Thanks Traci,
Last night I emailed two places. The Guelph Vet college/oncologist there that is registered as board certified and another facility in Scarborough (just outside of toronto) at tvrh.ca. I recieved an email last night from tvrh from the 24 hour staff saying they would pass it on to the referral dept and at the very earliest, I could hear back from them on Monday. (they work M-F). I don't know tvrh's expertise. Although the website says they have experience in various areas, including oncology, I have to wait to see what they reply. I outlined what we have done so far for Oz. Of course I would consider alternative treatment for surgery if I can find someone who is experienced enough to do it. I'm no expert, but it sounds pretty delicate to remove these lymphnodes, so I have to consider the risks. (although i don't know how extreme they are at the present time) Costs are a factor and of course, I'm not asking for it do be done for free, but that combined with chemo and any other additional testing sure does add up.
I have emailed my vet to tell her of our meeting with the oncologist today. Of course I said there was no way I can come up with this kind of money. Since our vets referred us to the oncologist, I suspect they don't administer chemo drugs. Had that been an option, I would suspect they would tell us. I don't know if rules/regs are different in Canada in terms of vets administering chemo drugs. I have read that some U.S. vets administer them at a much lower cost than specialized services. This is something I am looking into today although it is a slow going process to find this info out. (basically researching vet sites for their services and/or calling some later today)
As well, I am still doing research as to the benefits of chemo as a stand alone. From your experience/knowledge, would chemo for this particular region help? I have read a lot of info from pet parents who have their kitties on this protocol, however, their furkids have non-hodgkins and the tumours are usually in the stomach or (internal organs)...as opposed to localized in the neck lymphnodes. I haven't found anyone who has used the MW protocol to treat lymphnodes in the neck specific.
So basically, I am looking for any alternatives I can find to treat Oz. My ideal situation would be that Guelph could take on this surgery if the cost was suitable, and then find a much lower cost option locally. Guelph is a 1.5 hour drive at the minimum, and I can't fathom putting Oz in a car once a week for such a drive for 17 trips. He's a pretty calm cat, but I think that would in itself take a toll on his mentality. Even yesterday, I could sense, he loathed having to get back in the car for his second trip of the day. (we went to the reg vets to have stiches removed as well).
So here we are...emailing other experts, calling random vets, and hoping for a suitable alternative.
Help/advice on possible lymphoma
Re: Help/advice on possible lymphoma
Since the lymph nodes are involved, it is better to remove them with surgery, you have to understand that the lymph nodes, when affected by neoplasia, have the ability to spread faster as opposed to just from one area or organ. Therefore, I don't think you should rely on chemo only as the sole approach. If the affected lymph node(s) are removed, this affords the best chance of NOT spreading to other areas.
I know this isn't what you wanted to hear, but in my opinion, the surgery is warranted. Did you at least ask about payment arrangements? Not knowing about the onco specialty's policies, they may arrange that at least a downpayment is given then payment arrangements, it's worth asking about.
I don't know for certain, but I don't think there are any special rules in CA that would prohibit one vet from administering chemo regardless of a different referral vet. It is ideal for all vets involved in the case to be working together anyway, so that everyone is on the same page regarding treatment. All that should be necessary is transferring of medical records and current treatment, so all the vets have a record that is current. Usuall;y, referral vets do some sort of specialty practice and any number of subsequent treatment plans can still be practiced by the primary vet.
I know this isn't what you wanted to hear, but in my opinion, the surgery is warranted. Did you at least ask about payment arrangements? Not knowing about the onco specialty's policies, they may arrange that at least a downpayment is given then payment arrangements, it's worth asking about.
I don't know for certain, but I don't think there are any special rules in CA that would prohibit one vet from administering chemo regardless of a different referral vet. It is ideal for all vets involved in the case to be working together anyway, so that everyone is on the same page regarding treatment. All that should be necessary is transferring of medical records and current treatment, so all the vets have a record that is current. Usuall;y, referral vets do some sort of specialty practice and any number of subsequent treatment plans can still be practiced by the primary vet.
..........Traci
Re: Help/advice on possible lymphoma
We came home from the vet tonight, as we took Oz in for an ultrasound and x-ray. Of course we got results we did not anticipate based on our previous biopsies which told us otherwise.
The report read...
The jejunal lymphnodes were enlarged in a cluster of 4. and measure 0.5-1.2 cm, causing a. Similar lesions ere noted in a duodenal lymphnode and measuring 0.5x0.7 cm.
The liver was normal in size and the parenchyma was isoechoic. Also, the gallbadder was not distended.
Unfortunately, the caudal spleen presented an irregular, hypoechoic mass measuring 1.2x2 cm.
Both kidneys were similarly affected and presented an increased cortical thickening and echogenicity and papillary thickening without pelvic dilatation. Also, they presented a moderate to severe overall increase in size measuring 4 and 4.5 cm in length (n=3.5 cm) on the left and right side, repectively. These findings confirm your index of suspicion and are compatible with a moderate ascending nephritis/pyelonephritis. However, the presence of lymphoid disease cannot be completely ruled out.
The stomach was mildly distended with fluid and hypomotile.
The liver was normal in size and parenchyma was isoechoic. Also the gallbladder was not distended.
The remainder of the abdominal ultrasound was apparently normal. Iliac lymphadenopathy was not seen.
Diagnosis-Multicentric Lymphosarcoma
Of course, we are better off knowing. I will be making an apt for Oz tomorrow for Friday to hopefully start treatment on chemo. We finally found a vet that administers chemo/has a knowledge of cancer at a much reduced price which on the financial side, helps immensely. I refer to another forum as well, and there is a point that the vet should administer a aspirate or biopsy based on the ultrasound report in order to determine the chemo protocol which up until now was MW. I will ask my vet about this at our apt. Of course, I don't want to put him under anestithia yet again (this would be the 3rd time as he already had 2x biopsies done). Perhaps this is necessary. Perhaps not. We will see & go from here.
We will remain positive. I have to believe chemo will help Oz despite the obstacles I know we are up against. Oz, Chemo and Me against the Cancer. Three against one....we are going at it!
The report read...
The jejunal lymphnodes were enlarged in a cluster of 4. and measure 0.5-1.2 cm, causing a. Similar lesions ere noted in a duodenal lymphnode and measuring 0.5x0.7 cm.
The liver was normal in size and the parenchyma was isoechoic. Also, the gallbadder was not distended.
Unfortunately, the caudal spleen presented an irregular, hypoechoic mass measuring 1.2x2 cm.
Both kidneys were similarly affected and presented an increased cortical thickening and echogenicity and papillary thickening without pelvic dilatation. Also, they presented a moderate to severe overall increase in size measuring 4 and 4.5 cm in length (n=3.5 cm) on the left and right side, repectively. These findings confirm your index of suspicion and are compatible with a moderate ascending nephritis/pyelonephritis. However, the presence of lymphoid disease cannot be completely ruled out.
The stomach was mildly distended with fluid and hypomotile.
The liver was normal in size and parenchyma was isoechoic. Also the gallbladder was not distended.
The remainder of the abdominal ultrasound was apparently normal. Iliac lymphadenopathy was not seen.
Diagnosis-Multicentric Lymphosarcoma
Of course, we are better off knowing. I will be making an apt for Oz tomorrow for Friday to hopefully start treatment on chemo. We finally found a vet that administers chemo/has a knowledge of cancer at a much reduced price which on the financial side, helps immensely. I refer to another forum as well, and there is a point that the vet should administer a aspirate or biopsy based on the ultrasound report in order to determine the chemo protocol which up until now was MW. I will ask my vet about this at our apt. Of course, I don't want to put him under anestithia yet again (this would be the 3rd time as he already had 2x biopsies done). Perhaps this is necessary. Perhaps not. We will see & go from here.
We will remain positive. I have to believe chemo will help Oz despite the obstacles I know we are up against. Oz, Chemo and Me against the Cancer. Three against one....we are going at it!
The COP protocol is generally the protocol for multicentric lymphomas. COP includes cyclophosphamide/vincristine/prednisone, with or without a maintenance dose of doxorubicin. (for renal, possible use of cytosine arabinoside - which combined with the COP, is the COAP protocol - vet needs to differentiate the lymph nodes involvement from lymph node hyperplasia - it doesn't sound like renal disease is apparent at this point, but ask about the additional chemo agent if vet feels it can help prohibit kidney disease)
If a biopsy is warranted, it should probably be a lymph node (i.e., the one most easily accessible, and probably the one most clustered - this gives the pathologist a better indication of the structure, behavior and progressiveness of the lymphoma and is able to differentiate from lymph node hyperplasia). Again, an FNA is probably NOT going to be useful, a full removal of a lymph node might be the best course of action for determining chemo protocol.
I don't think I would opt for any major internal surgical biopsy/removal, since recovery could be prolonged or difficult. The last thing you want is prolonged recovery or a potential infection post-surgery (in which chemo would have to be delayed).
That said, removal of a lymph node may not be necessary. Who did the ultrasound, the oncologist or someone else? If the oncologist, please speak to him first before proceeding chemo with the other vet to determine whether or not a removal of a lymph node is or is not warranted.
The good news is that while not curable, the COP protocol is generally effective for achieving remission, or, for improving and extending life to some degree - depending on the stage, anywhere from months to a couple years or so (again, depending on grade and stage). The bad news is that since Oz is FIV+, it makes this a bit more difficult in terms of predicting survival rate (as it is in FELV+ cats). However, that should not be any deterrent to proceed with chemo and hope for remission.
Please make sure you get a CBC prior to all chemo sessions, to monitor for anemia, effectiveness of treatment, etc. This is a requirement when giving chemotherapy. Likewise, at home, monitor Oz like a hawk for any signs of discomfort, pain, nausea/vomiting, diarrhea, etc.
Please update us when you know more. Hang in there!!!
If a biopsy is warranted, it should probably be a lymph node (i.e., the one most easily accessible, and probably the one most clustered - this gives the pathologist a better indication of the structure, behavior and progressiveness of the lymphoma and is able to differentiate from lymph node hyperplasia). Again, an FNA is probably NOT going to be useful, a full removal of a lymph node might be the best course of action for determining chemo protocol.
I don't think I would opt for any major internal surgical biopsy/removal, since recovery could be prolonged or difficult. The last thing you want is prolonged recovery or a potential infection post-surgery (in which chemo would have to be delayed).
That said, removal of a lymph node may not be necessary. Who did the ultrasound, the oncologist or someone else? If the oncologist, please speak to him first before proceeding chemo with the other vet to determine whether or not a removal of a lymph node is or is not warranted.
The good news is that while not curable, the COP protocol is generally effective for achieving remission, or, for improving and extending life to some degree - depending on the stage, anywhere from months to a couple years or so (again, depending on grade and stage). The bad news is that since Oz is FIV+, it makes this a bit more difficult in terms of predicting survival rate (as it is in FELV+ cats). However, that should not be any deterrent to proceed with chemo and hope for remission.
Please make sure you get a CBC prior to all chemo sessions, to monitor for anemia, effectiveness of treatment, etc. This is a requirement when giving chemotherapy. Likewise, at home, monitor Oz like a hawk for any signs of discomfort, pain, nausea/vomiting, diarrhea, etc.
Please update us when you know more. Hang in there!!!
..........Traci
Re: Help/advice on possible lymphoma
I had a rather lengthy phone conversation with the new vet and he did recomend the COP protocol as what he would usually use under these circumstances, with introduction of doxorubicin after several treatments (if I understood correctly, of course)
He did not say I could not opt for MW protocol if I want, however, he said the degrees of effectiveness between the two have shown to be only degrees difference. He called the MW is rated amongst oncologists/specialists as the "gold standard" for treatment and tend to go that route, but not always necessary. He said travel on COP is less (not weekly?) and of course, the cost is less.
Something to think about in terms of the options. Part of me wants to opt for the MW protocol as I read how well some cats do with full remission on it.
He would go in on the treatment day early to get his blood work tests/chemo and then I would pick him up after work so he'd have a full day at the vets.
He is going to call me tomorrow to discuss treatment as we'd like to get him started next week. (due to scheduling, Tuesday seems the best day)
He did not say I could not opt for MW protocol if I want, however, he said the degrees of effectiveness between the two have shown to be only degrees difference. He called the MW is rated amongst oncologists/specialists as the "gold standard" for treatment and tend to go that route, but not always necessary. He said travel on COP is less (not weekly?) and of course, the cost is less.
Something to think about in terms of the options. Part of me wants to opt for the MW protocol as I read how well some cats do with full remission on it.
He would go in on the treatment day early to get his blood work tests/chemo and then I would pick him up after work so he'd have a full day at the vets.
He is going to call me tomorrow to discuss treatment as we'd like to get him started next week. (due to scheduling, Tuesday seems the best day)
Re: Help/advice on possible lymphoma
If the vet has access to VIN, he can consult with some specialists on your behalf (just a login away for him and/or phone call) to help determine which protocol best fits Oz' needs and health status.
Here's a site that explains the protocols.
Here's a site that explains the protocols.
..........Traci
Re: Help/advice on possible lymphoma
It's been some weeks. Just an update. Oz has been on the MW protocol for 3 treatments now. He is doing very well, and the mass in his neck has disappeared to the touch...woot! We haven't had any side effects from the chemo itself. The outlook is looking very bright at the moment and we are very pleased.
Re: Help/advice on possible lymphoma
Thank you so much for the update, I'm so glad Oz is doing so well, it sounds like he is a sweet little trooper!
..........Traci
Re: Help/advice on possible lymphoma
Hello
I thought I would post an update. Oz has just completed his 25 weeks of WM protocol and he's breezed through it without any major complications.
He's a trooper for sure to put up with all the vet visits. We now will be starting Lukeren and continiuing with the Pred for a maintenance stage. We are thrilled with his success, and continue to hope for a healthy, long term remission. We couldn't be happier at the moment.
I thought I would post an update. Oz has just completed his 25 weeks of WM protocol and he's breezed through it without any major complications.
He's a trooper for sure to put up with all the vet visits. We now will be starting Lukeren and continiuing with the Pred for a maintenance stage. We are thrilled with his success, and continue to hope for a healthy, long term remission. We couldn't be happier at the moment.
Re: Help/advice on possible lymphoma
DJC, thank you so much for this update!!
Did the onco do surgery first, or did you go directly into chemo?
I'm so thrilled to hear things have turned out so well, and even more thrilled that you persevered and went above and beyond for Oz, he is a very special kitty to have a mom like you!
Did the onco do surgery first, or did you go directly into chemo?
I'm so thrilled to hear things have turned out so well, and even more thrilled that you persevered and went above and beyond for Oz, he is a very special kitty to have a mom like you!
..........Traci