Caring for a Three Legged Dog or Cat
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Oslo got his 4th round of carbo at the end of november. At first, when we started chemo treatments, our plan was to have 3-4 rounds of carbo. Then, the oncologist who is giving our vet advices on Oslo's case went to a conference somewhere in the USA and came back from there suggesting to go for 5 to 6 carbo. Apparently, a study shown that survival time for patients who had received 5 to 6 carbo treaments was increased around 200 days . (I hope I am explaining it well) . So our vet strongly suggested that we go for a 5th round.
So Oslo was scheduled to get this 5th carbo on Dec 15th. But prior to that, his blood tests showed that he had hit a low (both WBC and RBC were low). Thus, his treatment was postponed to the following week. Meanwhile, he caught an infection 
(104 F , coughing, heavy breathing…lung X-Rays were clean of metastasis) . Of course, his chemo was postponed again and because of the holidays period, we all agreed it would be safer to wait till the beginning of January. Oslo had another blood test on last Monday, just to be sure WBC, RBC, neutrophils etc were back to normal. Unexpectedly, they are not.
WBC: 5.7 (normal values are between 6-17)
RBC: 37 (instead of 39-60)
neutrophils : normal
My questions are: What can explain his low RBC? Is there any supplement for dogs (or food) that helps to prevent anemia? Also, if Oslo finally gets his 5th carbo on next week, it will be almost 6 weeks after his last treatment. Is it still worth it ?
Thank's in advance
Suzanne and Oslo
I did 5 carboplatin treatments for Tazzie because she was handling it so great and I figured one more could only help.
I would not be worried about a red cell count of 37%. Many dogs undergoing chemo tend to run a little low, especially when you get towards the end of the treatment and Oslo's results should come back up to normal after the chemo leaves his system. There are oral supplements to help anemia (Pet-Tinic and Lixotinic are two used here in the States) but I would not bother unless he goes below 30%.
Since his neutrophils are normal he can have chemo now, even if his total white cell count is a little low. Were the neutrophils low when he had a fever? If so the oncologist might consider lowering his carboplatin dose by 10-25%. Since chemo drugs accumulate in the body over time it is always possible that the next injection could cause more side effects.
Even though it has been 6 weeks since his last injection I would probably do 1 more since his lung rads were still clear. Then you could consider trying metronomic chemotherapy or maybe something like artemisinin . I do not know if any of those things helped my Tazzie make it to 14 months but I sure felt better trying something.
I hope this helps,
Pam
oslomoka said:
Then, the oncologist who is giving our vet advices on Oslo's case went to a conference somewhere in the USA and came back from there suggesting to go for 5 to 6 carbo. Apparently, a study shown that survival time for patients who had received 5 to 6 carbo treaments was increased around 200 days .
With a experience base of one, I cannot comment on the relative merit of any specific number of treatments or why the blood tests came back with the anomalies. However, was the 200 days an "absolute increase" or was it "increase to 200 days". There have been so very many changes it is very hard to keep up with the protocol. Cherry received her very first treatment hours after the amputation, just after her body warmed back to normal. At the time, this was "new" and parallels the advancements in breast cancer treatments where they are now giving chemotherapy before mastectomies. Given Cherry's age, 11 the day before amputation, we cannnot complain about the additional 405 days with her. (Who's counting?) Even considering the problems that Cherry had with her chemotherapy, we would have opted for more at the time if this does indeed give an "increase of 200 days".
Till we get our experts to respond, just wanted to provide some support. It is so darn difficult when the target keeps moving. However, I am sure that if it does move to extend the "life expectency", then we like that move.
Wishing the best and sending Pawsitive Thoughts and Prayers,
Spirit Cherry's Dad
Cherry said:
With a experience base of one, I cannot comment on the relative merit of any specific number of treatments or why the blood tests came back with the anomalies. However, was the 200 days an "absolute increase" or was it "increase to 200 days".
Sorry I was not clear! ARF! (sometimes I read what I am writing and I am not sure I understand myself hahah) I meant an increase of 200 days. With 4 treatments we were targetting 300-400 days and what we have been reported is that carbo #5 and #6 could add 200 days to the previous 300-400 days. I would like very much to get this study paper. Unfortunately we never talked directly to the oncologist to ask him all the questions we have regarding this study. How many dogs were in this study? At what stage was their tumor when they were diagnosed/amputated and started chemo?
But we do trust our vet tremendously. If he thought all this was not reliable, he would not suggest to pursue chemo treatment. Of course, we are realistic and know there is no guaranty. We can only do our best with the cards we have in our hands.
Thank's for your support. It is really appreciated 
Pam,
thank's so much for your quick reply. As always, your input and advice are helping tremendously.
I would find it rather incredible if 1-2 more treatments increased survival by that much, based on the different studies I did read, some of which had 4 and some 6 treatments of different drugs. Definitely something to look into - can you get the reference for that paper? If it does have the chance of increasing survival that much, go for it! But you might want to use antibiotics pre-emptively if his counts get low given Oslo's tendency to get infections. If 1-2 more treatments do not change things much, that is a hard call given Oslo's issues. Weren't his infections pretty hard to shake?
Most of the chemo studies I have seen involve small numbers of dogs, usually about 4 to 10 in two categories (e.g., amputation vs amp plus chemo or two kinds of chemo). They seldom control for all the factors such as length of time post-limping and most dogs, included those in these studies, have chemo without having body scans to really know what else might be present (okay, other than chest x-rays).
Statistics are not as bad as people say. But you have to know how to use them. I bet if I really had information on the factors that are involved (time since limping, age, type of cancer; details obtained from scans; type of chemo, when the chemo began, etc.) that we could predict quite exactly how long a dog would survive and, more importantly, identify the factors that make the difference. Most of these small studies simply do not have the sample size needed to control for the variety of factors that could influence the outcome.
What could be useful to dog-owners and researchers would be a "meta-analysis" that incorporated results of different chemo studies to find out which chemo was most effective and how the timing of chemo relative to surgery affected the outcome. For a meta-analysis, one combines the results of a large number of small studies and therefore increases the statistical power enormously. (And no, I am not going to conduct a meta-analysis on chemotherapy for dogs!) But maybe someone at CSU or somewhere has done a meta-analysis. They are becoming coming in some areas of science, e.g., ecology.
Anyway, best get back to the topic for tomorrow's class: the process of science (does it show 
? In that I emphasize logic and do not mention statistics).
Susan
(For some human cancers, they have been giving chemo before surgery for many years. My sister-in-law had a highly aggressive breast cancer 22 years ago, when she was 30 and was giving chemo well ahead of surgery. I'm too far out of that world now - Tazzie has been my first major cancer experience since then - to know when they treat before or after surgery.)
Suzanne and Oslo,
I would definitely ask your vet to contact the oncologist and ask for the reference. If it was an abstract or poster that was presented at the conference proceedings, the oncologist would probably be able to get a copy of it. An abstract is a summary of ongoing research with preliminary results, like a news bulletin of what's to come, that is presented at national and international meetings. Once a study is completed and a manuscript written and submitted to a journal (sometimes it's not accepted the first round so it may need a rewrite, or submission to another journal), it can take several months before it is accepted and finally published in a peer-reviewed journal. At least that has been my experience in the human cancer field. I would love to read the abstract!!! It sounds very interesting!!!
Angel Jake's Mom
Jake, 10yr old golden retriever (fractured his front right leg on 9/1, bone biopsy revealed osteosarcoma on 9/10, amputation on 9/17) and his family Marguerite, Jacques and Wolfie, 5yr old german shepherd and the newest addition to the family, Nala, a 7mth old Bengal mix kittie. Jake lost his battle on 11/9/2009, almost 8 weeks after his surgery. We will never forget our sweet golden angel… http://jakesjou.....ipawds.com ….. CANCER SUCKS!
It sounds very promising. Frankly, if there is any chance that that is any validity at all, I would go for it. What I wouldn't have done for 200 more days with Emily. You can treat the side effects but the cancer is a harder thing to fight,
Debra & Angel Emily
Debra & Emily, a five year old doberman mix, who was diagnosed with an osteosaecoma. She had a right rear leg amputation on May 19, 2009. On November 10, 2009 she earned her wings and regained her fourth leg.
To answer Pam's question in an other topic,
An update!
Oslo finally got his 5th carbo treatment yersterday!! A few days after I last posted here, Oslo had an other blood test .We all expected WBC to be on its way up but surprisingly, it had lowered more. Our vet suggested to wait for a better "timing" so that is what we did. Blood test every week, to target the right moment. In spite of many delays, he thought a 5th carbo was still worth it. We will see how things goes before deciding for a 6th one. (that means...if my nerves can handle it for an other round hahah )
P.S. I saw somewhere else on the forums that Jerry posted the abstract of the study we had been talking about here. Many MANY thank's!
Chemo is really a bad time for the humans because we sit around and 'what if'. Oslo didn't have a care in the world, I'm sure. Good thoughts for you as you navigate through this portion of the journey. And lots of love to Oslo, I love his face.
Shanna & Spirit Trouble ~ Trouble gained her wings 3/16/2011, a 27 1/2 month cancer survivor, tail wagging. RIP sweetheart, you are my heart and soul. Run free at Rainbow Bridge.
The November Five - Spirits Max, Cherry, Tika, Trouble & Nova. 11/2008 - 3/2013 An era ends as Queen Nova crossed the Bridge.
oslomoka said:
P.S. I saw somewhere else on the forums that Jerry posted the abstract of the study we had been talking about here. Many MANY thank's!
Hey that's terrific news Oslo, thank you for the update. Tell your pawrents to relax, we know you can handle anything!
Here is the link to the new carboplatin protocol we mentioned the other day.
Tripawds Founders Jim and Rene
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