Need advice about lymphoma in civvie

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Heather & Angel (GA), Jul 17, 2010.

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  1. Heather & Angel (GA)

    Heather & Angel (GA) Member

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    Jan 16, 2010
    I've been reading about the return of Cleo's lymphoma :sad: , and I'm worried about my civvie Zoe who has had it in the past. I'd like to hear from others who've dealt with lymphoma, both with aggressive treatment and without.

    Zoe was dx'd with lymphoma in her 3rd eyelid 4.5 years ago. Supposedly, that's very rare in cats, although common in dogs. At the time of dx, her bloodwork didn't show any signs of spreading it elsewhere, and she was active and playful. Still, the vet (the same crappy regular vet's office that treated Angel so poorly -- we don't go there anymore) said that she had less than a year to live, and that chemo is only 50% effective in cats, and at best, it might buy her a couple more months of poor-quality life in the end. Since Zoe wasn't acting like she felt sick at all, DH and I decided to go with the most conservative treatment option, and only have the eyelid removed and not to do chemo or other drugs unless it seemed necessary.

    For 3.5 years after this, Zoe had no more problems. Then last year, she had runny discharge from her other eye, and that 3rd eyelid also had to be removed, again with the dx of lymphoma. Again, we only had the eyelid removed and did not do chemo or steroid therapy. She's seemed fine for the past year, since that last surgery -- so that makes 4.5 years after the first lymphoma dx, with no chemo. A few weeks ago, she had runny discharge from the eye that had received the first dx. I took her to the ophthalmologist, but he said he thought it just looked like normal eye discharge and he didn't think it was necessary to do anything further diagnostically, unless it got worse.

    Her eye actually looks better now -- the discharge seems to be gone, and she seems fine. I worry that we're tempting fate by being too complacent about things, but Zoe seems fine, her weight has been stable, and she has good appetite.

    Have other kitties here managed to do this well after lymphoma dx without chemo or other treatment? What about those who've had chemo -- did it cause bad side effects, weakness, sickness, etc? The biggest reason we chose not to do chemo for Zoe was because of the horror stories of how awful it is for humans, and how it weakens the immune system. We didn't want to make Zoe sicker.

    I've been saying for months that I want to take Zoe for a checkup with Angel's internist, since I trust her to know what to look for and I don't want to miss anything. I don't want to borrow trouble by taking her to the vet unnecessarily. But it HAS been a year since her last surgery, and she's WAY past her predicted life expectancy at this point, so I kind of want to get an idea of how she's really doing now. We're still looking for a good regular vet, and Angel's internist is the only one I'd trust anyway for serious problems. Am I just being paranoid, or should I go ahead and make that appointment?
     
  2. housecats4

    housecats4 Well-Known Member

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    May 31, 2010
    I guess you have to do what makes you feel better.. We know you will do the best for her. Kath :mrgreen: Prayers & Angels coming to help ;-)
     
  3. chriscleo

    chriscleo Well-Known Member

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    Dec 28, 2009
    first thing i'd want is a full ultrasound (and xrays if you can afford them too), and full blood & urine panel, to see what's going on.

    cleo's lymphoma hasn't returned, per se, she has just never gotten into remission even tho we caught the lymphoma as it was just starting.

    when a cat is that sick, it is really hard to tell what is causing anything, as there are often multiple explanations. her biggest symptom has been vomiting and inappetance. but i can't tell if it's from the lymphoma itself or from the treatment. guessing it's a little of both.

    depends on the chemo and on the cat. [i'd always add steroids into the mix, too, coz they're part of most protocols.] some cats do better on certain types of chemo than others. cleo started with leukeran, which is part of the more successful protocol for small cell low grade lymphoma, but it made her so sick i just couldn't put her thru it any more (other cats tolerate leukeran perfectly well). so we switched to ccnu. chemo can have an effect on the organs and cause anemia. it can make them so punky looking (cleo feels better if i give subQ fluids then), but it doesn't seem to have near the effect it has on people. that said, we all know cats tend to hide feeling sick, probably as part of their predator drive: act weak and the other predators attack. but even tho i heard cats all lose their whiskers with ccnu, cleo never has. so i just never now how she'll react. we do the best we can to control things by testing her blood and urine monthly and doing periodic ultrasounds.

    i am guessing your civie does not have the same kind of lymphoma that cleo does. the fact that zoe has gone this long after diagnosis (was the lymphoma diagnosis definitive?) tells me you did the right thing. if it's progressing, you do what you need to do to make things better, knowing just how much your kitty can tolerate.
     
  4. Heather & Angel (GA)

    Heather & Angel (GA) Member

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    Jan 16, 2010
    Chris, thanks for the reply. I also assume that Zoe's lymphoma must be a different kind than Cleo's, because she only had it in her 3rd eyelids and hasn't shown any other signs of illness. That said, I don't want to wait until she's suddenly lost a huge amount of weight or something, because that would probably be too late. My husband still thinks that the lymphoma dx was wrong, because Zoe just seems too normal to have an illness that serious. I mentioned this idea to the vet after the original dx, and he said there was no way the pathologist got it wrong, because that's what those people do for a living, and they wouldn't make a mistake like that. (?) Then the second time, we thought that maybe the pathologist assumed it was lymphoma because she'd "already had it" in the other eye. (?) In any case, her bloodwork at the time didn't show anything unusual in her CBC, etc., so it didn't look like it was spreading throughout her body.

    I just don't know enough about this disease to feel like I know how to handle this. In Angel's case, I regret so much that I didn't take her back to the internist sooner, because she probably would have caught the early stages of CRF and Angel could have felt so much better. At the very least, we could have gotten her on a better insulin sooner. I don't want to put Zoe through unnecessary trauma with vet visits, plus I'm still paying for Angel's last week of hospital bills... but I don't want to look back at some point in the future and think that if only I'd gotten Zoe checked out sooner, and seen that trouble was brewing, something could have been done to help her.

    Kath - look at Zoe's picture! (Kinda look like someone else you know?)
     

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  5. Jess & Earl

    Jess & Earl Member

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    Dec 28, 2009
    Hi heather

    I would make an appt with an oncologist to review the record. If you call, and they already know you as a client of the internist, you can probably do a "no pet" appt-- you send the records in advance then meet with the oncologist for his or her opinion. If they want to do something (send out certain tests, do x-rays, etc) you can have things done at your vet, if possible, or make an appt to bring the cat in for a workup. Some types of lymphoma - like Barb's cat's Tori's particular case, for example, have a very good 'cure' rate through surgery and may never need chemo. Other types, like my dog's, there is no option but heavy-duty chemo. Chris's Cleo has been hanging in there with a much less rigorous protocol because of the type of lymphoma cleo has.

    I have become extremely skeptical of regular vets who make a 'lifespan' pronouncement based on a single test result. I would consult an oncologist for a full picture.
     
  6. Heather & Angel (GA)

    Heather & Angel (GA) Member

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    Jan 16, 2010
    Hi Jess,

    The oncologist that we consulted with after the first dx is actually in the same practice as Angel's internist, so they're both already familiar with Zoe's case. In fact, when the second eyelid had that problem last year, the ophthalmologist contacted that office for the previous oncology records, and Angel's internist asked me about Zoe the next time I brought Angel in for a visit. So I have confidence that if I take Zoe to see Angel's vet, she'll consult with the oncologist there if she feels it's necessary. We weren't too happy with the oncologist before, because she just threw out the options and refused to give any recommendation for what we should do. We went with the conservative, surgery-only treatment based on how Zoe was acting. If she'd seemed sicker, we probably would have tried chemo then, but really we didn't feel like we got good guidance from the oncologist.
     
  7. Jess & Earl

    Jess & Earl Member

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    Dec 28, 2009
    Oh, that's a stinker. Oncologist's main job is guiding treatment and palliation, it stinks when you get one who's not good at it. No other onco in the same practice? Sound like the internist is a good choice then.
     
  8. Heather & Angel (GA)

    Heather & Angel (GA) Member

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    Jan 16, 2010
    Jess,

    I agree that it stinks. There's no other oncologist in that practice, either, or any other good ones around here that I know of. It's helpful what you said about the different types of lymphoma, and that some respond well to surgery alone. Should the oncologist be able to tell whether that's the case, based on the pathology report? If so, then it does sound like this one just isn't good at it, because she didn't give any indication that this type of lymphoma would respond well with surgery alone, and yet it apparently has. Angel's vet is very good analytically, so I'm hoping she'll be more helpful than the other vet was before. It's a sad situation when it's so hard to find a vet you can trust, since I don't exactly live in the boonies. :sad:
     
  9. Deanie and Boo (GA) and Scout

    Deanie and Boo (GA) and Scout Well-Known Member

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    Dec 28, 2009
    Heather, my Abbey had GI lymphoma and was on chemo for 4.5 years. Her only real side effect was fur loss--she never got sick from the chemo. She had an induction phase of 6 weeks and then went to a small monthly maintenance dose. Because she tolerated it so well, we just kept going. In my mind, stopping the chemo was an invitation for the cancer to come back.

    Unfortunately, the chemo finally did stop working and she came out of remission but at least she had a happy 4.5 years past her initial diagnosis. We did try a couple of other chemo options but within 2 months, it was obvious that they weren't working. She starting wasting away and the first day that she got really sick was the day I let her go.

    Chemo for cats is generally very different than chemo for humans. Don't let the human horror stories influence your decisions. Besides, if she can't tolerate it, you can always stop.
     
  10. Jess & Earl

    Jess & Earl Member

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    Dec 28, 2009
    They would usually want to stage it first (look for evidence of spread) before making any pronouncements. Staging for lymphoma usually involves chest x-rays, blood work, and abominal ultrasound to look at the spleen and lymph nodes, and usually aspirates of nearby lymph nodes (these would be affected first). I just did a little research and it seems that in most cases, lymphoma found on the third eyelid may spread so chemo could be recommended even if it looks like the excision is complete. I don't know specifically, but in most cases where chemo is done on the presumption (rather than the confirmation) of spread, it is more gentle than the total-body blast that animals with full-on metastatic lymphoma get. Really, it seems like the jury is still out on these 'solitary' lymphomas -- systemic chemo doesn't hurt in most cases, but in many animals removal of the sole lesion is curattive. Since your cat's other eyelid was affected, though, I wonder.

    If you want, you can PM me your city/state and I can see if my dog's oncologist knows anyone in your area. If you are in the NYC area, I certainly recommend her -- she's very experienced and has been more than gracious in dealing with my constant questions and hand-wringing. I ask very frequent, very detailed questions so if someone can put up with me, they are close to sainthood ;)

    PS Regarding the side effects/horror stories: cats tend to tolerate chemo extremely well. As I mentioned, my dog is now getting blasted with strong, systemic chemo agents and is tolerating it pretty well. I can always stop the chemo, if he starts to do poorly, but if I'd waited until cancer had progressed even further, starting chemo wouldn't have helped. Does that make sense? You can always stop it, but you can't turn back time to start it in time to help the patient.
     
  11. laur+danny+horde

    laur+danny+horde Member

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    Dec 29, 2009
    I'll chime in on the chemo too - nowhere near as it is for people. Despite a very very grim prognosis, Danny did really well on chemo, with minimal side effects. He had diarrhea literally once, lost his whiskers (they grew back), and generally was pretty tired the next day after chemo (but this also was probably vet stress). He wouldn't want to eat his regular food the day after chemo, but he would eat hand-fed bits of simmered pork chop (his favorite) and drink pork chop broth. Aside from the day after chemo, Danny seemed to feel pretty good.

    I believe the agaricus blazeii really helped keep up Danny's immune system - the vets were always astonished at how good his weekly white count was. It's very reasonably priced too. See atlasworldusa.com for purchasing, medical studies (NIH, Sloan Kettering), etc.

    laur
     
  12. housecats4

    housecats4 Well-Known Member

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    May 31, 2010
    Sending Angels & Prayers for the Dvet to see and help the right way Hugsssss to all

    Zoe does look a bit like someone I know :lol: :shock: :lol:

    I pray your baby get the right help ....Kath
    Oh yes lots of Beautiful Green Healing light surrounding your babies and you
     
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