Your dog has lymphoma. What now? Do you undertake a course of chemo? If so, which one? What about holistic care? Are you finding conflicting information? Perhaps you are unsure of how to approach your vet with questions or advocate for your dog in the face of conflicting advice. That was the position I found myself in when a canine lymphoma diagnosis threw my family for a loop.
In May 2015, I learned that our corgi Ty has lymphoma. Since then, I have learned more than I ever thought I could know about canine lymphoma, from its symptoms, diagnosis, and prognosis, to treatment and diet. From that, I gained a lot of valuable information and found some excellent resources on canine lymphoma. I put off writing about it for awhile though because it simply is not very pleasant to use Ty’s illness for blog post inspiration, nor is writing about it a fun experience. But I have gained a lot of knowledge to share, and one place I found a void in my research was pet parent stories of their own journey through dealing with the disease. I found many good articles on treatment, but not so much on how to work through the many personal decisions required and how to personally advocate for your dog in the face of often conflicting medical advice on lymphoma treatment. I hope to fill that void a bit with this ongoing series covering Ty’s journey through canine lymphoma. This is the first post of hopefully many, and in it I address the initial personal decision making side of the disease. Later posts will cover the nitty gritty basics such as canine lymphoma symptoms, treatment and diet, along with Ty’s story.
Your Dog Has Lymphoma. What Now?
When I learned that Ty had lymphoma I felt like the world was ending. I was told that my sweet little boy, only 6 year’s old, suddenly had perhaps as little as a few weeks to live without treatment. As is often the case with cancer, everything happened quickly. One day Ty was fine, and then a week later he was weak and not eating. Soon after, we had a full diagnosis of stage Vb lymphoma (the worst stage you can be at) and we started chemo. Lymphoma often comes on quickly, or it is sometimes found through abnormal blood work when the dog is still doing just fine, thus catching the pet parent by surprise. Either way, from the very beginning, choices must often be made quickly, with a lack of time to fully research the options. Below are a few of the first step decisions that I faced. As I write dedicated posts on these topics, I will come back and link to them here.
(1) Diagnosis Decisions: Right off the bat there are decisions to be made regarding how far to go with diagnosis and staging of the cancer. An ultrasound and fine needle aspirations are pretty much standard for lymphoma testing. Beyond that, a vet may recommend a bone marrow aspiration, which is an uncomfortable process for your dog. In my case, I was not willing to do a bone marrow aspiration solely for the purpose of determining the stage of the cancer, nor was that recommended to me. I was willing to do it to differentiate between Lymphoma and Leukemia if it became necessary, but we did not have to go that far. Other diagnosis decisions involve whether to additionally test the aspirate for B cell v. T cell lymphoma, which can be useful for knowing prognosis and treatment. We tested for T cell in order to know in case we wanted to use some very new monoclonal antibody therapy treatments, also known as MAb, that are just now becoming available and have different formulas for each B cell and T cell. We learned that Ty’s cancer is B cell, which often responds better to treatment. Dogs with B cell lymphoma are also potential candidates for T-cell infusion, which is a very promising new treatment.
(2) Treatment Decisions: One of the toughest decisions to make can be whether to treat your dog with chemotherapy, treat through less expensive means such as prednisone only, seek hospice treatments simply to make the dog comfortable, try holistic treatments, or some combination. There are also the new monoclonal antibody treatments (MAb) and T-Cell infusion. To make matters more confusing, starting on predisone alone can preclude use of chemo down the road should you change your mind, there are multiple chemo protocols to choose from, and holistic vets and conventional vets sometimes disagree on diet and the use of various supplements. When faced with so much information, coupled with the need to make quick decisions, it can be overwhelming. We decided to do full chemotherapy using the Madison Wisconsin protocol, also known as CHOP. This is an intensive protocol that is also the most expensive, but it also has the best remission and survival rates. Update: We later became enrolled in the Canine T-Cell Infusion Project, which is a new immunotherapy treatment that offers the potential for a very long or permanent remission for dogs with B cell lymphoma. Follow Ty’s process with that here.
Note, throughout this series, I will not make any judgment calls on the best course of treatment. It is a very personal decision and every pet parent’s circumstances are different. Just because I chose the most expensive option does not mean that is the right option for everyone.
(3) Monetary Decisions: The course of treatment is often directly tied to what the pet parent can afford. For those with low income, there sometimes are places that can help. Often these are not made known to pet parents by vets. Ask for information about financial assistance, and search the internet for resources. You might be able to find financial help. I plan to cover some of those resources in a later post. Update: Paws 4 a Cure is one such organization that I recently donated to, as is Magic Bullet Fund.
Questions to Ask
When facing these decisions, there are good resources available on the internet, but the first and foremost best resource is your own vet. In many cases you will probably also be referred to an oncologist. Asking questions can help you make key decisions and will help you advocate for your dog as the process goes on. Here is list of potential questions to ask and my notes on them:
- What tests are absolutely necessary for a diagnosis as compared to only useful for staging? The stage might not really matter in regard to treatment. So you might decide to forego some tests to save money and avoid discomfort to your dog.
- Would the treatment be the same regardless of the stage? It often is, but might not always be.
- Will you test for B cell v. T cell lymphoma? I recommend this if you think you will pursue chemotherapy or other new (but expensive) treatments such as monoclonal antibody therapy (MAb) or T-cell infusion, because the treatment protocol might vary based on the type of lymphoma. But if you don’t plan to do that, then this test probably matters only in terms of prognosis. T cell dogs tend to not live quite as long a B cell ones, but there are also always exceptions to that.
- What is my dog’s prognosis without treatment, with prednisone only, and with different chemo protocols? These will vary and your oncologist should be able to present all of the options with median survival rates. My oncologist gave me a folder with printouts of all of the schedules, costs, and median survival times.
- What are the costs of each course of treatment? Your oncologist should have cost information on all of the options.
- What are the side effects of each course of treatment? Chemo, while not as hard on dogs as it is on humans, does have side effects, so does prednisone.
- What can I give my dog to prevent side effects? Your vet might give you various medications to help treat or prevent side effects.
- What supplements are recommended for my dog and what should be avoided? This is an area of controversy for some vets, so be prepared as the journey goes on to reexamine this matter. More on that in the next section.
- Should I give my dog a special diet? There are books and internet articles on homemade cancer diets. There is also a commercial cancer diet made by Hills backed by a scientific study and other commercial diets that are high protein, which can be better for a dog with lymphoma. Some vets will not be supportive of homemade diets, and there is especially quite a bit of controversy over feeding a raw diet to a dog with cancer. Ask your vet and also be prepared to do research to draw your own conclusions. Holistic vets and conventional vets sometimes disagree on the diet and supplement issues.
- Can I discontinue vaccinations? The answer to this should be yes. It is a rare vet who will vaccinate a dog with lymphoma and many will provide letters to take to your town or city to waive rabies vaccine requirements. Most will recommend that you continue with heartworm, flea, and tick prevention. More on those tricky issues in a future post.
- What are carcinogens in the environment that I should avoid? Your vet may warn you against lawn chemicals and other potential products that could affect your dog’s cancer.
- Are there agencies or charities to help me with the vet bill? Are there interest free or low interest credit programs to help? There are various charities that help low income people with veterinary bills and many vets offer care credit, which sometimes comes with no interest for one year.
- When can I expect to see improvement with treatment? I was very surprised when Ty bounced back to almost normal within a couple of days. I hadn’t asked this question and had expected him to be sick longer.
- How will I know when my dog is in remission or if he comes out of remission: Your vet can show you how to feel for swollen lymph nodes and signs to look for to see if your dog is probably in remission or is coming our of remission
If you choose to forego chemo, you will want to ask additional questions about medications you can give to make your dog comfortable, how long you might still have together, and what you can do when the time to help your pet move on arrives. Those are not pleasant questions, and even thinking about them can be upsetting, but having the information up front is extremely helpful.
Preparation for Conflicts, Holistic v. Conventional Lymphoma Treatment
My biggest challenge in the beginning was dealing with conflicting information. Conventional veterinarians often are not experts in nutrition and supplements. Meanwhile, holistic vets often can provide a wealth of information on both, but many holistic treatments lack the backing of full scientific studies. It isn’t uncommon for a holistic vet to recommend items that a conventional vet or canine oncologist will disagree with. A few examples of areas of controversy are as follows:
(1) Giving antioxidants during chemotherapy: Some holistic sources say to give various supplements with antioxidant effects, other sources say not to because it can decrease the effectiveness of the chemo. Most seem to agree to avoid mega doses. My personal decision was to wait until chemo is done to use supplements with antioxidant effects such as K-9 immunity or Apocaps (disclosure, Some Pets uses affiliate links when we link to Amazon.com). My oncologist was OK with it, but I was on the fence.
(2) Diet: Now that Hill’s has done a study on high protein, low carb food in dogs with lymphoma and entered the market with a prepared food, it seems to be more acceptable to vets to recommend a very high protein diet. But there is disagreement over the use of hommade cooked diets or raw diets. My personal decision was to feed a freeze dried high pressure processed (HPP) raw diet using Primal Turkey and Sardine (affiliate link). HPP kills the bacteria that can be of concern in a raw diet. My own oncologist was fine with even a truly raw diet, but I feel more comfortable with something that is at least put through HPP. Update: Here is my post on diet for dogs with lymphoma.
(3) Use of general supplements: Aside from antioxidants, there are many other supplements that have recommendations for use in dogs with lymphoma. Some, such as fish oil have little controversy. Others, such a curcumin, are touted by some as the next big thing while many conventional vets will note that there is a lack of scientific evidence that it is effective outside of impossibly high doses. Supplements can also have side effects, and some seemingly harmless items, such as glucosamine, are reported to potentially lower the effectiveness of some types of chemo (specifically doxorubicin in the case of glucosamine). It isn’t unusual to see different opinions on the use of any given supplement. There are also supplements such as essiac tea that some swear by, but that others will say are quite dangerous and could make the cancer worse. My own approach has been to not give anything that has a lot of controversy or mixed information that suggests that the item could cause harm. Personally, I am giving Ty high doses of fish oil (my favorite after a ton of research is Grizzly brand – disclosure, this is an affiliate link) milk thistle for his liver, and green lipped mussel (affiliate link) which he took before for bursitis. I added K9 immunity and apocaps when Ty was done with chemo. Update: Here is my post on supplements for canine lymphoma.
Ultimately, the effect of the amount of conflicting information means that you have to become informed enough to ask the right questions and to question some of the options found out there. Here is my list of the resources that I found most helpful when dealing with these conflicts and personal decisions, and resources for personal stories of hope.
You can follow Ty’s updates on his Facebook page.