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.
Really helpful article. Thank you.
Thank you for this. We are seeking aggressive treatment for our dog who was diagnosed in December after presenting with a cough I hoped was kennel cough.
Into remission immediately, then out and back in. I don’t know what the future holds and will need anti anxiety meds to deal with the stress….but we are throwing what we have at it.
we treated our Barton for Lymphoma… he was a 8 1/2 year old lab… we gained 15 months of Cancer Free… in hindsight.. the Chemo was tuff.. tuff to watch him on the chemo rounds the after effects.. .. tuff to give him all the meds… etc… I am not sure I would do again… 🙁
Hello sue how old was your dog that had chemo .we have an 11 year german shepard that was diagnosed with lymphoma
Hi Dr Ettinger
My 6 year old female boxer, Nica, was diagnosed with lymphoma and passed away 8 days later. She was eating, active, and showing no signs of illness one day, and the next day she threw up twice and wasn’t interested in eating. We had her seen by a vet the next day. When he did an X-ray, he thought he saw a mass and referred us to a veterinary hospital. She was placed on fluids for dehydration, had an ultrasound, and blood work done. The next day we met with an oncologist at the same hospital who explained that Nica had enlarged lymph nodes and a thickening of the intestinal wall and said Nica had lymphoma. She recommended we have her do biopsy of the nodes and fluid to determine which type etc. We agreed and per the oncologist suggestion, we had her first chemotherapy treat the next morning which was a Wednesday at 11 am. The chemo she used was CHOPS. She told us the next few days may be tough, but if it worked we should see improvement. She also scheduled us for a 2nd treatment at the same time 1 week later.
That day; Thursday;and Friday were rough on Nica. She still wasn’t interested in eating so we made her boiled chicken and rice and had her lick ice cubes from our hands because she wasn’t interested in drinking. That Friday evening I started noticing that she was having difficulty breathing and her breathing was labored so we took her back to the hospital and she was seen by an ER Dr. The Dr told us that the loss of appetite was probably from the chemo but and she did notice some labored breathing. I asked if she had noticed anything on her X-rays or ultrasound that the oncologist did that could be causing her labored breathing, and she suggested we contact the oncologist Monday morning and discuss it with her. The next day was Saturday, and she appeared to feel better. She also seemed better Sunday. She had an appetite, was drinking water, and starting to acting a little more like herself. We were so happy and thought that meant her lymphoma was receptive to the chemo. On Monday, she began to seem more tired, but was still eating and drinking. On Tuesday, the day before her 2nd chemo treatment, I began to notice she was again having difficulty breathing. In the meantime, we were calling the vet hospital daily to ask if the results from her biopsy were in because we were told type B lymphoma responds better to chops and T cell lymphoma was less receptive. I also continued to ask if the lymphoma was in her GI tract. Each time they told me the results were not in and the oncologist said she couldn’t tell. I’d looked at the differences between B & T cell and GI lymphoma and was hoping it was B cell and not GI because the prognosis seemed much better. Nica had already has x rays, ultra sounds, bloodwork, and biopsies done prior to starting the chemo so I thought the oncologist would at least be able to tell us if it was GI. I called again for results on Monday and was told they weren’t in. I called on Tuesday and was again told they weren’t in so I asked if they could check again. A few minutes later, they said they did have the results and it was T cell lymphoma. I told them her breathing was worse and they said to bring Nica in the next morning for her 2nd chemo treatment and they would check her breathing. When we arrived and spoke with the oncologist the next day we told her we were most concerned about her breathing, and we asked if we should continue with the same chemo treatment now that it was confirmed it was T cell lymphoma, because she was getting sicker, and that our number one concern was that she was having such a hard time breathing. She said she wanted to try a rescue drug because she thought it may help. We were willing to do anything to help her feel better and give us even another month, or a few weeks if she felt better. We also told her again they she was favoring her one leg and acted like she was in pain. We asked if she could re assess her lungs and give us something that could help with any pain or discomfort she may be experiencing, but she said Nica wasn’t in pain and that her breathing didn’t seem bad but that she would do another ultrasound. After the ultrasound, she told us she saw a some fluid around her lungs, but not enough to cause Nica discomfort or to have difficulty breathing and that it would help to aspirate any fluid.
She then gave Nica the rescue chemo therapy as we waited. Nica was done with the chemo treatment at 12:30 in the afternoon. When we were leaving, We again discussed our concerns about her bread discomfort. We told her the breathing would get so labored that Nica couldn’t sleep because she was breathing so fast and hard. And, we again most concerned about her breathing and that it was causing her discomfort and keeping her from being able to close her tees and rest. We again asked if she could give Nica something for pain or to help relax her so she could rest. She told us that she did not think Nica was in pain and did not give her anything for pain and did not write a prescription for pain medication. She also never discussed an end of life plan in the event she became worse before her next treatment. That was on Wednesday afternoon. We got home an hour later and Nica seemed worse. She had no interest in eating anything even when we tried to hand feed her. The only way I could get fluids in her was by putting ice chips in my hand so she could lick them. About 2 hrs after we got home from the hospital, her breathing got even worse so I called the hospital to report what was happening. They told us we could bring her back in and they would give her oxygen. I reminded them we were just there and had discussed her breathing and that Nica wasn’t feeling well enough to be put back into the car for another hour or more so they could give her oxygen. So I again asked if I could speak to the oncologist or that they tell the oncologist her breathing was so bad that Nica couldn’t even keep her eyes closed to relax because she was struggling to breath. They put me on hold and came back and said the oncologist said we could bring her back to give her oxygen. I asked if the oncologist could give us something to relieve any pain or discomfort she may have and anything that could help relax her and told them my husband would drive to get the prescription while I stayed with Nica but they said no and that our only option was to bring her back in to give her oxygen. I laid on the floor right beside Nica telling her I was there and I loved her and got up to get more ice and she actually got up and followed me. She then laid back down on the hardwood floor. My husband had to leave for a business trip so I was alone with Nica. As I was laying beside her on the floor she tried to get up and fell back down. It was heartbreaking. I didn’t want to leave her on the hard floor so I tried putting her in her soft bed but I couldn’t get her in it. I then tried to lift her onto the couch so she would be more comfortable and so I could sleep beside her and she could see me. It wasn’t easy, but I managed to get her on the couch and laid with her. I spoke to her and told her I was there and loved her and I wouldn’t leave her side. Within min she started gasping for air and it was horrible. I tried everything I could. I put a pillow under her head and one between her legs to help open her airway but nothing helped. I somehow managed to put her in her soft bed because I thought she may be able to breath better. She had a few more gasps and her breathing stopped. I still had my hands on her and could feel her heart still beating and for a min I thought her breathing got better but then realized she had taken her last breath. A few seconds later her heart stopped beating and I realized she was gone. I laid with her and had my hand under her face and noticed my hand was warm. Then noticed she was bleeding from her mouth and nose and that the blood and fluid had soaked thru her bed and had puddled onto the floor. She had choked on her own fluids that the oncologist told us wasn’t a significant enough to cause her discomfort or worth removing.
I apologize for the length of this message, but I was hoping for some guidance.
When we saw the oncologist several hours earlier, before she gave her rescue chemo I asked if we could have Nica’s records so we could get a second opinion. The oncologist seemed offended and told us she had just as much experience as any other oncologist and that any oncologist would do exactly what she planned to do, and that Nica’s best shot was the rescue chemo treatment. We were so desperate to help Nica that we decided to trust the oncologist and do as she advised. In hindsight, I so wish we wouldn’t have allowed the rescue treatment because it didn’t help and she was already dying.
I’m not a Dr., but I have to believe that an experienced oncologist who I’d assume deals with end of life care would recognize that Nica was dying and that giving her rescue chemo wasn’t in Nica’s best interest and what was most important was to advice and give us a plan for end of life care in the event we were forced to deal with that in the near future. Even if she didn’t realize Nica would die a few hours later, I would think that she would have at least given us a plan and given her something to comfort her.
I would so appreciate if you would respond and give me any feedback. I’ve already contacted the oncologist but she only said she was sorry for our loss but did not respond further.
Nica died on Wednesday, October 2nd and I still miss her so very much.
My email is. Jackie87@comcast.net
Best regards,
Jackie Komoroski
my 12 year old English bulldog has t-cell lymphoma which was first seen in February of this year. Positively diagnosed in May. I was told that without treatment she would last 1 -2 months and with treatment a few month longer because of her age. She has already exceeded her life expectancy for bulldogs by 3 years. Because of this I chose the non-treatment option, but also changed her diet from kibble to canned dog food (Instinct limited dies because she is allergic to wheat and grains and poultry). She cant eat a normal meal as she will vomit so I give her a couple of tablespoons every 1-2 hours when she wants it. While we expected her to pass or have to put her to sleep in July, it is not October. She still has a great appetite, was outside playing with a beach ball yesterday, and doesn’t seem to be slowing down at all. While we expect this to change, I think the diet approach has worked very well. She still will vomit but this is only once or twice in a two-three week period, if she is fed a little more. She has all the other symptoms (black tarry stool, bruising, etc) but doesn’t act like her age,
My 9 yr old beloved Golden was diagnosed w/lymphoma Dec. 12. I was given choice: Prednisone, enjoy for 1 month then for 2nd month, watch him fade away and die–2 months; given 4-6 months on CHOP w/possibility of remission. Victor was on chemo, died in my arms, it wasn’t pretty, not like in the movies, one month after diagnosis and I had withdrawn $5000 to do his treatment. I was told 4-6 months; he lived 1 month. I didn’t even know what was going on when he was dying–it was a shock because I knew he had 4-6 months. If I ever had a dog diagnosed with lymphoma, and I did adopt a rescue 3 days after Victor died–I was devastated, I would enjoy the dog for a week, maybe 2,, then put him down as lovingly as I could. It’s not worth the chance you take no matter what you read or hear about CHOP.
But would you do it twice? Bob is 10.5 yrs old. started the CHOP in Jan. He did fabulously… Just found out it has now progressed. Would you do it again? or what would you do?
Hello Ann,
Thanks for writing. In Chapter 29 of the Dog Cancer Survival Guide, Dr. Sue writes, “if a dog has relapsed, the owner usually wonders whether to start chemo again. It is helpful to know that, in general, the likelihood of a second remission is 50% and the second remission usually lasts 50% as long as the first.” For more information, check out the chapter on Lymphoma 🙂
Thank you, Dr. Sue, for writing such an honest, common sense article about electing to treat lymphoma with a CHOP protocol. There are so many articles out there written by people with very limited knowledge about lymphoma and often no experience with chemotherapy in dogs. It is refreshing to read an article favoring CHOP and telling us why in practical terms.
What if after a year being in remission and than it comes back to internal lymph nodes and she was coughing badly they also said she has bronchitis.
Hello Lisa,
Thanks for writing and we’re sorry to hear that. In chapter 29 of the Dog Cancer Survival Guide, Dr. Sue, a veterinary oncologist, writes about Lymphoma, treatment options, protocols and what to do if the lymphoma relapses–there is a lot of information there that you may find helpful. It would also be a good idea to consult with your vet to find out what you can do to help lessen the coughing.