Caring for a Three Legged Dog or Cat
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Quick background. My Saint Bernard who we decided to not amputate due to size and medical concerns has osteo of the right distal radius. Through discussing options with our vet, we went with an Iv chemo in conjunction with metronomics and biphosphonates palliative care approach. Iv included adryiamiacin, among others, metro included palladia and cytoxine, biphosphonate is oral fosomax. Along with tramadal and deramaxx for pain control. Pepsid and pepto for tummy issues. Mirtzapine for appetite to no avail.
We've been at this for a month and pain control seems great. No limp. Tumor actually shrunk. Yay.
But we've had MAJOR eating problems since all of this started. Major. We have tried almost everything to get him to eat. Hand feeding. Boiled chicken and rice. Meat oat balls. Lunch meat. Fish. Ground beef. Goats milk. Dog biscuits. He won't independently eat at all. He used to take small bits at a time by hand. Now he won't eat at all. I try forcing it. He spits it out. Over and over and over again. I'm pretty much covered in peanut butter and meat all day.
He had diarrhea at first, got it under control, now it's back. Vomited twice, when I tried to mx goats milk with baby food and use a syringe to get him to keep it down. Started supplementing with ensure. He's keeping that down.
His attitude used to be good, but he's slowing down. Sleeping most of the day the last two days. Also, when he got up from his nap his back leg wouldn't go down. He seemed surprised. It then went limp. Top of he paw face down. After a few seconds he got it to work. Pinched nerve? Something more? Doc doesn't seemed concerned. Doc doesn't seem concerned about any of this. That's where my questions come in...
Chucks kidney levels were slightly elevated. He sent us home with a b vitamin shot and he mirtzapine to stimulate appetite. Didn't work. Today bringing him in for Iv fluids.,..
If this doesn't work when is enough enough! Doc keeps saying that he doesn't want to wait too long to put off second round of chemo because "this is a deadly disease" and I keep thinking so is kidney failure and starvation. Will the doc tell me if he thinks this is the end? Would mets to the kidneys show up on a blood panel? What about lung mets?
I'm concerned we won't be able to get him to eat and I can not sit and watch him starve. I'm starting to go crazy I think. Doctor keeps pushing more treatments. My family wants me to end it all. Say goodbye. IM so confused as to the right thing I'm spinning. I don't know what the right thing to do is anymore because I thought that this treatment was the right thing and now I feel like I'm killing him even faster with no quality of life.
Thanks for listening
Lori and chuck
Lori, as you know I'm not a vet. But what I can offer you is this:
When is it enough? When you believe it is. Not when the doctors or the statistics or the treatments say it is. It is when you and Chuck come to an understanding that you want his days to be filled with quality moments. If that means tossing all of the medication and treatments out the window, then so be it. In a strange way there's a lot of comfort and relief once you've made that decision. At some point, in my opinion, it's not worth it when your days are consumed by challenges related to the treatments. Ignore what everyone else says, and listen to your heart.
{{{{hugs}}}}
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Lori,
I totally agree with Jerry. Sometimes vets get caught up in treating the disease and not the patient, if that makes sense. No one knows Chuck better than you. You know the things that make Chuck happy, that give him enjoyment in life. Many people get to the point where they have to pick quality of life over treatments. I know I did with Wookie.
At the end of the day, the best advise on how to proceed comes from your heart.
Wishing only the best for you and Chuck.
Right hind limb amputated 7/3/12 for OSA, started on alternating cycles of Carboplatin and Doxorubicin and oral Palladia. Single lung met 9/1. Met in the neck muscle removed 9/30. Large mass in sublumbar lymph node 10/2. Rescue chemo with ifosfamide 10/6. Mets to the rib and axillary lymph node 10/21. Started Leukeran and Pred 10/25. Wookie left this Earth for a far better place on 12/4/12. I miss you, Boo, you were my heart.
I've commented on the blogs, so I'm not going to repeat it here...but a couple of things I just thought of:
- At some point, as others have said elsewhere, the treatment is worse than the disease. That point is different for everyone. There is no one "right thing" to do--you do what you do out of love and compassion, and that is the right thing. Only you know what that is for you and Chuck. It's both an easy answer and a hard one...that's the burden we bear of being the bigger-brained ones, we have to make the decisions.
- Some of the fatigue and weakness could be coming from the lack of food, as opposed to anything disease related, too.
- Have you tried cat food? Seriously. Fancy Feast. And, if you can, have someone else feed him, if he's been rebelling against you, or if you are the one giving him the "unpleasant" parts of his daily food/med routine.
- Re: pepcid, etc.... some of the OTC stomach things can actually cause...wait for it...stomach issues. We tried using them with our piroxicam, and it actually made him LESS likely to eat than before.
- I don't know what the washout period is for Deramaxx (or how short you can cut it), but we did 36 hours on Piroxicam and then went to prednisone, and the difference was IMMEDIATE. FWIW, we have one (possibly two :eyeroll:) autoimmune conditions, a heart murmur (mid-grade), and a bunch of other crap...but at some point, you kind of have to roll the dice.
Hugs to you, in what is absolutely a sad and hard time 
"Let us think the unthinkable, let us do the undoable, let us prepare to grapple with the ineffable itself, and see if we may not eff it after all."
-Douglas Adams, Dirk Gently's Holistic Detective Agency
"May I recommend serenity to you? A life that is burdened with expectations is a heavy life. Its fruit is sorrow and disappointment. Learn to be one with the joy of the moment."
-Douglas Adams, The Long Dark Tea-Time of the Soul
I agree with the other posters - only you know when enough is enough. I would add that it is sometimes even harder to know what you want to do when other loved ones are urging you one way or the other. Try to figure out what you think the best course is, and leave room for yourself to change your mind. If he is not eating at all, it is going to be hard for him to have the strength to fight the cancer, with or without the chemo. I'm personally at the point (post amp and chemo) that I'm only doing what I can to make the rest of my pup's life as happy as possible- but it was a tough road getting here, with a lot of tears and second guessing.
As far as food, I got my dog to eat once using puréed beef baby food, but it sounds like you have tried far more delicious options. The tramadol killed Diesel's appetite and made him throw up, so I use it rarely.
I also would be worried about him putting his paw down on the wrong side - I would ask the vet what he thinks caused this. In the end, as long as your dog is with you and you are making the best decisions you can, there isn't a wrong decision. Good luck and don't beat yourself up too much-
This is just my opinion but that is quite a strong chemo plan. I think I would either do the metronomics with the oral Cytoxan and NSAID or do the Adriamycin but that combo plus Palladia commonly causes digestive upset. There is not much info on using injectable chemo such as Adriamycin to treat the actual bone cancer in the leg; it is supposed to prevent micrometastasis into the lungs, etc. Of course many oncologists will try anything since there is no standard chemo for this cancer so I do not mean to imply that your approach might not help.
It is good he is not limping! Have you thought of alternative treatments such as Artemisinin ? That is pretty benign on the GI tract. I know that you have already ruled out amputation but if he starts to walk on 3 legs anyway because of the cancer then that might still be an option later. I treated a 4 year old St Bernard a few years ago where initially the owners thought he could not handle amputation due to his size so they just elected pain meds. After 4 months he could no longer bear weight on the leg because the tumor was so large. Rather than euthanize we amputated and he lived another 8 months and got along just great (no chemo).
I know it is so hard to sort through all of the available options out there so we tend to want to try everything but different dogs handle the treatments differently so there is no one answer for everyone. I hope that you and your vet can fine tune the plan for your big guy so he can feel better.
Pam
Thanks everyone. I'm am hoping to get something will resolve his gi issues so we can discuss how to proceed but for sure it will be in a different direction than we are on now. I'm concerned that tramadal is at least a little behind this as his appetite started going down hill as he started that them with the agressiveness of the
chemo it completely wrecked his stomach. I hope we can get past this
It sounds like your whole persepctive would change if you could get him to eat (based on all your other posts too) Not only would it help Chuck feel better but it would do wonders for mom too:-)
I really don't have anythin dditional to add to the other replies I've left on Chuck's blogs.
Perhaps....just perhaps...if you let your vet know you may want to re-visit his treatment and adjust his chemp protocal....that your most immediate concern above all else.....is eating... then maybe the vet will take him off the Deramaxx a few days (whatever the safe amount of time is) and ut him on the PRED.
Just a thought
Wishing the best for Chuck. Amd congratulatins Chuck.....your tumore has shrunk, your kidneys seem to be better, your foot issue seems to not be anything bad.......you are trying so hard and you deserve a standing ovation!! We are applauding loidly so you ca hear us!
Lots of love to all'
Sally and Happy Hannah
Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!
Hi Lori,
I've commented on one of your blog posts too. Now that I see in one post all the meds that Chuck is taking it does seem like a lot all at once. I don't mean to question your vet or you, I know you want to hit the cancer with everything. My vet told me that at some point the treatment is worse than the disease- and it kind of sounds like you are there. What if you cut everything except the pain meds for a few days or a week. It would be easier to decide what is causing all the issues if he was only on one or two meds. If he starts feeling better then maybe add one or two things at at time. Right now there are so many chemicals in his system I don't think you can pin point the problem.
On palladia- I had done some research on it a couple years ago for mast cell cancer. Not only can it cause pretty bad GI upset, but it can cause weakness in the back and back legs. That may be the reason for Chuck knuckling his back foot.
I hope you get some answers and some relief for Chuck.
Karen
It breaks my heart to read this. I'm so sorry that you and Chuck are having such a hard time! I don't have any suggestions to offer, other than perhaps reconsidering amputation, but I wanted to post something so you know that I am thinking of you and Chuck.
Hopefully you get some of the answers that you're looking for soon,
Heather
Barret was diagnosed with Hemangiopericytoma May 16, 2013. Front left leg/scapula/pectoral muscle was amputated on June 11, 2013 and we've never looked back. Follow our story on http://barret.t.....pawds.com/ and read my column on That Pet Blog
Hey guys. Thank you all so much for ideas and thoughts. We are discontinuing chemo completely for now. Not sure if down the road, if we even get there, what the game plan will be. Chuck went in yesterday. We didn't end up doing iv fluids because he started eating a little before we got to the vet. A conbo of ensure yogurt smoothies via syringe seemed to start helping a little. A few shots at the vet and a ton of xrays showing no visible mets to lungs, spine, or organs and we were sent home. He did easy some hamburger and chicken last night on top of his ensure smoothie and he seems even better in regards to his personality today. He was so weak before that his spark wa completely gone which is why I was very seriously considering euthanasia. Hopefully this trend continues. Amp had always remained an option we would consider down the road if we felt it was a good next option but we are very hesitant considering his medical history on top of his family medical history. Hes definitely still too weak overall to do it right now but who knows what the future will bring. Paws crossed that this upwards trend continues!
Thanks again 
lori and Chuck
EVERY improvement, no matter how seemingly "small" , is truly MOMUMENTAL in this stupid disease!
YAY LORI:-)
YAY CHUCK:-)
You two are a strong team....standing strong against a lot of challenges......supporting each other...-.Chuck doing his best to show you he still wants to be here!!
KAREN, PAM and TAZZIE havee given you some great insight into backing off some of the chemo and it appears your vet is on board. It's about quality... always has been, always will be. If we can gain more time in the process, that's great too!
So glad you're hanging in there with your boy. NOW is the time to be totally immersed in the joy of having Chuck by your side! Relax and love and spoil and then love and spoil some more!
Love,
Sally and Happh Hannah
Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!
That is great news Lori. Yay Chuck. Keep on eating buddy
Hugs
Michelle & Sassy
Sassy is a proud member of the Winter Warriors. Live long, & strong Winter Warriors.
sassysugarbear.tripawds.com
07/26/2006 - Sassy earned her wings 08/20/2013
05/04/2006 - Bosch, Sassy's pal, earned his wings 03/29/19 fought cancer for 4 months.
"You aren't doing it TO her, you are doing it FOR her. Give her a chance at life."
This is a GREAT update Lori, we are cheering you and Chuck on!
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
We're cheering for you Chuck. Keep eating no matter what it is!
Spirit Shooter was a Miniature Australian Shepherd who was diagnosed with a MCT and had a LF amp 1/28/13 at 13-1/2 years old.
Shooter crossed the Bridge on 8/28/13, his 7 month ampuversary and two weeks from his 14th birthday.
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