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.
Which supplements would u use
Hi Joanne! There are no one-size-fits-all recommendations, so you have to do your research. This article might help you get started, but each supplement has to be weighed alongside your veterinarian to see if it will be helpful for YOUR dog. https://www.dogcancerblog.com/articles/book-excerpt/the-most-important-supplements-for-dogs-with-cancer/
My dog (Lhasa Apso) was diagnosed with lymphoma several months ago and is on chlorambucil (once a day). My problem is that her appetite has gone to heck in a hand basket. I’ve tried a number of things including special dog foods and giving her adequate amounts of protein, all to no avail. Perhaps you can suggest some things I might have overlooked.
Hello Carey,
Thanks for writing! We’re not vets here in customer support, so we can’t offer you medical advice. However, we can provide you with information based of Dr. D’s writing 🙂
You may find this article on “How to Get Your Dog with Cancer to Eat When He Won’t” to be beneficial in getting your girl to eat: https://www.dogcancerblog.com/articles/full-spectrum-cancer-care/dog-cancer-diet/how-to-help-your-dog-with-cancer-when-he-wont-eat/
We hope this helps!
Our beloved 11 almost 12 golden retriever did not finish his dinner Friday night then this morning Sunday the same. This dog is el piggo so knew something wrong. Still active no pain, etc. took him to vet today Sunday and had abdominal xray and labs drawn. Abdominal xray showed tummy full of rocks guess why no appetite. It was packed. Decided surgery needed to be done tonight before they passed to intestine or something, anyway needed surgery soon. So got psyched up for this and vet returns can not do surgery. Labs off and showing lymphoma or leukemia. They will be sending blood or slides to some specialized lab for confirmation. Told still may need rock removal? What to do? How would this surgery affect everything else. Will have to give chemo a whole lot of thought. Been there and done that with a much younger dog who didnt need stomach surgery on top of it. Right now our thoughts are stomach surgery and palliative care for lymphome or leukemia. Any thoughts.
Much appreciated. No apparent lymph node enlargement so obviously biospy as to type not done at this time. We want him to have quality over quanty. Previous experious with chemo not good, for dog or us and didnt really seem to increase life but then who knows. Must know he was not a happy dog. Want to bring him home and baby him to death…literally . Thanks for any thoughts.
Would you say age has a contributing factor to consider when giving dogs chemo my dog is 15 and the vet says he doesn’t recommend chemo and has given her steroids.
Hi Wendy, thanks for writing and we’re sorry to hear about your girl. There are many factors that will influence a veterinarians and your own decision on what treatments to use– finance, life-quality, guardian type, your dog’s personality and many more. The Dog Cancer Survival Guide dedicates a whole chapter (#20) on Treatment Plan Analysis that goes through each of these topics.
You may also find this post on “Cancer Treatment at My Dog’s Age?” to be beneficial. Here’s the link: https://www.dogcancerblog.com/blog/but-cancer-treatment-at-my-dogs-age/
Your veterinarian will be able to tell you why he doesn’t recommend giving chemo to your girl. You could always ask your vet what else you could do to help manage side-effects, pain and help increase your dog’s quality-of-life 🙂
This is a short summary of our journey with lymphoma so far, and what has worked for us. Our dog Tucker, a 9 year old yellow lab, was diagnosed in early December 2016. We got the typical diagnosis of 1 month to live if untreated, 3-6 months with prednisone, and 6 months-1year with chemo. We decided to wait to see the chemo specialist before putting him on prednisone, however they could not see us for two weeks (busy schedule) and Tucker went downhill quickly. His breathing became very laboured, and he lost his appetite completely. His nodes were about the size of golfballs. We were sure he would die in the next week if we didn’t do something, so we decided to forego the chemo and go straight to prednisone. It took effect fairly quickly, and within 2-3 days he seemed like his old self again. We monitored his lymph nodes and would “up” his dosage whenever they seemed noticeably enlarged. He has had a great last 5 months, coming up on 6, and we are convinced that the prednisone as well as our extra care for him has gone a long way in prolonging his life…
We put Tucker immediately on a high protein diet, with ground beef, and beef liver mixed with a high quality dog food. We also give him at each meal a mixture of supplements including: Omega 3 fish oil capsules (his coat has never looked so shiny and felt softer, and the omega 3 is very beneficial for the body overall), Turmeric capsules (great for anti-inflammation), and Milk Thistle (helps regulate the liver, as the steroids are quite hard on the liver). We mix it into his food, and he gobbles them all up with every meal. The prednisone seems to give him a constant appetite, so we have never had any issue with him eating his pills. I’ve also been cracking a few eggs into his food a few times a week for extra protein. The cancer cells feed off carbs, and don’t like protein, so a low carb, high protein diet is key. This, along with the supplements has done wonders for our special boy, and we hope it will continue to carry him through for a significant period of time to come. Hopefully some of this information from our experience can help with any of you who are wondering what to do with your precious pup 🙂
How is your dog? My 13 year old Golden was just diagnosed. On pred and I am deciding what to do…
Dr. Sue, The CHOP protocol is not working for my dog. What should I do?
I know this thread is old, but I’ve been through the ringer for my beloved little doxie mix rescue. I’d had him 4 years and he was perfectly healthy. I noticed enlarged lymph nodes but he seemed fine so I watched him. One week later the nodes under his jaw were as big and hard as walnuts. We went to the vet who wanted to do every test available, including aspirate biopsy. I had found a large tick on him 2 weeks before, and I asked if we could do the blood draw, and antibiotics and give him 2 days to respond( I was told that the nods would not resolve with antibiotic treatment, they would continue to get larger) after 2 days they were 75% resolved. We kept him on doxycycline for 9 days but he couldn’t eat- he doesn’t tolerate them well.
I brought him back as he had started to breath hard. THe vet took him off antibiotics because he had started to eat again but it was short lived. 5 days later I was back with him having coughing fits and high respiration. Took x-rays and while the vet said they couldn’t rule out cancer completely, it looked like pneumonia. For 6 days we did injections of baytril but he continued to decline and I brought him back and the vet felt he needed a hospital setting for supportive care. She was still convinced it was not a cancer because of how he responded. We went to a superior animal hospital in out area and within 12 hours we had the answer. He had cancer, very advanced now, either lymphoma or leukemia. WE started elspar and prdnisone immediately and he was given supportive care. His lungs hemorraged within 5 hours of starting his treatment.
My little love and I learned the hardest lesson- my oncologist confirmed that antibiotics can suppress the inflammation and his nodes CAN shrink with their use. They never got big again even after he was off antibiotics.
He lived 6 weeks from the first sign of enlarged lymph nodes, and exactly 1 month since his first vet visit for his problem. I wasn’t sure about chemo, but what I understand now is that the chemo protocal is really just the best palliative care. He was in wonderful hands with a wonderful Dr but I had been to visit him that day and 2 hours after I left he stopped breathing. I know he had people holding him and loving him- he had to be euthanized as his heart was still beating, and I wouldn’t get there in time and I wouldn’t leave him in that state in case he could actually be conscious as his body shut down. But he was in tremendous distress for 10 days, and frankly the ICU of a teaching animal hospital is not a restful place for an animal to be treated. It is loud, scary and any watchful creature will not be able to close their eyes and sleep.
I hope this helps someone…if my vet had even suggested another blood test we’d have perhaps given him a better chance and less pain. This disease progresses so fast – don’t hesitate if you can help it.
I came across this site in my frantic search for any information and reading what is here and one of the posts in particular were so helpful, I had to post our story thus far hoping it will help anyone else in the same spot. To make a long story very short, we took our 5 year old border collie lab to our normal vet on Saturday November 15th with a distended belly after swallowing 6 inches of a bully stick (AKA pizzle stick) three nights prior. He had mild diarrhea for two days but his belly felt tight and we could hear a lot of gurgling but not much else going on. He was less interested in eating food but still eating half of his portion until that morning when he really didn’t want to eat at all. Our fear was that he had an obstruction from the bully stick. Our vet took an xray, couldn’t see anything as she said he had fluid in his stomach. She then pulled some of the fluid and did a quick blood test. His blood test came back normal with the exception of a slightly elevated liver level (255 and it was supposed to be around 100). The fluid in his belly was pink tinged and he had a mild fever 102.9. Our vet sent us directly to the ER vet to get an ultrasound where he was promptly admitted and they ruled out everything from infectious disease, bacteria, septicemia, etc. over the weekend. By Monday, we had a confirmed diagnosis of large cell lymphoma of the liver. We were in such shock. Prior to the bully stick and the eating just that week, we didn’t have any external signs of cancer or tumors or anything. At this point, I just wanted my dog back and home. We decided to at least start chemo in the hospital that day with an l-spar injection and prednisone while I figured out what this all meant. I picked our dog up on Tuesday and had an appointment with an oncologist on Thursday. I was honestly so fearful of going to the oncologist, shell shocked by everything we had just gone through. Our oncologist was amazing and they were so understanding, kind and supportive and helpful. My biggest fear was that my dog would suffer, that I would have to leave him again to be monitored and be miserable and I wasn’t down for any of that. They suggested we start the Wisconsin protocol and see how he did after one treatment. Of course my dog is half border collie and we couldn’t start the Vincristine until we knew if he carried the MDR1 mutation which with Thanksgiving and everything else took 10 days to get results – weekend and holiday ERs seems to be our MO. So we ended up starting out of order with oral chemo on Nov. 17th followed by the Vincristine Nov. 28th since we received normal/normal test results for MDR1 the 25th (YAY!) I have to say that he is doing amazing so far. He has had some GI upset after each treatment but not the day of. So far it has been day 2 or 3 after the chemo and only lasting that one day. On those days, he isn’t interested in eating much but with the anti-nausea medicine (cerenia) he is eating. I’ve seen some folks suggesting chicken broth or things like that. What has worked for us when he won’t eat believe it or not are Gerber Graduates chicken sticks (the baby food), boiled chicken and organic turkey hotdogs. He will almost always eat one of those. On our “normal” days he acts like a 1 year old puppy, LOVES walks, playing and his normal border collie personality shines through. I am actually counting down the days until we can wean him off the prednisone which so far has been doggie crack with more energy than ever. We are still very early on with only two treatments under our belts but so far I am so glad we decided to give the chemo a try. It is still so hard to accept but we are living every dog day we have up to the best and will do so for as long as he is happy. I will not wait for him to start feeling “bad” and I plan to have his last day be one of his best. I wish all of you in the same position the best and hope this story helps.
Advice needed please!
My beautiful chocolate lab Kihei was 3.5 years old when diagnosed with presumptive CNS lymphoma. He presented with vomiting and diarrhea but then had seizures in the hospital. MRI revealed minor lesions on the brain. Numerous ultra sound and aspirites did not reveal anything conclusive. Type A or B test also inconclusive. We did 10 month round of chemo with Cytosar, prednisone and CCNU. Only side effect was elevated ALk Phosphate which is almost back to normal (he is on denamarin). He was diagnosed in March of 2013 and stopped chemo in November 2013. He has been doing great but recent routine blood test should elevated creatinine (2.8) and BUN 32. Re check and creatinine dropped to 2.5 two days later. Now they are recommending an ultrasound to look at kidneys. We have spent a crazy amount of money on our boy without even a conclusive diagnosis. We are committed to keeping him happy and healthy but I am so lost in feelings of worry and despair and anger. I have lost many loved ones to cancer and had cancer myself so I don’t deal well…but to have such a wonderful amazing dog come down with this at such a young age and without a conclusive diagnosis we just wonder what is really going on. Any advice or guidance would be beyond appreciated. It just seems like one thing after another. If you didn’t know, you would think he looks like a normal happy crazy energetic chocolate lab…its just every time we go to the specialty hospital they tell us something is wrong. Any advice or words of wisdom are appreciated
My 7 1/2 year old American bulldog, Mia was diagnosed with lymphoma about a week ago. A little background: Approximately 9 months ago my husband and I noticed enlarged/swollen glands in her neck/throat area. We waited a few weeks to a month not thinking too much of it. When the swelling did not go down we took her to the vet. They pulled a sample from the area and sent her home with antibiotics. When the results came in we were not given much insight or information at all. We were mainly told that it was too early to see anything and to bring her back for a second round of antibiotics. The swelling did not go down. We were back and forth for a couple of months with the vet until we decided to take her somewhere else for a second look. At this point there were clusters in her throat/neck region and they were getting bigger. After taking her to another vet they did a white blood cell count. The results came back normal. There were no other swollen lymph nodes. They recommended a biopsy as the next step. We waited a couple of months and took her back in for the biopsy. This brings us to the diagnosis of lymphoma. At first we decided against the chemo thinking that it would make her feel bad. We decided that whatever decision we were going to make at this point was going to be for her and not for us. We scheduled her for surgery to remove the affected lymph nodes and to get her started on prednisone. After researching the chemo option and realizing that the cost was not as high as we expected it to be my husband and I decided to inquire about it with our vet. I asked the question “if it were your dog, and it were financially feasible, would you do the chemo?” I could tell he was also reluctant to answer that question but it came down to “yes, without a doubt, I would do the chemo.” I was told that lymphoma generally responds very well to chemo. We would have had to drive 2 1/2 hours for each visit to the oncologist but I was willing to do it. Thankfully our vet has gone back and forth with the oncologist and is making it possible for us to do the chemo at our vet instead. The only downfall is that our vet does not have the vincristine. (I believe that is the one he said. It is the one that costs about a thousand dollars for a bottle) They are going to give her the doxorubicin and something else that I cannot remember the name of at this time. All the while my sweet girl has been her normal self. She has shown no signs of pain or distress. The ONLY reason we knew to get her checked out was the swollen lymph nodes. This was AT LEAST 9 months ago when it started. I just keep thinking “wow. They say without treatment they have weeks to 3 months to live. We are going on 9 months and her diet has not changed one bit, she is energetic, happy, tail wagging constantly, playful, and just as cheerful as she has always been. I am so devastated about her results. She is more than a dog to me. I am sure you all feel the same way I do. When you have a dog and you love them and care for them the way you’re supposed to they become more than a pet. They become family. She has brought so much joy into my life. She has such a sweet disposition. Everyone loves her. She is always wagging her tail and scooting around on the floor because she can’t keep her composure (cause she’s so happy to see you) yet she still wants to be a good girl and sit like she’s supposed to) and any time you walk up to her she puts her paw up to shake your hand. (it’s actually her way of saying she wants to be pet) She is such a good girl. She listens so well. I’m getting carried away. 🙂 Since all of this I am so thankful to know that the chemo is a step we are able to take. Like I said we are only making decisions for her and not ourselves and now that we know and understand the chemo a little better I see that it is actually a very good option and I am so glad to know that I can give my baby girl more time with us and also the chance to live more comfortably. I do still know that the reality is I am going to have to make some hard decisions throughout this whole process. I’m just going to take it one step at a time. I’m so glad I stumbled across this page because you all have given me hope, encouragement, and information that I didn’t have before. I hurt for all of you who are going through this or have gone through this. I think the biggest thing to remember is the love and life you and your pet gave to one another.