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Osteo, amp, chemo, extravasation... now what? Your thoughts? (WARNING: GRAPHIC PHOTO)
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dukez
1
23 July 2012 - 12:34 am
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Quick background and update:

Duke was diagnosed with osteosarcoma 3/26/12.

Left rear leg amputation 4/2/12.

Carboplatin round 1 - 4/16/12; 2 - 5/7/12; and 3 - 6/4/12. 

Leg exceedingly swollen so ER visit 6/10/12.

Skin slough due to extravasation began 6/16/12.

Here is what it looked like last Wednesday 7/18/12 - one month later and it still looks like this!!  http://i1240.ph.....CN0173.jpg

So, the wound is still 5" long and wraps over 50% of the way around his leg. It will take months to heal.

 

I met with another oncologist last week. She had consulted with several others before I even met with her. She was thinking we should probably restart carbo, but she also thought the wound was maybe the size of a quarter from the info she got from the facility where I was taking him for treatment. She had no idea it was as huge as it is. She decided she needed to rethink things a bit, and was going to go back to her team and tell them how large it was and see if they changed their opinion on treatment options. She was also going to consult with another onco and with a holistic doc. I will speak with her about that tomorrow.

 

But, as of now, as I understand it, here are my options:

I could restart the carboplatin.

1) If this was an administration error we should be ok.

2) If this was some type of odd idiosyncratic reaction in Duke and it happens again, he will have to be put down.

If I am understanding things correctly oral chemo is not an option at this time because it greatly inhibits the healing process. Apparently carbo IV does not. So, oral is not an option yet and won't be until the wound heals which could be several months. (Although we are *finally* doing laser and other things to try and speed the healing. Thanks to my regular vet who is amazing.)

But... chemo may not be very effective even if I do restart because it has been so long between the last administration and any potential future administrations (although we would probably restart this Wed). Apparently cancer cells get smart quickly and so they may well have learned how to multiply in spite of the carbo given the fact he had 3 earlier treatments and they have had 6 weeks to get smart.

 

Or... I could stop. And just let Duke be a dog. And enjoy whatever time he has left. And wrap and rewrap his leg while he stands there without making a fuss. And cry because he got so screwed. Osteo, then an extravasation, and then denied treatment which shouldn't have been denied. (And so I play the "if only" game and drive myself nuts.) 

Duke is feeling OK/pretty good considering. He is still on some pain meds and they make him kind of lethargic. He is happy sometimes (think mealtime! 🙂 and is able to put weight on his front left leg again.

I know you can't make the decision for me.... but can anyone offer any thing(s) I should be considering that I might not be? I'm sure there are plenty. Has anyone restarted chemo after a long lapse like this? I won't even ask "What would you do?" because that isn't fair. 

As much as I've wanted to be aggressive and provide Duke with the best opportunity for as long a life as possible, I think I'm leaning toward not taking the chance on further chemo given he could have a bad reaction (although I totally think this was an administration error) and given that it may not be helpful even if he does tolerate it. Maybe it is time to quit poking and prodding him. If they do move forward with chemo they will use an IV catheter (ouch!) not just a butterfly needle so it will be painful.

Thoughts? Thanks in advance. My brain is a bit muddled.

On The Road


Member Since:
24 September 2009
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2
23 July 2012 - 9:05 am
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I can't blame you for feeling so muddled. I would too, you've both had a ruff go of it.

You have to make a decision you can live with; if he has another bad reaction, will you be OK with that? If the cancer comes back sooner despite a successful chemo, how will you feel? It sounds like your heart is leaning in one direction.

Chemo is always a gamble, sometimes the stakes are higher for some dogs than others. No matter what, keep in mind, there are no guarantees.

Why not have a talk with Duke and see what he wants? Spend quiet time together, look into his eyes and ask him if he wants to continue. If you be still and listen, you just might hear his answer.

For now keep in mind that you are absolutely doing the best for Duke, and no matter what you decide to do or not do, he understands that. 

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

On The Road


Member Since:
24 September 2009
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23 July 2012 - 9:07 am
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Just a thought, if you are OK with the idea of consulting an animal communicator, Stacy K of All Spirits  Healing can also help you learn to communicate with Duke to better understand what he wants. 

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

dukez
4
23 July 2012 - 10:39 am
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Funny you should say look into his eyes. He never makes eye contact unless he is in trouble. But this morning he has been making eye contact - and I have been having that conversation with him. As I sit here sobbing I think he has given me his answer and permission to stop. In fact, I think he has given me even more permission than just that. I think maybe he has had enough.

 

There has been a lump I have had my eye on that some of the docs we have seen have ignored and others I have forgotten to mention it to. I wasn't clear if it was a mass before, but it seems much larger today and when I press on it he looks me in dead in the eye like "Yes, Mom... that's what it is." And I've been thinking over the past few days he doesn't feel well. I know I said he was feeling OK in my original post last night, but maybe that was wishful thinking. And, I think this is a different "doesn't feel well" than just meds and med side effects. He is still eating so that's something. I'm afraid his time is very near. And I can hardly stand it.

 

We see his regular vet this afternoon. I'll see what she has to say. Currently I am too broken up to even call the other onco like I am supposed to do today. Maybe later. 


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22 August 2008
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5
23 July 2012 - 12:57 pm
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I am not sure that I would do chemo again until that heals.  What about an NSAID or artemisinin ?  Are you doing raw honey bandages?  If so that should heal within 1 month. I would also add Power Mushrooms to help stimulate immunity (if your oncologist gives the okay).

Pam

dukez
6
23 July 2012 - 4:17 pm
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Thanks for weighing in Pam. I'll talk to our new onco soon. I'm waiting on a call from her. My regular vet didn't think the lump was significant because it wasn't hard and she said osteo is a hard cancer. So that's good!

I think I'm done with carbo, at least for now, and will try alternative things like the mushrooms, try the K9-Immunity again, and ask again about arte. I think I was told that artemisinin is an antiangiogenic agent and those are more likely to slow healing, as opposed to traditional chemo. So, I think she is not in favor of that. I didn't know Metacam (NSAID) could help healing. ? I took him off that over the past week. I'll get him back on. Besides which, I think it is hurting him a little more than it was and maybe that's why he isn't feeling well.

We are starting to really get aggressive on getting this wound healed... thanks to my regular vet. Given what you say and the results my vet has seen with the laser maybe this bad boy really will be healed in a month. And Duke will still be with me in a month. I can only hope. I will say the very top and bottom tips of the wound have closed over the course of the last week. I think I'll start using honey on the days I change the bandage, and on the days my vet does she is using the laser and some gel that is supposed to encourage the production of collagen. (I want some of that! 🙂 She talked about using insulin mixed with some other product but she doesn't have the second one on hand. I have not done honey because the place I was going to kept telling me not to. I've pretty much moved my care to other places and will start doing it.

I'm feeling a little better this afternoon. My vet seems to be wanting to keep going on getting this healed, although I know she wouldn't do further carbo if this were her dog. She'd be done.

I'm rambling. Sorry. My brain is mush.

Sydney, Australia
Member Since:
13 September 2011
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7
23 July 2012 - 4:49 pm
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I'm sorry you have had such a rough time of it.  That wound looks soooo painful.  We were lucky with chemo, no serious side effects.  But, after 1 month on Palladia (when lung mets showed up) Magnum had some terrible tummy upsets. I immediately stopped it and decided we wouldn't continue, that quality of life was more important than quantity. Unfortunately for Magnum the mets to other bones brought her battle to an unexpected halt just a couple of weeks later.  I'd give anything to be able to take away the pain she endured from the tummy upsets.  It was as bad as the pain of bone cancer.

 

Sending you lots of healing thoughts as you make your decision.

 

Karen and Spirit Magnum

Magnum: 30th May 2002 to 5th May 2012. Lost her back left leg to osteosarcoma on 5th Sep 2011. Lung mets found on 20th Mar 2012 but it was bone mets in the hip that ended her brave battle. Magnum's motto - "Dream as if you'll live for ever, live as if you'll die today" (James Dean). Loyal, loving, courageous and spirited to the end. My beloved heart dog, see her memoirs from Rainbow Bridge ...... http://princess.....pawds.com/

dukez
8
23 July 2012 - 5:35 pm
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Eesh... sounds like you had a rough time of it too. I guess most of us have. Poor baby that it made her tummy hurt that much. Sounds like you made the most compassionate decision for her. I'm hoping I can do the same for Duke. Cancer sucks. There is just no getting around that.

Thanks for your thoughts. I'm hoping I can figure out what's best for my handsome boy - not too aggressive but not too complacent.

San Diego, CA
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29 October 2010
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23 July 2012 - 5:35 pm
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I'm also so sorry that you and Duke are having to go through all this. It's a bad enough journey without the extra added complications.

I hope you can let go of worrying about not finishing the chemo. From what I've seen here on this site, it sure seems like a c**p shoot. Some dogs do great and live a long time after chemo, others do great and live a long time w/ no chemo. Some dogs pass way too soon even with the chemo. Others pass early w/out it. I know the onc says the stats show that dogs have a longer survival time with chemo... but I honestly wonder how they got those stats? Do the dogs that don't have chemo get tracked as thoroughly as the dogs that do??

Anyway, you never have to apologizing for rambling here. I'm pretty sure we've all done it at one point or another. It's what we're here for! Hang in there. Sending pawsitive thoughts out to Duke and to you.
Jackie, Angel Abby's mom

Abby: Aug 1, 2009 – Jan 10, 2012. Our beautiful rescue pup lived LARGE with osteosarcoma for 15 months – half her way-too-short life. I think our "halflistic" approach (mixing traditional meds + supplements) helped her thrive. (PM me for details. I'm happy to help.) She had lung mets for over a year. They took her from us in the end, but they cannot take her spirit! She will live forever in our hearts. She loved the beach and giving kisses and going to In-N-Out for a Flying Dutchman. Tripawds blog, and a more detailed blog here. Please also check out my novel, What the Dog Ate. Now also in paperback! Purchase it at Amazon via Tripawds and help support Tripawds!

dukez
10
23 July 2012 - 8:21 pm
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Thanks for the kind words Jackie. I decided the carbo c*#p shoot is no longer for us. And despite my new onco recommending we go forward with carbo from a scientific point of view, from a personal point of view she completely understands my decision to hold off for now. Said, in fact, she would sleep better at night with my making that decision. If I had been working with her weeks ago I would have gone ahead, but... something has changed.

Pam - just wanted to say that I stand corrected. She did not say arte was an antiangiogenic. She is trying to get a better answer about whether we could start that. Hopefully we can. And she said go for it with re. to the power mushrooms. (I had already ordered them before she gave me the go ahead.) =)

Thanks again for the encouragement.

On The Road


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24 September 2009
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11
23 July 2012 - 9:13 pm
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Your brain isn't mush, but even if it was, we're here for you regardless.

You sound much better now, and it sounds to me like you listened to your heart, and Dukes. That's good, that means you are making progress, which is completely opposite of complacency, so please don't worry about that OK? 

Now it's time to live life to the fullest. Enjoy your time together, no matter how long you have, always keep in mind that Duke isn't keeping track on a calendar the way humans do. All he wants is to enjoy your time as a pack, right here, right now. Nothing else matters for this moment, so get out there and enjoy life, together. 

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

Caledonia MI
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13 October 2011
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24 July 2012 - 6:00 pm
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I would skip the carbo too. I feel like it did nothing for Levi but make him feel poopy. One supplement that i loved was "Stasis of the mansion" i feel like it really perked him up. Levi lived with lung mets for 6 months with all the supplements I was giving him...i hope Duke heals soon and you can have some great time with him for years to come.

Levi was diagnosed with Osteosarcoma 7-7-11
Ampuversary 10-14-11
Lung Mets Discovered 1-4-12. Chemo seemed to not be working so we switched to Artemisinin and other supplements. In May, Levi developed a sinus infection and started having seizures. The cancer had moved to his brain. We let him go 6-26-12.


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24 July 2012 - 9:13 pm
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I think the artemisinin is pretty harmless.  The Metacam actually may be antiangiogenic as far as the cancer goes and should not delay healing.  I do not want to step on your vet's toes but I have seen honey heal some pretty deep and nasty wounds and I do not think it should interfere with other treatments.  The laser therapy is great!

Pam

Portage Lake, Maine
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8 December 2009
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25 July 2012 - 6:03 am
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I'm sorry you have to deal with this with your pup!  Wow, poor guy 🙁

Food for thought on the alternative therapies...you could try homeopathics with him by doing a phone consult with Dr. Charles Loops.  Several dogs on here are treated by him for various types of cancers.(including my own dog as well).

http://www.char.....psdvm.com/

Good luck and I hope that wound heals up quick!!

Tracy, Maggie's Mom

Maggie was amputated for soft tissue sarcoma 10-20-09

Maggie lost her battle with kidney disease on 8-24-13

http://maggie.t.....t-24-2013/

On The Road


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25 August 2012 - 9:23 am
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Hey Dukez, how you doing? It's been a while, drop us a line when you can, we are thinking of you.

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

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