What I Would Do for My Dog with Lymphoma
Sue Ettinger, DVM. Dip. ACVIM (Oncology). Dr. Sue is a boarded veterinary medical cancer specialist. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), she is one of approximately 400 board-certified veterinary specialists in medical oncology in North America. She is a book author, radio co-host, and an advocate of early cancer detection and raising cancer awareness. Along with Dr. Demian Dressler, Dr. Sue is the co-author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity.
Updated: November 2nd, 2021
Summary
What would a veterinarian oncologist do for her dog with lymphoma? Dr. Susan Ettinger tells us how she would handle this dread disease.
When Guardians come in for a consultation with me after receiving a cancer diagnosis, they often ask “Doc, what would you do if this was your dog?”
I usually refuse to answer the question (with one important exception, which I will get to in a moment).
It’s very difficult for me to answer that question because there are way too many personal factors that go into the decision of what to do. In addition to the overall prognosis for that particular cancer, there could be other pre-existing conditions. It can become very complicated, and so much just depends upon the person who is asking.
So I can’t tell you what I would do, because really my answer is irrelevant at best and confusing at worst.
Everyone Is Different, No Answer Is the Same
Some Guardians want to be aggressive and take the treatment approach associated with longer survival times, even if it costs more, requires more visits to the oncologist, and has more side effects.
Others don’t.
For example, when I tell some Guardians the median survival time for their dog’s cancer is 18 months with treatment, they don’t feel that is long enough … while others will tell me that getting an extra three months is more than they hoped for.
What I would do for my dog is likely not what you would do for your dog.
I used to say I would have given Paige, my Labrador, a kidney if she needed it and it was medically an option.
I would have given my dog a kidney if she needed it!
(She is no longer with me, but she did not need my kidney. And no, you cannot transplant your human kidney to your dog.)
I am pretty aggressive with medical options for my own pets.
For example, I am not afraid of some side effects from diagnostics and treatment, especially when the “side effect” of not treating is worse (in my opinion).
I am more likely to go for surgery, radiation, and/or chemotherapy for my dog than choose a palliative approach such as pain management only.
But that is a pretty generalized statement. It’s what I would do — and that doesn’t mean it’s what YOU should do.
And again, my choice may not be the choice of the Guardian sitting across from me in the exam room with their dog by their side.
So, in order to keep from projecting my personal feelings onto Guardians, I usually just refuse to answer that question.
When it comes to lymphoma, I answer the question: CHOP.
Except when it comes to lymphoma. When it comes to lymphoma, I will share what I would do.
For me, that is an easy choice: I would treat my dog with a CHOP multi-agent protocol.
For much more of Dr. Sue’s insights into Lymphoma, get a copy of the Dog Cancer Survival Guide and read chapter 29, which starts on page 297.
Dogs with Lymphoma = CHOP Protocol
This protocol is a cyclic protocol usually lasting 5 to 6 months. In each cycle, the protocol includes vincristine, cyclophosphamide, and Adriamycin (doxorubicin). In the 1st cycle (usually the 1st treatment), the dog may also receive Elspar. Prednisone, a steroid, is also given orally daily for the 1st 4 weeks during the 1st 4-week cycle.
It’s typically a nineteen-week protocol, and it involves plenty of vet visits and some heavy-duty chemotherapy drugs. If it sounds like a lot, you’re right, it is.
So why do I universally recommend it?
For dogs with lymphoma, chemotherapy has a significant and positive effect on not only how long a dog lives but how well they live. Let’s look at some numbers.
Typically, a dog with lymphoma lives only one (1!) month without treatment.
The median survival time with a multi-agent chemotherapy protocol is 13 to 14 months.
So if your dog has lymphoma, and you don’t treat with chemo, you would expect to have one month more with your dog. But if you DO get the CHOP protocol, it would be reasonable to expect that your dog would live another 13 months.
Note: median survival time of 13 months means that of all dogs with lymphoma who undergo this protocol, half are still alive after 13 months. We don’t know, of course, which dogs will make be in the 50% who die earlier, and no one can guarantee your dog will be in the half that lives past 13 months. But it’s a REALLY long time compared to other cancers and other protocols!
Don’t Be Scared of Side Effects!
Dogs tolerate chemotherapy treatment so well that their life is considered good to great by most Guardians in my practice during the protocol and after the protocol (when they are in remission).
There is a LOT you can do at home to help with side effects. This webinar is a must-listen!
Dogs with lymphoma treated with chemotherapy live longer and live well.
So, yes I would treat my own dog for lymphoma with chemotherapy. No question for me.
Best,
Dr. Sue
Sue Ettinger, DVM. Dip. ACVIM (Oncology). Dr. Sue is a boarded veterinary medical cancer specialist. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), she is one of approximately 400 board-certified veterinary specialists in medical oncology in North America. She is a book author, radio co-host, and an advocate of early cancer detection and raising cancer awareness. Along with Dr. Demian Dressler, Dr. Sue is the co-author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity.
Hello, My little girl Roxy (6 1/2 year old solid black german shepherd) was diagnosed with lymphoma in late June 2012. We did the Wisconin protocol Chemo. I would HIGHLY reccomend doing the chemo. Roxy never really felt sick after the treatments and lived a high quality life.
Today was the hardest day of my entire life. At around 5:43pm… I had my vet come over and I said my final goodbye.
In December of 2012, Roxy came out of remission. I tried 3 different rescure protocols with negative results. Her lymphnode on her rear left leg was the size of a golf ball. It stayed like this for around 2 1/5 months. I thought maybee it would stay this way for awhile and she could get maybee another year. Then after about 3 months, the lympnodes in her neck came back. She stopped eating and became very lethargic. Her legs became very swollen and today, her face became swollen.
I miss my little girl so much.
My best advice I can give you guys is just love your dog every day. Take them to the beach, the lake and let them live the best lives you can give them.
The chemo will give you the time you need to show extra love. I’m so sorry you guys have to deal with this. I know how you feel and pray that all of you will have success with your dogs. Best of luck to you all.
Dr. Susan Ettinger,
I just got a call from my vet and she said the lab that did the needle aspiration in july could use that sample and do some DNA test for $350. I don’t understand. I called the lab and they would not talk to me. How could a sample be inconclusive 7 months ago and now give you results. I will spend the $350 but not if I am just going to get the same answer. I am so upset — right now I wish I had cancer and would die. I cannot deal with any more pain. My boy is suffering and I am helpless.
To Arlene…..
I hope you stop the chemo while you can. A dog doesn’t understand some distant buying of time. 5 or 6 days of sick in a week or two week period is a lot of days of a dog feeling badly. They are all about NOW. They are in the moment….that’s what we love so much about them. I regret profoundly putting my dog through a hopeless chemo regimen and making his last few days so miserable. My whole life was about making the dog happy….about doing what was right FOR HIM. That meant leaving social functions and concerts and baseball games early. That meant never leaving him with a stranger. That meant fixing his food every day for him from scratch. That meant hiking him, when I really wanted to be on a bike or skis. And the idea that I chose poorly for him at the last moments of his life will haunt me forever.
I am devastated…..our precious Harley did not make it through this battle. Less than 10 days after we started the Wisconsin protocol, Harley died. We had to put him down on Friday evening. He had tolerated the first round of Elspar and dex. But the next drug in the protocol, the vincristine injection did not go well for him. He had pain immediately following the treatment…..he was leaping around the car in distress, so much so that i took him back to the vet. They had no clue as to why he had this reaction. He calmed down after a bit, and had one good day the next day which was Wednesday. Then thursday he started downward, drooling and panting–miserable. By Friday he was flattened, tired out from panting, and malnourished from loss of appetite. I tearfully put him down while he laid in my arms panting. It was the most heartbreaking moment of my entire life…and I was holding on to my mothers hand when she left this world. This was worse. I would NOT recommend this protocol for a dog to anyone. A dog doesn’t know it’s doing it to get “more time”. A dog doesn’t have a concept of “more time”. We look to these animals because they are so in the moment. And trying to buy more time is a human construct.
Harley had a lifetime of medical challenges. He had chronic allergic bronchitis that led to multiple pneumonias and steroid use (pred and then an inhaler instead). I’m sure those drugs took their toll on his immune system and that may have made him a poor candidate for chemo. He had torsion surgery. He had UTI’s. But this one last battle he could not fight. And if I had this to do all over again, I would NEVER EVER EVER put my dog through chemo. I just want this out there so that there is a more realistic picture of what doing chemo with a dog means. “Most” dogs may tolerate, but not all. And it’s a big price to pay for your precious most trusting of friends who is counting on you to do the right thing by them. My baby is gone and we are bereft. Horrible experience.
Thank you for all the feedback and resources, etc. For now, I just want this other viewpoint out there. Best to all of you…..
Dear Laura,
I am so sorry for your Harley and for you in this.
🙁 That sounds horrible.
I’m sending you my best thoughts right now.
Dr D
Thank you for your reply Dr. Dressler. I had read your suggested reading yesterday. It helped me with my latest discussion today with my vet. She told me we will figure out a plan together. It pains me to include budget as a concern, also. I hope your guide include specific types of chemo chemicals and supplements that will not interfere with effectiveness of the Pred and the chemo killing the cancer cells, while giving my Cosmo some natural protection to his liver, heart, stomach, spleen, etc in a non-toxic way. Of course breed comes into play, for ex: Cavaliers and their heart as well as current blood levels as a result of treatments, existing conditions like IBD. There must be documentation out there on such things since this form of cancer (I am learning) seems to be common. I can’t be the only one seeing the need for nutritionist (and oncologists or any specialists) to partner with a primary vet in caring for a pet. Sometimes what is read online from someone else case is taken out of context and wrongly used as a remedy. For example, I read Turmeric was a good natural anti-inflammatory (that I came across in a blog Q&A), but he had thrown up once already that day. I added a pinch to his dinner and he threw up again but with blood. Maybe I caused it? Oh the guilt. Hopefully the guide will give me some guidance and I can find a nutritionist who can help us make educated decisions. Thank you again. It’s wonderful what you and Dr Ettinger are providing here. Every bit helps! – Gina and Cosmo
Dr. Susan Ettinger,
I wrote to you in Feb. about my boy with lymphoma. I am frustrated with my vet. Back when she said he had lymphoma she said the test were inconclusive (she did it twice) but they showed lymphoma cells. With her experience she said he did have it and she thought it would be a waste of money to do more test if I was not going to do chemo. But now it is almost 7 months — he has gained almost 5 lbs and he is only a 15 lb dog, papillon. She did another needle aspiration and said since he is on predisone the test would not be able to tell if he had lymphoma. She said a x-ray would not tell me anything. What do I do? From what I read he should not be alive if he has lymphoma. 7 months of predisone cannot be good for him. I called another vet and they said they would take him off the predisone for 2-3 weeks and redo the aspiration but we could still get inconclusive results and if that happened they would take out the node to do a biopsy. That would cost around $2000. I am a disabled veteran and recently had a dog with epilepsy dumped at my home — he has taken a huge bite out of my budget. But if I take him off the predisone and he has lymphoma I will kill him. Since I wrote last I loss a second cat — my grandma always said things come in threes. I am so afraid that I will do the wrong thing and he will die. I need some guidance I have no idea what to do for my boy. Please help me!
Update: Cosmo vomited twice on Sunday(yesterday). The 2nd time with blood. I had given him a pinch of Turmeric. That could have been it… He had some protein in his urine when it was tested last week. His Spleen and Liver were reactive with early lymph changes. Bloodwork today showed liver and pancreas levels elevated. He was given an injection for nausea. We dropped Prednisone down to 1 tablet 2x/day. Stop Clavamox. Stop Prilosec and replace with Pepsid. Add Carafate 3x/day 2hrs after other meds. He still will take the Flagyl in the am with the Pred and GlycoFlex with dinner. His chemo is being postponed to make sure he is holding his food. Again, I appreciate it if you have any suggestions. Thank you!!! – Gina and Cosmo
Just replied Gina. Have you consulted with the oncologist?
Dr Sue
I have a wonderful, precious 8 yr old Cavalier King Charles Spaniel, Cosmo. He has been diagnosed with Lymphosarcoma. Who knows how long his nodes have been large. Could have been 1-2 weeks. If you can give me any direction, I would greatly appreciate it. He’s had allergies for a long time, IBD (July 2012) takes Flagyl, arthritis/hip dysplasia since 1yr old (takes GlycoFlex), Spine trauma from collar 2009 (took Rimadyl, luckily I refused Pred steroid use). No heart issues previously.
Over the weekend of 3-09-13, we noticed large ‘glands’ under his jaw(concerned this is effecting his breathing), bulging in lower ab area as well as his skin rather red in inner thigh. He also for the past week had been uncomfortable sleeping moving from crate, to bed, to floor. Occasional hack/cough to clear his throat. He has felt heavier in weight lately.
I brought him in on Monday 3-11. Blood taken, xrays of both chest and abdomen. We could see enlarged lymph nodes above his heart and in other areas. His organs also looked ‘thickened’. Aspirations done of his lymph nodes in his shoulder and back leg (nodes have been enlarged in that area in the past due to inflammation from hips). It didn’t look good.
Tuesday 3-12 dropped off for an ultrasound. His bark was horse from nodes pressing on his vocal cords. Vet confirmed results of aspirations: lymphosarcoma. His spleen and liver may also be involved. When pressing on his spleen, he had discomfort. Biopsy was done. Urine shows protein, I think. He had chemo. Overnight stay. Weight 25.5 lbs.
Wed 3-13-13 Responded well to chemo, shrinking of the nodes. Picked him up, he was his happy tail-wagging self. His bark was to normal.I noticed lymp node shrinkage, but not as much as from vet’s point of view. They do feel squishy.
His first chemo was with Elspar. Sessions will be weekly for 6 wks. Sometimes an needle injection, sometimes IV over 2 hrs or so. He is on Pred. Took him off Rimadyl. Clavamox for 7 days, Prilosec antibiotic for 14 days. Chemo is CHOP(COP?) protocol. 6 weeks. Up to $2100 so far.
He had allergies and we didn’t know for sure from what. Food? Environmental? He would get his anal glands cleaned often. I would give him benadry which sometimes helped. I switched his food to a grain-free food. He was too heavy, so I switched him to Core Wellness reduced fat turkey/chicken which was grain-free. Added to food and treats consisted of apples, carrots, frozen string beans and yams, which help when he is constipated (also can be from allergies and anal glands).
Due to IBD, I change his food AND stop giving him the fruit/veggies. Switched to Wellness Limited Ingredient “Simple” Dry Salmon and Potato. I wasn’t sure if the proteins were the IBD issue, so I chose Salmon. He gained the weight he lost over the summer (from 18.9 lbs to 22 lbs) His weight is now over 25 lbs.
Thurs 3-14-13 Vet called me to set up Chemo #2 on Tues 3-19. He is thirsty, peeing a lot, still breathing issues, still unsettled sleep. She said we will work on a plan together. I continue research on line for treatment, diet, supplements and herbs. There is an oncologist in the area I could see. Don’t know if he is T-cell, but vet thinks he may be. Bone marrow was not tested yet. I don’t know the results of the biopsy of spleen or liver yet.
I feel like I am cramming for a test (against time) to research this cancer and find the best supplements for him to take and I want to get him these right away. Do you have any suggestions? Thank you!
Dear Gina,
sorry about your Cosmo.
It is very difficult for even a vet or medical person to research all the supplements in a critical way in a short amount of time. Luckily this has been done for you in the Guide, which has downloadable forms for different electronic readers (kindle, nook, etc) so you can get the info you need.
Also here is a post I would read that will get you started.
https://www.dogcancerblog.com/blog/an-overview-of-what-else-can-i-do/
Remember to get your vet’s input in all health care steps,
Best
Dr D
Gina,
A complete overview of lymphoma is in the Guide, plus lots of other helpful info to assist you and Cosmo through this journey.
I do recommend an oncologist. I personally believe cancer should be managed by a person who specializes and focuses on cancer.
Remember lymphoma is very treatable and most patients tolerate chemo VERY well.
All my best, Dr Sue
Hi Laura,
As you can see from Dr. Ettinger’s response many dogs do very well with chemo. My own vet is treating a poodle as well and the only side effect he had was some swelling of his legs which stopped with a adjustment of his dosage. No gastrointestinal side effects.
Heidi has not been so lucky. She has lost her appetite, sometimes a little, sometimes alot. She is nauseous, but she only threw up once, and last week had diarrhea for a couple of days,She is usually sick for 5 days, maybe 6, just getting better in time for her next treatment. So, it has been very upsetting. Then, she also developed an anemia first, and then low white count and low platelet count. She had a scheduled week off in her protocol, and because of her low counts, she was given a second week off. We will see what next week’s blood tests tell us. Despite her normal sized lymph nodes now, her vet is not sure if it is because of her chemo or if the lymphoma is still active in her bone marrow. However, because of her break in the chemo, she is feeling very well now. She is eating all her regular dinner, on her own, and looking for my food as well. And she wants to go and sit outside in her favorite place on the back steps, not trying to hide under a bush like she did for a ccouple of days. I assume there will be an adjustment to her dosage due to the counts, assuming they are ok for her to continue. Maybe this will help her nausa as well.
Laura, I too had cancer last year, and while I did not have to go through chemo, they were thinking for awhile that I would so I learned a little. While they can give you some idea what each drug’s side effects might be, each person’s journey with chemo is different, as is each person’s journey with radiation (which I did get). I am learning that it is no different with our dogs. The doctors just have to do their best to help keep the side effects to a minimum if and when they occur.
All the best to you and Harley. So sorry you too have to go through this.
And, Dr. Ettinger, I would love to get your comments on Heidi’s low white, red, AND platelet counts.
Thanks so much.
Arlene
Arlene, our dog Harley just had his first treatment with the elspar, and as of day 3 has totally lost his appetite. i’ve gotten him to eat some cooked fish out of my hands, and some cooked carrots. but he won’t really touch much else. is this the first treatment you spoke of, where your girl heidi wouldn’t eat for 4 days? this is going to seriously weaken harley, and he’s supposed to have treatment two on tuesday. if you see this, i’m wondering if you can shed a little light. thank you…..