Caring for a Three Legged Dog or Cat
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Hi all,
If you have been following our Charlie, you know he doesn't respond to much on this journey normally. Well the saga continues. On thursday he has his 2nd round of chemo which they cut the dose and added Cerenia instead of Reglan and he did much better. But then on day 3 he started to go downhill, not eating, uncomfortable and just wanted to be alone and outside. Even in the middle of the night in the cold, which is not Charlie at all. The second night he did this he vomited out there, and then again vomited his water in the morning. So off to the ER he goes to check for sepsis and supportive care. Well he wasn't septic, however his liver enzymes were very high at 1836 (normal up to 105) so he had to stay.
They gave him fluids, Zofran, a broad spectrum antibiotic and denamarin . They checked for Leptospirosis and did an ultrasound to check for tumors or anything else and everything came was normal. The ER vets conferred with the onco who said she has never seen this with Chemo (he is on Carboplatin) and they don't know why it happened. We are having a hard time believing chemo, a chemical toxin, couldn't have this effect. And even if it is uncommon, it could still be the cause. Liver enzyme elevations is one of the most common side effects of chemo in people.
Fortunately he was able to come home last night, the enzymes came down to 995 and he was eating again. He is being rechecked next week. The following week is Chemo round 3 and I just don't know if I want to risk it again, I really think this was from the chemo - but I am afraid to not have him continue chemo if it decreases his chances. The ICU care and tests came to $2,000 and we are getting to the point of not being able to charge much more - on Monday our 1 year old cat was in critical care and newly diagnosed with heart disease so its been a tough week. I think we will be paying off trying to keep these family members alive for years.
So torn how to proceed with Charlie, even if his values come back down, I am nervous it will happen again with Chemo #3 and he won't rebound next time, has anyone had a similar experience with liver damage from chemo???
Mary Beth, Charlie, Annie and Winky too
Dang! Charlie, you're one for the books! Goodness gracious, you are writing your own chapter on how NOT to do anything within the "norm"!
There is some good news in that all Charlie's tests came out good and his liver enzyme count is getting better!!
Charlie's "recovery" has been far from what's "generally expected", that's for sure! Just because a professional has "never seen" a specific reaction, certainly doesn't mean it can't happen...just ask Charlie!! Additionally, just because you have no reason to believe he didn't get into something toxic, doesn't mean it couldn't happen.
Sometimes if there is no clear answer, I think you do end up having to listen to your inner voice...your gut.
Of course we all want to give our puos THE best chance possible! Sometimes "statistics" may point slightly towards one treatment or another. HOWEVER, the individual dog and all their little individual nuances are the unknown factors that cannot really be taken into account on statistics. And goodness knows, Charlie is a unique individual with his own " nuances"!!
To me, this statement of yiurs speaks volumes:
"And even if it is uncommon, it could still be the cause."
SOMETHING caused this severe reaction. If...IF...it was the chemo...it was a reduced amount...and STILL caused severe reactio. Again, IF, but it sure seems possible.
There TRULY, TRULY, TRULY NO GUARANTEES that Charlie would get extended time with chemo!! What does "appear" to be true is it "seemingly" has a bad effect on him.
I think any dog who has a really rough time with any treatment that interferes with their quality would, if they could "speak", would say,
"Forget days on a calendar, I'll take quality and feeling good over a few extra days on the calendar anyday!!!"
I know we could give you "case scenarios" where dogs seemingly got extended time in chemo, as well as thise who didn't get past kne or two chemos before that nasty liece of crap diseq took over. And then, the same can be said for those who did no chemo...some got extended time..some didn't.
Whatever decision you make, you have to be comfortable with it! Well, as comfortable as any of us can be with the least second quessing possible!
Do you have a sense what Charlie would want?? He may already be "speaking" to you. I think he is...maybe.
Lots and lots of love
Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!
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!
Thanks so much Sally, very helpful all around. I do think we are getting plenty of signs Charlie and Chemo may not agree with each other, especially after such a rough time he had with his amputation he really could use a break! At this point he is getting a full bad week for every 2 good weeks. I agree it certainly could be possible he randomly got a mushroom outside or something, but it does seem coincidental. We will take him in next week for the repeated blood work and exam either way since it is still quite elevated, and then make a decision. If we do discontinue chemo I will dive into a homeopathic treatment plan at least to keep fighting the cancer, I just know how I am and if he get mets soon after stopping chemo it will just eat me up inside! But if he ended up with another severe reaction to chemo he may not survive it would too! Why does it all have to be so uncertain??? Sigh.
Loving them so much really does make this all unbearable. 🙁
Oh, for heaven's sake Charlie! (channeling my grandma there)
You so deserve something normal to happen to you!
My quad pug Tani was one of those dogs who was 'different'. She never reacted to meds like 'normal dogs', her illnesses never followed the 'normal' course. I know that there are just some dogs like Tani and Charlie who blaze their own paths even when you don't want them to!
My pug Maggie developed kidney failure a couple years after she did her chemo for mast cell cancer (6 months of two different drugs). The oncologist assured me that she had never seen kidney failure from the drugs that we used. A few years later there was a report occasional (still rare) kidney failure in dogs who had one of the meds Maggie did.
I would certainly not consider chemo again until his enzyme counts are normal for a week or two. Assuming the counts come down to normal by next week (it may take longer) maybe just let him be for a couple weeks and see if anything else triggers a reaction. Check your yard for mushrooms or other toxic stuff, and follow him around and see if he shows any interest in a particular spot.
You have to follow your gut. Make a pros and cons list about continuing chemo and include finances. The truth is you will never know what would have happened if you chose a different path. When I chose not to treat Maggie's second cancer I wrote down my thought process so I could refer to it later. When she passed I of course started thinking 'what if'... when I looked at my notes I was sure I had done the right thing.
Karen and the Spirit Pug Girls
Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.
1999 to 2010
Thanks so much Karen, that is a good idea to write down all the pros and cons and be able to refer to it later. I have a feeling one way or the other, I am going to need to look at it in the future. We have a very tiny yard so I will most definitely be scouring it for any signs of mushrooms!
I have a feeling his ALT's won't be down enough next week for continuing chemo in time, but he is already pushed back a week due to the holiday coming up. So that does give us almost 3 weeks until the next round is scheduled. So hard to make these decisions, especially if they do rebound, you feel like in their present state they are good to continue. Then something happens again, and we kick ourselves for doing it again!
Thank you to everyone for weighing in, definitely helps to throw around some thoughts and wisdom from previous experiences.
Can he stay on the denamarin ? Murphy had CCNU for his chemo and he took the denamarin every day during the treatment to protect his liver. Because the CCNU could cause damage to his liver is what I was told.
What else could hurt his liver? Did they check for gallstones? What food is he on?
I would definitely hold off on the next dose until his levels are down, if not stop altogether. I don't remember what the cost of the denamarin was, but I don't think it was too bad.
Donna
Donna, Glenn & Murphy
Murphy had his right front leg amputated due to histiocytic sarcoma at 7 years old. He survived 4 years, 2 months & 1 week, only to be taken by hemangiosarcoma at 11 1/2 years 6/12/17
Read about Murphy's Life on Three Legs
I do intend to keep him on the denamarin for as long as his liver function values are elevated, and certainly if we continue with chemotherapy. The ultrasound showed normal liver and gallbladder (just had a small amount of echogenic debris?) and they didn't think it showed anything that would explain his elevations. So unless its a random mushroom or something, there is no explanation given.
I am starting to really lean toward discontinuing, its all getting to be too risky it seems. I got his labwork and see his ALKP is also elevated, really hoping this isn't due to the bone cancer rapidly progressing, since its also produced in bone, and I have read it can be an important marker for bone cancer. Fortunately it did also come down with the supportive care and medications, but it remains elevated at 687 at discharge. I guess we will wait and see what happens with his bloodwork next week and what the oncologist has to say about it. She didn't bring up anything regarding the ALKP but he wasn't really in her care at the ER - they just consulted with her.
I just wish I knew what caused this - it would really help make the decision for him!!!
We all feel, and understand, the agonizing emotions involved in trying to do what's best for our pups, especially when there are no certainties regardless of what we do! Ugh!
The "individual" dog that statistics are unable to take into considerstion, must be put into the equation when it comes to Charlie! Charlie had such a rough time during recovery, and for several weeks afterwards compromising his quality. The surgeries, the antibiotics...his immune system nas to be completely out of whack! Then he had a rough time after his first chemo, and then his second, compromising his quality, regardless of the reason (which may or may not be the chemo).
No wonder you are completely frustrated and confused and emotionally exhausted on what to do next!
Checking with a Holistic Vet is a good option also.
As you noted, you won't do chemo anyway (if at all) until the liver enzymes return to normal. That gives you a little breathing room to just step away from the decision making process and step into thoroughly enjoying being in the moment with Charlie WORRY FREE!! YAY! Stepping into a worry free zone for awhile has to feel good!! 🙂
Keep sharing your thoughts here with those of us who understand. Obviously, we love and support you no matter what! And Charlie ALWAYS knows you have his best interest at heart. Again, he doesn't care abpjt days in a calendar. That's a human thing, not a Charlie thing! Ahhh...........the blss of being dog!
Now go give that boy a big hug for us, and a bunch of treats!!
Lots of love!
Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!
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!
If his ALT was normal before chemo and now is that high it is possible that he has hepatitis. Typically carboplatin does not cause hepatic necrosis like CCNU does but any chemo does decrease the immune system and could allow an infection to set in. My dog Tazzie turned yellow (jaundiced) after her amputation and she needed to take 6 weeks of antibiotics (Baytril) post-op. She did have a pre-existing inflammatory liver disease and was on denamarin pre-op but I think the long surgery stressed out her liver and allowed the infection to take hold. The normal antibiotics that we give for orthopedic surgery (such as cefazolin) do not penetrate the liver well.
Tazzie did have 5 doses of carboplatin without further liver issues.
The only way to know if your dog has inflammation versus an infection is usually a biopsy but your vet might want to consider a course of antibiotics for the liver as well as the denamarin .
Pam
Thank you everyone for responding, and thank you Pam for your advice. He is on Baytril as well as denamarin and Ursodiol. He is doing quite well now, more his normal self than ever actually, so we are so thankful he has rebounded from this. I don't think he was ever yellow, at least the whites of his eyes weren't and they didn't mention it at the ER. His bloodwork is being redone on Wed and it will be interesting to see where the liver enzymes will be and what the oncologist advises. He does still have conjunctivitis so I need to ask for some ointment as it isn't going away.
But we did have an eventful weekend in some ways. Friday night Charlie's regular vet called me back (since we had ordered some EN diet for him and she saw all the paperwork from our ER) and she really felt that we should discontinue the chemotherapy. When I told her how we were wavering she even went on to say that it may be so risky to continue we wouldn't have him for the holidays. So in a sense, it was quite a relief to have his vet weigh in and voice what I have been thinking, including the liver enzyme elevation being a mostly likely response of the latest chemo treatment. But it was also upsetting to stop the chemo and give up on giving him the best chance. A very tearful night.
Since that conversation I was feeling at peace of finally having a decision made that felt safer and in line with what I was thinking, and then last night we found a very weird cluster of mushrooms that grew out of the dog's feces in our backyard! So now I am questioning everything again! We have a tiny backyard and I don't think they were there before, they don't look like any were eaten, and there aren't any others. But it could be the culprit! I feel like I have to at least rule out that they are poisonous to move forward with confidence with our change in plan. I am trying to figure out who can identify them for me today, I looked online for hours last night trying to figure out what kind they are and couldn't find any really that looked like them. At least they aren't looking like the top 3 most dangerous to dogs. But who knows! I would post a picture but I am not really sure how to.
And just when I was thinking everything was settled, it goes on. 🙁
You could always discontinue the chemo until his liver recovers and then consider other options such as holistic treatments. Some of those also can harm the liver so you need to be careful. I would see what the oncologist has to say....
Pam
Thanks, Pam - I think that's the best plan. I appreciate you weighing in on his situation.
Best,
Mary Beth & Charlie 🙂
I am way new to the conversation and it is obvious you have already received great advice. Let me just say I love Charlie's face!!!! He is so cute! Deb
Hi everyone,
I did find out tonight that the mushrooms are not toxic, so back to the chemo or infection from being immuno-compromised on chemo likely being the culprit. Pam, if he has hepatitis wouldn't his WBC be high as well from fighting an infection? He gets his repeat blood work tomorrow so I will see both. He remains on the Baytril but I believe it is just a 10-14 day prescription. I imagine if the liver enzymes aren't back down we will continue longer, along with the denamarin and Ursodiol.
I was thinking of asking his regular vet about some holistic treatments that wouldn't be hard on the liver. Otherwise, I guess I could try to find one in this area. But it would be nice to feel like we are still staving off the cancer as best we can. Meanwhile, I am just enjoying his newly returned hardy appetite and lack of pain. A very different picture than we have experienced along the journey of osteosarcoma!
And thank you Deb for the compliment, Charlie thanks you! Those eyes do just get me every time. 🙂
Mary Beth
Hi Charlie and Mary Beth 🐶💗
My goodness, what a huge ordeal you've been going through ... just as if osteo wasn't stressful enough 😔
I am sorry I cannot make any relevant comment as me and Eurydice have, so far, had a smooth journey (touching woof madly here) she also has osteo and lost her front leg 6 1/2 months ago.
I just wanted to say to say we are thinking about you too and, as Deb said, he is a total teddy bear 🐻💘 no wonder he melts your heart whenever you look at his gorgeous little face.
Fingers, toes and paws tightly crossed for you both, really hoping you can find a way out of this predicament and a solution will be found asap.
Sending you an avalanche of kisses and tons of belly rubs to that cutie boy of yours 😘💗💕💕🐾💞🐶
Eurydice 77kg/170lb Great Dane limping end of April 2016, amputation (right front leg/osteosarcoma) 4 May 2016 6 courses of carboplatin followed by metronomic therapy, lung mets found 30 Nov 2016. 3 courses of doxorubicin, PET scan 26 Jan 2017 showed more mets so stopped chemo. Holistic route April 2017. Lung X-ray 5 May 2017 showed several tennis ball size mets, started cortisone and diuretics. Miss Cow earned her XXL silver wings 12 June 2017, 13 months and 1 week after amputation and 6 1/2 months after lung mets, she was the goofiest dawg ever and is now happily flying from cloud to cloud woof woofing away :-)
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