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Continue with treatment or not? Could use perspectives...
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Member Since:
21 January 2013
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17 February 2014 - 1:15 pm
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Hi everyone,

It's been about a year since I posted on a tripawds forum last time, mainly because Cassie's life as a tripawd became the "new norm" for all of us and she has been doing so great since her amputation in January 2013.  She had 4 rounds of Carbo treatments and has been on a relatively mild metronomic therapy (Chlorambucil 4.2mg) since 2nd Carbo application post amp.  Throughout the chemotherapy, she had shown no sign of health deterioration or negative side effects, getting near perfect blood test results every time and getting stronger physically.  Alas, her x-rays started to show a different story last fall, with faint lung mets starting to be visible and slowly increasing in the last 3~4 months.

In December, in consultation with her vet, we decided to get her back on another series of Carbo treatments to see if lung met growth rate could be slowed down.  When x-ray showed further met expansion before the scheduled 3rd treatment, we stopped Carbo and Chlorambucil, and decided to try Palladia, again, looking to somehow slow the rate of metastasis. For future reference for others, here's what her current protocol looks like:

  • 80mg Palladia Mon, Wed, Fri
  • 60mg Omeprazole every 24 hours to protect her GI system from Palladia
  • 160mg Maropitant  on days Palladia is given to prevent nausea
  • 75mg Rimadyl every 12 hours on days Palladia is NOT given 
  • 10mg Metoclopramide every 12 hours to promote appetite as needed
  • 500mg Metronidazole as needed to address diarrhea 

Tomorrow will be the 3 week mark since we started this protocol, and I must admit it has not been easy.  In the first week, we immediately noticed significant drop off in her mobility, which we learned was one of many side effects of Palladia.  She had been going on 2~3 walks a day with long hikes on weekends, but since we started her on this protocol, she wouldn't want to move around a lot and had difficulties going down stairs as if she's not very stable.  We stayed with the treatment because this side effect had been reported by others and most seemed to have dissipated after a while.  She did start to move more again in the 2nd week.  She had also experienced diarrhea and very soft stool during this time, which was also very uncharacteristic of Cassie but well noted side effects of Palladia. We also noticed that she did not want to talk/bark much any more.  We consulted the vet after the 2nd week, and he wanted her to continue on at least for 4 weeks on Palladia to give this protocol a chance to see if it is helping to slow down metastasis, but we agreed to reduce dosage to 65mg per treatment to ease the side effects. 

Now we are in the 3rd week, her appetite seemed to have dropped considerably even though mobility came back.  This is a dog that did not flinch and always ate her food with gust even during her Carbo treatments, so this has become very worrisome.  Last night, she was panting heavily all night long, moving from one spot to another every so often and not sleeping much at all.  Then this morning, as I walked downstairs with her, she was laboring to breath with heavy wheezing.  We have been on a lookout for signs of respiratory difficulties since her lung mets started growing, and this was the first time we noticed of any breathing difficulty.

So here we are, at a crossroad. She will go back to see her vet in one week to have another x-ray done, to see if Palladia had any impact on mets progression. On one hand, we don't want to have any regrets about NOT doing something that could have helped her to have more time with us.  We are blessed enough that we don't have to worry about cost of treatments, and are prepared to do everything we can.  But on the other hand, if growth of lung mets cannot be stomped, we want her remaining life to be as pleasant for her as it can be.

At this point, we are just not sure whether some of these changes to her condition is caused by Palladia or by progression of lung metastasis.  It just feels like some of the deteriorations have come up too sudden to be anything but side effect of a potent drug.  But then, reading through many of the posts on this site seems to indicate that sometimes changes could come very rapidly.  

As I go back and forth on this, I would be very grateful for any perspective from pawrents who had gone through this process before, particularly ones who dealt Palladia in their treatments.  

 

Orange County, CA
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17 February 2014 - 4:40 pm
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Hi Cassie and Family!  I can't offer too much advice, because we never went the Palladia route; it wasn't available to us when our boy Max was going through his treatment.  But, we have a similar story, just without the Palladia part.  Max did his 6 rounds of carbo.  Then, we decide to do metronoic protocol just to add a little insurance that the mets (hopefully) would not show up.  After a few months on MP, we found out he had lung mets.  At that point, our doc said to go off MP and try a different IV chemo treatment. So we did.  We did several weeks of that, and discovered that it did not slow down or shrink the mets.  In fact, an additional one had shown up.  So at that point, we stopped all treatment and decided to let Max "just be a dog" for whatever remaining time he had left.  I have to add that at this point, Max was still not showing any symptoms of his lungs mets.  No trouble breathing, no coughing, no gagging, and still running around like a track star.  

About a month later, we noticed one night Max had trouble getting comfortable to go to sleep.   The next morning, I noticed his chest seemed to be "out" further than normal. We took him in and found out the lung met had caused fluid to build up around his lungs, further restricting his lung capacity.  I wonder if this is what is happening with Cassie?

I don't know if any of this is a help to you, but I just wanted to add our experience (even though it is a bit different from yours).  Please know we're thinking about your girl and sending positive thoughts your way.

On The Road


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17 February 2014 - 5:37 pm
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Wow it's great to hear from you and know that Cassie has been doing well and kicking cancer's butt!

I have no experience with Palladia but you'll find that others here do (just one search in the Forums reveals tons of posts). What I can say is this; when the treatment drags down quality of life, that's when I would want to stop it. That's just me though, and every dog is different. I have seen many Tripawds members' dogs have some icky side effects like this from Palladia, probably more with side effects than without.

It's good that you're in communication with your onco and I agree that if you're making the investment in Palladia it's smart to give it enough time to see if it works. One week will seem like a million years away but if that's the tiimeframe in which the onco believes it will show if it's working, I would want to wait until then, UNLESS symptoms get worse. Stay in contact and keep a close eye on her to make sure.

Many, many hugs coming your way. No matter what happens, never question yourself over whether or not you've given this cancer battle a good fight. You have definitely done that, you're a great pawrent.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

Member Since:
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17 February 2014 - 8:16 pm
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Thanks, Jerry.  Yes, you were spot on - it's only a week away until we know better about Palladia, but it does feel like a million light years away right now.  So anxious, and so worried that Cassie just does not want to eat...

Maximutt, thank you for your insight as well.  The thought of letting Cassie "just be a dog" is what is tormenting us the most, seeing how she is struggling with Palladia.  Was Max showing any sign of pain when there was fluid built up around his lungs?  Cassie is in her full winter coat right now so it's hard to tell, but her chest does not look to be much different than what I am accustomed to seeing and she doesn't seem too concerned when I feel around the area.

We caught a sun break between bouts of rain this afternoon and took her for a hike.  She did seem to need more frequent stops to catch her breath than normal, but then when all was said and done, she did 1.2 miles on a rolling trail in just about 40 minutes, which is a great pace for her. I'm hoping this "up" side continues...

Orange County, CA
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17 February 2014 - 8:33 pm
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Hi there.  No, Max was not in any pain from the fluid.  The first sign was that it would take him quite some time to get comfortable when we went to bed.  He would toss and turn and breathe shallow.  Then, once he finally got comfortable, he went into a normal deep sleep (which gave us much relief).  For us, all of this happened within a 36 hour period.  He couldn't get comfortable (Friday night) and that continued into Saturday.  On Sunday, I noticed his chest was more pronounced, so we took him in.  They did an ultrasound and found all the fluid.  They told us they could insert a needle between his ribs and drain the fluid, but it would just come back within 2 - 7 days and would never go away.  The fluid was a direct result of the lung tumors, and was making his lung capacity that much smaller.  We had made a promise to our boy that we would never do procedures on him to keep him around "for us."  So, instead of having this done over and over again, we decided to let him go. And I will add this:  Max let us know he was ready.  He just had "that look", that he was tired and done fighting.  We did what we thought was best for him.

You know Cassie best, and you can read her better than any doctor.  So, I would say to just watch your girl, confer with your doc, assess everything from there.  Her symptoms may be from the Palladia.  You will find plenty of stories here on the forums where Palladia just didn't work out for everyone.  It's a powerful drug, with some powerful side effects.  But you are on top of this and so is your doctor.  And that is the best thing for your girl right now!  Stay strong Cassie!

Sussex, England
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18 February 2014 - 7:18 am
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Hi, This is so hard isn't it, Im sorry you are all going through this dilemma. In our case we decided not to do any treatment except holistic as we felt quality was better than quantity in our case as Dexter doesnt cope well on meds. Its deciding when to draw the line isnt it. I personally would stop any treatment that made Dexter feel unwell, he currently has a lump on his neck we could have it removed if its the cancer but thats more surgery and more stress for him so we are just taking a day at a time now as long as he is happy and he only has a short timecwith us thats all that counts as heartbreaking as it is:/xx

On The Road


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18 February 2014 - 11:00 am
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I forgot to mention, you might want to get some Green Clay for the bouts of diarrhea and runny poo, it works wonders.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

New Haven, CT
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18 February 2014 - 3:47 pm
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I know that cute face!  Cassie!!!  Oh, Cassie.

If it were me and Jackson, I'd let him be a dog.  You've described numerous changes to her behavior, mood, and wellbeing.  I wouldn't be surprised that if you took her off it all, except for perhaps an NSAID, she's regain some life.  That's a lot of drugs and Palladia seems to hit them really hard.  It also seems that once the mets are there, there's so little, if anything that'll work.  This damn cancer moves and is really stubborn.  Let her be a dog.  Let her chow down on her favorite meals with her favorite people w/o anything stopping her.  She'll shine again.  She's got some shining left, I know it!

Belly rubs to Cassie.  Thanks for coming back to report.  I'm sorry mets are here and that you're facing this troubling decision.  It's awful.  But, there are still so many wonderful, magical moments to spend with your little lady.

HUGS

~ Katy & Jackson

ACL tear in right hind leg 12/5/12 and scheduled ACL repair surgery 12/21/12. Pre-op xrays revealed osteosarcoma. Amputation 12/28/12.  Chemo (carboplatin) started Jan 10, 2013 and ended on April 5, for a total of 5 doses. He handled carbo like a champ!  No side effects.  We started metronomic therapy at his third chemo and have been also doing some holistic treatments.  He's a lively, playful 10 year old huskie-boarder collie and a very proud member of the Winter Warriors!  Our love. Our funny little guy!

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18 February 2014 - 5:33 pm
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We just came back from seeing her vet.  Her scheduled appointment was not until a week from today, but her condition deteriorated materially since my last post.

Maximutt, THANK YOU for describing what you went through with Max, as it turned out Cassie went through almost exactly the same thing last night.  Every time she tried to lay down to go to sleep, she started gasping for air and ended up jumping up to catch her breath.  Laying down on either side as she normal would seemed to exacerbate her breathing difficulties, and the only way she seemed remotely comfortable was when she was laying down on her tummy.

We took her in first thing this morning after none of us getting any sleep overnight, and sure enough, ultrasound found fluid built up on both sides of her chest, so we did have it drained.  They could not get all the fluid out because there was so much of it, all over and around her organs, but in the end, they drained almost 2.2 litters of fluid out of her chest cavity.  That's like having 2 big coke bottles strapped against your lungs on either side and putting ever increasing pressure on them.  No wonder she couldn't breath!

The vet took x-rays after fluid was drained, and showed us the films from today compared to the last ones from 3 weeks ago.  Her chest was now full of visible nodes instead of just a few small ones, and previously visible ones were now so much bigger. Previous one didn't show any visible shadows from fluid either. We also saw her lungs collapsed to almost half of what normal lungs should be in size.  Doctor told us that there is no way to tell how long the fluids had been building up, particularly since he didn't hear any abnormality in her lungs just 1 week ago.  So at this point, the maximum time we have before fluids build back up again is probably 3 weeks, and it could be as little as few days.

She is now back at home, breathing more comfortably but looking slightly dazed from the meds given for the procedure.  She'll be off all of her meds going forward, and we'll only give her non-narcotic pain meds, just so that her remaining days will be peaceful.  I am so grateful that we will have a few more days with Cassie because my daughter, who picked Cassie out of hundreds of dogs waiting to be adopted 10 years ago, is by sheer chance flying home tomorrow from out of state for a few days.  The trip was in the plan long before all of this started to unfold, so it made me think that someone must be watching over Cassie...

Cassie after the last big hikeImage Enlarger

 

Orange County, CA
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18 February 2014 - 6:42 pm
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I'm glad Max's experience could be of help to you and Cassie, and more importantly, I'm glad Cassie is breathing easier today!  So glad to hear your daughter is on her way home to see Cassie!!

On The Road


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18 February 2014 - 7:19 pm
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Oh guys, my heart just sank when I read this. I'm so sorry. It's amazing how Max's people were able to tell from your symptoms what was going on. I'm just glad that you took her in and were able to find out right away. It is VERY serendipitous that Cassie's #1 girl is coming home this week, I'd say that your family certainly has a guardian angel looking out of all of you.

We are always here for you if you want to talk OK? Most nights there are people in the chat room so please feel free to stop by.

Where was that photo of Cassie taken? It's a beautiful picture, she just lights up the world in it.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

New Haven, CT
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18 February 2014 - 7:29 pm
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What a GORGEOUS photo of your girl!  She's lovely!

Wow - what a day, indeed.  I'm so glad Max's story helped fuel your move today and that she was seen right away.  2.2L is a ton of fluid!  Did they send her home with diuretic?  Would that even do anything?  I hope everyone gets a sublime night's sleep.  She's got some drugs to clear out of her body and a lot to recover from today.  What a day!

Tomorrow is a new start.  Back to being Dog!  I'm optimistic she'll feel much better - and you, too.

~ Katy & Jackson

ACL tear in right hind leg 12/5/12 and scheduled ACL repair surgery 12/21/12. Pre-op xrays revealed osteosarcoma. Amputation 12/28/12.  Chemo (carboplatin) started Jan 10, 2013 and ended on April 5, for a total of 5 doses. He handled carbo like a champ!  No side effects.  We started metronomic therapy at his third chemo and have been also doing some holistic treatments.  He's a lively, playful 10 year old huskie-boarder collie and a very proud member of the Winter Warriors!  Our love. Our funny little guy!

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18 February 2014 - 9:01 pm
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Thanks, Jerry.  The picture was taken two weekends ago, right after her last big hike.  She went for 2+ miles that day, strong girl.  She indeed lights up the world around her.  Now that I think about it, we bought our first house together 10 years ago April and she came to us not that much after that, so we practically never had our lives together without Cassie as a part of our family… 

Thanks for the encouragement, Katy. Doctor didn't give her any additional drugs, including diuretic. Since she is refusing to eat, I'm afraid accelerated excretion of electrolytes may do more harm than good at this point. I do hope she gets to have a calmer night to sleep off the drug, and wake up with a bit of appetite. 

I remember Jackson and Cassie started their journeys right around the same time last year.  Our journey seems to be nearing its end, but we are so rooting for you guys to pull through all the way!

In a hind sight, many of the negative symptoms that we attributed to the side effects of Palladia may have been all due to the progression of metastasis. In Cassie's case, the drug unfortunately did not seem to have meaningful impact in slowing the mets down, but I certainly hope people reading this in the future would not discount the drug thinking it's nothing but negative. In the world of canine oncology, it's so tough to make this type of decision because there is just not enough empirical data to help us and doctors to make an informed decision with higher confidence. We didn't have to get the final x-ray done today, but by actually getting it done, I am hoping it adds a piece of data to the body of clinical knowledge to help these great specialty vets.

 

 

On The Road


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19 February 2014 - 9:20 am
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Wow, a 2 mile hike in her condition is pretty amazing, she looks SO happy there. Would it be OK if we posted this in our Tripawds Photo Gallery?

I hope you both had a restful night. How did it go?

And I agree, Palladia just needs more time to be studied and watched how it works for dogs. It's shown such promise.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

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19 February 2014 - 10:14 pm
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I don't do Facebook, so please, feel free to cross-post it. She's always been a big hiker, and she has regularly done that 2.2 mile loop since about 2 months post ops.  She seems to be the happiest when she's meandering on dirt trails in the woods, sniffing out imaginary or not so imaginary deer in the distance.

She still had difficult time sleeping in her normal position last night, so her Dad ended up sleeping on a couch so she could lay upright next to it.

Today, she seems to be doing much better now that the drug wore off completely.  She ate a few bites of food this morning, spent all afternoon lying next to my daughter, and ate some dinner too.  Her breathing sounds almost normal at this point, so I'm cautiously optimistic that we may still be able to spend a little time romping in the snow (her most favorite activity) this weekend….

 

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