Sweetie’s Progress- December 2009

December 24th, 2009

Blog Six:  Well, we’ve beaten the odds.  Sweetie has lived one year  — six months beyond the expected outcome for Lymphocytic Leukemia.  Last week, at her “fighting weight” of 47.3#, she finally was able to do her entire, beloved Vanderbilt circuit. We plan to decrease her CEENU dose slightly by dosing her every 4^th week, instead of every third.  This is still a published protocol, and while one might say “if it ain’t broke, don’t fix it,” but Sweetie is clearly in remission, so lowering her drug dosages are indicated. Everything has gone wonderfully well for Sweetie in 2009 – let’s look forward to a wonderful 2010!

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Sweetie’s Progress-November 2009

November 13th, 2009

Three more pounds!  Blood values remain excellent, her strength stable, and she is enjoying her hikes at Vanderbilt Mansion again, although she still cannot go as far as she once did.  Sweetie continues to do very well as we approach her first anniversary of when the prednisolone/CEENU protocol was initiated for her Lymphocytic Leukemia –December 16, 2008

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Sweetie’s Progress- September 2009

September 24th, 2009

SWEETIE BLOG FOUR: September Report

She’s lost four pounds! And her blood values continue to be excellent as we approach the first anniversary of her diagnosis, December 15, 2008. She has responded remarkably well to low-dose, alternate day Prednisolone combined with CEENU administered orally every 21 days. I see her only every third week now to examine her and check her blood values. Her weak right hind leg continues to be her biggest problem, but now that she has lost a little weight, we have started a very simple fitness program. Ron, an athlete himself, will ask her to do a five Sit-to-Stand commands twice daily. I have asked Ron to be sure she has her right side against a wall so that she can’t cheat, letting her weak leg wing out to the side. With all Ron has done for Sweetie, I know that she’ll be building up her quadriceps well over the next three weeks until I see her again in October.

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Sweeties Progress-April and May

September 3rd, 2009

Everyone at Pleasant Valley Animal Hospital is very pleased with how well Sweetie has done since we decreased her prednisolone dose. There has been no evidence of any relapse of her leukemia, and all of her liver enzymes have returned to normal values. In fact, it seems her biggest problem is one common to many of our older pets – arthritis and lower back pain which is limiting her enjoyment of spring and her hikes at Vanderbilt Mansion. As reported in March, we are using acupuncture and Adequan, but, if her blood values stay in the normal range, we may add other pain medications to see if they help her more than the Adequan and acupuncture have to date. Nevertheless, we have been very happy with her response to treatment so far, and are eagerly anticipating her exam and blood test results at the end of June, since that will be her six month milestone.

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Sweetie’s Progress-March 2009

March 24th, 2009

Sweetie Blog Two: March Report

February and March have seen a few modifications of Sweetie’s protocol – nothing unusual for a dog with lymphosarcoma or lymphocytic leukemia. As often happens, Sweetie could not tolerate the high fat content of Hills N/D; she developed diarrhea which responded only partially to a home-made chicken and rice diet combined with the antibiotic metronidazole. Also, her liver enzymes continued to climb, and I became concerned that either an infection or a reaction to her chemotherapy drugs was causing this. We began to monitor her blood values weekly, rather than every three weeks, and finally decided to do an ultrasound. Everything pointed to a reaction to her prednisolone, not an infection or a reaction to her CEENU. Since her blood counts continue to show NO lymphocytic leukemia, we began to drop the dose of prednisolone. I am happy to report that her liver enzyme values continue to decrease and that she is still free of any signs of recurrence of her leukemia.

On March 10, 2009, Mr. Lipton reported that Sweetie was limping and not completing her two mile walks at Vanderbilt Mansion National Park. We added doxycycline since a recurrence of Anaplasmosis is not unusual in cancer patients undergoing chemotherapy, since the chemotherapy weakens the immune system. At this time, she is still limping, so we may add an additional drug called Adequan to help with arthritis type inflammation. We also may need to diet Sweetie as she has gained 15 # on the prednisolone and home cooking! We certainly want Sweetie and the Liptons to enjoy all the wonders of a Hudson Valley spring and hope our April report brings us that good news.

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The Sweetie Report

February 4th, 2009

Febuary 1, 2009

Sweetie and her human, Mr. Ron Lipton, have touched many lives, and I hope to keep all of you who care about them informed of her health as we work to manage her leukemia. Additionally, I hope that Sweetie will become an ambassador for all pets who have cancer and that her blog on our website will help to educate many people about this important health issue for our pets.

It is important to note that Sweetie is in my care, and while I am board-certified in Companion Animal Practice, I am not a board-certified ACVIM oncologist. The closest human medical parallel would be to say that I am like a board-certified Family Practitioner. However, I have a special interest in cancer and have written academic as well as several articles in “Dog World” and “Cat Fancy” on the subject. Several of these can be read on this website. Should Sweetie’s condition change, indicating the need for medical care at a Specialty Clinic, the generosity of the many people who care about her will make this possible. In the meantime, I am pleased to tell you that she has responded wonderfully to the current regimen of prednisolone and CEENU (also called lomustine).

When I first met Sweetie on November 12, 2008, she had lost weight, was lethargic, and not eating well. She had a mild fever, but all her lymph nodes as well as her spleen palpated normally. She was positive for Anaplasmosis on the 4Dx test. This disease used to be called Ehrlichia equi, and it can cause all the symptoms Sweetie exhibited. She left the office with a prescription of doxycycline pills, responded quickly, but two weeks later, Mr. Lipton called and said she was relapsing, despite being on the doxycycline.

At this second exam, she did not have a fever, and her physical examination was still normal. Consequently, blood work was performed, and her white blood cell count was three times (3x) normal. Only lymphocyte cell numbers were increased, and many of these were abnormal in shape. A tentative diagnosis of lymphocytic leukemia was made, but, to be sure, a second sample was taken two weeks later and sent to Antech laboratories for an independent confirmation by a board-certified pathologist. Not only was the diagnosis confirmed, but her white cell count was now 4 times the normal range.

Treating a pet with cancer can be a difficult decision; not only are there many treatment options available, one must decide if ANY treatment at all is the right decision to make. Each pet and each pet owner’s situation are unique, and many factors must be taken into consideration. After careful consideration, Mr. Lipton elected to treat Sweetie, not only because he loves her, but because her heart, kidney and liver tests were all normal. Additionally, she was still eating despite her leukemia. She seemed a good candidate for treatment.

Prednisolone, a corticosteroid, is the cornerstone of all drug regimens for leukemia and lymphosarcoma, but, as you probably know, the drug also is used to treat allergies. For prednisolone to be effective as an anti-cancer drug, it must be given at high doses for extended periods effects include a ravenous appetite, a profound thirst, possible urinary accidents and incontinence due to the excessive water intake, and, sometimes, mood swings, including aggression. Since Sweetie is such a sweetie, the last side effect has not occurred, but she certainly exhibits the others. Loss of muscle tone has also occurred, so now Sweetie has a bit of a pot-belly. Liver enzymes have increased, but this is expected with prednisolone and not a real worry at this time. Routine blood testing will monitor the enzymes as well as blood sugar, since the risk of developing diabetes mellitis also increases with prednisolone.

Fortunately, her leukemia has been controlled so well that we have been to be able to reduce her total dose of prednisolone by half, beginning this month. The use of CEENU, also called lomustine, has provided that help. This chemotherapeutic drug is being used increasingly in veterinary medicine for many reasons. First, it is an oral pill purchased from human pharmacies. Secondly, it is effective against many cancers and is often as effective as many other drugs that must be given by injection at the veterinary hospital. I have used this drug for many resistant cancers in cats, dogs and guinea pigs, either alone or in combination with other drugs.

Additionally, this month, we have added the anti-cancer prescription diet made by Hill’s called N/D (Neoplasia Diet). This is a low-carbohydrate, high fat, modest protein canned diet that applies the research of Dr. Greg Oglivie. The Veterinary College at the University of Colorado is considered a Center of Excellence in Animal Cancer. Dr. Oglivie has demonstrated that cancer cells thrive in a high sugar, high protein environment, but that they have a great deal of trouble digesting fats.

Due to the high fat content of N/D, we will need to wean her onto this new diet slowly or she may develop diarrhea. The diet was tested in dogs with lymphoma, but Dr. Oglivie’s research really applies to all cancers and this food can be fed to any canine cancer patient. Unfortunately, there is no commercial anti-cancer prescription diet made for cats or ferrets, but recipes do exist and the same principles of low-carb, high fat, modest, high-quality proteins apply. By our March report, we should be able to tell you if she likes the diet, and if she remains free of leukemia on the lowered dose of prednisolone.

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