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During our time in the VHUP waiting room, we have seen many, many dogs with cancer. Some cancers, such as tumors in vital organs or cancers that are very advanced, are not treatable, and a responsible vet will recommend care that will make the dog comfortable. But other types of cancer allow for extended, high quality life with treatment. And even advanced lymphoma can be managed: Berry was classified as Stage V but has enjoyed nearly a year of normal functioning since his diagnosis. We have talked with many owners at VHUP whose dog's cancer has been controlled for significant periods of time through surgery, radiation, and/or chemotherapy.
Basic Treatment Choices
If your dog’s lymphoma is treatable, you may have several basic treatment choices: your regular veterinarian; a canine cancer specialist in his or her own practice; or a larger research or teaching hospital. Depending on your location, finances and your pet’s disposition, each has advantages and disadvantages. The chemotherapy protocols require frequent trips for treatment, so proximity may be an important consideration.
Berry is a very social dog who loves VHUP and seems unaware of pain – but if treatment itself is an ordeal for your dog, this may affect your decision. Check out the Owners’ commentaries in our Links section for examples of different experiences. The key is to find a professional with the requisite technical knowledge, practical experience, and strong communication skills.
Your dog knows your vet, who is probably also the closest source of treatment, and the one where your dog is most comfortable. But if your vet will be the sole care giver, make sure he or she is really conversant with the complex issues involved in treatment of lymphoma and the drug therapies. You may want to investigate working out a consulting arrangement between a canine cancer specialist (usually a board certified veterinary oncologist) or teaching hospital, and your vet.
Canine Cancer Specialist
This will typically be a board certified veterinary oncologist. We considered this option very early in Berry’s treatment when we were concerned that the institutional setting at VHUP might affect his care. We thought that if only one person were responsible for Berry’s treatment, this would mean greater continuity and knowledge of his individual case. But Bill and Linda reported that the specialist who treated Murphy also had a packed schedule of dogs and relied heavily on assistants.
The advantages of a veterinary hospital, particularly a teaching hospital, are the high level of care and access to multiple specialists. There is always another doctor who can take over if "your" vet is unavailable. We live 6 blocks from VHUP, so this was the option we choose. And once we were admitted to VHUP’s Oncology Service -- which has a staff of oncologists, not just one specialist -- we were impressed by the level of expertise.
But hospitals can have an institutional feel, particularly until you become familiar with the routines and personnel. For example, when Berry was admitted to the VHUP Emergency Service early in his treatment, his "file" – containing the results of hundreds of dollars worth of valuable test data -- was in transit to the records department and could not be located. If your dog is being treated at a teaching hospital, keep in mind that he will be seen by doctors with varying levels of hands-on experience with canine oncology. In this setting, it is particularly important to know the identity of everyone who works with your dog and to that ensure your dog has consistent attention from a supervisory specialist even though more junior veterinarians participate in his care.
Wherever your dog is treated, try to learn the identity of every member of the treatment team – his or her professional training, years of experience with oncology, and role in your dog’s treatment.
Cost of Chemotherapy
In several of the Owners’ sites in our Links, you will see information about the cost of treating lymphoma. This is a question that we asked VHUP at the outset. The estimate we were given was about one thousand dollars for the staging and an additional two thousand dollars for about a year’s treatment, assuming no side effects. While those two estimates were reasonably accurate, here is a more detailed answer.
There are three basic components of cost:
Depending on your degree of success in communicating with your dog’s treatment team, you may also have some "unnecessary" expenses -- costs associated with work that is redone or tests that were not needed.
Be realistic going in. It is true that chemotherapy does not cause in dogs the extreme side effects typically seen in humans. But our conversations with other owners (and our informal "eavesdropping" in the VHUP waiting room), as well as the owner reports in our Links, reveal that many dogs do experience one or more side effects. Assume that your dog will have at least some side effects that will require additional treatment outside of the basic chemotherapy protocol.
By expecting and watching for side effects, in addition to increasing your dog’s comfort, you may be able to avoid emergency treatment. Emergency treatment is costly and often involves doctors who are not as familiar with your dog or his treatment. If we (or the VHUP Emergency Service) had understood the timing of the vincristine side effect (which we later learned may not arise until 48 hours or more after administration of vincristine) and anti-nausea medicine had been prescribed, we could have skipped a crisis point in Berry’s treatment.
Our records reflect the following approximate costs:
Diagnosis, staging, and re-staging (at 4 months): $1,100
Basic Treatment: $2,000
Emergency Treatment of Vincristine Side Effects: $1,200Regular Dog Care Issues (Campy, Hot Spot, Coat Problems): $350
Total after 11 months: $4,650
Berry's treatment since January 2001 when this summary was written has been relatively inexpensive, with his restagings in March and August being the only major expenses.