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Regrets about Chemotherapy
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csmpez
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22 January 2010 - 7:41 am
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I see we have a post about “regrets about amputation” but I don’t believe I’ve ready a post about “regrets about chemotherapy” and if there are any? We’re still trying to decide which way we’re going with this and it is difficult for us, but for our vets/surgeons, they don’t see the apprehension on moving forward. So anyway, back to the topic at hand, any regrets about doing chemotherapy? Thanks a bunch.

Scott, Charlotte & PEZ

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22 January 2010 - 8:28 am
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Scott, Charlotte & PEZ

Absolutely no regrets for us! For us there never really was any decisioin on the course of our treatment after discovering the Osteosarcoma. Only the amputation followed by a very aggressive chemotherapy treatment protocol would give us the chance to return Cherry to the quality of life that had defined her eleven years before the cancer. Her first treatment actully occured just hours after her amputation. However, I also realize that chemotherapy is a little more difficult decision and depends on the type of cancer, the spread, the availability, and any complications. Cherry really did not suffer any nausea, vomiting or drop in blood cell counts that can accompany chemotherapy. However, she did have a total loss of appetite due primarily to the chemical taste. Even I could “taste” the chemicals as I kissed her, but through a number of techiniques we were able to make it through. The vast majority of the 405 days that followed her amputation were great. The sparkle returned to her eyes and while different, she enjoyed a wonderful quality of life. I was able to hold onto my Cherry for those 405 days and will carry those memories forever.

As I said, the chemotherapy is a different choice because any results are much more difficult to measure while the amputation removes the pain immediately. As soon as Guide Dogs for the Blind posts their 2009 fourth quarter newsletter I will be posting the story of Fallbrook who had an extremely difficult time with chemotherapy, but at the urging of the doctors GDB followed through. The result was five full years of cancer free life. It just goes to show how different the results for very different initial conditions.

Spirit Cherry's Dad – Bob

Winnipeg
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22 January 2010 - 9:21 am
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Hi Pez

Thanks for posting this topic. I mean to write something up with my retrospective take on my dog's case (that means you will get an earful here!). Tazzie had subcutaneous mets, which are supposedly very rare. This plus what I have seen with a few other dogs who developed mets even earlier has influenced my view on the course of action I would follow if I were to it again (hopefully I won't have to).

The oncologist did chest x-rays but no other scanning before surgery or chemo. They said it was so rare to show up in other 'long bones' that it was not worthwhile x-raying. We started chemo 2 weeks after surgery. I did extra chest x-rays to alleviate those worries, but nothing else. Then I found a subcutaneous lump (yes, it was an OSA met) 8 weeks after surgery, the day before his third chemo. So we never knew if that was present at the beginning or showed up during the chemo. We removed the lump once, but it was the size of a watermelon another 12 weeks later and finally brought too much pain for him to go on.

What I would do before chemo if going through it again: I would want scan other body sites for potential mets. (Knowing condition of heart, kidneys and liver also does not hurt re: surgery). I'm not sure the type of scan (ultrasound or CT scan or MRI). Obviously cost is a huge issue here. Ultrasound is not that expensive and can give you baseline info on the liver, kidney and spleen, all sites where many of my cohort seem to have had problems (e.g., Shilo, Raven). US does mean cutting hair which might not re-grow any time soon if the dog takes Adriamycin for chemo. CT or MRI would be great but I bet they cost a bunch. Once Tazzie's SQ met was found, we did an ultrasound of the internal organs and found two 'suspicious' nodes in the spleen. But apparently the spleen is a bit of a trash bin so who knows what these were. A baseline US (which is not that much more expensive given the cost of amputation) would have let us know whether it was new and therefore probably cancer. That matters so we would have know if we had one met or many mets.

Okay, so maybe we were the odd ones out. But from what I have seen around here, we aren't. Shilo, Jake, and others who had surgery around the same time or even more recently (Tazzie was in July; those dogs came after us) developed mets within 6 to 8 wks and they were not lung mets, although Shilo might have had those too Sad 

If Tazzie already had mets when we began chemo, would we have taken that road? Probably not, given they stopped chemo once the met was found. That of course would have made those 9 weeks during chemo higher quality time. We also probably would have figured out that palliative radiation on the SQ met was appropriate at a time when he could have benefitted from it. Metronomics might have been appropriate if we had known he already had a met. At least we could have monitored growth if we proceeded with chemo.

You mention high liver enzymes. That would make me more tempted to get the liver scanned in case anything is present there and just to assess its condition. From what I understand (I could be wrong here), liver enzymes can be high due to changes in the bone such as cancer. I don't think any of this affects the amputation decision, but it might affect what you do before deciding on chemo. (Which liver enzymes are high?

Type of chemo: My oncologist pushed for her preferred form of chemo (in this case, she prefered to alternate cisplatin and adriamycin). Both those drugs have potentially serious side effects. If I were to do chemo again, I would opt for the one that has lowest possibility of side effects. This seems to be Carboplatin for most dogs. (Having said that, my Tazzie had a kidney history and seemed to have kidney problems after his one Carboplatin – but I have not heard of a kidney problem for anyone else from Carbo.)

There is a lot to be said for just letting your dog recover from surgery and get back to being a Dawg! Chemo should not make that much of a difference, but it will mean regular visits to the Dr. to check the blood and do the chemo. Depending on the dog, she might or might not be lethargic for a couple of days.

Pre-surgery: If I had a giant breed known to be susceptible to heart issues (e.g., Pyrenees, Dane, St Bernard, English mastiff), I would do a heart US before amputation. It seems we lost some of our giant friends due to heart problems within a couple weeks of surgery (e.g., Hori and were Angus's or Peanut's problems heart related?). Pez is not a giant (he has a giant personality but not in sheer size) so this does not apply

Well, that is my first book for the day!


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22 January 2010 - 9:27 am
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Pez, I can tell you that most dogs handle chemo very well with minimal side effects.  I am not an oncologist but we do quite a bit of chemotherapy at our practice (mostly for lymphosarcoma) and about 90% of our patients have no issues.  The most common side effects are nausea and diarrhea but we always give an injection of a drug called Cerenia about 45 minutes before a chemo injection and clients always go home with a supply of metronidazole and sucralfate to use “just in case”.  I find it is much better to prevent problems early rather than let a dog get sick from the chemo drugs.

There are a few different IV protocols for treating osteosarcoma.  The most common one involves giving carboplatin every 3 weeks for 4-6 injections.  This drug is fairly benign but can cause nausea or low white cell counts.  Some oncologists use another drug called Adriamycin (also called doxorubricin) alone or in combo with carboplatin.  This drug has a few more side effects including damage to the heart muscle and must be given carefully because if it goes out of the vein it will cause the tissue to die and the skin and muscle can be permanently damaged.  This is very rare since vets using this drug are well aware of this.

You could also consider metronomics (oral chemo) given at lower doses along with an NSAID like Metacam to help limit metastasis of the tumor.  There are no studies that I know of looking at longevity with metronomics alone.  Most oncologists will use metronomics after standard IV chemo has been given but some dogs like Polo have started it in lieu of IV treatments and have done well.

I have only seen 1 dog die as a direct cause of chemo.  This was a little 16 year old Sheltie with lymphosarcoma in his mouth.  The oncologist gave only 2 doses of an oral drug called CCNU (lomustine) and his bone marrow was permanently damaged. He started bleeding spontaneously so had to be euthanized.  The really sad part is that his tumor went into remission.

So this is a long post but in my experience if you can afford it I would at least try IV carboplatin.  If Pez does not handle it well you can always stop the treatments.  If money is an issue then I would go right to metronomics .

Good luck with the amputation surgery.  I'll bet Pez will do just fine!

Pam

My heart lives at Rainbow Bridge
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22 January 2010 - 11:30 am
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I, too, was VERY skeptical about the chemo, so I know what you are feeling.  Once Trouble's amputation was done and the pathology report was back, and with all the pre-surgery x-rays, and bloodwork behind us, our vet was certain based on all these factors she should have chemo.  Her bloodwork was great, her x-rays showed no mets, the pathology came back as a 'contained' so all indications were in our favor.

I was still hesitant.  The vet and my husband convinced me to give her one treatment and see how she reacted.  We could stop after that one if I felt she wasn't handling it well.

All that said, it was a great decision for us.  Trouble had minimum side effects, and I feel it has helped get her to this 14 month mark.  Each case is different, and you must follow your heart.

Shanna & Spirit Trouble ~ Trouble gained her wings 3/16/2011, a 27 1/2 month cancer survivor, tail wagging. RIP sweetheart, you are my heart and soul.  Run free at Rainbow Bridge.
The November Five - Spirits Max, Cherry, Tika, Trouble & Nova. 11/2008 - 3/2013 An era ends as Queen Nova crossed the Bridge.

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22 January 2010 - 2:34 pm
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Good question!  Emily only made it 5 1/2 months after amputation and that was with chemo.  I can't say I regret the chemo because I feel like we gave her every chance at life and with the exception of low white blood cell counts Emily didn't have any other problems.  Everyone at OSU treated her like the queen she was so she liked going and getting a full day of their attention.  What I do sort of regret is putting her on the drug study.  If we had not I might have pushed for more treatments or started her on K9 Immunity and maybe she would have loved longer.  However, the drug study has a higher impact than just my girl so Im glad I didn't know what the outcome would be at the time we enrolled her in the drug study.   

I've also daydreamed about going back in time and running over her leg so it would be amputated before she got cancer so you can't really go by me.

Debra & Angel Emily

Debra & Emily, a five year old doberman mix, who was diagnosed with an osteosaecoma. She had a right rear leg amputation on May 19, 2009. On November 10, 2009 she earned her wings and regained her fourth leg.

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22 January 2010 - 2:40 pm
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To clarify, my regrets are not so much about having done chemo as about failing to obtain more information before starting chemo. Perhaps we should add how long our dogs survived to our posts here. Mine developed mets 8 weeks after surgery, and lived to 4.5 months post-amp. Other dogs, some of which had chemo, had surgery after us and developed weird (non-lung) mets and died more quickly, e.g., Shilo. I can't remember if Shilo had chemo – I think she did.

If my dog had reached the “median time” of 12 months post-amp with chemo (Cherry, Tazzie I, Trouble all exceeded that average, and still is in Trouble's case), I probably would not see a need for having had additional tests at the start. But it does not appear as though my dog is particularly unusual in developing non-lung mets really early (even if his SQ met was kind of weird). The ultrasound of liver, kidneys or spleen could be useful for a few reasons unrelated to cancer, as Pam indicated. I just think it would have been nice to have that information so we could have selected the best course of treatment. Plus we could have avoided wasting the time we had left with those post-chemo days in which the dog might not feel horrible, but does not feel 100%.

My heart lives at Rainbow Bridge
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22 January 2010 - 3:21 pm
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I totally understand TazzieII.  The more information you have to help make a decision, the better your chances for having no regrets when the journey ends.

All of this is why it is so important for us to share with each other and learn from each other.  Just like you, we all want Pez to have the very best journey he can possibly have.

Shanna & Spirit Trouble ~ Trouble gained her wings 3/16/2011, a 27 1/2 month cancer survivor, tail wagging. RIP sweetheart, you are my heart and soul.  Run free at Rainbow Bridge.
The November Five - Spirits Max, Cherry, Tika, Trouble & Nova. 11/2008 - 3/2013 An era ends as Queen Nova crossed the Bridge.

Linden, MI
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22 January 2010 - 3:47 pm
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We are in the same boat as Trouble, here with Nova.  I do not regret chemotherapy one bit.  But it's hard to say that if Nova died during or immediately after chemo, I am not sure that I wouldn't have had regrets.  Nova has survived 14 months (and counting)… she and Trouble were diagnosed within days of each other.  4 rounds of carboplatin with no side effects whatsoever.  I was offered adriamycin too (one of the protocols was to rotate adriamycin and carboplatin), which was presented to me as a “more affordable” option. But after reading so much about the horrible heart-related side effects of adriamycin, I decided against the adriamycin.  I was not taking that risk, just to save a few bucks, even though I had always been told that Nova (Great Dane) had a very strong heart.

We started with cytoxan (metronomic chemo) immediately after, combined with piroxicam, but Nova did not tolerate the cytoxan well, so she has just been on the piroxicam since late january 2009.  The last time we had x-rays done (June 2009) they were all clear, but I have opted to not do them again unless she starts exhibiting symptoms.  Bloodwork has been “perfect”, the last time was in December.

I have also been very vigilant about feeding Nova a grain-free “anti-cancer” diet and feel strongly that it has contributed to her survival.

Sue and Nova

Dane Mom Sue at nova.tripawds.com and Mom to Beautiful Great Dane Queen Nova, a Blind Tripawd, who kicked cancer's butt from 11/08-03/13. The Queen is Spirit Nova now, but her legacy lives on here at Tripawds!

The Rainbow Bridge



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22 January 2010 - 4:48 pm
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Scott, Charlotte & Pez,

Great topic, thank you for starting it. We can totally understand the feelings you are having about whether or not to do it.

When I got sick, we lived in a small rural town, 6 hours (each way) from the teaching hospital where I had my surgery and where I could get chemo treatments . My docs at UC Davis said that they would work with my local vet and have her administer the chemo if she was willing. But while she was a great vet, my pawrents did not feel comfortable proceeding like that. They considered making the 6 hour drive for chemo, but with the poor prognisis I was given (4 months, max), did not want what was supposed to be my last few months on earth to be spent in the car, far from the kind of care they would have liked, should something go wrong. That was totally not what I was all about. I just wanted to have fun, darn it! So we opted not to do chemo. And instead, we hit the road and went on the road trip of our lives.

Seventeen months later, while still on the road, we learned that I had mets. My Mom had some huge moments of regret about not doing chemo at first, and she cried a lot But I did my best to convince her not to look back, and just move forward with what we could do at that point, which was metronomic, low dose oral chemotherapy. Had we known about that type of chemo from the get-go, we might have done that first. But there was no point in trying to re-live the past, for it cannot be done. It’s also very un-dog-like, which I am just not about.

So I guess what I want to add is; to honor Pez, whatever you decide to do, please don’t hold regret in your heart if the outcome isn’t what you hoped for. If it is, wonderful! But if things take a different path, remember all the things that Pez has taught you about living life to the fullest, and let go of the “should haves” and “would haves.”

And remember, everyone here will support your decision no matter what.

It's better to hop on three legs than to limp on four.™
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krun15
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22 January 2010 - 4:50 pm
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First off Maggie has mast cell cancer, there are not too many regulars here dealing with this.  From what I know about  mast cell tumors (MCTs) and mast cell cancer it is often not as aggressive as OSA, and in general the prognosis for dogs with MCTs, especially cutaneous ones, tends to be better.

That being said Maggie's second tumor in her leg was more aggressive than the cutaeneous one she had earlir, and it was not able to be removed without taking her leg. I chose to spend dollars up front to do a lot of tests.  Mast cell tends to spread in the lymph system, and shows up in the liver, spleen and bone marrow, it doesn't usually spread to the lungs.  If the oncologist had seen spread I probably would not have done the amp, and just kept her comfortable.  Because she appeared clean I went a head and had the surgery, thinking that would be the end of it.

Then the test results came back that there were lots of cancerous mast cells in the lymph node removed with the leg.  Faced with that I felt obligated to do chemo- I had already put her through the amp.

The regret I do have is that I was not prepared to deal with the cancer diagnosis after the amp- I had let myself believe that we would be done and Mag would be fine.  I made the right decision as it turned out, Maggie has far, far, far exceded the 6 to 9 months she was given. But I didn't really ask about or learn about options.  I wanted to get the most time, and without chemo the vet told me she might have only a couple of months.

So my advice is learn all you can, research and ask questions, find out all your options, then make the best decision on treatment that you can.

Karen

Here and Now


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22 January 2010 - 5:04 pm
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Jerry lived two years without us putting him through IV chemotherapy after his amputation, and we often wonder how he might have fared if we had. But do we have any regrets about not opting for the chemo treatments? Absolutely not. Jerry taught us to never regret. Shouldng all over ourselves about how he coulda… if we woulda… will not change anything, and only cause unnecessary stress. We enjoyed our time with him to the fullest after his amputation, and were prepared for the consequences of deciding against chemo, but very fortunate to have as much time with him as we did.

When we discovered Jerry's lung mets, we put him on metronomics with oral chemotherapy (Cytoxan). Again, absolutely no regrets there, regardless of cost. We believe it helped him enjoy life as long as he did.

Thank you for starting this topic. It is certain to help others get a better picture of what to expect when facing the same difficult decisions we all have with our canine cancer heroes.

Winnipeg
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22 January 2010 - 10:03 pm
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I am glad that Jerry and family spoke. Definitely no room for wouldas and shouldas there! It is hard to imagine you would have obtained any better result than you did in any other way! 22 months is amazing (she says wistfully but with great appreciation)!

Pez – I don't think you said what kind of chemo the onco wants to use: Carboplatin, Adriamycin (Doxyrubin) or something else? As you see, most people here root for Carboplatin to lessen potential side effects, but there are different regimes out there.

In our case, we did not even discuss or worry about chemo until 2 weeks after the amputation. But then the onco was out of town as was usually the case Mad. Chemo wasn't really something I could even consider until Tazzie became more mobile. So I don't think you should spend too much time worrying about that decision now.

To be fair to the memory of young Barney, I thought I should draw attention to his blog from Jan 1. I do not mean to alarm you, but I know you want any information you can obtain. Amputation recovery went well, but he succumbed after the 4th chemo (doxyrubin). I don't know if they really know why he died. Barney lived in the UK, so who knows how the treatment compares. But it is consistent with what the preference of others around here for Carboplatin.

http://bigbarne…..ipawds.com

I am not against chemo, and if I had a dog with no prior kidney problems, I'd probably go the Carboplatin route or just get the dog on metronomics right away. Personally I would check out the liver and other organs with an US before using regular chemo, but I guess I said that one a few times already.

Kirkland, WA
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22 January 2010 - 11:09 pm
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Everyone has shared great personal experiences, but I will add ours just for more information 🙂  Jack was diagnosed with high grade, highly productive osteosarcoma.  We did amputation right away, and started chemo 2 weeks afterwards (after his stitches were taken out).  We were advised to do 6 sessions 3 weeks apart, but had to stop after 4 sessions due to finances (we did adriamycin which was almost $500 every 3 weeks…not sure of the cost of other protocols).  As you have seen, many other dogs have chosen the chemo route and have developed mets after a handful of months.  There are other dogs who have chosen chemo and have celebrated 1 year or longer.  We will celebrate 8 months on Feruary 3rd (assuming Jack will stick around till then).  I guess the point of the story, is that every dog will fight the disease in their own way.  Chemo, No Chemo, Metronomics, whatever it is you choose, someone on here has probably done it.  And don't forget what Bob always advises…remember to treat the spirit.  Happiness boosts the immune system, which is super for our cancer doggies 🙂  Decisions are difficult, so I wish you strength and calmness while you decide which way you would like to go 🙂

<3 Laura and JackJack

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23 January 2010 - 10:53 am
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It was recommended that Yoda get 4 Carboplatin treatments.  He started a little over two weeks after his amputation (after the sutures/staples were taken out).  Before the final chemo though, they did an extra x-ray just to be safe, because he had developed a little cough.  That cough went away just a couple days later, but they did find mets and advised not to do the fourth treatment, and that his best options would be to try a different chemo drug (another four rounds) or Palladia.  Neither option was affordable, unfortunately, so we just lived it up for his remaining time.  Not sure that chemo did Yoda any good, but there was no way to know whether it would or not, and it did him very little harm.  I didn't see any adverse reactions at all after his first treatment.  After his second, he did have an allergic reaction where lots of gunk start draining out of one eye and then the other.  The oncologist said she'd never seen that reaction before, but an ointment treated that just find.  I did have to continue it as long as he was getting chemo and probably about 3 weeks or so after his last one.  He didn't have any vomiting (never really had lethargy or loss of appetite) until his third treatment, which ended up being his last.  I had Cerenia pills on hand though, and he was fine by the next day.

Yoda&Mom united: 9/5/06 …….… Yoda&Leg separated: 6/5/09……… Yoda&Leg reunited: 10/14/09 ……… ……………….………….………….……. Yoda&Mom NEVER separated! …………………….….……....….…… Though Spirit Yoda currently free-lances as a rabbit hunting instructor for tripawds nationwide

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