Always Get Insurance

I did something foolish today. I added up all of our vet bills from the day Jenna was diagnosed with lymphoma to the present. And I thought, well, what the hell, the blog is supposed to be about sharing information about lymphoma, so ... I'm sharing.

Four months of chemo, plus accompanying medications and bloodwork = $6045.63

Granted, we do still have 5 more treatments to go. The chemo treatments average about $400-$500 a pop. Sometimes it's better (about $100 for the cyclophosphamide weeks) and sometimes it's worse (about $700 for the doxorubicin weeks). Bloodwork-only weeks run up just a painless $90. Sometimes after these weeks we start getting wild ideas about purchasing groceries or getting our car's shrieking brakes fixed.

We do not have veterinary insurance, because we are idiots. By the time it crossed our minds that coverage might be a good idea, both of our dogs were already churning out lamenesses and rare diseases as fast as veterinary medicine could cure them. No insurance company in their right mind would have us. As it is, I have this irrational fear that any future dogs we have will be refused insurance based on the medical records of our previous dogs.

But this is what money is for, n'est pas? For about $1500/month, we are keeping our dog alive - healthily, happily, and energetically alive. Will this delay some of our financial plans? Yeah. In 30 years, when I look back at this, am I going to say to myself "jeez, I wish I'd just put the dog down and saved that money for a mortgage down payment"? No, I most assuredly will not.

Just the same, I advise all new owners to take out insurance the instant puppy comes home. We're extraordinarily lucky that we are in a position to pay for this. If this had happened a year ago, I really don't know what we'd have done. Imagine having to euthanize a beloved family member only because you didn't have the money to save her?

A New Year

Happy new year everyone! We are so thankful that Jenna is still here, and still hale and hearty as we begin the new year. She did great over the holidays, and survived all the visiting and the endless goodies with energy and appetite to spare. She met the cousins' new baby, endured an entire 24 hours with my sister's crazed one-year-old Lab/Beagle, and stole and devoured an entire gingerbread cake, the only consequence of which was a prolonged bout of gag-inducing flatulence.

Next week she's scheduled for her week 16 chemo treatment, and we will be able to celebrate 4 whole months of extremely high-quality life with lymphoma. Of course we're grateful for whatever time we get with her, but the way things have been going ... well, it tends to make you pretty hopeful. So here's hoping for a healthy 2009 for Jenna!

Chemo Week #12

Well, it has been exactly 3 months since Jenna was diagnosed, and she's still going strong. Yesterday was chemo day, and as usual, she did great. She got home and gobbled up her dinner and then proceeded to beg for ours.

The only concern is that the vet thinks Jenna's submandibular (under the jaw) lymph nodes are a tiny bit enlarged. She isn't that worried, because none of the other nodes are at all enlarged, not even the original chest lymph node that was huge back in September. However, when Jenna goes in for her checkup next week, if the jaw nodes are still a little weird, we will just go ahead with chemo, instead of giving her the week off. This is fine, because Jenna tolerates the drugs so well, but we were looking forward to a bit of a financial break over Christmas. Oh well. Our Christmas present to each other this year is Jenna!

Week #11 Checkup

No chemo this week!! Jenna went in today for a checkup, and all is well. Blood work normal, lymph nodes not enlarged, appetite very much intact. Vet ecstatic. Lymphoma, you should just give up now. You are no match for the Big Bad Bear. Can I get a whoop whoop?

And here is the long awaited Santa picture:

Chemo Week #10

Well, yesterday was week 10 - doxorubicin. This drug makes me a bit nervous because it can cause heart problems. Also, if it accidentally gets into her skin or muscle tissue (as opposed to into the blood vessels, where it's supposed to go), it causes tissue death. As usual, though, Jenna had no problems.

In fact, the clinic was doing pet pictures with Santa in support of our vet's Rwanda charity, and the vet insisted that Jenna stay after her treatment to have her picture taken. I wish to stress that we are not normally the sort of people who pretend our dog is a child or that she enjoys the same things that children do. (I once saw a young woman pushing a Shih-Tzu, which was wearing a fussy little dress, in a stroller. I was vaguely disturbed by this.) But anyway, when the vet who is giving you huge dicounts on your chemo wants you to stay for Santa pictures, you stay for Santa pictures. Therefore, I will soon be posting a ridiculous picture of my dog wearing reindeer antlers and sitting beside Santa. I don't think Jenna minded anyway - as long as she gets a cookie, she doesn't care what you do to her.

Chemo Week # 9

Yesterday morning I dropped Jenna off at the vet for chemo. While the receptionist dutifully asked me questions like "has she had any diarrhea or vomiting?", "is she eating well?", and "how is her energy level?", Jenna alternated between attempting to launch herself at an animal health technician of whom she is particularly fond, jumping up to stand at the counter so she could lick the receptionist, and making sorties towards the cookie jar. I was unable to sign the treatment authorization form until someone came out to take her from me. When we got her home at the end of the day, she went straight for her bowl, as usual. She's doing so well that most of the time, I forget she even has cancer.

The Chemo Regimen

The chemo protocol that Jenna is on is a slightly altered version of something called the University of Wisconsin-Madison canine lymphoma protocol. It is what's known as a "multi-agent" chemotherapy protocol - that is, several different drugs are used in a course of treatment. This is Jenna's chemo regimen:

Week 1: vincristine (brand name Oncovin) given once IV at the clinic, prednisone (pills) given daily at home
Week 2: asparaginase (brand name Elspar) given as a single subQ injection at the clinic, prednisone given daily at home
Week 3: cyclophosphamide (brand name Cytoxan) pills given for 4 days at home, prednisone daily at home
Week 4: vincristine IV at clinic, prednisone daily at home
Week 5: doxorubicin (brand name Adriamycin) given IV for a full day at clinic
Week 6: no chemo - blood work and recheck only (yay! This is a cheap week!)
Week 7: vincristine once IV at clinic
Week 8: cyclophosphamide pills for 4 days
Week 9: vincristine IV at clinic
Week 10: doxorubicin IV at clinic

If in complete remission at this point, treatments continue every other week:

Week 12: vincristine
Week 14: cyclophosphamide
Week 16: vincristine
Week 18: doxorubicin
Week 20: vincristine
Week 22: cyclophosphamide
Week 24: vincristine
Week 26: doxorubicin

If in complete remission at this point, all therapy stops and monthly rechecks are done. (Keep your fingers crossed!)

It sounds intense, but it isn't so bad. We only go to the clinic once a week. For the vincristine, asparaginase, and doxorubicin, we drop her off in the morning and pick her up at end of the day. Our vet likes to keep her there for the day so that she can monitor her for several hours after treatment, to make sure that Jenna isn't going to have any serious reactions. For the Cytoxan, we just take her in for a checkup and blood work, and then we take her home and give her the chemo at home. Our vet does an exam, including blood work, every week. Jenna also gets Sulcrate pills every day, to protect her stomach from the potential side effects of chemo. Right now, we're starting week 9. So far, so good!

Introduction

I decided to write this blog for me, for all of those who are rooting for Jenna, and, hopefully, to help other people and their dogs who are faced with the same questions, worries, and decisions that we find ourselves facing.

In September, we found out that our 8-year-old Humane Society mutt, Jenna, had lymphoma. We had been noticing for several days that she seemed a little lethargic and strangely "off" to us. Then one evening, our dog, who is normally an eater of all things, edible or non, turned her nose up at her dinner. We went straight to the vet, where an enlarged lymph node was discovered in her chest. They took a needle aspirate of the node, and the results from the lab came back with the diagnosis: lymphoma.

The good news, we were told, is that lymphoma tends to be one of the more treatable cancers, and survival times with chemotherapy can extend to over a year. (Survival time for untreated lymphoma patients, by the way, is about 1 month.) We had lost our other dog from a rare, terribly aggressive type of cancer just 7 months before Jenna's diagnosis, and we were not prepared to go through that again so soon. We decided to try the chemo.

There was a catch, though. About a year ago, Jenna had a near-death experience with a condition called Evans Syndrome. It's basically an autoimmune disorder in which the immune system attacks red blood cells and platelets. It makes the animal life-threateningly anemic and prone to unstoppable bleeding. Jenna lived through this ordeal and made a full recovery, but she is always considered to have the condition, and it is always possible that it could return at any time. The oncologist that advised our veterinarian about chemotherapy said that Jenna was not likely to have the same survival time as a non-Evans dog, but that there was no way to be certain of what kind of timeframe we might expect. She also stated that Jenna may have complications from the chemo because of her previous blood disorder.

However, the thing about Jenna is, she's a tank. We know from the Evans episode that she can tolerate massive doses of some pretty unpleasant drugs without even slowing down. She has a cast-iron gut, which we know from her years of habitual garbage looting, random sidewalk litter swallowing, kitchen pillaging, and shoe/belt/coat eating. So despite the uncertainties,we decided to try the chemo anyway.

After the first treatment, her lymph nodes, which by then ranged from golf-ball-sized to billiard-ball-sized, decreased by about half. As of today, we're 8 weeks into the chemo, and she's plowing through it. Her appetite is as excessive as usual, and she's happier and more energetic than she was before we even started the chemo. The vet has been crowing for weeks that she can no longer even detect the lymph nodes. We don't want to jinx ourselves by saying the "R" word yet, but after 2 more weeks, if she continues to do this well, we can openly declare that she is reaching that ultimate goal: Remission.

This has been a long post. I promise, the rest won't be! Future posts will cover things like drugs, costs, and, of course, regular updates on Jenna's condition, because I know those were things that I was looking for when I found out Jenna had lymphoma. I hope this blog will help other dog owners to feel more hopeful about treating lymphoma, and I hope it will dispel some common fears about chemo. Most of all, I hope that I will continue to be able to blog about Jenna, because it means that she will still be here.