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Caring for a Three Legged Dog or Cat

Tripawds is the place to learn how to care for a three legged dog or cat, with answers about dog leg amputation, and cat amputation recovery from many years of member experiences.
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Chemo after amputation
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Forum Posts: 111
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19 August 2010 - 1:39 pm
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Hi there, we're unsure about chemo for Honey after her amputation and wanted to ask for advice.

She's a 9 year-old golden with osteosarcoma in her front, left leg. She had 4 rounds of chemo before her surgery on 7/21/10. Our vet recommended chemo before amputation because she said the cancer resisting/fighting cells in the affected leg can aid in preventing the cancer from spreading?

Honey ended up with an infection and arrhythmia (elevated) and is now on anti-arrhythmia medication. The vet doesn't want to take her off because they had a lot of difficulty getting her heart rate back to normal. But Honey is now back to herself again, thankfully!

The vet is recommending chemo again and we're very torn. She's so happy and out of pain and we don't know if we can/should put her through chemo again – although she tolerated it very well (carboplatin) and her lungs were cancer-free after surgery. 

We've read through the forum and see that every dog's response is so unique but we wanted to ask for recommendations. We're also in discussion with our vet. She recommends that we not wait any longer than 5-6 weeks after surgery to resume the chemo.

Thanks very much. We really appreciate all the caring support we've received here!

Alice

Dx Osteosarcoma  3/31/10.  Amputation 7/21/10. Honey put up a valiant fight and lost her battle 9/22/10. Missing her and treasuring 9 years with our Honeygurl.

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19 August 2010 - 2:13 pm
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How many more doses of chemo is the vet recommending?

"I don't know where I am."

Portage Lake, Maine
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19 August 2010 - 7:48 pm
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Hi Alice,

I have no advice for you regarding chemo but I thought this was a good chance to give a “plug” for homeopathic treatments for cancer.  I use Dr. Charles Loops from NC(via phone consults), as do others(although not many that I know of) on here.  Roxy the Boxer is, as is Eisen a GSD(over 2 years I believe).  My dog was amputated in October and started treatments with him in December.

Just a thought…as homeopathic treatments have the added bonus of being 'easy' on the dog's body vs. how chemo can sometimes not be.

Tracy, Maggie's Mom

Maggie was amputated for soft tissue sarcoma 10-20-09

Maggie lost her battle with kidney disease on 8-24-13

http://maggie.t.....t-24-2013/

Los Angeles
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19 August 2010 - 8:15 pm
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I think I'd be torn too since Honey has already done the carboplatin.  Not sure about what the effects are before amputation vs. after amputation as I haven't read too much about treating osteosarcoma before the amputation.  My question to the vet would be if this will make a difference in life expectancy seeing how you already did 4 treatments. Also resuming chemo after so many weeks of not doing it may also play into this (may not be as effective if you wait too many weeks later) and how many more treatments would this require to really have an effect (and how far do you go.) Some real dilemmas here.  

  Right now the new protocol is 6 if a dog can tolerate it and after 6 there's no more benefit to doing chemo from what my oncologist said.  You might want to look at other options too like the metronomic (low dosage chemo with little side effects) which has shown to be pretty effective.  After Mackenzie did 5 carboplatin treatments she's now on the metronomic as a kind of maintenance plan.  And/or look at Tracy's information on homeopathic treatments – which seems to be a very good option too.

Best of luck to you in your decision – I know how tough it can be. When Mackenzie was finally done with her chemo treatments I was jumping for joy! It was so freeing…

Kami (Mackenzie's Mom)

My sweet golden Mackenzie.  She became my angel on Dec 29, 2010 at the age of 8 1/2  although she was always my angel from the time we brought her home.  She was diagnosed with osteosarcoma in Sept 2009 and officially became a tripawd (front leg) on Nov 5, 2009.  She will be forever in my heart and now she's running free with all of our other tripawd heroes.  I love you Mackenzie!

Edmonton, Alberta
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19 August 2010 - 8:56 pm
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Wow. There seems to be a lot of differing protocols for osteosarcoma. Like Kami said, the typical post-amputation protocol consists of up to 6 treatments (we stopped at five). I haven't read about pre-amputation chemo treatments before. The immediate concern of our surgeon regarding Catie was removing the diseased and very painful leg once diagnosis of osteosarcoma was confirmed.

I don't have any advice for you. I am curious as to how many more treatments your vet is recommending since she's already had four.

This is a very difficult call and such a very personal decision. Good luck in making your decision. 

Catie -

Birthday – November 4 2003

Amputation – January 13 2010

Crossed the Bridge – June 2 2011

 Catie Caitlin 

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19 August 2010 - 10:41 pm
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Here's my three paws worth. I asked that same question after Gus had his surgery and answers were varied. I decided to not do chemo since I wanted the best quality of life for Gus once he healed from the surgery. I didn't want him to have to deal with side effects if he would have had some. I achieved that goal, he was his old self the whole time once he healed. He was a very active dog and if he would have had to deal with side effects that meant more time to not enjoy life. At the time of his surgery his lungs were clear, 7 weeks later we found mets. His surgery was 4-7-10 and we lost him 7-26, the cancer was so aggressive I don't think chemo would have helped, and even if chemo would have slowed it down, what would his quality of life been. Do I regret it, not one bit because he had a full life and did everything just like he loved to do it. It's a tough call, make sure you are comfortable with your decision and can live with it. It sucks we lost him so soon, but I know I did everything I could for him, and knowing that is a good feeling. We did try the metronomic therapy of cytoxin, mushrooms, prednisone and doxycycline with no side effects but not sure that really did much now, but I gave it a chance. Good luck with your decision, I know it's not an easy one, Spirit Gus and Dan  

My buddy Gus had a left front amputation on April 7, 2010 and lived a great life until July 26,2010

My heart lives at Rainbow Bridge
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20 August 2010 - 4:11 am
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This is really a tough call.  I can see why you would be torn.  Here are the questions I would be asking, and I'm sure they aren't something you haven't thought of.  How many additional treatments?  Was the infection and recovery a result of the chemo or just a coincidence?  If there is a chance Honey would have the same reaction again, I'd be looking at something like metronomics instead.

Best of luck with your decision.  And remember, there is no wrong decision.  Make you choice based on what is best for Honey and you won't go wrong.

Hugs to both of you!

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.

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20 August 2010 - 5:23 am
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Thanks very much for the responses. So sorry you lost Gus, Dan. I love that picture of him. He looks so happy! We've been looking into both homeopathic and traditional treatment and appreciate reading about your experiences with both.

The vet is recommending a minimum of 4 doses of chemo every 4 weeks. She did say that Honey could be at risk for another chest infection like before (< 15%). She had surgery 4 weeks ago, so we have about a week to decide about the chemo.

Honey is so happy now. She's learning how to do things she did before. She drank from a pool yesterday for the first time since her surgery. Everyone thought she'd fall in but she figured it out. Small steps, big victories!!

In case you're interested, here is the vet's rationale for chemo before amputation:

There is some new research which suggests that there may be an advantage to delaying amputation until it becomes necessary for pain relief (uncontrollable pain or fracture). Firstly, the primary tumor appears to secrete molecules that inhibit growth of micrometastases. Secondly, it is virtually universal for osteosarcoma patients to die of metastasis post-amputation, which means that the cancer spreads prior to the time of diagnosis. I do have several patients who have lived >1.5 years with the leg in place (the longest is 27 months and still going strong).

Thanks again to all of you.

Alice

Dx Osteosarcoma  3/31/10.  Amputation 7/21/10. Honey put up a valiant fight and lost her battle 9/22/10. Missing her and treasuring 9 years with our Honeygurl.

The Rainbow Bridge



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20 August 2010 - 9:02 am
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Small hops, big victories indeed! It's such fun watching them feel more confident, isn't it? Now, not worrying is the hard part for humans!

Honeygurl said:

In case you're interested, here is the vet's rationale for chemo before amputation:

There is some new research which suggests that there may be an advantage to delaying amputation until it becomes necessary for pain relief (uncontrollable pain or fracture). Firstly, the primary tumor appears to secrete molecules that inhibit growth of micrometastases. Secondly, it is virtually universal for osteosarcoma patients to die of metastasis post-amputation, which means that the cancer spreads prior to the time of diagnosis. I do have

Hi Alice,

We have actually discussed this before in a previous chat with Dr. Michael Lucroy, an oncologist from Indiana. See:

Does Amputation Speed Cancer Metastasis?

Also, something that is showing promise as a pain reliever and an anti-tumor drug for dogs who haven't had amputation yet is Zoleddronate, a bisphosphonate, which our vet friends in Santa Fe are using to conrol pain in dogs who aren't amputation candidates. This is another option that vets are looking into.

If your vet is ever interested in doing an Ask a Vet Live Chat with Tripawds, we would be thrilled to talk about this some more! Spread the word that we're always looking for a professional opinion here! Thanks.

It's better to hop on three legs than to limp on four.™
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20 August 2010 - 11:29 am
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Sorry for the delay in posting.  I have never seen an oncologist give that many doses of chemo pre-amputation so I can only say what I would do if it was my dog.  It sounds like she has only had carboplatin and not Adriamycin so I would not worry about her heart being affected by more carboplatin, but you can get further immunosuppression so if your vet thinks that she had an infection caused by a low white count secondary to the chemo then you might want to reduce the dose by 25%. 

Do they have any idea what caused the arrhythmia? Do you know the name of the type of arrhythmia (atrial fib? atrial tachycardia?)?  Did she have an echocardiogram done?  What heart drugs is she on?

If her heart is currently normal I would probably continue carboplatin but I would make sure to check a CBC every 7-10 days to check for immunosuppression.  If she is not on Power Mushrooms or other mushroom product I would start that now to stimulate her immune system.  If further chemo makes you nervous you could try metronomics or artemisinin .

Pam

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20 August 2010 - 7:57 pm
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Alice and Honey,

A number of people were amazed when they found out that Miss Cherry's first chemotherapy was just hours after the amputation surgery – as soon as her body returned to “room temperature.” Honey clearly takes the cup for the most pre-amputation but from what our oncologist described to us and your comments from your team, this does make sense to me. However, chemotherapy is not as clear-cut as the decision to amputate, which rids the body of the source of the pain. I am totally convinced that our aggressive (aggressive for that time) chemotherapy protocol was the reason that Miss Cherry was with us for so very long after the diagnosis. However, she had some type of growth on her kidney at the time of the surgery and did not have a very good prognosis. One only has to look to Jerry to see a very excellent length of life without chemotherapy. I really am waffling on suggesting any direction for your very difficult decision.

The bottom line – let your heart lead you. Honey has already undergone much chemotherapy to attack this nasty diagnosis. There is a diminishing return for more chemotherapy after a certain point. I would agree with your vet, that if you are going to do additional chemotherapy that the sooner the better. I would start now if you decide to go that route. However, one just has to ask themselves just how much you will put them through. Our oncology/surgical team wanted to do exploratory surgery to positively determine the growth on Cherry's kidney. That is where I drew the line. To me, any additional insult to her could only extend her life at a cost to the quality of that time. It would have been selfish of me to ask any more. Thus, the recommendation to use your heart on this one. Please take heart that you have already gone far and away beyond what most whould do.  (This community excluded)

Wishing you and Honey the very best.

Spirit Cherry's Dad

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22 August 2010 - 9:23 am
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Thanks to everyone for posting. We feel like we have a whole new family here!

Pam, thank you for asking about Honey. I was trying to get the most accurate info before answering your questions. I believe our vet’s approach was to keep her leg as long as the pain could be controlled with medication and there was no breakage with doing chemo every 4 weeks. When we found Tripawds just before Honey’s surgery we realized that her course has been very different than most.

I believe the vet told us that the arrhythmia (atrial tachycardia) was caused by an infection. I also think the vet noted elevated white blood cell just before surgery. I don’t know if an echocardiogram was done  –  Honey’s heart was continuously monitored but probably that's not the same. She is on Mexiletine and Sotalol for the arrhythmia and she has a couple more days of antibiotics. We just bought some power mushrooms but wanted to check if they’re OK to give with the other medication she’s taking.

At this point, we're thinking of doing one chemo treatment and see how that one goes but we'll consult with our vet first.

She had a great time at her favorite park yesterday running for the ball, playing with other dogs and making best friends with the other humans! She tires easily but it's so good to see her run!!! smiley  I’ll try to post some video.

Thanks again.

Alice

Dx Osteosarcoma  3/31/10.  Amputation 7/21/10. Honey put up a valiant fight and lost her battle 9/22/10. Missing her and treasuring 9 years with our Honeygurl.


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22 August 2010 - 5:09 pm
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Thanks for the further info!  I would feel pretty comfortable trying another dose of carboplatin, since the goal of the chemo now is to kill any circulating cancer cells that might still be present.  Her problems might have been due to the chemo plus the stress of the surgery, and you don't have to continue with chemo if her white count drops too low.

I'm glad that she is feeling good!

Pam

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