Sue,

There is no right answer on what to do next.  My original plan for Tazzie was to stop after 4 Carboplatin treatments and then do nothing.  I ended up doing 5 because she tolerated them so well.  As I researched Artemisinin I thought it looked promising and safe so I started that.  I can't remember how much Nova weighs but I know she is smaller than Tazzie.  Tazzie is on 2 forms of Artemisinin from 2 different companies.  She gets 2 capsules once daily for 8 weeks and then she will be reduced to every other day.  This is the prevention dose; those with lung mets can take a higher dose.  I buy the Artemather from Hepalin.com and it costs $60 for 60 caps (a 30 day supply for Tazzie).  The Artemisinin comes from Holley Pharmaceuticals and I got a "buy 2 get 1 free" deal so 3 bottles of 60 caps each cost $85 (90 days).

She also gets 3 tsp "Bone Stasis" powder twice daily which might help prevent bone mets. A 100 day supply of that costs about $60.

I decided to try metronomic therapy because Tazzie's oncologist felt that this was the most promising way to prevent/delay mets and that is pretty cheap because she can use human meds due to her large size.  I get the generic Metacam (meloxicam) for $4 a month from Fred Meyer pharmacy (you can also use Walmart or Target) and her Cytoxan was about $125 for 100 days.  I decided not to do doxycyline because most oncologists do not think it is all that beneficial.

I looked into K9 Immunity and Tazzie would have needed 18 capsules a day.  I decided that this was too many pills on top of everything else and it was the least likely to help her.  It is a good product to boost immune function but she already takes several antioxidants for her liver and seems to have a pretty strong immune system.  I might change my mind if she gets lung mets!

So the above treatments cost me $5 per day.  I do get a slight vet discount on the Bone Stasis powder and Cytoxan but the other meds are not discounted.  I haven't added up the cost of her liver supplements or food but I really don't want to know!!  Even with all of the things I can do at low cost like bloodwork and xrays I still estimate that we have spent about $5000 to $6000 on Tazzie since August.  Well worth it for a happy pain-free dog but we are feeling the pinch!  No vacations and less dinners out this year, but I will gladly keep it up if we can keep our girl with us as long as possible.

It may be that none of the above even helps since OSA is so aggressive.  On the other hand, there have been dogs that have lived over 2 years with amputation alone, and the amp plus carboplatin can also lead to long-term survivors so you have already done the 2 most important things.

Pam and Tazzie

Sue,

If you look back in the old postings in “Treatment and Recovery” I did a post on Tazzie's complete protocol (I think it must have been the beginning of January). Everything is the same except I recently added the Bone Stasis powder on the advice of the holistic vet that I use for one of my other dogs (Kona). The website for this is http://www.tcvmherbal.com but you need to be a vet to actually order.  I found my holistic vet through word of mouth but they might have a “search” function on this site to find one in your area.  So yes, for this you will need a vet or at least a prescription but the company can ship direct to you.

There are several postings elsewhere on artemisinin and Kim (Buster's mom) found a good article on this herb from the BoneCancerDog website. Basically, when researchers mixed this herb in a petri dish with cancer cells (including osteosarcoma cells) all of the cancer cells were killed!  It works by restricting the iron that the cancer cells need to grow, but does not hurt normal cells. It is unknown if this will work when a dog takes the meds orally.  There are 3 forms of the herb; artemisinin , artemather, and artenusate.  The first 2 are the most potent.  If you go to http://www.Hepalin.com you can order all 3, plus they have a product called Artemix that has all 3 combined.  The reason I did not go this route is strictly cost!  I found that the artemisinin was cheapest on the Holley Pharmaceuticals site since they had a “2 for 1″ deal but they did not sell the other forms.  It was cheaper for me to buy the artemather separately and since artenusate is not that potent I just skipped it.  The artemather is the only one that can be harmful in high amounts so do not exceed 0.5 mg/pound bodyweight/day (Tazzie is slightly underdosed here at 80 mg daily).  They are testing artemisinin at OSU vet school and the Dr there recommended 200-300 mg daily for Tazzie's weight.  You do not need a prescription for any of these and if you can only afford one I would just do the artemisinin or Artemix product.  If you go to the Holley Pharmaceuticals website they have some good articles and also offer a drug called butyrate that is very cheap ($12 for 100 caps) which may help the artemisinin be absorbed better.  Tazzie takes 2 of these per day.

Metronomic protocol refers to periodic low dosing of drug.  Some docs do daily, some every other day, and some weekly.  The current info I found is to give cyclophosphamide (Cytoxan) at 10mg/m2 every day or 25 mg/m2 every other day.  These doses need to be calculated by your vet and you will need a prescription.  It will have to be compounded for Nova's size.  Jerry could give you an idea on cost per month because he was on it (I think from RoadRunner pharmacy).  Your vet/oncologist probably already knows a local pharmacist that does this.  Side effects are rare and involve the bladder (infections or minor bleeding) so urine should be checked every 3-6 months.  No problems with bone marrow or platelets due to the low dose 🙂  The other part of this protocol is a daily NSAID.  I chose Metacam for Tazzie because it is one of the safest on the liver and GI tract plus it is only $4 (generic is meloxicam). You will need a script for this but due to Nova's smaller size she would only need 1/2 of the 7.5 mg tablet.  Your vet might think that she would do better with a different drug like piroxicam or Deramaxx. Side effects with these drugs usually involve the GI tract so watch for vomiting or dark, tarry stools (due to bleeding).  Some dogs can have side effects that involve the liver or kidneys so periodic bloodwork (1 month after starting then every 6 months) is prudent.  Tazzie has a form of liver disease called chronic hepatitis and her values are still normal after 4 weeks of Metacam.  The whole point of metronomic protocol is to prevent cancer cells from “taking hold” in a new spot so this protocol starves their blood supply (anti-angiogenic).  Some vets used to also add doxycycline (an antibiotic) and this would not be wrong but many oncologists have stopped this since there does not appear to be an anti-angiogenic effect.  I decided not to do it in the interest of less pills/money but if your oncologist still uses it then it would not hurt.

So this is a long, technical post but I hope it answered your questions.

Pam and Tazzie