 2017 13:28:53 GMT

[quote user="Ashlea"]He surprised me when he was in for sedation for investigation, he's been almost impossible to sedate before[/quote]

[quote user="Ashlea"]I've used Lomustine before but am I correct in thinking it's hideously expensive? [/quote]

[quote user="Ashlea"] the owner is happy to pay whatever is necessary,

RE: Options for lymphoma in an aggressive dog?

Ashlea — Wed, 21 Jun 2017 12:44:47 GMT

I'll have a chat to the owner, given that the dog is so bright we may elect to just let him live med-free until the time comes to PTS. He surprised me when he was in for sedation for investigation, he's been almost impossible to sedate before - snapping with any attempt at approaching him, usually covering staff in urine and managing to bite someone on one occasion. He's apparently lovely at home but the owner but only to a certain extent, he's got conjunctivitis at the moment and topical medication is completely out of the question.

I've used Lomustine before but am I correct in thinking it's hideously expensive? The dog's not insured although the owner is happy to pay whatever is necessary, maybe unmonitored might be worth a try. It's very sad for the owner, she lost her other dog only a few weeks ago after a lot of investigation and treatment, I think she feels guilty that we're not able to do the same for this one.

RE: Options for lymphoma in an aggressive dog?

Bob Russell — Wed, 21 Jun 2017 09:57:17 GMT

Preds may not particularly prolong life but can make a massive difference to the quality of the limited time available.

Not sure how much there is to lose with unmonitored lomustine etc as this is a terminal condition. Adverse effects stop +- euthanase. Just important that the owner is fully aware and on board with the risks/benefits.

RE: Options for lymphoma in an aggressive dog?

Martin Atkinson — Wed, 21 Jun 2017 09:00:08 GMT

[quote user="Beats"]No good options,[/quote]Hi Beats. It seems one star man/woman doesn't like our posts both of which are perfectly reasonable. Sad they don't have the courage to explain why.

RE: Options for lymphoma in an aggressive dog?

Sarah Wheadon — Tue, 20 Jun 2017 22:37:09 GMT

I suspect that the longevity of improvement with pred will depend on the type and stage of lymphoma. I have had 1 case which lived for 6 happy intervention-free months on pred alone. If your owner is happy to pay a consultation fee, Iain Grant at Chemopet (https://chemopet.co.uk/) is very knowledgable and helpful.

RE: Options for lymphoma in an aggressive dog?

Nicola Cole — Tue, 20 Jun 2017 22:04:53 GMT

[quote user="Beats"]

4) Is a tube of Sileo any good at sedating these patients prior to visits? (assuming the owner can safely administer something into mouth?) i.e. does it work better than the usual suspects at presenting a genuinely sedated dog, esp. pre-euthanasia?

[/quote]

n=1:no. Made it mildly easier to get an i.m. injection in when given double dose sileo.

RE: Options for lymphoma in an aggressive dog?

David Mills — Tue, 20 Jun 2017 19:38:05 GMT

Long walk, short plank, assisted by preds.

RE: Options for lymphoma in an aggressive dog?

Clive Ansell — Tue, 20 Jun 2017 19:12:28 GMT

+1 for preds, with pts when worsens

or maybe just pts?

RE: Options for lymphoma in an aggressive dog?

Beats — Tue, 20 Jun 2017 19:08:22 GMT

No good options, but thoughts to consider:

1) Sedate and give doxorubicin every 4 weeks for maybe 4 administrations?

2) Give chlorambucil or cyclophosphamide or lomustine alongside some pred WITHOUT sedating for hematology every couple of weeks - just tailor your dose to lower end unlikely to cause serious neutropenia - results likely to be better than pred alone.

3) I'm unconvinced that giving these dogs preds alone extends their lifespan by more than a few weeks at best and often makes them pee everywhere... I'd be tempted to euthanase without going through the pred phase?

RE: Options for lymphoma in an aggressive dog?

Emily Rainbow — Tue, 20 Jun 2017 16:30:31 GMT

If the dog gets that worked up at every trip to the vets and had a life limiting condition is if really fair to do more than just palliative pred and then PTS when QOL is diminished?

RE: Options for lymphoma in an aggressive dog?

Martin Atkinson — Tue, 20 Jun 2017 16:03:37 GMT

[quote user="Ashlea"]The owner is understandably not keen on him having multiple sedations. [/quote]Why? Sure its not a cost issue? Explain its a lot better to sedate the dog regularly than compromise on treatment.

IMO it is a lot safer to sedate patients for IV chemo regardless of their temperament, I usually do to start until I'm fully confident we can do it without risk to staff or of extravascular injection. Some I have sedated up to every 1-2 weeks for an entire course.

You could substitute L.asparaginase for vincristine as it's an SC injection but horrifically expensive.

RE: Options for lymphoma in an aggressive dog?

Linda Filshie — Tue, 20 Jun 2017 14:55:36 GMT

Pred and leukeran or pred as a sole agent in these circumstances - need to sedate for haematology every few weeks with the former though.

RE: Options for lymphoma in an aggressive dog?

Ashlea — Tue, 20 Jun 2017 14:55:06 GMT

Thank you Sarah and Braden, I think the need for repeat blood samples may mean that steroids are the only thing I can do. I feel awful as we did everything we could for her last dog and with this one there's nothing we can offer which won't risk the staff. She's a lovely lady and her other dog was beautiful but this one has never liked us!

RE: Options for lymphoma in an aggressive dog?

Braden Collins — Tue, 20 Jun 2017 14:52:44 GMT

For a dog like this, I would stick with pred. To use oral products such as lomustine would be an issue for monitoring cell counts if you can't blood test safely.

RE: Options for lymphoma in an aggressive dog?

Sarah Keir — Tue, 20 Jun 2017 14:51:37 GMT

There are oral only protocols but you still need to do white blood cell monitoring so the patient would need blood samples taken.

Otherwise steroids only and euthanasia when the time comes.