Leukeran Price Gouging Causes Feline Chemo Cost to Skyrocket

Leukeran Price Gouging Causes Feline Chemo Cost to Skyrocket.

One Leukeran tablet is now more than $11 a pill and cat owners cannot afford that.

In my feline-exclusive veterinary practice, I am frequently presented with a middle-aged or elderly cat that has been losing weight.  Common causes for weight loss in this population of cats are diabetes, hyperthyroidism, and chronic kidney disease.  Cats with diabetes and hyperthyroidism tend to have excellent appetites.  Cats with chronic kidney disease often have poor appetites.  Diabetics and cats with kidney disease usually show excessive thirst and urination.  Some cats with hyperthyroidism also drink and urinate excessively.  Some don’t.  The bottom line is that there is a lot of overlap in the clinical signs of these three disorders.  Fortunately, some simple tests (namely, a “senior profile” consisting of a complete blood count, serum biochemistry panel, thyroid test, and urinalysis) are all that is usually needed to reliably distinguish between these three.
If a senior profile comes back showing normal kidney and thyroid function, and no diabetes, then the cause of the weight loss often ends up being a gastrointestinal issue. Performing abdominal ultrasound in these cats usually reveals thickening of the intestinal wall and enlargement of the mesenteric lymph nodes (the lymph nodes that reflect what is going on in the intestinal tract).  If this is identified on ultrasound, then a biopsy sample from the intestinal tract is needed in order to make a definitive diagnosis.  Biopsy can be achieved either through exploratory surgery (you get great biopsy specimens, but surgery is costly and invasive) or endoscopy (you can get decent biopsy samples, and it is less costly and invasive). At my hospital, we do endoscopy.  We take many biopsy samples, increasing the accuracy of our diagnoses.  In about 60 percent of the cases, we make a diagnosis of inflammatory bowel disease.  In the remaining 40% of cases, we diagnose low-grade lymphosarcoma. 

Lymphosarcoma is a common feline cancer.   It can strike any cat, at any age, in any organ, but there are sites in the body that are more commonly affected than others.   The gastrointestinal tract is probably the most common site affected.  The most common form of gastrointestinal lymphosarcoma is the “low-grade” form.  This form is less aggressive than the ominous “high-grade” form.  High grade gastrointestinal lymphosarcoma tends to appear as a tumor somewhere in the gastrointestinal tract.  Low-grade gastrointestinal lymphosarcoma tends to occur as a diffuse infiltration of the gastrointestinal tract, rather than as a discreet tumor.  Both respond to medication, however, the low-grade form has a much better prognosis. 

Treatment of the low-grade form consists of giving two medications – prednisolone and Leukeran.  Prednisolone is given twice daily, initially, and is then gradually tapered to a lower dose, usually given once daily.  Leukeran is typically given every other day. With this protocol, the median survival time is about 25 months.  In my practice, we’ve had cats survive much longer. Once cat, Oscar, survived almost five years.  A few others exceeded four years.  We’ve had very good success with this protocol.

One downside of the medical protocol for gastrointestinal lymphosarcoma is the cost of the Leukeran.  This little brown tablet is relatively expensive, costing almost $6 a tablet.  Given every other day, this comes to almost $90/month.  The other drug, prednisolone, is cheap. 

A median survival of 25 months is pretty darn good, considering that lymphosarcoma, despite being low-grade, is still cancer.  Ninety dollars a month for a drug that could keep your cat alive and happy and healthy to a degree that you wouldn’t know that the cat was even ill is a price most of my clients are willing to pay. 
Recently, however, the company that made Leukeran was purchased by another company. What did the new company do?  They immediately raised the price of Leukeran to almost DOUBLE what it was before!  

Those dirtbags! 

Leukeran might as well be made out of gold!!
One Leukeran tablet is now more than $11!  It’s outrageous and infuriating.  We have 11 cats in our practice who receive Leukeran every other day, and they are all doing very well.
At $11 per tablet, the cost of treating a cat with this drug comes to about $165/month. 

For some cat owners, this is simply cost-prohibitive.  However, my staff and I did some calling around, and working with some compounding pharmacies, we were able to come up with some very affordable alternatives to the brand name Leukeran tablets. 
Leukeran tablets are not available as a generic.  The drug – chlorambucil – is only available as the 2 mg brand name tablet Leukeran.  However, compounding pharmacies can prepare the generic drug in capsule or liquid form.  We tried to order 2 mg capsules, however, for legal reasons (which I don’t really understand), the compounding pharmacies are not allowed to make 2 mg capsules.  They can either make 1.9 mg. or 2.1 mg.  I chose 1.9 mg.  The pharmacy that I use is able to make 30 capsules for about $60. The capsules have a six-month shelf life.  30 capsules will last for 60 days (since the drug is given every other day), so the cost of treating is now merely $1/day.  Not bad.  Another pharmacy that we work with is able to prepare liquid chlorambucil at a strength of 2 mg per ml in a 30 ml bottle, at a cost of about $120.  The bottle has a two month shelf-life.  The dose is 1 ml every other day, so a 30 ml bottle will last 60 days. That’s $2/day.  Also not too bad. 
The question on everyone’s mind is whether the compounded generic form is as effective as the Leukeran tablets.  I don’t know if there’s a real answer to that question.  I can go into Duane Reade and look for Pepcid, and right next to the Pepcid is Walgreen’s antacid for half the price.  If you look at Pepcid’s ingredients, it says famotidine 10 mg.  Walgreen’s antacid is famotidine 10 mg.  They’re identical.  Do they work the same?  I think they do.  Some people will swear that the name brand Pepcid works better. 
A few of my clients are going to continue to give the Leukeran tablets, even at the new $11/tablet price, either because they don’t want to mess with success, or they’re in the fortunate position of not being financially limited.  For those clients who now find the tablets unaffordable, I would recommend the capsules, as I believe that powdered chlorambucil, in the capsule, is probably closer in composition to the native Leukeran tablet than liquid chlorambucil.  Some cats, however, are impossible to pill and can only be medicated if the medication is in liquid form.  For these cats, I would (obviously) recommend the liquid form.  Time will tell, I suppose, if the compounded medications are as effective as the Leukeran tablets. 

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The Relationship Between Coat Color and Personality in Cats

Although most of us cat lovers will tell you that it’s a cat’s personality that matters most, many of us will admit that we find ourselves drawn to a cat’s particular coat color.  At my cat hospital, my technician Hiromi is drawn to orange boys.  I tend to go for the torties.  My technician Gina favors black cats.  A close friend of mine, Arden Moore (the famous writer and pet educator) feels that there is certain personality traits are tied to coat color in cats.  Only a few studies have been done, however, that explore the potential link between coat color and cat personality, and these have shown mixed results.  One study from 1995 suggested that orange male cats may have difficulties in “tolerating the proximity of other males”.   A study (that was never published) on the reactions to novel situations showed that orange and cream colored kittens reacted more aggressively than other colors of kittens when held by an unknown  human.  A more recent study (in 2010) looked at cats of certain coat colors (black, orange, brown, and tortie) and compared them to cats of the same coat color but with white patches (i.e. black and white, orange and white, brown and white, and calico) in terms of how the cats reacted to novel situations and handling by a stranger.  No significant differences were found between any of the coat color groups.

No significance. Good.

So, studies of actual personality differences based on coat color are decidedly mixed.  But what about people’s perceptions of cats of a certain color?   Whether studies show differences or not, people definitely do associate personality and color.  It’s not just coincidence that black and brown cats are the less likely to be adopted from shelters compared to other colors.  Studies have shown that the color of a cat plays a significant role as a basis for adopting a cat, however, the cat’s personality takes on the greater role when it comes to whether or not to keep the cat in the home once it’s been adopted.

Exactly how are certain colored cats perceived by people?

A recent study was conducted that helps shed a little light on the topic.  A questionnaire was distributed to participants in a study.  Using a 7-point scale (where 1 = strongly agree, 2 = agree, 3 = agree a little, 4 = neutral,  5 = disagree a little, 6 = disagree, and 7 = strongly disagree), participants assessed ten characteristics (active, aloof, bold, calm, friendly, intolerant, shy, stubborn, tolerant, and trainable) and the extent to which these characteristics could be applied to five colors of cats (Orange, tortie, white, black, and bi-colored).  [Bi-colored was a weird category to me, because this could be black and white, or it could be orange and white. They chose this color scheme to see if the presence of white patches might impact attitude toward cat personalities.]  The statements in the questionnaire was made very matter-of-factly, and participants had to indicate how much they agreed or disagreed with the statement.  For example, “Orange cats are active” or “tortie cats are friendly” or “black cats are aloof”.   189 people participated and produced valid questionnaires.

The way the results were reported are a bit odd, so I’ll just report it the way the article says:

All other listed colors of cats were deemed more “active” than white cats.

Torties, black cats, and white cats were more “aloof” than orange cats.

All other listed colors of cats were termed more “bold” than white cats.

White cats were considered more “calm” than torties and bi-colored cats.

Orange, black and bi-colored were considered more “friendly” than torties; orange and bi-colored cats were seen as being friendlier than white cats.

Torties were rates as being more “intolerant” than orange, black and bi-colored cats.

White cats were ranked as being more “shy” than orange and bi-colored cats, and black cats were ranked as being more “shy” than orange cats.

Orange cats and black cats were said to be more “tolerant” than torties.

Orange cats were said to be more “trainable” than white cats.

To further describe the researchers’ findings, they concluded that a color group was different in terms of personality if they were statistically different from at least two other colors of cat.  Using this scheme, they determined that …

Orange cats were perceived as being high in friendliness and low in aloofness and shyness

Torties were high in aloofness and intolerance, and low in friendliness and tolerance.

White cats were thought to be aloof, calm and shy, and not very active, bold or friendly.

Bi-colored cats (black and white, orange and white) were said to be friendly, and not aloof.

Interestingly, black cats were not rated differently from more than one color category on any of the traits.

And what did the study say about me?

The questionnaire asked the participants how important was color, and how important was personality, when it came to adopting a new cat. 26% said color was important or very important, 24% were neutral about it, and 50% said that color wasn't important at all.  Personality was considered important or very important to 94.7% of the respondents.  3.2% felt neutral, and 2.2% felt that personality was not important at all.  (Who the heck is in this 2.2% group?  I’d love to ask them, “So, personality does not matter at all?  You’d be willing to adopt the crabbiest, nastiest, most aloof cat in the world as long as it looked nice?”  People are strange, I tell ya.)

Anyway… what can we conclude from all of this?  I guess we can say that people seem to perceive coat color as a factor that contributes to the personalities of differently colored cats.  Orange cats were thought of as being friendly, not shy or aloof.  I think this is interesting, given that some of our cultural feline icons, like Morris and Garfield, are not depicted this way.  Morris is “The world’s most finicky cat”, and Garfield is portrayed as being lazy and cynical.  Perhaps it’s not the personality traits that are given to Morris and Garfield that’s important, but more the fact that these orange cats are anthropomorphized (for example, Morris and Garfield are depicted as being able to talk) in advertising is what makes them appealing. Compared with other colors of cats, orange cats tend to be adopted more quickly from shelters, and we see the same at my own veterinary hospital.  When we have an orange kitten in the window for adoption, it tends to be snatched up immediately, while other colored cats tend to linger for a while.  Torties and calicos were ranked as being aloof, intolerant, and unfriendly.  I have to say, though I’m skeptical about these kinds of studies, in my own veterinary practice, there is no doubt that calicos and torties do indeed fit this bill.  I didn’t want to believe it, but it can’t just be coincidence.  These cats give me more grief than any other color pattern.   White cats were considered less friendly and more aloof, and I wonder if this is because of the Fancy Feast cat – a white Persian cat being fed from a crystal goblet – which depicts the cat as being “snobby”.
And I play Mozart too

Dark colored cats have been documented to remain in adoption centers longer, and are more likely to be euthanized than lighter colored cats or cat with a patterned coat.  Black cats have also been associated with bad luck.  Surprisingly, though, there were no significant differences between the ratings assigned to black cats compared to cats of other color groups.  So, if black cats weren't assigned any negative personality traits, their lower adoption rate must be due to their appearance.  Either people consider black cats “plain” looking, or they still harbor that negative stereotype of them being bad luck.

Missy, our snooty hospital cat
Although I find it a little irritating that coat color may be a predictive factor in the adoption and euthanasia rates of some cats in shelters, I was pleased to learn, from the article, that when cat owners are surveyed after the adoption, personality is the primary reason cited for their satisfaction with their cat.  Again, appearance may play a role in the adoption selection, but personality plays the major role in the satisfaction after adoption.  It looks like there might be a disconnect between the way people choose a new cat and how appropriate that cat might really be for them.  This also emphasizes the need for shelters to really screen their cats for personality, and then make this behavioral assessment clearly apparent to potential adopters.  When people are faced with a lack of accurate behavioral information about a specific cat,  they will revert to making decisions based on their personal perceptions about cats, including the idea that color coat is an indicator of personality.  Also, if shelters know that people think white cats are shy and aloof and torties and calicos are unfriendly, they can try to counteract these perceptions by featuring these cats in advertisements and fliers that emphasize their positive personality traits.

More Resources on the topic:

Human Perceptions of Coat Color as an Indicator of Domestic Cat Personality

Don’t be so fast to judge a cat by its color, study warns

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Manhattan Cat Specialists - Ten Year Anniversary

It all started in a 5000-watt radio station in Fresno, California…

Actually, it all started exactly ten years ago.  On January 2, 2003, Manhattan Cat Specialists opened its doors to the public.

It’s truly hard to believe that a decade has passed. Our story, in a nutshell:

I had just finished a 3-year stint working for The ASPCA, and I was ready to branch out on my own.  A colleague of mine from my Baltimore days, Anne Sinclair, had recently opened her own cat hospital, Cat Sense, in Bel Air, Maryland, and although she said it was very hard work, there was nothing more rewarding than being your own boss and controlling your own fate.  She graciously loaned me a copy of her business plan, and using that as a template, I prepared a business plan for my own feline-exclusive veterinary hospital in Manhattan.  At the time, there were only two cat hospitals in NYC – one on the upper east side, and one downtown in the Flatiron district.  There were no cat hospitals on the upper west side.  Yet.

After having my business plan reviewed by an adviser at the Small Business Association, I presented it to three banks.  One bank balked.  The other two said okay.  JPMorganChase offered the better terms, and so, with a quarter-million dollars in seed money, construction began.  At the time, businesses in Manhattan were still reeling from the aftermath of September 11th.  Many businesses were still closed, and many others decided to pack up and move out of the city.  It pained me to see my hometown, my glorious city, struggling to get back on its feet.  The time was ripe for starting a new business, and contributing, in my own small way, to helping bring the city back to the thriving metropolis that it has always been.   Armed with my loan money, I strolled the streets and avenues of the upper west side, looking for appropriately-sized vacant storefronts to serve as my potential cat hospital.   Lo and behold, I spotted the perfect site, just off of West 76th and Broadway.

The inside was a mess.

But the realtor promised me that once the lease was signed, they would deliver to me a big “vanilla box”, for me to design and construct as I saw fit.  I signed the lease, construction began, equipment was purchased, signage was applied, and…. voila!

Manhattan Cat Specialists came into being.

My initial staff was small:  Sharon and Hiromi were my technicians, Joshua was my receptionist, and Ethel was our hospital cat and mascot.

Six months after we opened, Sharon and her husband had to relocate to Maryland, and I hired Rita to take Sharon’s place.  Here’s our first official staff photo.

I must be doing something right, because ten years later, Hiromi and Rita are still working for me.  (Wow…my hair was so much darker… and more plentiful… and so few wrinkles.  Sigh.  I guess I can believe it’s been ten years.)

Of course, a lot has happened since January 2003.  We’ve gone from one receptionist to four (Jackie, Jeaneth, Lois and Deniz) and from two veterinary technicians to five (Hiromi, Rita, Gina, Liliane, and Gill).  We’ve also gone from one doctor to two (Dr. Victoria Sheheri).  And we added a director of operations to handle our marketing, computers, and generally keep the place running smoothly (Brad).  We’ve gone from being open 5 ½ days a week to 7 days a week.  We started a cat/kitten adoption program, and in ten years have adopted out over 300 kitties.   We added a veterinary house call service on Thursdays.

And so, our second decade begins today.  I’m proud of what I’ve built these last ten years, and am grateful for my supportive staff who have helped me turn this dream into a reality.  I’m also grateful for the clients who have put their faith in me and my staff, trusting us to care for their cats.   Here’s to another decade of keeping cats happy and healthy.
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