Caring for a Three Legged Dog or Cat
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Hi Pam,
Isabelle is six months out from her amputation (OSA), without clinical evidence of mets. She was imaged from head to toe last week.. Her last abdominal US was last month, (she has chronic, unchanged splenomegaly w/a few hypoechoic nodules unchanged since her first US 4 years ago) when she had a gr 2 (MI: 0/10hpf) MST resected from her remaining rear leg. The excision was complete with adequate margins. She did not have chemo following her amputation. Her other significant issue is L-S spine arthritis, very successfully managed with acupuncture, aggressive underwater treadmill, chiro, cold laser, massage, & monitored activity. She has been on Metacam for a little over a year. I'm not sure she needs it everyday anymore because she's fine most mornings before her dose. I haven't changed anything, partly because I don't want to mess with success & partly because there may be some angiogenic benefit. Otherwise, she has a chronically elevated ALT, max over the years 356. A liver biopsy more than 3 years ago, showed nothing significant. Her PLTs & WBCs have always been at the low end, or slightly below normal, most recently 150K/4.9. She has a hx of heartworm disease & Rocky Mountain Spotted Fever.
I decided at the onset, if she were in this position at six months, I would explore metronomics and decide if there was any benefit to her. Her quality of life is excellent and compromising that, isn't an option. I also have to consider, she is about 13.
I consulted an oncologist today. His recommendation was low end dosing of Palladia M-W-F/low dose cyclophosphamide T/Th/Sat. Leaving her on Metacam, rather than switching to piroxicam. His opinion was the more toxic side effect of Palladia have been minimized with dose reduction. She can stay on all of her supplements/homeopathics: fish oil, Hoxsey, SAT, Marin, SAM-e, Vit a, CoQ10, ester-c, apis-mel, arnica. He is not completely against her staying on a raw diet, provided she continues to eat Stella & Chewy's.
I'm sorting through the risk-benefit now & wonder if you would offer your thoughts. The human data on all the metronomics is mixed, but particularly with the VEGFR2. The animal models are promising, but the reality is looking more like VEGFR unrelated pathways are negating the benefit. Of course, life expectancy is different and humans are more willing to sacrifice quality for time. I realize any data without previous IV chemo is anecdotal, so I'm likely looking for unavailable information. I'm particularly worried about muscle wasting, as well as general fatigue, GI complications. Inactivity for Isabelle would be severely debilitating because of her arthritis.
Isabelle & I will live with this decision & I don't believe I will pursue further treatment, so I want to carefully consider the choices.
Thanks so much,
Cynthia
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Hopefully Dr. Pam can give you a more professional opinion, but we wanted to make sure you reviewed the following posts and topics regarding metronomics . We put Jerry on a protocol of cytoxan and metacam after discovering his lung metastses, and believed it contributed greatly to his longevity along with his K9 Immunity.
Metronomics for Canine Osteosarcoma
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Thanks, I did review all them...10 times, at least! I think I'm most concerned about the Palladia & am just not convinced it's worth the risk.
Hi Cynthia,
I couldn't help but respond to your post. As you may know, Mackenzie was on palladia and cytaxin (and metacam) once she was diagnosed with lung mets (low dosage for the palladia and cytaxin.) I truly believe that the palladia kept her lung mets at bay and helped her to live longer than she would have if she hadn't been taking it. I know you have to make your own decisions about this and I completely understand your concerns but I just wanted to offer my experience and let you know that my oncologist is using palladia more and more and finding very effective results. Believe me, I wished we had more time with Mackenzie but as it was, she survived another 6 months and I think palladia had a lot to do with it. I don't know however, if it's something that should be taken if there are no lung mets present. So that might be something to check into. I'm sure Pam can advise on all of this.
If you want to talk more about this, just let me know. Hope you get all the answers you need to help you with your decision.
Best,
Kami, Angel Mackenzie and Kobe
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!
I would have no problem with your oncologist's plan. My plan was always to try Palladia for Tazzie but she never got lung mets. It is only recently that oncologists have started using it as part of metronomic chemotherapy . The main side effects are on the GI tract although some dogs can have low white cell counts but this should be unlikely at low doses.
I just finished researching metronomics for Sammy and here is what I found. Most oncologists prefer meloxicam (Metacam) as the NSAID due to it's wide safety range but a few still prefer piroxicam. There are 5 different chemo drugs that are being tried but the only one with research behind it (so far) for this use is Cytoxan (cyclophosphamide). The main side effect is on the bladder with some dogs getting infections and some getting sterile hemorrhagic cystitis (bleeding and pain without infection). This is rare and usually reversible by stopping the drug. Some oncologists give a low daily dose of a diuretic (Lasix) to try and prevent this but most don't since diuretics can affect the kidneys. My holistic vet recommends cranberry capsules as a way to prevent a UTI. Tazzie took Cytoxan for 2 or 3 months but I had to stop it due to a severe bladder infection (she had a history of bad UTIs so I wasn't too surprised). I kept her on the meloxicam alone and then did artemisinin .
The other drugs used are Palladia (main limitation is cost), CCNU (possible side effects on liver so not good for your dog), Leukeran (chlorambucil), and Alkeran (melphalan). The latter two are safe but not much info yet on efficacy but there are oncologists trying these.
Metronomics are so new that no one is sure yet what is the best protocol. Some dogs might do well on 1 drug and others may not. It is hard to evaluate results since some dogs live a long time with amputation alone and no chemo so are these drugs really doing anything? I think it is worth a try!
Pam
Thanks for the scoop Pam, this is fantastic information. If you're around this Saturday, we hope you can listen, call or chat during our conversation with an oncologist, Dr. Johnny Chretin from VCA West Los Angeles.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Thanks Pam,
I really appreciate your input. I think I'm OK with the Cytoxan, but the Palladia makes me very nervous, even though the dose would be low. The oncologist did offer other plans, but was strongly in favor of this one. Isabelle was on artemisinin for about a month, but had severe reflux that was unrelieved w/H2blockers, so I stopped it. I'm having a hard time justifying the risk to her quality of life.
Thanks so much,
Cynthia
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