Hemorrhagic Cystitis

Dear Doctor,

My dog is going through chemotherapy for his lymphoma. He has only two more shots to go. He just had his Cyclophosphamide shot on Monday and the next morning he started to have blood in urine. I took him back to the doctor and he gave him IV fluid trying to flush out the drug waste of the system. Doctor tested urine sample and did not think there was any infection, so he did not give antibiotics.

Basically, what doctor told me is to try to give my dog plenty of water and wait to see if he's improving. So far I have not seen improvements yet and start to get really worried. I know Yunnan Baiyao is useful for internal bleeding. Will this be useful/helpful for this case? If so, what dosage should I use? My dog is only 9 pounds.

Any other supplements or anything I can use or do to help treat the bloody urine? Thanks a lot for your time and help.

Regards,
Kathy

[Arnold L Goldman, D.V.M.]

Dear KathyPalmer,

Hemmoragic cystitis, essentially inflamed urinary bladder lining with bleeding into the lumen (cavity) and therefore the urine, is an occasional adverse effect of the cyclophosphamide (Cytoxan). In and of itself, it may not be a serious thing, although significant bleeding in an already anemic animal, may be.

Even if the drug is discontinued, the inflammation and residual blood may take some time to resolve. Another drug, chlorambucil, is from the same chemotherapeutic drug family (alkylating agents) and is sometimes substituted for cyclophosphamide when cystitis occurs.

The key here, is that lymphoma and its treatment is the priority. Short of real quality of life issues, bringing the lymphoma under control and into remission must take precedence over all else. Acceptance of some degree of inevitable adverse effects due to the drugs used is required. Your own doctor, in consultation with you is best suited to determine how much adverse effect to balance against therapeutic benefit all in the context of quality of life, and your perception of and tolerance for your dog's discomfort.

Your doctors advice, to encourage drinking, is excellent as the storage of the drug in urine leads to and worsens the cystitis. Frequent emptying has the opposite effect.

As far as herbal remedies ("Yunnan Baiyao is useful for internal bleeding"), this is not the right board for that, as I do not employ such modalities and cannot comment. Please repost that part of your question on the "holistic treatment" board.

Talk to your doctor again and get him/her to re-explain the benefit-risks of continuing on the present course. If you understand, your confidence that you are doing the right thing will increase and a better clinical outcome, and better relationship with your doctor will result. That/s all for the best for your dog.

Good luck and let us know how things are going from time to time.

Sincerely,

Arnold L. Goldman DVM, MS
for MedHelp