I’d like to start with some nice “before and after” pictures…I think Sarge’s throat is less swollen just 24 hours after the first treatment!
Throat when first diagnosed
One day after 1st treatment
Dr. Hamilton had said there should be dramatic improvement initially, which is why he did not want to wait to start treatment. Yay for Sarge! Thank you, Dr. Hamilton!
Moving on to the more sobering part of the afternoon. Sobering but still hopeful.
Dr. Hamilton called this afternoon and said Sarge has very early signs of bone marrow involvement. Argh! Which officially makes him Stage 5. One hundred times arghhhhhhhhhhhhhh!
Dr. Hamilton, however, was not overly concerned about the bone marrow involvement because it is very slight. He also said staging was not prognostic with dogs and that it does not relate to how much time he has left.
Only 10 – 15% of dogs show bone marrow involvement.
Today he said 80 – 90% of dogs respond well to treatment, with 12 – 15 month survival time on average. A quarter of them make it to 2 years, and if they make it past 2 years, they are considered home-free!
So what are we going to do about this nasty cancer?
Dr. Hamilton plans to use the Wisconsin Protocol (which he also called a form of CHOP) to treat Sarge. Typically there will be 16 treatments over a 25-week period, with 3 drugs given over a 4 drug cycle (one is repeated) and a total of 4 cycles.
The vet’s office is going to give me a print-out of the treatment plan, but I found this online and it appears to be what they are recommending:
Week 1 – Asparaginase (which technically he got in Week 0, i.e., yesterday), Vincristine, Prednisone
Week 2 – Cytoxan, Prednisone
Week 3 – Vincristine, Prednisone
Week 4 – Adriamycin, Prednisone
Week 5 – Take a break from vet visits (although we continue with the Prednisone for one more week)
Week 6 – Vincristine
Week 7 – Cytoxan
Week 8 – Vincristine
Week 9 – Adriamycin
Week 10 – Take a break!
Week 11 – Vincristine (now we are on an every-other-week schedule)
Week 13 – Cytoxan
Week 15 – Vincristine
Week 17 – Adriamycin
Week 19 – Vincristine
Week 21 – Cytoxan
Week 23 – Vincristine
Week 25 – Adriamycin
Possible side effects by drug:
- Vincristine – no side effects; out-patient service.
- Cytoxan – 5% of dogs have blood in their urine. If I see this happening, I need to call Dr. Hamilton. Out-patient service.
- Adriamycin – 10 to 15% of dogs have side effects, which are usually GI in nature: loss of appetite, constipated diarrhea. Problems can show up 4 – 14 days after the treatment. Side effects can be minimized with Pepto Bismol. Sarge will need to be dropped off at the hospital for this drug treatment.
I asked Dr. Hamilton for the bottom line: besides the financial considerations, why would I not do this? He said if Sarge was his dog, he would do it in a heartbeat. Sounds like a plan to me.
But then there is the little factor of cost…for budgeting purposes…
After talking to Dr. Hamilton, the nurse called me and explained the protocol in more detail. What she explained seemed to match up pretty closely to the info I found online and posted above.
Cost-wise, she said the Vincristine will be $175 per treatment, the Cytoxan will be $195, and the Adriamycin (gulp) will be $400. There is some hope for relief on the Adriamycin cost if they eliminate the backorders that exist on the generic version of this drug. Apparently the problem is nation-wide, and it is affecting canines and humans who need it. Hopefully, by week 4, the generic will be back in supply. Surely by week 9! All costs include a full exam and a CBC test as well as the drug itself. If they decide not to proceed with a treatment one week, I will be charged for the cost of the exam and CBC only.
I asked the nurse how the treatment plan would change once they get the results of the PCR, which diagnoses B (Better) vs. T (Tougher) type of lymphoma. She said it would affect how aggressively they pursue the treatment schedule. If Sarge has type B (oh please, oh please, oh please) then they may be more willing to take a break from the plan if he shows signs of needing it (e.g., his blood count is not where it should be). If he has T type (Boo! Hiss!), then they might be more likely to stick to the schedule. The PCR results are due back 14 days from yesterday.
I also asked the nurse when I get my prescription for Valium. When does the owner get some prescription relief? 😉
We have an appointment for our first Vincristine injection next Wednesday, the 22nd. We should be in and out of there in 45 minutes. In the meantime, we are going to take it easy and hopefully, have some fun.
P.S. I must mention that the vet’s prediction of increased frequency of urination has come true. And not just frequency, but volume too. I took Sarge out to pee last night around 10 PM and when I woke up this morning a little after 7 AM, I found a puddle in the living room…mostly on the hardwoods (which was easy to clean) but a little on the Oriental rug. Oh well. I am so *over* worrying about the state of my carpeting! Sarge also had loose stools today (the late afternoon deposit had a little bit of blood too), but then Daphne’s stools were also a little loose today. (I won’t go into the state of mine.) I think we are all suffering the side effects of stress!
Greyt Matters 
Beth B. Said:
on September 19, 2010 at 11:09 pm
I can’t think of an appropriate thing to say, but for you, Sarge and Daphne to hang in there. Sarge is well-loved and cared for — that will take him far. It is great that you have wonderful doctors involved in his case. Sarge is in good hands. Can’t wait to see you, Sarge and Daphne soon.