Luna's Case Study  

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Other Diseases/Conditions: None Story: Luna, my female DSH Torbie, was born November 1996. We live in Los Angeles with my boyfriend James, dog Jean Luc and 2 kitties Jules & Jim. Mid 2008 I noticed Luna looked skinnier but I just assumed it was part of the aging process. She was up to date with physicals and vaccinations. 10/28/08 I mentioned the weight concern to my Vet but a complete physical and blood tests showed normal results and since Luna had no other symptoms my Vet said to re-check in 6 months. Spring 2009 Luna seemed considerably thinner, vomiting more than her usual 1x week and had very loud, gurgling gut noises all the time. 4/28/09 Vet did blood tests; they were normal so she did an X-ray. The radiology report showed "Increased irregular gas pattern, could indicate inflammation of intestine or inflammatory bowel disease". However the Radiologist did not write "lymphoma", although my Vet said lymphoma normally goes hand in hand with IBD. She recommended I comeback to do an ultrasound. 5/11/09 Vet did an ultrasound to look through abdomen, intestinal wall thickness and lymph nodes and did a fine needle aspiration cytology. Results were "inconclusive" (they only saw a little inflammation, like there's an infection on the lymph node) so my Vet recommends seeing an Internal Medicine specialist. 6/16/09 Went to an Internist at Animal Specialty Group in Glendale CA. During the consultation the Doctor explained my two options and price estimates. Option one is an endoscopy that would access the stomach and some small intestine, but can't get into vast majority of intestine (estimate $2600). Option two is surgery (exploratory laparotomy) where they would create an incision from neck to groin to access Luna’s entire abdominal cavity (estimate $5000). The decision factor would be another ultrasound and if the ultrasound showed uniform thickening of the entire small intestine then we could do endoscopy, otherwise the laparotomy would be the only way to pull biopsies from various parts of her intestines. Noon same day, Doctor called to say the ultrasound showed global intestinal thickening so can will proceed with endoscopy and won't need to do exploratory laparotomy. Doctor called a few hours later saying the endoscopy went well and biopsy results will be ready in 48 hours. Luna had a feeding tube (E-tube) inserted at the time of endoscopy so I could inject Reglan (to prevent nausea/vomiting and increase appetite) and also inject liquid food into her tube. Fortunately the Reglan kept her appetite up so she ate on her own. Immediately started on Leukeran 2mg every other day and Prednisone 5mg every day. Pilling Luna is no problem using cheese or Greenies pill pockets. A 90-day prescription at CVS Pharmacy cost me $174.00 for Leukeran and $17.00 for the Prednisone. 6/18/09 Biopsy results came back and Luna is officially diagnosed with small cell intestinal lymphoma, it is in the low grade stage. 6/30/09 Luna had a checkup for blood work and to remove the E-tube since she was eating on her own. The blood work came back normal, indicating no adverse effects to the chemo/steroids so far. Outcome: Updated April 9, 2010 - Since my last update Luna has had 2 Doctor visits and is doing great. Her weight was 4.22 in February and as of yesterday's Doctor visit she is at 4.44 lbs (in June 2009 she was at 3.66 lbs!). The Doctor said the weight gain is an indication that she's in remission. I think the switch from Prednisone to Prednisolone was a big help. I'm giving her 1ml of liquid Prednisolone every other day, and starting today her Leukeran has been reduced to 2mg every 3 days. May this information provide hope to some of you reading this. The Feline Lymphoma Caregivers Guide was the first website I went to when Luna was diagnosed in June 2009 and the case studies have been a tremendous help to me. When she first got sick I was so scared and worried, but reading other kitties' stories on this website gave me comfort and optimism. Thanks everyone! Outcome: Updated January 1, 2010 - On 12/30/09 Luna saw the Doctor for her monthly checkup. The blood count came back normal and her weight is stable, averaging around 4.14kg. Giving meds is still a daily struggle especially since she no longer likes to eat the Greenies Pill Pockets. Each night I have to corner her and give orally and she is not happy about it. Luna takes Leukeran 2mg every other day and Prednisone 5mg every other day. For the Leukeran I put a little butter around the pill and use a pill gun. For the Prednisone I went to a compounding pharmacy and got the RX in liquid form hoping I could mix it with her food but no luck, we tried both fish flavor and chicken flavor but she wouldn't eat the liquid. So now I inject 1ml of liquid orally, it's easier than injecting a pill. FYI – the compounding pharmacist mentioned the option of a transdermal gel I can rub on Luna’s ear but the Doctor won’t prescribe it, stating that transdermal medications are harder to dose control and Luna might not get the proper amount of Prednisone. Starting this week the Doctor is switching her from Prednisone to Prednisolone (the active metabolite of prednisone). They are changing the form of steroid in case Luna's body doesn't process the Prednisone well. Outcome: Updated August 21, 2009 - On 8/18/09 Luna saw the Doctor for weight check and bloodwork, it's been 9 weeks since she was was diagnosed with lymphoma. The bloodwork came back normal but I'm concerned about her weight. Since she started chemo in June her weight went up from 3.66 kg to 4.09 kg - gaining almost 1 pound in 9 weeks. But lately her eating has slowed down. She has no side effects from the Leukeran/Prednisone, no vomit/diarrhea but her appetite is failing. The Doctor said her inappetence my be related to nausea secondary to the meds or cancer that is only partially in remission, and she gave me a bottle of Reglan to perk up Luna's appetite. Giving meds has recently become a problem, it's getting much more difficult to pill her. I've tried all kinds of pill pockets, treats and cheese but Luna won't eat the pills. I hate forcing them in her mouth. I was hoping to use the the Reglan to make her hungry again but injecting liquid Reglan in her mouth is almost impossible. Outcome: I have to bring Luna back to the Internist late July 2009 for a weight check and blood work. She's still not eating very much at all. I've tried all kinds of wet/dry and homemade foods but she only eats a few mouthfuls. I might ask for a drug to stimulate her appetite if her weight hasn't stabilized/increased. Right now the goal is to go into remission and keep her eating. - By Deb Luna's Mom -

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