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love my goofy goldens
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I posted that my friend's golden had liver cancer. Well, the tests show lymphoma and not liver cancer. She has an appointment with a specialist next week and she asked that I go with her. I have read through all the threads about Meggie and Duke, but thought I would also post asking for advice. What questions should we ask?

I don't know any more than that it is lymphoma.

Cyndi is a single mom (teacher) living paycheck to paycheck, so I am sponsoring Zeus's treatment. I don't want lack of money to affect what treatment Zeus gets.

Thanks for any advice you can give.
 

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Suzanne - you are a sweetheart and I know Cyndi is so grateful for your love, concern and help.

Lymphoma is one of the problems I have not had to deal with. On all other issues, the best thing is to find a vet you like and who truly has Zeus' best interests at heart. Ask about diet and supplements as well as medical treatment.

Make a list of the things you need/want to ask about so you don't forget once you get there! I'll keep them in my hearts and prayers for good results.
 

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First, you want to know what kind of lymphoma it is: T-cell or B-cell.

Then, what's the involvement? Cutaneous? GI tract? Lymphoma can be involved in many other systems, which completely changes the outcomes and treatment options.

Then, what's the stage?

Finally, what's the recommended course of chemo, and what are the survival rates for dogs with Zeus's exact condition? In the most treatable lymphomas, many dogs get a year or more with few side effects from the chemo. Different chemo protocols have different rates of side-effects, though, so check with the doc.

It is wise to discuss early and openly what your threshold is for the dog's suffering. Some dogs don't tolerate chemo all that well, and it's a hard thing to put a dog through just to buy him a few months. There are situations in which, in my opinion, it is more humane to euthanize the dog than to put him through chemo, even if you can afford it.

In my experience, specialists err on the side of treating a dog, since they want to practice their specialty. Only the dog's owner, though, can know when enough is enough or the side effects are too much. Decisions are different for a dog than a person, because a dog's whole joy is tied up in his body, and he can't understand that the current suffering will stop after the chemo cycle.

These conversations are really hard, but having them early is important.
 

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You are a wonderful friend!

I don't know anything about lymphoma but I have recently made some major decisions about my golden's hemangiosarcoma treatments. Copper's Mom and Tippykayak gave some great advice.

Making a list of your questions and concerns is very important because you might forget something. I made a copy for Barkley's vet so he knew what I wanted to know.

Finding a vet you trust is of utmost importance. The chemotherapy protocol for hemangiosarcoma is pretty straightforward. We had previous experience with an oncologist with our previous golden and it was very unfavorable. Having someone else that I trusted and respected was very important to me.

Finally, be prepared to stop the chemo at any time if you see it's not helping, but creating more problems in the quality of life department. This is where it is hard. Barkley's other regular vet (he has a whole team of people looking out for him) has promised us she will help us if/when that time comes.
 

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PS - Do not be afraid to bring a pad so you can take notes. It's a stressful situation, and you don't want to forget any questions or forget any information you're given.
 

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PS - Do not be afraid to bring a pad so you can take notes. It's a stressful situation, and you don't want to forget any questions or forget any information you're given.
A digital recorder is also a good idea because it can free you up to just listen and then review later on.
 

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I just typed out a whole long response and my computer ate it. I hate it when that happens!! basically I said:

I am a Cindy, single mom (son in college), school teacher who lives paycheck to paycheck and I wish I'd had a friend like you! However, using the old credit card I managed M-W protocol, radiation treatments and even the unrelated pneumonia and myasthenia diagnosis that came later the same year. I just cut out everything and found I didn't miss it.

My experience with oncologists was that I was told up front that dogs do respond differently to chemo, but usually not as badly as people b/c the drugs are not administered in as strong a dose; the idea is to prolong a quality life, but not cure. I was also told that if Meggie did react badly they would reconsider her as a candidate for chemo b/c quality of life was always most important. Megs had a very bad reaction to Vincristine, it was removed from her protocol, and she did well with the other drugs.

The first trip to the vet school involved the staging & typing along with the baseline information on whether the disease was in her organs. This included a sonogram, liver and bone marrow aspirates, x-rays and in Megs case a cardio consult. It was one of our most expensive trips.

I imagine you will ultimately hear the choices:
doing nothing gives your dog 6-8 weeks
prednisone will buy maybe 2-3 months
different chemo protocols will give 12 -18 months depending on whether the dog is b-cell or t-cell with the Wisconsin-Madison protocol (or some version of it) giving the longest remisson time
second remissions are common with up to about 6 months
each remisson afterward comes harder and lasts shorter

NC State is still the only vet school I know of offering bone marrow transplants after first remission has been achieved if the dog is accepted into the program, the cost is estimated at $15000 beyond chemo treatments

As for nutrition and supplements it's worth asking, but I imagine you will hear - don't change anything if you go with chemo. They want to know what your dog is reacting to - change in diet or a drug reaction. Unless your onco is a holistic vet, you probably won't get much encouragement to add any supplements bandied about the internet. You might specifically ask about fish oil and arginine. Both have research to show that they can inhibit tumor growth and are not immunity building supplements that can interfere with chemo.

Ask about antinausea drugs and administering before chemo treatments. Also ask about anti-diarrhea drugs.

Good luck and I hope your friend knows how lucky she is!
 
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I really can't think of anything else to ask except maybe if there's some grant or funding to help with the cost if chemo is chosen or some trial available.

Also, if it were their dog, what would they do?

You're friend is very lucky to have you and I also am a Cindy. Be prepared to just be there for her. There's something about talking to a specialist with that "cancer face" that tore me up and I was there alone. Well, me and Duke. But, the specialists here anyway are very compassionate.
 

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I really can't think of anything else to ask except maybe if there's some grant or funding to help with the cost if chemo is chosen or some trial available.

Also, if it were their dog, what would they do?

You're friend is very lucky to have you and I also am a Cindy. Be prepared to just be there for her. There's something about talking to a specialist with that "cancer face" that tore me up and I was there alone. Well, me and Duke. But, the specialists here anyway are very compassionate.
When this first started for us I told all Barkley's vets I didn't want anything to be sugar-coated and our goal was Barkley's comfort and quality of life. I felt a sense of relief from each of them that they didn't need to paint things in the best light possible but could be completely honest with us.

That "cancer face" is really hard to see but if you can tell your friend to possibly put her emotions aside and look them in the eye when they speak to her(without tears--hard), I think she might be able to get more candid information. There is plenty of time for tears afterwards. I kept on telling myself when we were hearing the bad news that I needed to focus on Barkley, focus on Barkley, focus on Barkley.

Having a good friend like you with her is such a blessing.

It's tough.
 

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I just typed out a whole long response and my computer ate it. I hate it when that happens!! basically I said:

I am a Cindy, single mom (son in college), school teacher who lives paycheck to paycheck and I wish I'd had a friend like you! However, using the old credit card I managed M-W protocol, radiation treatments and even the unrelated pneumonia and myasthenia diagnosis that came later the same year. I just cut out everything and found I didn't miss it.

My experience with oncologists was that I was told up front that dogs do respond differently to chemo, but usually not as badly as people b/c the drugs are not administered in as strong a dose; the idea is to prolong a quality life, but not cure. I was also told that if Meggie did react badly they would reconsider her as a candidate for chemo b/c quality of life was always most important. Megs had a very bad reaction to Vincristine, it was removed from her protocol, and she did well with the other drugs.

The first trip to the vet school involved the staging & typing along with the baseline information on whether the disease was in her organs. This included a sonogram, liver and bone marrow aspirates, x-rays and in Megs case a cardio consult. It was one of our most expensive trips.

I imagine you will ultimately hear the choices:
doing nothing gives your dog 6-8 weeks
prednisone will buy maybe 2-3 months
different chemo protocols will give 12 -18 months depending on whether the dog is b-cell or t-cell with the Wisconsin-Madison protocol (or some version of it) giving the longest remisson time
second remissions are common with up to about 6 months
each remisson afterward comes harder and lasts shorter

NC State is still the only vet school I know of offering bone marrow transplants after first remission has been achieved if the dog is accepted into the program, the cost is estimated at $15000 beyond chemo treatments

As for nutrition and supplements it's worth asking, but I imagine you will hear - don't change anything if you go with chemo. They want to know what your dog is reacting to - change in diet or a drug reaction. Unless your onco is a holistic vet, you probably won't get much encouragement to add any supplements bandied about the internet. You might specifically ask about fish oil and arginine. Both have research to show that they can inhibit tumor growth and are not immunity building supplements that can interfere with chemo.

Ask about antinausea drugs and administering before chemo treatments. Also ask about anti-diarrhea drugs.

Good luck and I hope your friend knows how lucky she is!
This is wonderful advice. I got the same information about the diets and supplements. In fact I was told to increase the fish oils (but make sure no Vitamin A was in the formulation) and decrease the other antioxidents, especially C.

Speaking of fish oils, your friend might want to start taking some herself if she isn't already on them. This is an incredibly stressful time emotionally (and physically if nights are interrupted with side effects of chemo) and the fish oils help build one's own immunity. I also increased my Vitamin D intake for that reason. I'm still physically exhausted from waking up in the night when Barkley is restless, but I'm trying hard not to get ill so I can take care of him.

Having the anti-nausea and anti-diarrhea drugs on hand in advance gave me peace of mind Barkley wouldn't suffer in the middle of the night if any symptoms started during those hours. Our vet also gave us his personal cell number to call if these things happened. More peace of mind.

If the dog is already on an anti-inflammatory for arthritis/hips, chances are they will keep that regimen going. We had Barkley on rimadyl off and on before his diagnosis, but now he's on it daily because these anti-inflammatories also retard growth of the cancer cells.

Make sure to buy a rectal thermometer (and lubricant, and covers) for taking the dogs temperature after the chemotherapy. Catching a fever early is important.
 

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Be sure to let them know of ANY drugs the dog is currently on. You cannot give prednisone with Rimadyl and pred is part of the W-M protocol if you go that way.

I was in such a state when we went in for the first onco consult it didn't occur to me to mention Meggie having a pre-existing heart murmur. My son had presense of mind to mention it, though I suppose they would have caught it in the exam. Might be a good idea to go through the dog's medical history to see if there is anything you might need to mention. Reactions to drugs etc...

Are you going to a vet school or a private oncologist?
 

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This is an informative thread. Sometime when I've got some free time I'd like to list all the suggestions and possibly make it a sticky. The first few days after diagnosis are terrifying (at least for me) and having a list of things to think of or ask would be most helpful to others facing the big C.
 

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Discussion Starter · #15 · (Edited)
Thank you all so much for the information. I have a lot of experience listening to doctors and asking questions. Cyndi is so upset that she is afraid she won't ask everything or remember what was said, so I am going to do that for her.

Zeus comes to stay with us when Cyndi and the girls go out of town, so he is like a member of the family. He gets along really well with my girls and is such a love! I feel responsible for him since I am the one who got them together.

Again, thanks for all the advice. I really appreciate it - and I know Cyndi will, too. I knew I could ask my GRF family for help and that you would come through. I was right. I hope you know how much it means to us.
 

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First, you want to know what kind of lymphoma it is: T-cell or B-cell.

Then, what's the involvement? Cutaneous? GI tract? Lymphoma can be involved in many other systems, which completely changes the outcomes and treatment options.

Then, what's the stage?

Finally, what's the recommended course of chemo, and what are the survival rates for dogs with Zeus's exact condition? In the most treatable lymphomas, many dogs get a year or more with few side effects from the chemo. Different chemo protocols have different rates of side-effects, though, so check with the doc.

It is wise to discuss early and openly what your threshold is for the dog's suffering. Some dogs don't tolerate chemo all that well, and it's a hard thing to put a dog through just to buy him a few months. There are situations in which, in my opinion, it is more humane to euthanize the dog than to put him through chemo, even if you can afford it.

In my experience, specialists err on the side of treating a dog, since they want to practice their specialty. Only the dog's owner, though, can know when enough is enough or the side effects are too much
. Decisions are different for a dog than a person, because a dog's whole joy is tied up in his body, and he can't understand that the current suffering will stop after the chemo cycle.

These conversations are really hard, but having them early is important.
I agree very strongly with the parts I bolded. A few years ago we lost our 7 yr. old dog (not a golden) to lymphoma after going through the Wisconsin Protocol chemo treatment. It bought him an extra 8 months and he tolerated chemo fairly well.

When we went for our first visit to the oncology vet specialist, I anticipated a thorough discussion of all the options: from doing only a little bit such as prednisone pills to buy a month or two to whatever full-blown treatment was available. But I was very uncomfortable with the assumed attitude that we would automatically do anything and everything possible. Specialists, be they for animals or humans, often want to use every tool they have available to them. It's just part of the mindset.

Would we put a dog through chemo again? I have my doubts even though we could afford it. Just because technology is available, I don't think its always the kindest thing to do. Giving a dog comfort care and a great month or so of extra special companionship should be considered every bit as valid of a decision.

I guess my advice is not to feel pressured into making a decision on the spot or to think you have to have every test in the book performed. Sending positive thoughts your way as you go through a very difficult time.
 

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I am sorry that My Bentley and Tippykayak had this experience with their oncologists. I can say unequivocally that I did not. I never felt pressure from the oncos at NCSU to choose chemo, they did lay out all my options unemotionally and were willing to have me take time to make my decision. I had done my homework before I ever went to the appointment and knew what I wanted to try with Megs. I did not tell them this up front, but waited for them to tell me my options. I was also told that Megge's quality of life was first and foremost and if at any time they felt she was not a candidate for chemo they would not continue with the treatment but would advise me differently. I do not know where the two of you went, but it is not the same every where. Maybe vet schools have a different approach from private oncos?? I am sorry you feel that your doctors felt they were in it to practice their specialty instead of putting the patient first. Meggie's doctors treat her like family - I've seen them sit in the floor and let her kiss them and her doctor that is now at the Mayo Clinic pursuing yet another doctorate emails me frequently for updates. There are veterinary oncologists who actually care about the dog!!! I hope you have one for Zeus, Desilu!
 

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I didn't want to give the impression that our specialist was interested in only the medicine and not the dog. He was wonderful with Gus and supportive of our decision not to treat. However, he was clear that he would like to treat, even though Gus was blind and his cancer was exceedingly rare and exceedingly aggressive. Knowing that the chemo would buy him 3-6 months without curing his blindness, we did not agree that it was worth it.

Perhaps there's a difference between a private oncologist and a university doc, but I do think that owners are the ones who are ultimately in the best position to decide whether or not to treat with chemo and that the way we make decisions about a dog's suffering are sometimes different than the way we'd choose for ourselves.

At the very least, it's possible to end up in the situation that MyBentley and I did, so it's wise to be prepared and to have free and open conversations about what kind of side effects will be too much and how much time you can really buy.

Remember, when a dog has early stage B-cell Lymphoma, there's an excellent chance that chemo will buy a symptom-free year or even more. Not all situations are like that, though, and some lymphomas have all kinds of debilitating systemic involvement that won't necessarily go away when the chemo hits.

Given how much pain some Goldens will shoulder without flinching, I think it's our responsibility to consider these questions freely and openly between our families and our vets.
 

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I think some vets and especially specialists are eager to help your dog or cat and sometimes get over eager to perform tests and/or administer treatment. I have not had the feeling that they were out for my money though. I felt they just believed their knowledge could truly help my pet and they were eager to help. Thank goodness my experience does not include cancer although we have had some scares, so I don't know as much as those who are or have dealt with this. Your vet will hopefully be great and be the source for your best advice through this ordeal.

I have had this experience with both a cat and Copper, but I still like and trust his specialist and she will accept whatever I have to choose for treatment. Sometimes I have chosen the advanced test/treatment and other times I have not so I know she will let me choose. So far, I've been right with the decisions for Copper but I attribute that to dumb luck on my part.

You have gotten good advice from some people who have been right in Cyndi's shoes and we will all offer our support.
I hope Zeus goes into remission and stays there. You, Cyndi and Zeus will be in my thoughts and prayers.
 

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I read that and need to amend. I have not had experience with cancer, but with a vet wanting to try more advanced and expensive tests than I could afford.

My cat was misdiagnosed so the tests were of no use even though we paid for them. The oncologist wanted to test Copper for cushings a few months ago and I felt he didn't have sufficient symptoms to warrant it. It turns out that his skin problems were related to lack of a spleen and an undiagnosed skin infection, not cushings so no test needed.:):p:;)
 
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