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Metronomic chemotherapy for Tazzie: Protocol Details | Treatment, Recovery and Oncology

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Metronomic chemotherapy for Tazzie: Protocol Details
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7 January 2009 - 7:21 pm
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Tazzie had her last dose of chemo (carboplatin #5) on Dec 18th and for the last few weeks I have been doing lots of research to determine if I should do anything else for her.  Traditionally this would be to take the "wait and see" approach; taking xrays every 3 months and just enjoying life. There are currently several alternative paths to take, including the chinese herb artemisinin or trying  a daily low-dose chemotherapy plus NSAID (metronomic protocol).

I have contacted Tazzie's oncologist (Dr Karri Meleo of Seattle) and she thinks that both are reasonable and should be started as soon as traditional chemo is done.  I also contacted a holistic vet, and several of the doctors researching artemisinin (Dr Cuoto and Dr Singh).  Everyone agrees that artemisinin is safe, and it can kill osteosarcoma cells in a petri dish, but we still don't know if the herb can work to kill cancer in a dog's body or if the oral dose can be absorbed properly.  Hopefully the ongoing study at OSU will determine a universal protocol for using this herb.

I originally wasn't going to try metronomics since Tazzie has chronic liver disease.  I am not worried about the chemo drug (cytoxan/cyclophosphamide) because that is fairly safe at low doses and tends to affect the bladder not the liver. I am more concerned with the NSAID since they all have to cycle through the liver to work.  But Tazzie's recent blood test is fine and she is still taking her liver meds (SAM-E, milk thistle, Vitamin E) so I am going to try Metacam and Cytoxan daily and see how her liver handles things.  I can always stop if she has issues.  She is also getting stiff on her remaining front leg and I think the Metacam will make her feel better!

If she handles metronomics okay then I will add the artemisinin and I will recheck her xrays every 3 months.  Hopefully as more tripawds try these things we will get some info that can help others in the future.

This will be Tazzie's new protocol (bodyweight 180#)

AM MEDS

1 Marin tab(milk thistle and Vitamin E)

500 mg Vitamin C

25 mg cyclophosphamide (Cytoxan pill)

1 HOUR BEFORE DINNER

3 denamarin tabs (SAM-E and milk thistle)  has to be on empty stomach!

PM MEDS

3 fish oil caps (1000 mg each)

2 Dasequin (glucosamine supplement)

1 meloxicam 7.5 mg (generic Metacam)

BEFORE BED (3-4 hours after eating)

200 mg artemisinin

80 mg artemether (artemisinin derivative)

1200 mg butyrate (to increase absorption of above 2 drugs)

She will also continue her Innova Large Breed Senior 3 cups dry plus 1/4 can twice daily.  If she stops eating I will probably stop the artemsinin drugs but that is a rare side effect.  If anyone has any questions about these things feel free to ask!

Pam and Tazzie

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7 January 2009 - 8:12 pm
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Pam, this is an incredibly valuable resource, thank you so much for posting the details of Tazzie's plan. We know that lots of others will benefit from this detail, and any other information you follow up with.

We really applaud you for looking into all of the options, and having the courage to go forward with alternative therapies like artemisinin, SAM-E and milk thistle, etc. Sharing your experience will help to ease the fears and concerns of other pawrents who might be too scared to try them because they didn't know anyone else who had.

Thank you very much for helping us all to beat this cancer thing head on!

It's better to hop on three legs than to limp on four.™
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7 January 2009 - 8:17 pm
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Thanks Pam for sharing that with us.  It is really helpful. I was wondering about your food. I was feeding both my dogs the Innova large breed before, but felt that I should switch to the Innova EVO with the cancer diagnosis for Wrigley ( I was going to switch both for convenience) to eliminate the grains- I see you continue with the regular Innova-  your thoughts???

 (Also, I posted a question on Chemo leaks- one of the drugs Wrigley's oncologist is

recommending( Doxorubicin) is listed in  one of my readings as one that tends to have chemo leaks- do you know anything abou that ?)

Thanks again for all your advice.

Seanne and Angel Wrigley

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7 January 2009 - 8:59 pm
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Pam -

Thank you SOooo much for posting this information.  Barney is on a weekly dose of Cytoxan, but with meloxicam and doxycycline daily.  Do you recommend daily Cytoxan instead? 

Thanks and hugs to the big girl!

Barney B & Linda

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7 January 2009 - 11:08 pm
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Thank you so very much Dr. Pam for sharing Tazzie's health plan with us!  Jake will be receiving his last dosage of chemo in a few weeks so it is very helpful to have information and options to discuss with my vet when I go in.  I wasn't sure what the next step would be but it sounds like there are options... I guess if the vet is willing to "go there" and try different things, right?  So happy to hear Tazzie girl is doing so well!  Smile

Luv Spirit Jake, Smooch, Baby Gus & Mom (Sherri)

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8 January 2009 - 1:07 am
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Wrigley,  I would definitely stick with the EVO...Tazzie can't have it because of her liver disease (too high in protein) but it is a better diet for cancer.

Barney B, I think the older protocols used cytoxan weekly but the trend is now to use 10 mg/m2 once daily OR 25 mg/m2 every other day.  This pill only comes in 25 or 50 mg sizes so smaller dogs might need it compounded.  If your dog is doing well with the weekly dose he might be fine but I think the assumption is that daily "pulses" of drug help keep the cancer cells from taking hold.  Some oncologists use doxycycline, and some don't.  I decided to try to keep drugs to a minimum due to Tazzie's liver condition but doxycycline certainly won't hurt anything.

Pam and Tazzie

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8 January 2009 - 2:56 am
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Pam,

Thanks for sharing the info with us.  I have researched the use of artemisinin here in South Africa and it seems as if the capsules are used in effective healing of malaria in humans in Africa.  It also states that it can be used for cancer treatment as it destroys cancer cells.  It is sold under the name original name - Artemisinin, so I am going to try and buy it at the pharmacy - without prescription, I hope!

I will let you know how much mg each pill is and will appreciate it if you could let me know what dosis I should give to Dee per day.  I am not sure how much he weighs, but he is a large breed - Border Collie/German Shepard mixed breed.

Thanks for sharing your knowledge with us - I am also going to phone our vet and share the information with him!  I will also have to put all my fears aside and take Dee for a check-up and xrays, as I havent done this since he was operated in May '08. (Too scared!!)

Kind regards,

Ansunette (and Dee) xxx

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8 January 2009 - 10:50 pm
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Dee, here in the States Artemisinin comes in 50 or 100 mg capsules so a dog your size probably needs 50 to 100 mg daily.  The Artemether is dosed at 0.5 mg per pound so if you are 60 pounds you would need 30 mg.  Dr Singh said not to exceed that dose of Artemether but Artemisinin is very safe and some like to use higher doses so Tazzie could have up to 300 mg daily for her size.  The butyrate comes in 600 mg capsules so if you can find this (it is very cheap here) I would give 1 capsule daily to help with absorption of the other drugs.  Dr Singh also suggested giving the pills with dairy products like milk or cottage cheese to ease digestion, and it was his suggestion to give a Vitamin C capsule in the morning as well as Vitamin E (I think you would need 250 mg Vit C and 200IU of Vit E).

Good luck with your vet visit!

Pam and Tazzie

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9 January 2009 - 1:59 pm
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Hi Pam & Tazzie,

 Buster is on a similar protocol, except for the butyrate.. I have recently noticed his stool is very loose. Can you suggest something to help bind him naturally ? He already eats chicken & pumpkin....

I don't want to give him anymore new meds since I am afraid it might interfere with the protocol...

Thanks for the info,

Kim & Buster

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9 January 2009 - 3:32 pm
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Kim, have you tried probiotics?  I used FortiFlora made by Purina when Tazzie had diarrhea from the chemo and it worked great!  I know there are other brands out there and sometimes yogurt also works.

How much pumpkin are you giving?  I usually have people try this if the pet is constipated so maybe it is too much for him.

Glad to hear from you!

Pam and Tazzie

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9 January 2009 - 11:33 pm
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tazziedog said:

How much pumpkin are you giving?  I usually have people try this if the pet is constipated


We thought pumpkin was for runny poo?

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12 January 2009 - 2:22 pm
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Hi,

Thanks for the info!!  I am going back to the pharmacy again tomorrow.  They have the pills at the natural health / alternative health counter. The lady there have been very helpful - she is going to ask her chinese herbal doctor for advise and to double check if Dee can use it.

Good wishes,

Ansunette & Dee xx

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19 January 2009 - 5:13 pm
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Hi Pam & Tazzie,

   Do you mind if I ask which brand of Butyrate you are using? I've been looking on line and they vary according to mg and how much sodium each one contains.  I have been able to find one that is 500 mg with 70 mg of sodium and 100 mg of potassium. Is the potassium harmful???

Ps.. Genie sent me a wonderful link for the avemar. Have  you heard anything about it?

Kim & Buster

Kim & Angel Buster

"Until one has loved an animal, a part of one's soul remains unawakened."
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19 January 2009 - 10:21 pm
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Kim,

I am using Butyrex made by Holley Pharmaceuticals (they also sell Artemisinin). One capsule has 480 mg calcium, 240 mg magnesium, and 3.6 grams butyrate.  Tazzie gets 2 capsules in the evening with her Artemisinin.  I actually haven't started yet because I am doing 1 drug at a time and then waiting a week to check liver values and see if she has side effects.  This week I will start the Bone Stasis powder then next week the Artemisinin combo with butyrate.

1 bottle of 100 caps was only $12.99 plus shipping. I do not think that the extra calcium would hurt unless your dog has ever had calcium oxalate bladder stones (rare in big dogs) and the potassium and sodium in the product you mentioned are low so should also be okay.  I think that the butyric acid has to be buffered by another ion (sodium, calcium, etc) which is why there is no "pure" product.  This is also what helps it "bond" to the artemisinin and makes it more available to the dog's digestive system.  I think that the Holley Pharm website had a paper on it and Dr Singh also recommended it so I thought it might help.

Has Buster had any side effects from his drugs?  They all seem pretty benign to me, I just have to watch the Metacam with Tazzie.  Her first liver test last week was normal so that was good!

Pam and Tazzie

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10 November 2010 - 1:01 pm
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Dear Pam,

 

I was interested in applying the Artemisinin and also ordered the Butyraid to help with the absorption.  The difficulty for me seems to be timing the dose outside the 3 hour window of feeding.  This eliminates any idea to use it twice daily. I was on a 10 and 10 schedule for his meals.  Is it imperative that I feed by 9 if I am going to dose at 12 just before bedtime?  Do I need to allow for a greater window?  (4 hours?)  I have been feeding Alexei a BARF diet prior to amputation and I read the high Iron of the meat is a concern.  Also the antioxidants in his diet is a concern of the free radicals which will be present if the drug is effective.  I am also giving Alex the K9 Immunity (all three) regiment in the early afternoon.  Any suggestions would be greatly appreciated...

 

Paul & Alexei

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