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Dr. Gary
Dr. Gary, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 17023
Experience:  DVM, Emergency Veterinarian, BS (Physiology)
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My dog has been treated for lymphoma since early May and has

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My dog has been treated for lymphoma since early May and has not gone into remission. He also has heart problems and is elderly (at least 16 years old). He has serious breathing problems, including coughing. The veterinary oncologist doesn't seem to know what to do for him. They have taken X-rays of his chest and see something in the lungs, but it is not clearly cancer. They think the lymph nodes may be affecting the lungs. They won't extract cells from the lungs because they say it is risky and they won't do other imaging. My dog is on prednisone and antibiotics. What more can I do for my dog besides put him to sleep?
Submitted: 5 years ago.
Category: Dog Veterinary
Expert:  Dr. Gary replied 5 years ago.
Hello,

What treatment are they doing for the lymphoma? Chemo or just Pred?
What type of breathing problems- exercise intolerance? Shallow rapid breathing? Increased abdominal component to breathing? Loud breathing?

What type of dog is this?
Customer: replied 5 years ago.
All kinds of chemo - vincristine, elspar, mitoxantrone and others. When he's not coughing, he has rapid shallow breathing. He also has sick sinus syndrome and had pneumonia a few years ago. They have also given him neupogen and darbopoetin.
Expert:  Dr. Gary replied 5 years ago.
Ok thanks,

The rapid shallow breathing is often due to lung compliance rather than an infiltrative disease in the lungs. If there is fluid around the lungs (pleural effusion) then it could be tapped off easily and fairly non-invasively. This would have been seen on the x-rays. If this is due to cancer invading the lung tissue then you're left with doing more chemo- a rescue protocol although the prognosis becomes much worse when we're doing these rescue protocols. The one chemo drug I don't see on your list that works well for lymphoma is Doxorubicin (Adriamycin). Adriamycin is a bag of orange fluid if it helps any.

Another potential cause of the increased respiratory rate is a side effect of the Prednisone. It may be worth a shot to wean off the Pred or go down to every other day and see if that helps.

The coughing makes me think something is compressing the bronchi. This is most likely the tracheobronchial lymph nodes. There is not an easy way to diagnose this as x-rays are not all that sensitive to visualizing lymph nodes in the chest. Again, we're left with higher doses of chemo as our only real option.

I know you don't want to hear it, but it may be getting close to time to make that hard decision. It is usually when we get respiratory involvement that we start thinking euthanasia. I'd still give Adriamycin a shot if it has not been done already- I suspect it may have been given the sick sinus syndrome as it can be cardio toxic when we reach high cumulative doses. If not, then try that one and see if it helps.

Cough suppressants are another option to control the signs. Hycodan would be my first choice. Torb (Butorphanol) is another option.

I hope this helps, let me know if you have any other questions.
Customer: replied 5 years ago.
If I recall correctly, they would not give him adriamycin due to his heart condition. Is that a valid excuse? Should I get a CAT scan or MRI for him? I also don't know if the variety/ inconsistency of chemo treatment has been a factor in the progression of the disease. It was determined at the start that it was a B-cell problem, which should have been treatable.
Expert:  Dr. Gary replied 5 years ago.
Yes B-cell lymphoma is more responsive to chemo, but the survival time is still a median of 12 months. This means that some will live in the 8-10 month range while others will be luckier and get 14-16 months. The longest survival times are no more than 2 years with lymphoma.

So the heart condition was there prior to chemo. I would still consider giving Adriamycin. It can cause heart disease, but it's an accumulative effect. Basically that means that a certain amount (mg/kg) should not be given to a dog. If we stick with normal chemo doses and give it a couple times during the typical University of Wisconsin 24 week protocol, we don't get anywhere near that range. I'd give it to this dog without too much hesitation.

As for MRI/ CT. A CT may help to look at the tracheobronchial lymph nodes. An MRI does not help much in the chest- difficult to get a good scan with the movement. I probably wouldn't do the CT because it wouldn't likely change my treatment plan. This has got to be related to the lymphoma- so treat the lymphoma. It would be highly unlikely that this is due to another disease process in the chest. General anesthesia is also required for a CT- it's relatively safe, but there are always concerns anesthetizing a cancer dog with respiratory signs.



Customer: replied 5 years ago.
I took Sam to the oncologist today. Dr. Beck decided to put him on the MOPP protocol, with mustargen and vincristine. I'm supposed to give him more pills this week. I also have an appointment for Thursday to take to a vet about radiation therapy. Thanks to you, the vet prescribed Hycodan - however, it's only available in syrup form now. I picked it up tonight from the pharmacist. Sam isn't coughing tonight (like he was last night), but he's clearly having trouble breathing (he even sounds like he is gurgling a little). I'm not sure whether I should give him the hycodan when he's like this. I also had to force feed him today. He was walking earlier - though weakly - and he hardly seems like he can get up now. Today's chemo clearly took a lot out of him. I'm praying that he lives through the night and feels better tomorrow. I'm really glad that I contacted you because you gave me a little peace of mind. The oncologist says there is a pill form of adriamycin that the Swiss have used that doesn't hurt the heart - she's trying to find it.
Expert:  Dr. Gary replied 5 years ago.
I'm glad the Hycodan is helping with the cough. I would hold off on another dose until he shows you he's coughing. If he's gurgling and having labored breathing then don't give it.

That's interesting about the Adria coming in a pill, never heard of that.

I hope he does ok tonight as well, best of luck.

Dr. Gary, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 17023
Experience: DVM, Emergency Veterinarian, BS (Physiology)
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