Hi Pez

Thanks for posting this topic. I mean to write something up with my retrospective take on my dog's case (that means you will get an earful here!). Tazzie had subcutaneous mets, which are supposedly very rare. This plus what I have seen with a few other dogs who developed mets even earlier has influenced my view on the course of action I would follow if I were to it again (hopefully I won't have to).

The oncologist did chest x-rays but no other scanning before surgery or chemo. They said it was so rare to show up in other 'long bones' that it was not worthwhile x-raying. We started chemo 2 weeks after surgery. I did extra chest x-rays to alleviate those worries, but nothing else. Then I found a subcutaneous lump (yes, it was an OSA met) 8 weeks after surgery, the day before his third chemo. So we never knew if that was present at the beginning or showed up during the chemo. We removed the lump once, but it was the size of a watermelon another 12 weeks later and finally brought too much pain for him to go on.

What I would do before chemo if going through it again: I would want scan other body sites for potential mets. (Knowing condition of heart, kidneys and liver also does not hurt re: surgery). I'm not sure the type of scan (ultrasound or CT scan or MRI). Obviously cost is a huge issue here. Ultrasound is not that expensive and can give you baseline info on the liver, kidney and spleen, all sites where many of my cohort seem to have had problems (e.g., Shilo, Raven). US does mean cutting hair which might not re-grow any time soon if the dog takes Adriamycin for chemo. CT or MRI would be great but I bet they cost a bunch. Once Tazzie's SQ met was found, we did an ultrasound of the internal organs and found two 'suspicious' nodes in the spleen. But apparently the spleen is a bit of a trash bin so who knows what these were. A baseline US (which is not that much more expensive given the cost of amputation) would have let us know whether it was new and therefore probably cancer. That matters so we would have know if we had one met or many mets.

Okay, so maybe we were the odd ones out. But from what I have seen around here, we aren't. Shilo, Jake, and others who had surgery around the same time or even more recently (Tazzie was in July; those dogs came after us) developed mets within 6 to 8 wks and they were not lung mets, although Shilo might have had those too  

If Tazzie already had mets when we began chemo, would we have taken that road? Probably not, given they stopped chemo once the met was found. That of course would have made those 9 weeks during chemo higher quality time. We also probably would have figured out that palliative radiation on the SQ met was appropriate at a time when he could have benefitted from it. Metronomics might have been appropriate if we had known he already had a met. At least we could have monitored growth if we proceeded with chemo.

You mention high liver enzymes. That would make me more tempted to get the liver scanned in case anything is present there and just to assess its condition. From what I understand (I could be wrong here), liver enzymes can be high due to changes in the bone such as cancer. I don't think any of this affects the amputation decision, but it might affect what you do before deciding on chemo. (Which liver enzymes are high?

Type of chemo: My oncologist pushed for her preferred form of chemo (in this case, she prefered to alternate cisplatin and adriamycin). Both those drugs have potentially serious side effects. If I were to do chemo again, I would opt for the one that has lowest possibility of side effects. This seems to be Carboplatin for most dogs. (Having said that, my Tazzie had a kidney history and seemed to have kidney problems after his one Carboplatin - but I have not heard of a kidney problem for anyone else from Carbo.)

There is a lot to be said for just letting your dog recover from surgery and get back to being a Dawg! Chemo should not make that much of a difference, but it will mean regular visits to the Dr. to check the blood and do the chemo. Depending on the dog, she might or might not be lethargic for a couple of days.

Pre-surgery: If I had a giant breed known to be susceptible to heart issues (e.g., Pyrenees, Dane, St Bernard, English mastiff), I would do a heart US before amputation. It seems we lost some of our giant friends due to heart problems within a couple weeks of surgery (e.g., Hori and were Angus's or Peanut's problems heart related?). Pez is not a giant (he has a giant personality but not in sheer size) so this does not apply

Well, that is my first book for the day!

I, too, was VERY skeptical about the chemo, so I know what you are feeling.  Once Trouble's amputation was done and the pathology report was back, and with all the pre-surgery x-rays, and bloodwork behind us, our vet was certain based on all these factors she should have chemo.  Her bloodwork was great, her x-rays showed no mets, the pathology came back as a 'contained' so all indications were in our favor.

I was still hesitant.  The vet and my husband convinced me to give her one treatment and see how she reacted.  We could stop after that one if I felt she wasn't handling it well.

All that said, it was a great decision for us.  Trouble had minimum side effects, and I feel it has helped get her to this 14 month mark.  Each case is different, and you must follow your heart.

To clarify, my regrets are not so much about having done chemo as about failing to obtain more information before starting chemo. Perhaps we should add how long our dogs survived to our posts here. Mine developed mets 8 weeks after surgery, and lived to 4.5 months post-amp. Other dogs, some of which had chemo, had surgery after us and developed weird (non-lung) mets and died more quickly, e.g., Shilo. I can't remember if Shilo had chemo - I think she did.

If my dog had reached the "median time" of 12 months post-amp with chemo (Cherry, Tazzie I, Trouble all exceeded that average, and still is in Trouble's case), I probably would not see a need for having had additional tests at the start. But it does not appear as though my dog is particularly unusual in developing non-lung mets really early (even if his SQ met was kind of weird). The ultrasound of liver, kidneys or spleen could be useful for a few reasons unrelated to cancer, as Pam indicated. I just think it would have been nice to have that information so we could have selected the best course of treatment. Plus we could have avoided wasting the time we had left with those post-chemo days in which the dog might not feel horrible, but does not feel 100%.

I am glad that Jerry and family spoke. Definitely no room for wouldas and shouldas there! It is hard to imagine you would have obtained any better result than you did in any other way! 22 months is amazing (she says wistfully but with great appreciation)!

Pez – I don't think you said what kind of chemo the onco wants to use: Carboplatin, Adriamycin (Doxyrubin) or something else? As you see, most people here root for Carboplatin to lessen potential side effects, but there are different regimes out there.

In our case, we did not even discuss or worry about chemo until 2 weeks after the amputation. But then the onco was out of town as was usually the case . Chemo wasn't really something I could even consider until Tazzie became more mobile. So I don't think you should spend too much time worrying about that decision now.

To be fair to the memory of young Barney, I thought I should draw attention to his blog from Jan 1. I do not mean to alarm you, but I know you want any information you can obtain. Amputation recovery went well, but he succumbed after the 4th chemo (doxyrubin). I don't know if they really know why he died. Barney lived in the UK, so who knows how the treatment compares. But it is consistent with what the preference of others around here for Carboplatin.

http://bigbarne.....ipawds.com

I am not against chemo, and if I had a dog with no prior kidney problems, I'd probably go the Carboplatin route or just get the dog on metronomics right away. Personally I would check out the liver and other organs with an US before using regular chemo, but I guess I said that one a few times already.