Thank you so much!!  It is so helpful to have such wonderful support,  Isn't your girl gorgeous!  I just saw a Great Dane puppy yesterday, and I grew up with them as well in my Dad's family.  My grandparents got a Great Dane puppy when they were 93 and 89, they loved their Danes so much.

I am trying to get on some new posts and pay it forward after all the help and guidance Charlie and I have received here.  Thank you again for your kind and thoughtful post.  And to everyone who has followed Charlie's story and helped us along the way!

First off, I heard back from the head mycologist at NAMA and he said the species of mushroom we have could cause some GI upset if eaten raw but definitely not the liver damage Charlie experienced, it doesn't contain the toxins the poisonous mushrooms do.  So that is off the table finally for good.

I just got off the phone with the oncologist, and his ALT is 252 (from 1836 a week ago) and his ALKP from 217 (from 800), so very good news on that front.  We discussed all his medications as she is weighing any of them, including chemo, causing the elevation. Amantidine and Gababpentin were the only ones he was on before chemo, she said both being very unlikely, but we need to consider everything, and perhaps its a combination of them and the chemo that did it.  Of course, we will never know.  

We stopped the Amantidine a week ago so that is now a non-issue.  The Gabapentin has been decreased in half over the last 3 days, I may try to see if I can get him titrated down to see if he still needs it at all, and then discontinue. And that leaves the Carboplatin.  She said she has never seen it happen with dogs, and its not well documented, however it occurs in 15% of humans, so its of course possible.  We think he didn't have liver injury with his first chemo, but she said we could have missed it since we did not do a blood chemistry before the 2nd round.

She gave me 4 Options:

1. Carboplatin:  try again at a lower dose (again)

2. Cisplatin:  another platin with renal issues and intravenous problems (and same class as carboplatin but more toxic so not really an option)

3. Doxorubicin or Adriamycin:  Can be more toxic than Carboplatin, and cause heart, liver or kidney issues but they do use all the time, more for lymphoma, different class of chemo than Carboplatin, but sounds risky and she's not so keen on that either

4. Stop Chemo:  thinks 2 rounds will have helped him a little, but according to research not as much as 3, 4, or 5

She said she will support me in any decision and she doesn't envy me having to make it, wishes she had an option she could just say this is what we should do, but none of them are ideal.

We are continuing the Ursodiol until we decide, and the denamarin for months, and she put him on Flagyl (he now has awful diarrhea)

And so on we go....

:/

Hi everyone,

Thank so much for weighing in and for all your ideas, experience, thoughts and support.  After a serious sit down with the other person who loves Charlie as much as I do, my husband, we have made the final decision to stop chemotherapy.  We just can't risk another serious complication and really feel just one more could have potential life-threatening effects.  Sally, your advice about thinking hard about what I could live with the best in all the options was really helpful, I know I would just be devastated if we tried it and he didn't make it, or even if it made him so gravely ill for a time.  There have been too many signs to listen to that I would beat myself up about, and I do tend to really beat myself up when there are very negative consequences in clinical decisions, admittedly irrationally so.  After my cat who died last year at age 6 from an aggressive blood cancer was put to sleep, I was inconsolable for days thinking I made the wrong decision, so distraught I couldn't leave my room and filled with regret, until the vet called and told me she got his bloodwork back and he was clearly bleeding internally.

I also think its the best decision for Charlie.  He just needs a break.  He never has a week when he consistently feels well.  Even now he is a bit down and out again, and appetite back down, from the diarrhea - which I think it probably from the antibiotics he is on (thankfully they are done tomorrow).  Even the antibiotics are from the liver elevations, which is probably from the chemo.  Or hepatitis, which could be raging from the chemo.  It all comes back to the chemo for him.  His eyes seem to be saying that's enough.  Just let me be.  So I know I will beat myself up if and when we find out his days may have been greatly decreased by making this decision - I will just have to look back and remember he wasn't happy.  He was ill and suffering and could have died 9 weeks after amputation with that 3rd round of chemo.  But I know it will still be hard.

Thank you for all your support, and the metronomics may be something we can investigate, I am not sure why she didn't mention this as an option, does Eurydice have Osteo?  I know it is indicated for soft tissue cancers, it is effective for bone cancers as well?  I am sure I will be researching that along with holistic options (cautious of the ones that can affect the liver as Pam cautioned) in the days ahead.  His liver enzymes are still elevated so he needs a few weeks off from everything - I think I will use that time to make an appointment with his regular vet next week to discuss a plan, call the oncologist and cancel his chemo treatment and ask about metronomics , and perhaps jump on a Dr. Dressler type plan....  I am just still not sure about all those options and how they affect the liver (like Apopcaps, etc.) so I want to be careful.  It would be good to have a vet who is in the know about these options and supportive.  I don't want to just give up and totally go into palliative care yet.  But I really like our regular vet and don't want to leave them.

And lastly, the one thing he is staying on is denamarin , and he gets 2 massive tablets twice a day on an empty stomach - and we just can't get him to take them!  We have to just put them down his throat, but then he starts to have trouble swallowing, I think they get stuck in there.  I was giving him a little broth afterwards but now he won't touch that either.  Does anyone have any experience with getting them down?  I just wish we were back in the peanut butter days, when it felt like we were giving him a treat, and not shoving them down his throat all the time. 🙁  He just won't take anything anymore with a huge pill in it.  I wish they came in a powder or chewable he liked.

Donna, I will try the pumpkin for the diarrhea, hopefully between that and the flagyl he will be feeling better soon!

Mary Beth & Charlie