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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 24414
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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My dog had B cell lymphoma found in his spleen. The spleen

Customer Question

My dog had B cell lymphoma found in his spleen. The spleen was removed, and the surrounding organs and tissue appeared to be healthy. Vin cristine was prescribed along with steroids. However after two treatments my dog developed diarrhea, and after suspending the treatment it was found that the steroid dose did not suit him. He is now on a quarter of the prescribed dose, and has normal bowel function. He is due to restart chemo treatment in two days time, at a half dose level. However I have noticed that in the last couple of days, he has developed a slight weakness in his back legs. Is this due to the chemo treatment? Also how effective is this treatment against this type of lymphoma? My dog is 8 years old.
Submitted: 3 years ago.
Category: Vet
Expert:  Dr. Michael Salkin replied 3 years ago.
Aloha! You're speaking with Dr. Michael Salkin
I'm sorry to hear of this with Eric. I need to know a bit more information, please. Can I assume that his other abdominal organs were biopsied at the time of surgery and found to be free of lymphoma? If so, Eric may have had a marginal zone lymphoma (MZL) of the spleen - a "quiet" form of lymphoma and these patients can have a prolonged survival time (at least a year) with splenectomy alone. Here's a recent study: http://www.ncbi.nlm.nih.gov/pubmed/23734665

I would bring this to the attention of Eric's vet. Hind leg weakness isn't pathognomonic (particularly indicative) of any one disorder and may be seen with general weakness secondary to chemotherapy and corticosteroids or due to a myelopathy (spinal cord disorder) such as degenerative disk disease, degerative myelopathy, or spinal lymphoma in Eric's case.

To answer your question directly, if Eric's splenic lymphoma is, instead, part of a multicentric lymphoma, single agent therapy such as vincristine alone gives response rates of 20-80% with remission durations of ~1-6 months. Combination protocols are recommended instead and one should be chosen from the many recommended by Eric's oncologist.

Please respond with further questions or concerns if you wish.
Customer: replied 3 years ago.


Hello Dr Salkin. Thank you for getting in touch so quickly.


This all started when Eric collapsed at home. I took him to the vets and an ultrasound scan showed that his spleen had ruptured and he was losing blood. Surgery to remove the spleen was performed within 2 hours, and a large tumour (7 - 8cm wide) was found to have ruptured. At this stage, samples were sent off for biopsy immediately. This was of the splenic tumour only. My vet cleared the abdomen of blood, but samples of surrounding organs were not biopsied as X-rays and the Ultrasound scans had not shown any other abnormalities.


After recovery from surgery, he was pretty much back to normal, and placed on a regimen of vincristine once a week for a month together with


Prednisolone initially (40mg) a day, followed by vincristine once a month. After the second chemo treatment, he developed quite severe diarrhea, and the vet recommended that he miss the next treatment. But the diarrhea continued, and we were told that it was probably the steroid causing the problem. This was cut down to its present level (5mg per day) when bowel movements became normal again.


He has been normal in himself since and is due to begin chemo again tomorrow. I started noticing the weakness about a week ago and because when you have an unwell animal, you tend to be on the lookout all the time for the smallest symptoms. On his walks however, he runs around happily with our other dog, and rarely seems unsteady. It seems to show itself more after he has been sleeping, mainly in the evenings. I hope this helps you get a clearer picture. When he goes to the vets, he is examined for lymph node enlargement, which so far has not been evident. He seems well in every other way and is eating well.


 


Many thanks - XXXXX XXXXX


 

Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you, XXXXX XXXXX the thorough history you provided. This doesn't sound like MZL.

Yes, vincristine isn't the likely culprit for Eric's diarrhea and that, of course, leaves the prednisone to blame. My assessment of his chemo protocol stands - a combination therapy should be considered but I would defer to his oncologist, of course.

As for his hind limb weakness, because he can run around normally with his housemate it would be unlikely to find a degenerative or malignant myelopathy. These don't wax and wane but, instead, inexorably progress. When our dogs are particularly painful/unsteady after prolonged rest we suspect osteoarthritic changes in the spine and hips as the etiology.

We can't administer nonsteroidal antiinflammatory drugs (NSAIDs) such as carprofen or meloxicam while he's taking a corticosteroid such as prednisone. That would be a recipe for gastrointestinal ulceration. You can, however, supplement with fish oil because the omega-3 fatty acids in fish oil are antiinflammatory. I dose fish oil products at 20mg/lb daily of the EPA in the fish oil. You should be able to find the amount of EPA on the label. Glucosamine/chondroiton sulfate supplements have become circumspect after recent studies have been published and found them lacking in efficacy. Perhaps they might be of value when given concomitantly with the fish oil. Some vets feel that the injectable neutraceutical Adequan (polysulfated glycosaminoglycan) is a valuable approach to osteoarthritis. Adequan is injected weekly for up to 6 weeks. Finally, if we feel that pain is present and we can't prescribe an NSAID, we'll prescribe a synthetic narcotic such as tramadol.

I'm going to check back with you in a few weeks for an update. Please feel free to return to our conversation - even after rating - prior to my contacting you if you wish.
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 24414
Experience: University of California at Davis graduate veterinarian with 44 years of experience.
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Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you for your kind accept. I appreciate it.

I'll speak to you soon.

Please disregard the info request.

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