Caring for a Three Legged Dog or Cat
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My poor dog presented with synovial cell sarcoma in his left leg, diagnosed March 20, 2009. His leg was amputated and he had 3 rounds of Doxorubicine. He never had the 4th because he then presented with vestibular disease, partially resolved, still some ataxia, and left facial paralysis and did not feel very good. Recently, mets were seen on CT of his liver and lymphoma found in his jejunume(spelling!) and abdomen. He had his first course of CCNU/Lspar/ 50 mg of pred. on Thursday. Today, Saturday, he had fever( 103.1), vomited and is very lethargic. BUN is 94, up from 64 at the time of drug administration. He had has diarrhea for weeks off and on which is what led me to return to the oncologist.. My vet gave him fluids with dex, B complex, Baydril, Centrine and his 50 mg of pred. I gave him oral Cerenia which he has kept down.He also gave him epogen as his rbc was low. His wbc was also low. We are home for 2 hours and he is still lethargic. Question: Was the epogen ok to give with the CCNU/Lspar/pred. The oncologist is off for the weekend and she never said to give him epogen. She is very specific on what to give him and now I am concerned it was not the right thing to do. Also, isn't this a rather extreme reaction to his chemo or could it be the cancer?
Thank you!
Susan
This is not a protocol I am familiar with. We use the Univ of WI protocol for lymphoma which is Pred, Elspar, vincristine rotated with Cytoxan and Adriamycin. They may have chosen an alternative protocol for your dog due to the prior use of Adriamycin (doxorubricin). Some dogs do get very sick with Elspar and pancreatitis or protracted vomiting is possible. CCNU is also very immunosuppressive so the two combined could really wipe out a WBC.
I usually give Cerenia prior to Elspar and then for up to 4 days after if nausea occurs. If the neutrophil count is very low then IV antibiotics (Baytril) are used. IV fluids are a good idea until vomiting stops. I only have used Epogen if the RBC count is chronically low (chronic kidney disease in cats). There is the possibility of an autoantibody reaction to Epogen since the product is for people but that is rare. Usually the RBC count comes up on its own after chemo so I have not used it for that purpose. I would probably not give any more until you can talk to the oncologist.
Is the lymphoma localized to the jejunum or are the lymph nodes also enlarged?
There are lots of different protocols for lymphoma so if your dog got this sick from the first doses then the oncologist may choose another plan.
Pam
Hi Pam,
Thanks so much for replying. You are correct. He is not getting the University of Wisconsin Protocol because he has had 3 treatments of doxorubicine 5 months ago. He was given a Cerenia injection prior to each dose after he got sick from the first dose. Vomiting is very serious for my dog because in addition to his left facial paralysis, he has had larengeal paralysis for a couple of years. He is almost 13. I am sure the oncologist will now give the Cerenia. this protocol is a "rescue" protocol for dogs who have come out of remission. He only vomitied once and with that and the fever, I took him right in. He ate tonight and feels much better. He had more fluids at 3:30 today with only Baytril and dextrose and may have another tomorrow if he is lethargic. His fever is also gone.
I did ask my vet not to give any more Epogen. I had a funny feeling it was wrong. The oncologist would have mentioned that he might need it as she is so thorough. Even though she covers everything with me, the reality of seeing my dog actually experiencing all these side effects is much harder and scarier than just discussing them. Is he out of danger of having an autoantibody reaction? Is that anaphylaxis?(spelling)
The node in his abdomen is enlarged but his other nodes are OK, I think.
I think the oncologist is being aggressive in the hope of giving my dog a few more months, depending on the behavior of the metastatic disease in his liver. It is just so sad and hopeless. I hope I have not done him harm with the Epogen. His RBC was 4.64M/uL. and I don't know which value is the neutrophil count. There are 2 tests called Neu, both within the normal reference range and a tests called HCT=30.5%- low: HGB=10.4g/dL-low and then WBC( Isn't that white blood count?) 12.71K/uL which is in the normal range. Everything else is within the normal range.
Thanks again. I realize you can't know from an email all the details but your help is much appreciated. My general vet has to know so much about so many species, it is amazing he can still tell a cat from a dog. it must be wonerdful to specialize and learn so much in such depth.
Susan
It sounds like your oncologist is on top of things. Your dog's hematocrit (HCT) of 30.5% is not that low for a chemo dog. Epogen is usually not warranted unless the count is below 20%. I do not think 1 dose would hurt. The autoantibody response is usually after more than one dose and causes the body to stop producing red cells so the HCT would actually drop and only transfusions bring it up. That reaction is relatively rare so I wouldn't worry since he only had 1 dose. His total WBC is over 12,000 (12.71) so that is normal and NEU would be neutrophils so that sounds okay, too.
It sounds like a reaction to the Elspar and it also sounds like he is on the mend. Good news!
Pam and Tazzie
Thank you again! I feel much better. yes, my oncologist is very much on top of things. She is very supportive and really cares about the dogs but the best is she is higly skilled and smart. I have three more questions. How would I know if he stopped producing red cells? Would this already be happening? I know you said it was rare but it does happen. And does he need more fluids given his BUN was 94? He ate this morning and feels better. He is a little wobbly and reluctant to walk-leg amputated in March so may be getting some arthitis. The vet also gave him an antispasmotic for his diarrhea. Can that effect his coordination and attutude?
You and this web site have again come to our rescue. Weekends can be tough with a sick dog but I hope you are enjoying yours. Thanks a million!
Susan
You can usually stop the fluids once the vomiting has resolved and the dog is eating. Centrine can cause some sedation and lethargy and can be replaced with oral metronidazole if the vomiting has stopped. The soonest I would expect a change in the Hct would be about 5-7 days although your oncologist may want to repeat a whole CBC to make sure that the CCNU is not causing low platelets.
Pam
Hi,
My dog is much better today so he didn't get any more fluids. He is eating his rice, beans and boiled ground sirlion. He is very hungry and playing with his toys.
He is to have a CBC one week after the chemo which is Thursday. .
He is having trouble using his back legs but I think it is just from laying around all day and from the stress of it all. He is still pretty tired. I sure hope so as he weighs about 53 pounds, with not an ounce of fat, but is too heavy for me to give him much help walking. The centrine was in the IV fluids so he hasn't had any since yesterday. I wonder if that is why he is so uncoordinated? I will put him back on the metronidazole tonight.
Thanks for getting us through this awful weekend.
Susan
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