I agree, great tip Michelle! 

No sign of swelling today so all is well on that score. And I heard from Dr. Kelly today!!!! While she did not give me any stats (which I was hoping for) we feel much reassured by what she had to say. She has been doing intralesional chemotherapy since 2003. She uses other chemo drugs as well, and has done treatments injecting tumors as well as treatments after tumor resection. While she has not had the wherewithal to actually do clinical trials she has scads of anecdotal evidence as she has done this treatment on 100's of pets, she thought she may have done close to 1,000! She has recently hired someone who has the expertise to set up and conduct a clinical trial so hopes to be publishing in the not too distant future!

Dr. Kelly literally said she loves 5-FU--she calls it an "incredible treatment". Its relatively affordable and has only rare side effects, other than hyperpigmentation of the treated area.

Travis' elbow a day after his first treatment definitely shows hyperpigmentation. The photos shows it as much redder than it actually is, it is actually much darker. The photo is also misleading in that it is not quite as swollen at the incision as it appears. 

Dr. Kelly went on to say that she also likes 5-FU because the treatment does not kill surrounding tissue as radiation does. This makes the possibility of further surgery, in the unlikely event that the tumor recurs, much more possible. When I asked about recurrence she said "most don't come back." She told me that there is rare potential for one serious side effect, neurological issues, because the drug crosses the blood-brain barrier. But she also said it was just something to watch out for in the first 24 hours after treatment, at the least it can cause agitation and/or vocalizing. At the worst it can cause seizures. It is cumulative so the risk increases as the treatments continue but it is still extremely rare. She said it is very treatable and also that the reaction is genetic so you can test for the marker prior to treatment and know the dog's risk level before you start. She said she has only had one dog die as a result of the treatment and that was due to the fact the dog's owners did not take it for treatment when it started having seizures.

When I told her about Travis' post treatment swelling Dr. Kelly said that she does not bandage after treatment! She feels the risk of chemo contamination is small and that she wants the chemo to be able to spread out from the injection sites and that bandaging restricts this. She also said that perhaps Davis is doing this for liability reasons eg if someone was to somehow be "poisoned" by leaked chemo they could come back and sue. So, going forward we are gonna ask them to bandage very loosely and if we see any hint of swelling that bandage is gonna come off tout suite! 

Finally she said to feel free to call with any further questions or concerns and that she would be more than happy to talk to someone at Davis re: her injection protocol and whatever else is needed. I am gonna email Davis and ask them again to get in touch with her. I asked what their protocols were and they just told me they extrapolated them from the presentation that was given a few years ago but didn't really give me the details of dosing, how many shots, etc. Dang, I wish we could afford to go hang out in Santa Fe for 6 weeks and just have Dr. Kelly do the rest of TR's treatments! 

Oh, and she talked about really wanting to get her experiences with this kind of treatment out there. She feels that this is something that ultimately can be carried out by any vet with appropriate training as it does not require any specialized equipment, which makes it that much more affordable. She is more than willing to consult with and even train other vets in how to do intralesional chemo. I told her Rene would be calling her for an interview and perhaps a guest blog on tripawds. 

Sorry for the brain dump, I just wanted to get everything we talked about written down to fix it in my mind and also to share with you guys. We feel great going forward with this treatment and I think that it could really be a very viable option for tripawds like Travis that don't have other options eg amputation. We just need to get the word out about 5-FU!! 

xoxo,

Martha, Travis Ray and the OP

Just a quick update...Travis went in for his second treatment on Wednesday. He did great! We told them what Dr. Kelly said about bandaging but they insisted on sending him home with one anyway. By the time he got home his paw had started to swell so we took the bandage off right away. No more swelling! So its the bandage and not the chemo...Yay!!!! No other apparent side effects either! Two down, four to go, we got this!! 

And extra added bonus for Ralph is he got to hang out with Fionn and Sessy's moms for part of the day as they were in for treatment too!    It is amazing how many tripawds we have seen each time we go to Davis. Its a good thing I recently delivered a huge stack of Tripawds brochures to them!!

xoxo,

Martha, Travis Ray and the OP