From:
"Tressie"
Date: 2009-02-09 00:51:13 UTC
Subject: [ferrethealth] Re: Posting for a friend : Seeking Lymphoma Advice
To: ferrethealth@yahoogroups.com
Hi Judy,
I am sorry that Perla has been diagnosed with lymphoma.
I'll share with you what I decided on for my 5 year-old, Ash. He was
diagnosed with suspected lymphoma at the end of November. I say
suspected because the needle aspirates taken were of poor quality and
the pathology lab couldn't use them.... sigh...taken by a radiologist
during U/S and not by my vet.
That aside, given all his clinical symptoms,results of blood panel
and x-rays, hard swollen periperhal lymph nodes, and poor overall
condition we were pretty certain it was lymphoma and proceeded
accordingly with palliative care.
Because of his frail condition a full chemo protocol was ruled out,
however, he was given one dose of L'asparaginase (Elspar), which did
shrink the lymph nodes and improved his overall condition. At 1 kg,
his BSA was determined to be 0.100 m2. The Tufts protocol is 10,000
IU/m2 -- which made his dose 1,000 IU - pre-treated with Benadryl
(received December 29, 2008).
All the meds he was on were based on his weight of 1 kg. and were
adjusted as needed throughout the illness trajectory.
Prednislone - oral (5mg/ml) 0.03mL BID
Dexamethosone replaced pred as it became obvious he wasn't absorbing
very well (x-rays revealed a hugely distended stomach) -SQ (5mg/ml) -
0.20ml BID for 3 days; 0.10ml BID for 10 days; 0.05ml BID indefinitely
Metoclopramide -SQ (5mg/ml) 0.04mL BID (for nausea and bloating)
He was given duck soup consisting of A/D; Carnivore Care, Chicken
baby food and 100% pumpkin exclusively. Appetite remained good
throughout.
His distended abdomen never went down and last week of life got
progressively bigger. (Later necropsy revealed a large tumor pressing
on the pylorus).
Overall he did not have any pain until that last week and that was
managed quite well with Tramadol SQ. Slept a lot but did
occasionally still play. Stools were a little mushy occasionally but
for the most part normal and regular.
January 19th, his breathing became more shallow and rapid with a
pronounced 'clicking sound.' My vet was away at a conference but
prescribed Ampicillin 0.04ml SQ BID, until his return. Ash was also
starting to grind his teeth so was put on Tramadol - SQ (50mg/ml)
0.10mL BID for pain.
Tramadol helped with pain and his breathing wasn't as labored but
remained shallow and quick. Lymph nodes also were swelling up again.
We decided to try one more dose of L'asparaginase - Ash received 1600
IU SQ January 23rd. X-rays were scheduled to be done January 26th to
give Elspar time to work and to assess his chest.
January 26th - X-ray showed that tumor had displaced heart and lungs
were compressed against chest wall. Consequently, he was euthanized.
Necropsy confirmed lymphosarcoma.
In retrospect, I would not have done anything differently. I believe
the Elspar gave him more time than he would have had otherwise and
certainly did shrink the lymph nodes. He had a good quality of life
until the last week of life. The Tramadol did manage his pain well
and did not sedate him in the least. His appetite only waned one day
and bounced back as soon as he started the Tramadol.
He was heavy care with a lot of medications, most given sub-q. He
had to be watched carefully and medications adjusted accordingly.
But all a labor of love. He was a happy boy in spite of his
prognosis and died peacefully in my arms.
Tressie
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