After being on cytoxan (10mg, 1x/day) for nearly 5 months, Jackson finally developed urinary cystitis (this is his metronomic protocol and it's proactive; he doesn't have any mets...that we know of yet).  At first, the volume of each pee varied; that's weird for him, as typically each pee would decrease in volume, with his final stops being almost nothing.  It's gotten a little worse: his first pee will pretty much empty his bladder, but he'll continue to try to pee SO many times along our route.  Fortunately, he doesn't seem bothered by it.  No weird behavior issues inside, although he recently peed in the onco's waiting room!  I mopped that up, and there was blood.  His onco collected more urine (via catheter! Poor guy...OUCH!) and cultured it.  We just got the culture back and there were no bacteria.  This means Jackson's system is “simply” inflamed.  To help him, we've doubled his anti-inflammatory med (now: rimadyl, 50mg, twice/day) and doubled his MSM (now: 400mg, twice/day).  I'm going to look into an herbal supplement, too.  Apparently this problem can take WEEKS to heal.  We're a week out since his last cytoxan and there's no sign things are getting better (they're not getting worse, though).

Because of the cystitis, Jackson will no longer EVER take cytoxan.  His onco feels that Jackson's bladder is sensitive to its side effects, so just merely going off cytoxan, waiting for it to heal, and then restarting it will only cause the problem again.  Makes sense to me.  The solution is to replace cytoxan with leukeran.  Leukeran is the brand name and Chlorambucil is the generic name.

Jackson was, for a 60lb pup, on 10mg cytoxan daily.  Now, he's going to start on 1.5mg leukeran every day, but can go up to 4mg.  NOTE: we're starting at the VERY low end, because he'll be starting this new drug while we're away.  We don't want any side effects while we're gone.  It's great his onco recognizes this and realizes we'll bump it up when we return.  Plus, Jackson is still dealing with cystitis!

About leukeran:

• Leukeran has been around a LONG time.  Perhaps as long as cytoxan.  It's pretty darn near as effective.  Plus it has fewer side effects than cytoxan.  So why is cytoxan preferred?  Well, in the studies looking at metronomic therapies in dogs, cytoxan simply has more studies and more stats.  Onco's love stats!  Cytoxan is also cheaper than leukeran.  So, if your pup handles cytoxan well, you're set: it's effective, it's cheap, and it's got some good stats.
• It's not necessary to keep Jackson on MSM while on leukeran.  Leukeran simply doesn't have that same side effect in the bladder as cytoxan.  MSM helps the bladder (also), so it's not needed while on leukeran but is helpful when on cytoxan.  But, since his MSM is in his joint and hip supplement, he'll still get daily MSM.  He's a tripawd, after all!  I want to preserve all his joints as best as possible!
• Leukeran can be given any time of day unlike cytoxan.  Cytoxan is usually given in the morning, thus allowing your pup to pee throughout the day vs letting it sit in his/her bladder overnight.
• Jackson was getting 10mg of Cytoxan.  Soon, he’ll be on a max dose of 4mg (see above story) assuming all is well and he handles it fine.  This doesn’t directly mean leukeran is more powerful than cytoxan.  Leukeran simply has a different mode of action and the dose is appropriate for its mode of action.
• The bad news is that leukeran is pricey.  Or it can be.  See this article posted by Jackson's friend, Jill: http://catexper.....ine.html  This article was written in Jan 2013.  When we got the word Jackson's medication was switching, I made phone calls.  I called the following pharmacies: Diamondback Drugs (where we have been getting his cytoxan from = 30 pills, 10mg were ~$40), RoadRunner, Stokes, BestPetRx, Wedgewood, Apex (a local, compounding pharm near me in CT), and my local Walmart.  For 45 pills, 1.5mg each, here are the prices: Diamondback = $85, Roadrunner = $144 pills OR $57 for a liquid suspension (this may be UBER helpful for kitties!), Stokes = $125, BestPetRx = $140, Wedgewood = $158, Apex = $48, and Walmart = $684.
• Yes, Walmart is $684.  Yes, Apex is $48.  I had all about given up until Apex got back to me.  I had a discussion with the pharmacist about this price and she mentioned how crazy the markup is.  Well, THAT’S reflected in the prices I got!  Wow.  Apex may be a registered pharmacy in your state and they do ship.  Give them a call, if you need to and are interested.  They may be able to ship to your state!  Their website is: http://www.apexpharm.com/
• If you want to or need to call other pharmacies I didn’t call, see this other article I wrote for Tripawds: http://www.nutr.....me-from59/  This article details how to find good, safe meds for your pet.  It provides links to where you can find compounding pharmacies in your state.  It’s entirely possible that the smaller pharms don’t mark up this dug (as was my experience).  Shop around for this medication!  The savings are immense!

~ Katy & Jackson