Caring for a Three Legged Dog or Cat
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Hi everyone, Graeme here. After Boston's left rear amputation on Dec 30th (6 yo 75 kg Great Dane) Boston has been doing exceptionally well in recovering and adapting. But we can't ignore the original issue of osteo sarcoma and I had a long chat with the oncologist today. A brilliant guy, very helpful and compassionate.
Our choice, we believe, is between a course of standard chemo or metronomic treatment - pet insurance will cover the majority of the costs. The issue is that standard treatment is 3 hours drive away. While I've been convinced the standard treatment isn't as onerous as it possibly might be (I know opinions are always divided and subjective) the day-long journey with over six hours in the car, and the treatment in-between, feels like it might be more uncomfortable and distressing for Boston than the potential benefits it might reap - particularly when he comes to learn what the trip means.
The problem with metronomic treatment, as I understand it, is that while the theory behind it is scientifically sound, there isn't a lot of hard data to confirm it actually impacts on the cancer - and that's only due to the relatively recent introduction of metronomic treatment, not for a lack of medical theory.
Metronomic strikes us as the best chemo compromise, but we're a little concerned about tales of having to be so careful administering it and, more than anything, the possible side-effects. Can anyone tell us of their experience using metronomic treatment, any side-effects and counter-acting these? Like, controlling the side-effects if they do occur. As for its effectiveness, well... we'll take any good news stories on offer, but we're coming to terms with the life-lottery that is cancer and understand nothing is guaranteed.
Thanks, Graeme and Lisa
Sorry everyone, I just discovered after posting this the huge amount of information here available on the topic, but any nutshell opinions/experiences would still be greatly appreciated. I think we're looking at carboplatin, by the way. In the meantime, we'll keep reading!
Graeme and Lisa
Hi Boston, Graeme and Lisa!
It's wonderful to hear Boston is doing so well! And it's still very early in recovery and it only gets better!
You REALLY have grasped the chemo-metronomic "discussion" very well. Good job to you and your vet for wrappng your head around such a complicated and, for me, sometimes confusing topic.
As you can tell by your research on the site, it's a hot topic here.
My Happy Hannah is celebrating her eleven month ampuversary and moving forward (knocking on wood) She had four rounds of IV carboplatin with zero side effects. I think one day I gave her an anti-nausea pill because I thought maybe she was a little nauseous, but wasn't even sure. As you k ow from your research and especially with carboplatin, some dogs may...or may not...experience a little tiredness or nausea for a day or two, but that's prerty much it. Many vets go with five treatments (some even six), but SUPPOSEDLY there are no studies that show a difference after four. Discuss that with your vet.
Also, for whatever it's worth, it's my understanding that metronomics is most effective when given after carboplatin chemo.....so the theory is to do both. Again, check with your vet. HOWEVER, Jerry just had metronomics after mets were found and did vey well.
After completing Hapy Hannah's chemo, I did decide to start metronomics (Cytoxan and Piroxicam). I understand some vets do Cytoxan every other day to help reduce the likelihood of a UTI as this is a side effect. This Onco. prescribed it everyday. Oh, and I learned from this site to give it in tne morning so she can "pee it out" without it sitting in jer bladder overnight. It really is easy to administer. Yes, you do wear gloves and "carefully" discard the package, but that's no biggie.
Anyway, they require bloodwork, uri e sample the first two weeks and then I think it's monthly sfter that, and then it lessens further down the road. Not sure about the frquency of xrays because we stopped after the first tw weeks!! YEP! A urinary infection.! Never had one in her life prior to this!
Now here's where I'm real fuzzy as far as what's caused by the Cytoxan and what's just a bacterial infection. But this I do know she had to have several more tests PLUS a bladder tap (they actually nsert a needle in her bladder...sounds awful but the great commnity here assured me it wasn't! There was a whole lot of lack of communication..lr zero..between my onco. and myself as far as what was incolved in this' the type of testing, etc. We have since parted ways. Yours sounds great by the way!
Okay, next option was to switch to Luekeran (sp), another metro. drug with no real studies either. But it does not cause UTI. Again, ready to start that and she wants more tests...just weeks sfter the ssmes tests were done.....ayway...my frustration level was off the charts at this poi t and I just decided maybe this wasn't meant to be! I feel like I still have Luekeran as an option f need be. Don't know if that's the case, but it just makes me feel better.
You will probably hear from Kati, Jackson's mom. Jackson has been on metroomics almost a year and is doing great ( (knock on wood) She switched to Luekran after Jackson developed a UTI from Cytoxan. I believe Michelle also swithed to Luekeran for Sassy for the same reason.
I apologize that my typing is so bad and I'm not savvy enough to direct you to the proper links. But it looks like you already have a handle n that.
Now, one more thing...and boy do I get the stress of long car rides and constant tesing on your dog or cat! You have to weigh that very heavily based on the nature of your dog. However, talk with your vet and the oncologist about your regular vet administeri g the IV carboplatin. Many refular vets work on a co sultation relationship because many areas just don't have access to an onco. without a lot of travel They can also do the prescrptions, testing, etc. whichever way you go.
I kow this whole journey is all avout getting used to the "new ormal" and living in the now' right! Sometimes it's just a little harder than others though! Remember, whichever plan you go with...it will be the right o e because it's made out of love!! As you've already determined...there are no right or wrong decisions and it's all pretty much a crap shoot anyway!
Stupid disease!!
Okay, don't forget to B R E A T H E.........B R E A T H E.......and devour chocolate and pretzels dipped in cheese!! YUM!
Give that sweet Boston hugs for us AND, we need pictures!! Yes we do! More photos of Boston!
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!
There's no need to apologize for asking, that's why we are here!
Anytime you click on "metronomics " it will take you to our information about that topic. But, to add our own perspective on things:
We didn't do chemo for similar reasons as you, and we choose metronomics until after mets appeared. When we did start using it, the onco felt it was successful and stabilized tumors because we didn't do IV chemo before, so the cells were surprised by the chemo and responded the way we wanted them to. It was just a guess though.
Meanwhile when it came to administering it, doing so wasn't that big of a deal. We had to wear gloves, and we made sure plenty of water was given and peed out, but otherwise it was easy peasy. As for side effects, we didn't have that problem but other dogs here have had the most common one, cystitis (irritation of the bladder). It's easily treated with antibiotics usually and cured pretty fast (usually). There's a risk of it happening, but it's not as common as it might appear at first. Through the years I can only recall a handful of dogs who were affected.
What we were told by Dr. Biller, one of the premier researchers on metronomics , is that while it's not the first choice for fighting cancer, if IV chemo isn't practical or affordable, it's a good option. It's cheap, and it's easy to administer, I think if that's what you're leaning toward you'd probably feel the same.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Thanks guys! One problem for us - and I reckon many people have it, too - is trying to make the best decisions for everyone concerned (us and Boston) and also trying to avoid the feeling We could have done more when all is eventually said and done. One thing that occurs to me, that might help others reading this, is that metronomics would - if nothing else - remove our levels of stress and anxiety over the long trips to standard chemo treatment and replace it with an orderly, controlled and positive regime of treatment. We all know that animals pick up on stress very easily and avoiding that is a good thing. (yes, breathe Sally, breathe...)
We believe Boston's cancer was established something like 6 months ago - that's when he started limping on occasions. We all thought it was the beginning of arthritis or an anterior ligament - the scourge of Great Danes. Yet in December extensive x-rays of his chest and bones detected no other cancer, which is almost miraculous for osteo sarcoma.
It may sound strange, but perhaps to go in swinging a heavy bat like standard chemo now will upset some kind of delicate balance, whereas metronomic is an easier, more preventative approach.
It's a holiday weekend here, so nothing can be decided until Tuesday now anyway. If anyone else has wisdom to offer, we'll gladly hear it!
Cheers, Graeme and Lisa and Boston (more pictures coming!)
Just want to commend you for being such a great advocate for Boston and analyzing everything so diligently.
Keep on processng and, at sl e pont, an option will just feel right. You'll just know.
I think no matter what path we take, we all still have a little twinge in the back of or mind saying, "Could we jave done more?" Or if so ething we tried din't go well, then the dkalogue would be, "Wish we hadn't tried thst!" Just another "side effect of this journey..
Okay, no laighing, but have you spoken with Boston to see what he wants?? You know what I mean!! Just get in a calm meditative state with him and see if you can sense what Boston would want. That's where you'll find your answer.
Sendingyou clarity and hugs!
Sally snd 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!
Well Sassy did great with the chemo up until somewhere between chemo 4 & 5. That is where she developed lung mets so we started metronomics . We were planning on doing them anyway even if she hadn't developed the mets. She did really well and survived 7 3/4 months with the mets. There is no right or wrong answer to anything. Sally is right about the always wondering if we could have done something different but no regrets on anything I did.
Hugs
Michelle & Angel 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."
Hi Graeme, Lisa and Boston,
Great to hear from you and to get the update.
It is a difficult decision, and you guys have the added issue of travel. Which chemo protocol is being suggested? Peda did 4 rounds only of carboplatin which was overall well tolerated. I know some vets suggest up to 6 rounds, but recent studies last year suggested four was optimal (someone here may remember the link to the study). Peda did get tired as treatments went on, but she was much older than Boston. Also, this chemo isn't like chemo for other cancers which can knock them around a lot more. But as many here have noted, each dog is different and there is no guarantee of no side effects. As our oncologist pointed out at the time, you can always stop the chemo - you don't have to continue if you feel either that he is not handling it well, or indeed if the travel is too much.
A couple of questions I would ask myself are: How does Boston handle travelling in the car? Bear in mind, any potential side effects from treatment usually won't kick in until the next day.
How well does Boston handle being in the vet clinic environment?
For me, Peda loved the car, and was a regular at the hospital (that's a shar pei cross for you!). She handled being in that environment well ... most of the time! Those two things meant that those issues were not a factor for us.
But if Boston doesn't handle hospital / vet well, or gets distressed in the car, then it's a different consideration for you guys.
I also see your point about whether to upset the balance of whatever is going on before with a sledgehammer of standard chemo. The hardest part of this decision is you can't ever know what is the best approach (in terms of future outcomes) .... all you can do is go with what you think is the best options for you guys right now.
After Peda finished the carboplatin, we commenced a metronomic protocol of sorts, including piroxicam. Unfortunately for her, she had a history of GI tract issues and so that actually made her much sicker than the carboplatin did (and so was ceased). Once lung mets were identified in March, we started Palladia treatment. I think that was helpful - but she became very unwell with vasculitis about a month or so after starting that and so we had to cease. Vasculitis could have arisen because of Palladia - however it is also an issue that arises in some cancer patients. We will never know if it was the Palladia that caused that terrible side effect, and I can't sit and dwell on the fact that it might have caused it. Certainly Palladia is not standard metronomic - but it is the first (I think) canine specific chemo drug developed and so it is getting more use. I've forgotten the other drugs used in metronomic chemo - but I know others above had mentioned them.
So personally, from my experience, carboplatin was a breeze and metronomic caused lots of issues. But, Peda had GI tract issues and so that may have been the difference there. Certainly many many people here, as you have read, have had great success with metronomics .
Whichever way you choose will be the right way for you guys. I suggest though that the optimal window for commencing carboplatin is closing and so you may lose that opportunity - my understanding is that the sooner that commences the better. However, that is also coming from the school of - 'hit the cancer hard and fast' and I think others on here have waited some time to start chemo. I cannot remember how that went though so I'm not able to offer any insight there.
It sounds like you are wanting to do something - it's just the choice of which way to go. I guess to sum up what I have rambled on about is to look at the impact on travel and vet visits (how much does he like or dislike the car) and then also look at his past medical issues if any. You can stop chemo (both types) at any time - it's not like a course of antibiotics! Also one other thing - Boston is not likely to associate the trip with any side effects from chemo - if he does feel unwell, it may be a day or two after the IV chemo. So don't worry about that aspect. Sorry - I probably sound like I'm pushing IV chemo - I'm honestly not trying to - just pointing out my experience. Interestingly you have highlighted all the same fears I had about IV chemo 
Sorry that I couldn't offer a positive insight in to metronomics
for you - but certainly I think (for what my comments are worth not being a professional) metronomic therapy is a completely valid treatment option and I know others have had great success.
Hope you guys have had cooler weather your way - we've sweltered here this week and it's been horrible. Looking forward to the cooler long weekend!
Take care and big pats to Boston!
Kirsty, (devil spawn) Boots and Spirit Peda
(Boots really is lovely - just a stroppy toddler in an adult body!)
I can relate to your theory about not disturbing the delicate balance of the way things are. Your story is a lot like ours, especially in how the cancer presented itself early on without anyone being aware. Once we discovered the cancer, we felt that the best way to keep making the most of our time together was to live life the way we had been, not necessarily in denial but just doing the things that we loved, with more of an awareness of how precious all the ordinary things are. The way we went about our own cancer journey changed our life. If you have time this weekend you may want to watch the Why We Love Cats & Dogs documentary featuring our story. It's an hour long but worth it. I think you'll relate.
You will probably always feel like there was more you could have done, there's no way to get around that when you love an animal as much as you do. That's just human nature. You just have to make the choice that you know you can live with, and one that will make Boston the happiest.
Sounds to me like your heart is leading the way. You can't go wrong in this situation by listening to it.
{{{{{hugs}}}}}
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
The main reason we decided against IV chemo is the toll it would take on Libby. She never enjoyed going to the vet but since her amp she especially hates it. She's a trooper once we get there for a checkup but she shakes like crazy when she realizes where we're headed.
Libby has been on metronomic therapy for 10 months (cytoxan and rimadyl). She had no side effects until a few weeks ago. She developed cystitis which is a common side effect of cytoxan. There was bacteria present as well and we were hoping it might have been just a UTI, but nope, she is still have the urgency to go but is improving. I've heard cystitis can last for weeks and we are about 3 weeks in at this point. We stopped therapy for 2 weeks and just started it up again 2 days ago. We switched to chlorambucil (Leukeran) and she will have blood work done in a couple of weeks to see how well she is coping with it.
Libby has been a rock star through this whole process and we are so excited to celebrate her 1 year ampuversary very soon.
Good luck with your decision.
Liberty (Libby) was diagnosed with OSA on 1-22-13. Right front amputation on 1-31-13. No IV Chemo. Metronomic Therapy started 2-19-13 along with supplements and some home cooking. Lungs clear until 1-06-14. She's still her happy, hoppy, bossy self. Living the dog life to the fullest and a proud Winter Warrior. :) RIP my Libby 4-21-03 to 3-19-14
Hi everyone, we had a huge, busy weekend and I'm not getting notifications of your replies, so apologies for not replying sooner (must check my forum settings!).
We've decided on metronomics only, plus some K9 Immunity stuff that we really believe gave our 10 yo Newfoundland cross (Luka, who had lymphoma cancer) an extra 6 months. It's all about balance and maintaining a worry-free environment around Boston, but compromising with a little bit of medical science - the metronomics .
No Sally, asking Boston isn't silly at all! His body-language says he trusts us to make the right decisions.
Another small component to our decision is that metronomics closely involves Boston's local, regular vet (they all love their "big boy" at the vets, but they probably say that to every client) and that's got to be a good thing. We can instantly ask about side-effects, etc and know they're completely up-to-date with Boston's current treatment, rather than having them need to refer to a specialist 3 hours away.
So it's paws crossed for a straightforward treatment and long three-legged life!
We'll keep you all posted!
Kirsty, I was in Busselton over the long weekend playing in a support band for Barnesy and co... very hot and humid! Bring on Autumn I say!
Cheers, Graeme and Lisa, Boston and Grace.
GREAT! You've got a plan and it seems to be a perfect fit for you AND Boston! Wonderful decision! And I know it's a releif to get this behind you and move forward to continuing to enjoy a stress free, pain free, life just lovng and spoiling sweet Boston!
Keeping all the paws in tripawd land crossed.....and that a whole lot of pawsitivity!!
Hugs to Boston and all his pack!
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!
The tone in your voice says it all; confidence, hope and love. Congratulations on finding your way and being more dog! We would love to hear about how your experience goes so be sure to update us when you can.
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Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
So happy to hear you've got a plan and way forward ... and it certainly sounds like the best plan for you guys. Well done. I swear - making the decision is always the hardest thing to do - once made, you can just get on with enjoying life!
Keep us posted on how you are all doing ... stay cool - looks like we are in for another hot week ahead! 
Kirsty
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