Help/advice on possible lymphoma

[DJC]

At this point, no an x-ray has not been done, however, I expect that to occur tomorrow when we meet the oncologist for the first time. They have asked for Ozzie not to eat 8 hours prior to the apt. Is that for possible treatment? X-ray? I should have asked.

[Traci]

Can you still call and ask?

It's possible the onco vet wants to do an xray (or a series) and in order to get certain views, the pet may require sedation.

However, I would think you'd have been told about any potential sedation measures occuring tomorrow, and someone should have discussed that with you in detail, since Oz has already been under anesthesia twice now in a short time frame.

So, if you can, call them immediately and ask specifically why they require Oz to be fasted tonite - ask specifically their reasoning and what, if any, sedation is in the plan. I thought this was only a consultation, but if the vet plans on doing any diagnostics that require anesthesia, they should have fully informed you first.

[DJC]

I just called.

Tha apt clerk said this is common practice and tell everyone this the first time there is a consultation. If I chose to feed him, I should just let the dr know at the apt.

Yes, hey do this in case they order tests, treatment, etc. (as a general rule) Does not necessarily mean they will do so.

[Traci]

Ok, it is good practice, but unusual for a consultation visit. At least they think ahead and can facilitate diagnostics when the need arises (also keeps cost down for you in avoiding multiple visits).

He may also want to do another CBC, and although fasting isn't always necessary for a CBC, sometimes it helps, depending on what you're looking for.

I'm kind of confused about the biopsy, I am assuming the first vet didn't actually aspirate the lymph node(s). So, the onco vet might (or might not) want to. In what I understand of hodgkins-like lymphoma in cats, a great deal depends on the testing procedures done on the biopsy sample, special techniques etc and the ability to determine certain types of cells in the sample (same applies to the lymph nodes) - those cells are what helps determine the diagnosis and prognosis and I suspect the pathology report was unable to determine for certain, or there might have been a lack of a certain cell form that might otherwise indicate malignancy . In the limited reviews of these cases, it appears most of the cell types don't mestasticize very quickly, as long as there is no multicentric masses elsewhere (or systemic). This gives chemo or radiation a good chance to get to those cells that otherwise can't be done with surgery alone.

Please keep us updated. Here's hoping for good news tomorrow and that Oz doesn't have to undergo any invasive diagnostics - give him a big hug for me, K?

[DJC]

To recap - Oz has had two biopsies, 10 days apart. The lymphnodes in his neck
have lymphoma. The lymphnode is his leg does not. Short story, he seems to
have a form of human-like hodgkins disease. A very rare type of cancer in cats
as most felines develop non-hodgkins type lymphoma.

We just returned home from the oncologist. Unfortunately, it did not go very
well. I expected them to quote us some high costs, but I was not prepared for
what we heard. It's curable, unlike the regular type of lymphoma cats get.
From what we know, an xray and ultrasound (need both) would have to absolutely
determine this & to ensure it hasn't spread to any organs. (at this point,
since it's localized only in his neck, it is thought to be Hodgkins). Those
tests in itself is just over $1200. Then, if it was truly hodgkins, the
protocol is to surgically remove the lymphnodes in the neck that are cancerous.
They didn't give me a true estimate on this as the surgical dr wasn't present,
but the oncologist seemed to think that would be $4000 (at the least). Then
after the surgery, they call for chemo for 17 wks (over a 25 wk duration)under
the Madison Wisconsin protocol. The chemo is to ensure all the cancer is gone. The estimate for that is
just over $5000. In theory, he would then be cured. So, all in...at least a
$10,000 date. (not counting the $1500 we've already spent)

Well, I'm sure you can guess....these costs are completely out of my league. I
would think for most, they would be. Aside the fact it is expensive, there of
course are no guarantees of Oz's health.

We are saddened and trying to think what alternatives we have. I suppose we can
consider chemo to try and prolong his life somewhat, but again, the cancer
eventually will spread to an organ. In any case, we are certain this will really help as a stand alone. Perhaps it could make it worse for him for longer term survival and possibly make him miserable from the chemo drugs?

I am torn what to do. There is no way I can afford the proposed treatment. The
treatment for chemo, although it is expensive, i suppose i can consider it. The
costs are per treatment of course and over a duration of time. Not financially
sure if we can swing it, as it would be tough, but we can think about the
pros/cons to consider.

I feel like I am failing Oz. I so want to cure him, but these are impossible
costs for us.

I understand my scenario is a little different than most
people's cats. There is not a lot of info on what Oz has, in fact the oncologist said
he might see 2 cases a year (if that).

An impossible situation to be put in right now.

[Tina B and crew]

I don't have any advice or answers, but just wanted you to know that Oz is in my thoughts and prayers. I know how tough it is to go through these sorts of tough decisions with a beloved furbaby.

[DJC]

Thank you Tina B and Crew.

Yes, it is difficult. My case is no different than many others of course. It was suggested on another forum that I shop around to see if there are any local vets in the area who can administer the chemo treatments at a lesser cost. I don't know. I'll look into it and make some phone calls tomorrow.

[KJMTA]

DJC is there a vet school around willing to take his case? Hugs and prayers your way.

[DJC]

I just sent off an email to the Guelph College to a specialist in vet oncology. I don't know if he will get back to me, but I thought I would try and get his opinion and/or advice.

Anything of course would help. At this point I don't know if help could be found elsewhere. Financially and with knowledgable expertise.

[Traci]

DJC, have you talked to your primary vet about this? (costs) Can she refer to another oncologist who can do the chemo for less? As others may have advised, to a degree, your own vet or another more experienced vet can do the chemo, for probably much less. I would question using your own vet however, as previous posts sort of give me the impression she may not have the experience?

Are you at least in the position to afford the lymph node surgery done by the onco surgeon? How soon could you get a more accurate surgical quote from him directly?

If by some chance you could afford the surgery, then it might be possible to get another oncologist to administer the chemo treatments for much less, considering most all vets use the protocols (i.e., the Madison-WI protocol). It could be this particular oncologist is charging more because he has a specialized practice or does only onco? Even an internal vet med specialist wouldn't charge that much.

As KJMTA notes, even a veterinary university might help you keep costs down. There are specialists and oncos at vet universities too.

Please talk to your vet and ask her for help in making contacts on your behalf, once she is aware this is potentially curable, she may be more helpful in taking some valuable time to make contacts for you to get these costs reduced.

Although I am glad you got the consult, please understand it would be good to have the onco surgeon do the surgery, because the lymph nodes are tricky areas for surgery - otherwise, the rest/costs quoted are, frankly, outrageous!!

Please don't let this persuade you from getting your vet involved in helping you check around for reduced costs. It would be worth it for the surgery and someone else (who is experienced of course), to administer the chemo, especially since you want the treatment at a facility that you don't have to drive far to etc.