Caring for a Three Legged Dog or Cat
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Tazzie had her RF leg amputated and her neck muscles on the right are bigger than the muscles on her left but she also has an enlarged muscle over her left ribcage. I'm sure that these muscles are hypertrophied (bulked up) from extended "abnormal" use due to being a tripod. Her back muscles were getting quite hard until we started acupuncture a few months ago and now those are improved.
It does not sound like the rib lesions were real on the rads and it is good that the lungs are clear. The splenic nodules could be benign (common in older dogs) so I would not jump to a conclusion of OSA there yet (possible but very rare). Rounded liver borders also do not mean much unless liver values are up a lot so the blood results will be important.
If the oncologist does not find any more soft tissue lumps and agrees that the rads are okay then I would remove the lump and get a biopsy. If it is OSA I would start by changing chemo and mitoxatrone seems reasonable and I think it is safer than Adriamycin (easier on the heart and veins but can still lower white cell count). Metronomics would also be possible and he should have less bladder issues since he is a boy. I can help you with artemisinin if you need info on that. It is the safest thing and easy to get but unknown if it helps.
Pam and Tazzie
Hi Pam
Gosh - we (local vet and person who did the ultrasound) seem to assume that the splenic nodes are OSA, but my vet has not talked to the oncologist yet. One of the nodes had a bright white appearance in the center, consistent with osteoblasts, and the ultrasound vet thought it was a common place for OSA to end up (I interpreted that as meaning that it did not affect the dog clinically since I have never heard of OSA mets to the spleen). IF it is a distinct possibility that the spleen lumps might not be mets, that would change things.
I am confused about possible chemo suggestions that have been raised (by oncologist and you): Maybe the current protocol is working but the lump over the hip was just there to start and grew (I don't think it has changed much since I found it 8 days ago). Or is it more reasonable to just assume it is new and that his form of cancer is not responding to the chemo? If we switch now, does that mean we go for another 5 treatments?
As an aside, don't they test human cancers after surgery with chemo drugs, so they can determine the drugs most effective on an individual's particular cancer?
Isn't metronomics hard on the kidneys, or do you think that is something that can be observed? We seem to take his blood pretty often these days. And don't we have to wait until he is off of chemo to begin metronomics ? I assume it has to be EITHER chemo or metronomics - that they are not safe taken together. Is that correct? Tazzie has even been off of metacam for the last 10 days because we are seeing if his creatinine will come down without it.
I would really like information on what (are they herbs?) to obtain and dosing for artemisinin . I was reading about it last night and see there are 2-3 related products (herbs?) plus different thoughts about whether to give them together or apart. It sounds a bit complicated so I'd love specific advice on products, timing and dose (currently a 33.5 kg dog which is where he should stay). It seems the safest of everything we are considering, even if we aren't sure if it helps. I should also find out when artemisinin cannot be given, e.g., it cannot be used with radiation but is it to be avoided when taking any drugs?
Your post was encouraging and very constructive, and begins to help to clear the webs.
Susan
Susan,
I am glad to hear the chest x-ray looked good and the ribs are probably okay. Just wanted to let you know that I am still praying.
Pam, we are so lucky to have your knowledge and encouragement. Thank you.
Debra & 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.
Last medical update (to help Pam make sense of all the details I have passed along):
Bloodwork came back. One liver enzyme is slightly elevated, just over the normal range. Unfortunately I don't know which one it is, and you probably need that information. The other liver enzymes were okay. However, given he has never had an elevated liver enzyme before (they were splat dab in the middle of the range until this test) and the questionable ultrasound, I am a bit concerned.
Creatinine is still high, just over the normal range, so it stayed there even after taking him off metacam for 10 days. The jump in Creatinine occurred immediately after the first Carboplatin treatment. Of course we made diet changes a few weeks before then (high protein, K9 immunity , fish oil, and now C0Q10 or whatever that heart thingy is called), but the vet suspects the Carbo, combined with his early-life kidney issue. Other kidney values and the ultrasound look good, so she is not too concerned here, but it would be nice to bring it down. She is thinking of switching him from metacam to Rimadyl. But if the liver enzymes continue to increase, I don't want to wonder if it is the Rimadyl vs. OSA causing the change.
We will decide whether to remove the lump on Monday when the oncologist is back in the office, but currently are leaning that way.
Susan
Oh Susan,
how relieving to know the x-rays are OK.
Hope between you, your vet + oncologist + Pam you can sort out wich way to go from here.
Don´t forget that Hori got some acid/ulcerations beginnigns from Rymadyl/Previcox... maybe you can give Tazzie something that counteracts that part of the medicine.
Hugs and energy from down here!
Cecilia + Spirit Horacia
Spirit Horacia, Castaño, Olympia + human family Cecilia, Georg and Julia - - - Hori first diagnosed 8/6/09, ampu 8/12/09, run over the bridge 9/10/09 – We miss you every day dear girl!
Susan,
I would be very careful giving any NSAID with elevated kidney enzymes. That includes Deramaxx, Rimadyl, Metacam, Piroxicam, Previcox, Etogesic, Zubrin, and aspirin. I was afraid to give my Tazzie the Metacam due to her liver condition but luckily her recent bloodwork was still okay. The difference is that the liver is able to regenerate itself once offending drugs are stopped but sometimes the kidney can't. Also, once you have an elevated kidney enzyme that means that about 75% of the kidney is not functioning. Any protein in the urine? Adding enalapril or benazepril can help with that.
Since an NSAID is part of the metronomic plan I would not start that unless your oncologist is okay with it.
Artemisinin is still an option but I would also discuss that first.
The only way that you can know if the splenic nodule is significant is a fine-needle aspirate of the mass. If it is too small then you could monitor it and see if it changes on the next ultrasound. If this was my dog and he was feeling good I would still proceed with the mass removal and biopsy.
Pam and Tazzie
No protein in the urine and BUN is okay, and the ultrasound doc thought the outline and shape of kidney looked good. He just saw a bit of a rough edge that was consistent with past renal failure. The bloodwork is kind of where Tazzie was for about 6 months following the acute failure 7 yrs ago, although this time the CREA is not as high. CREA finally came down then, which was a huge relief at the time.
Since the OSA was diagnosed, we have changed diet and supplements, but the jump in CREA (from the high end of normal to the low end of high) coincided with the Carboplatin. That is, we did blood work the morning before Carbo and then 7 days later, and nearly every 7 days since for various reasons! Of course, the effects of diet changes and other supplements might have just happened to coincide with the carbo; we can't really tell but it is suspicious.
Does high protein in a diet also affect the liver? You (Pam) mentioned that you avoided a high protein diet for reasons of the liver.
Yes, if there is any liver or kidney dysfunction you should really avoid a high protein (45% or higher) diet. Tazzie's dry food has a protein content of about 25% although I do add canned chicken and cottage cheese as well as veggies so the actual amount is probably closer to 30%.
Pam and Tazzie
And I thought things were confusing before . . .
I heard via my vet from the oncologist today. This is all unfolding SOO SLOWLY. It was fine when Tazzie had his chemo treatment two weeks ago, because we could not remove the lump that week (although I suppose we could have skipped the chemo which everyone now thinks is useless and taken the lump out instead). But now I just want the darn think gone IF we are going to take it out.
Anyway, the oncologist thinks there is no point in removing the lump because of the splenic nodes. She also thinks there is no point in using the same chemo protocol or in starting a different one if the mets have hit both the spleen and sub-q (under the skin). Instead, she said metronomics or Palladia might be most appropriate, seemingly more in favor of Palladia even though it is not available in Canada but apparently we could somehow get it (although this information is second hand and I was a bit rushed and confused when we got to that part of the discussion).
I do not mean to be bull-headed, but I don't fully get the oncologist's interpretation or advice. I think the spleen nodes are probably mets, but I see the possibility that both Pam and my vet indicated: dogs over 5 often have nodules in their spleen; they might be something else. Plus, if the cancer had to hit somewhere, I'd rather it hit the spleen than the lungs (shouldn't I feel that way?). Personally I am more worried about changes we might be starting to see in the liver, although there is no visible mass at this point. I figure if it does hit the liver, we are more likely to see clinical signs than if it hangs around in the spleen for a few months.
To me, it makes sense to do what Pam suggested. Get the subq lump out to confirm whether it is a met or not (I think it might have gotten smaller in the last two weeks, but it certainly is not growing like fire the way the primary tumor did). I figure that we have no way of knowing whether these lumps were present before chemo began (7 weeks ago) or developed during the chemo. Presumably, the oncologist is assuming the latter. No abdominal ultrasound was done at that time, and it would have been easy to miss a little bump in his skin. If there were mets in more places or another bump appeared during the last two weeks, I think I'd feel differently.
But then, what do I know about these things? This is not a form of metastasis that has come up in our forums. Can't growth from this one lump on his back potentially be enough of a problem that we should get rid of it?
I think it still makes sense to proceed with whatever treatment is most likely to reduce the possibility of lung or bone mets, rather than to worry too much about the spleen at this time. But am I wrong? And what would the treatment be that reduces lung or bone mets: chemo, metronomics or Palladia? (By the way, I am not going to open up his whole stomach to remove the spleen, well unless he is otherwise met free next summer, but currently that seems unlikely!)
The oncologist did not discuss the alternative chemo drug, mitoxantrone, with my vet today, because she dismissed the idea of further chemo. My vet is not against the idea of removing the lump. She is also receptive to different courses of treatment. If we proceed with chemo, she'd probably think it best to switch. But I don't want to start from scratch and give an additional 4-5 treatments (he still has 3 left if we follow the original protocol).
Do you think most oncologists would feel similarly to this one? Should we seek out another opinion?
I asked whether any damage to the muscle would result if we removed the lump, in case I am underestimating what would be involved with the surgery. The vet indicated that it appears to be in the skin, but to get a clean margin, a bit of muscle might have to come. . Obviously that is impossible to judge until they open up the site. She did not expect it to affect his mobility. I just don't want to set Tazzie back into recover-from-surgery mode, although it would require a general anesthetic. He is doing extremely well right now, really well.
As for whether we should go with the same chemo, a different chemo, metronomics or Palladia, I guess I'll have to write a shorter post someday about that. The oncologist did mention an updated protocol for metronomics and gave my vet a reference for that, which she is digging up.
Susan
Can they do a needle aspiration on the lump? I think I would want them to remove it for a biopsy if they cannot just aspirate it. I don't understand how you are suppose to make decisions based on finally hearing from the oncologist through your vet. I don't know what else to say except I would want to know. Good luck, Susan and Tazzie. Still praying.
Debra & 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.
It's so hard to say what other oncologists would think without talking to them. I wish I had more answers for you.
When you get the updated metronomic protocol information, let us know oK?
Glad to hear Tazzie is doing so great!!
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Hi Emily
It was determined that the lump (sub-q, I thought it was over the right hip, but now it seems to have slid rather to the right, although I doubt such a change is possible!?! Is it?!?) was sarcoma two weeks ago. It is most probably an OSA met, but they cannot be 100% certain without removing the lump (the alternative is that it is another primary cancer). So we did all the exams, ultrasound and chest-x-ray last week. The idea was that if Lots of Lumps were found, we would not remove the lump (probably) because mets would be all over the place so there would be no point in removing one.
But we only found two suspicious in the spleen. Sure, I'd rather not to have found those, but to me it does not appear that the mets have taken over (sure, we all know those cells are out there) to a point where we expect to see clinical signs in the near future (this is me talking - no veterinarian or oncologist has weighed in on this topic).
What harm is there in taking it off? Well, it is surgery and a general anesthetic (and he will not swim for two weeks until the stitches are removed). But I guess that is a pretty low degree of harm given the added certainty of diagnosis and removing what seems to currently be the primary source of mets. Having said that, his sub-Q lump seems smaller. I wonder if these things can burst and send out their cells.
My poor vet is having to do far too much work, in areas (oncology) that should really not be her job.
I had hoped we could time the removal so that he could potentially continue with the original chemo, IF we want to continue with chemo. I do not know enough to write the chemo off when it comes to lung mets. Sure wish this was like with humans when they test the damn cells to see what chemo drug they respond to. Why don't they do that with doggy cancer?
Susan
I would not just assume that the splenic nodules are OSA since no baseline ultrasound was done prior. Could they do an FNA of the spleen? If there are no other SQ lumps I would still take the one on his hip off while it is small.
I am curious to see if your oncologist keeps an NSAID in the metronomic protocol given the status of Tazzie's kidneys. Maybe there is something else that can be substituted. It is hard to know if the current chemo is working since you are unsure if the SQ nodule is new or may have been there prior. I would probably not do any more Adriamycin because of his borderline heart function and if you think that his elevated kidney values are due to the carboplatin then it might not be a good idea to continue that either.
I think that I would remove the SQ lump and send it for a biopsy, start metronomics and artemisinin , and monitor the splenic nodules for growth with a repeat ultrasound in a month or so.
Pam and Tazzie
I mentioned the idea of a splenic aspiration. But to get to the mass, that would require one person to do the aspirate while he was hooked up to the ultrasound. Otherwise, they would not know where the mass was. I don't think type of procedure is done here. There is only one US machine in this city, so we travel to a different clinic to have that done. (The vet said if we were just trying to aspirate cells in the overall spleen, that could be done, but not a mass of this size.)
My vet is waiting to hear back from the one board-certified surgeon in town to schedule lump removal. She figures it is best if a certified surgeon does it to get clean margins etc. If we have to wait 'too long', she will do it. Poor vet - she is spending an enormous time on our case and had never met us until late-August!
Having gone half-way through the chemo, I just wish we could go far enough to feel as though it would be likely to have some effect, and of course I want to keep the existing nodes small. Of course the mantra 'do no harm' is more important.
Pam, thanks so much for your input. It is particularly valuable this time when the direction we should head is so unclear.
Susan & Tazzie 2
Late afternoon update:
I have been fretting anxiously today about what is happening with Tazzie's cancer as we do absolutely nothing - a horrible feeling when I don't think his cancer is really at the "do-nothing" stage yet. But the vet phoned. The board-certified surgeon (only one in town) is not available until Oct 1 or Oct 14, so a vet will remove the subcutaneous lump at our regular clinic, and that will happen tomorrow afternoon (Yay). On one hand, I hate to set Tazzie back - he is increasingly energetic every day lately and showing behaviours that I have not seen since the amputation (like jumping on the bed in the morning and evening, and going farther at the park). But at least we will confirm the identity of the evil lump and get it out (good riddance!), and hopefully he will at be back at the park within a couple of days.
Susan
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