11/28/24, 2:23 PM Gmail - Discharge instructions for Neo (8868), Male, Canine, Indie Dog - Indian, Mixed, 23 kg,
, 23 kg, 01/01/2020 (4 years, 10 months)
Discharge instructions for Neo (8868), Male, Canine, Indie Dog - Indian, Mixed, 23 kg,
01/01/2020 (4 years, 10 months)
1 message
Thu, Nov 28, 2024 at 1:50
Cancervet Clinics Private Limited, Mumbai <
[email protected]>
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[email protected] Discharge instructions
Client Rama Tadepalli
Consultation 25/11/2024
For patient Neo
Oncology Consultation
Date: 25/11/24
Diagnosis: Multicentric Large cell lymphoma Stage IIIa/ IVa on FNAC of PLN
Patient details : Neo/unknown age (4-5)/M/ Indie/ Neutered.
History: Submandibular lymphadenopathy noticed on Oct 13. Suspected Tick fever treated with Simparica. Generalized
peripheral lymphadenopathy noticed a week back. FNAC of Left Submandibular and popliteal LN s/o Large cell
lymphoma.
19/11 CBC - WBC 30k, LYM 14k, PLT 97k. Platelet clumping.
LFT - AST 130.8
KFT - NAD
Currently on Doxycycline and Prednisolone @ 1mg/kg.
Physical examination : BAR,BCS 6/9, Temp 102.9 F, normal lung sounds and synchronised pulses on thoracic
auscultation. Cranial organomegaly on abdominal palpation. Generalized peripheral lymphadenopathy.
Body map :
Right Submandibular LN - 6 x 5 cm
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11/28/24, 2:23 PM Gmail - Discharge instructions for Neo (8868), Male, Canine, Indie Dog - Indian, Mixed, 23 kg, 01/01/2020 (4 years, 10 months)
Right Prescapular LN - 8.4 x 4 cm
Right Inguinal LN - 5.5 x 3.5 cm
Right Popliteal LN - 5 x 4.5 cm
Left Submandibular LN - 5.5 x 3.5 cm
Left Prescapular LN - 8.4 x 4 cm
Left Inguinal LN - 5.5 X 3.5 cm
Left Popliteal LN - 6 x 4 cm
In-house diagnostics: CBC - WBC 47.1, GR 27.8, LY 14.3 ,HCT 32.1, Hgb 11.1
: Ionised calcium - 1 mmol/L
: Manual platelet count : 112k
Discussion: Discussed about different treatment protocols and prognosis of the disease
Here's some information about Lymphoma:
There are several established prognostic factors for dogs with lymphoma. “Stage” is the extent of disease in the body.
Dogs with stage 2-4 tend to do quite well, but stage 5 disease (ie lymphoma cells in the blood stream) may have reduced
remission duration, although prolonged responses are still possible. Substage is determined based on whether a dog is
showing clinical signs (e.g., lethargy, reduced appetite). Dogs in substage “b” (those who feel ill) may have a poorer
prognosis.
High grade lymphoma in dogs may be B or T cell lymphoma. This cannot be determined just by looking under the
microscope, but requires special testing. T cell lymphoma is more difficult to treat than B cell: dogs with T-cell lymphoma
are slightly less likely to respond to treatment, and their length of remission tends to be shorter (about 6 months
compared with 12 months). Dogs with negative prognostic factors (higher stage, T cell, substage “b”) are statistically less
likely to respond to treatment and remissions tend to be shorter. When dogs do come out of remission after
chemotherapy, there is a possibility of a second remission using the same or similar drugs to those they had previously.
Second remissions are typically about half the duration of first remissions.
Treatment:
Unfortunately, dogs are rarely cured of lymphoma. Our goal with treatment is to extend good quality of life for our
patients for as long as possible. Because lymphoma is a systemic (whole body) disease , chemotherapy is the treatment
of choice. While there is currently no cure for lymphoma in dog there are a number of drugs which have been evaluated
in dogs with lymphoma that have been shown to improve both quality of life and survival time. With all chemotherapy
protocols, we may recommend repeating diagnostics at the halfway point of the protocol to assure that the therapy we
are using is effective.
1. A multi-drug protocol: The protocol which yields the best results uses a combination of drugs in sequence, referred
to as the CHOP protocol. The protocol involves using 4 drugs: vincristine, cyclophosphamide, doxorubicin and
prednisone (a steroid). This protocol consists of weekly treatments, a total of 16 treatments administered over 4 months.
If a patient is in remission at the end of this protocol, chemotherapy is generally stopped and the dog is monitored until
the lymphoma returns. With this protocol, overall we expect approximately 90% of dogs to achieve remission, for a
median of 10-12 months (from starting chemotherapy). Approximately 20% of dogs treated with CHOP will live up to 2
years. After the completion of chemotherapy we recommend recheck exams every 6-8 weeks for monitoring.
2. A single agent protocol: Other options include using single agent chemotherapy (typically with Adriamycin
[Doxorubricin], given once every three weeks for 5-6 doses) along with prednisone (steroids). With this approach, we
expect approximately 60-80% of dogs (with Stage IIIa, B cell) to achieve remission for a duration of approximately 6
months. Adriamycin can potentially cause damage to the heart muscle with repeated doses, and so for that reason we
do not give more than six doses in total.
3. Prednisone alone: Prednisone alone often has some efficacy in dogs with lymphoma, and can be used in a palliative
setting to improve how they are feeling overall and can cause some shrinkage of their lymph nodes. Generally, with
prednisone alone, we would expect to start seeing clinical deterioration from lymphoma in around 6-12 weeks.
Plan : Initiated CHOP protocol and continue with the primary vet.
Treatment received today :
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11/28/24, 2:23 PM Gmail - Discharge instructions for Neo (8868), Male, Canine, Indie Dog - Indian, Mixed, 23 kg, 01/01/2020 (4 years, 10 months)
Week 1 : Inj Vincristine @ 0.5 mg/kg iv + Inj Ondem @ 0.3 mg + Inj Perinorm @ 0.3 mg/kg sc
Prescribed,
T. Ondem 8 mg - 1 tab twice a day - half an hour before food x 3 days
Cap Synfosium - 1 tab once a day - with food/water x 5 days
T. Prednisolone 20 mg - 1 tab morning & 1/2 tab evening - with/after food x 7 days( can cause increase in hunger, thirst
and urination, elevation in liver enzymes) Do not stop without consultation.
Next CBC and Chemotherapy : 02/12/2024
As Per Pet Parents request, CHOP will be continued with the primary veterinarian.
WEEK 2 - (02/12/24) - Inj. Cyclophosphamide @ 220 mg/m2 + Inj Frusemide @ 2mg/kg iv + Inj Ondem @ 0.3 mg/kg iv
To be followed by - T .Ondem 8 mg - 1 tab twice daily half an hour before food x 3 days.
- Cap Synfosium - 1 cap once a day with food/water x 5 days.
- T. Prednisolone 10 mg - 1 tab twice a day with/after food for next 7 days.
WEEK 3- (09/12/24) Inj Vincristine @ 0.6mg/m2 (if there is no side effects with the first dose of vincristine. If there is any
side effects stay with the lower dose - 0.5 mg/m2) + Inj Perinorm @ 0.3 mg/kg sc + Inj Ondem @ 0.3 mg/kg iv.
To be followed by - Tab Perinorm 10 mg 3/4 -0- 3/4 X 3 days (half an hour before food) x 3 days
- Cap Synfosium once a day X 5 days (with food/water) x 5 days
- T. Prednisolone 10 mg - 1 tab once a day (with/after food) x 7 days
WEEK 4 - (16/12/24) - Inj Doxorubicin @ 27 mg/m2 iv + Inj Ondem @ 0.3 mg/kg iv
To be followed by - T .Ondem 8 mg - 1 tab twice daily half an hour before food x 3 days.
- Cap Synfosium - 1 cap once a day with food/water x 5 days.
- T. Prednisolone 10 mg - 1/2 tab once a day with/after food for next 7 days.
Discontinue T.Prednisolone after Week 4.
Advised cardiac consult ( 2 D Echo ) prior to doxorubicin administration.
CBC TO BE DONE BEFORE EVERY CHEMOTHERAPY
Recommended LFT,KFT tests once in a month
Further treatment can be decided based on 1st month treatment response.
Side effects of Chemotherapy in dogs :
The most common systems affected are the gastrointestinal tract (causing nausea, vomiting and diarrhoea) and the bone
marrow (causing low white blood cell counts which can predispose to infection). Approximately 30% of dogs will have
some chemotherapy side effects. The majority of the time these are mild and can be managed at home. Less than 10%
of dogs have side effects severe enough to warrant hospitalization for treatment or very rarely death. We learn a great
deal from the first month or so of chemotherapy. If dogs do well during this time, they generally continue to tolerate
treatment well. If they have a side effect which adversely affects their quality of life, then we reduce the dose or eliminate
that drug.
Doxorubicin can cause toxicity to the heart and Cyclophosphamide can cause sterile haemorrhagic cystitis (i.e blood in
urine).
We would have to get a cardiology consult (2 D Echo)done prior to giving doxorubicin.
Recommendations for family:
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11/28/24, 2:23 PM Gmail - Discharge instructions for Neo (8868), Male, Canine, Indie Dog - Indian, Mixed, 23 kg, 01/01/2020 (4 years, 10 months)
Most cancer chemotherapy targets rapidly dividing cells in the body—a characteristic typical of cancer cells. Treatments
used in pets are generally less intense than those used in human medicine. Still, pets will excrete potentially harmful
drugs in their body fluids (such as urine, faeces, vomit, and saliva) and care must be used to minimize your potential
exposure to these substances.
First 48 hours after your pet has been discharged following a chemotherapy treatment:
1. Keep children and other pets away from the pet that has received his or her chemotherapy treatment.
2. Wash food bowls and toys separately from other household items, using water and dishwashing or laundry
detergent (if the items are washed in the laundry machine).
3. Wash bedding separately from other laundry using laundry detergent and bleach if faecal-soiled.
4. Use latex gloves when cleaning up urine, faeces, or other body fluids:
The thicker the glove, the better. You may also double glove (use one pair of gloves on top of another).
Dispose of gloves in the trash; trash should be double-bagged.
Always wash hands after removing and disposing used gloves.
1. Encourage dogs to urinate on grass, in an area away from where other pets normally eliminate. Having your pet
urinate on grass rather than concrete (or other solid surface) will eliminate the need to hose the area down. Using
a hose increases the possibility of contaminated fluids splashing on people in the vicinity.
2. If there is an “accident” in the house (such as urinating or vomiting)
Try to contain and absorb the fluid by blotting with paper towels (that can then be double-bagged and thrown away).
After cleaning the area, disinfect it with household bleach (1 part bleach to 10 parts water)
We are wishing Neo our best of luck and love on his journey to recovery.
Please get back to us in case of any questions or concerns
Kind regards,
Dr Sneha Johnson, Oncology resident.
Dr Noopur Desai, Senior Veterinary Oncologist.
The Cancer Vet.
Cancervet Clinics Private Limited, Mumbai
Ground Floor, Signature Business Park, Postal Colony
Chembur
400071 Mumbai, Maharashtra
India
+91 87999 49294
[email protected] https://thecancer.vet/
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