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TwiggysMom

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    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    Victor, I am extremely surprised to hear that your oncologist is recommending a metronomic protocol simultaneously with iv chemo.

     

    I suppose if you are not using an oral chemotherapy drug as part of the protocol, that would probably not cause too many issues; but I would be very, very hesitant (truthfully, I'd probably run away as fast as possible) to go along with an oral chemo at the same time as iv chemo.

     

    IV chemo can cause very low blood counts, and so can Palladia and cytoxan. I am not aware of any studies that predict the effect of the oral drugs combined with the iv chemo. Not to mention the significant side effects that each of these drugs can and often do cause, particularly GI effects. Because they are dogs, they often soldier on while side effects are building, and then when they finally let us see that they are having a hard time, it can be fairly bad. Even just an NSAID (piroxicam, Metacam, etc.) can cause serious side effects (as the Metacam did for Twiggy).

     

    According to OSU, artemisinin is not to be started until after iv chemo has been completed (and artemisinin is not known to have any side effects at the 100mg/day level). I believe they feel that the arte and chemo may not play well together.

     

    Twiggy started her iv chemo exactly 1 month post-amp, so it was delayed by exactly 2 weeks. We did not start the artemisinin until after she completed her iv chemo (I believe we waited 2-3 weeks after the last treatment, to be sure that the side effects of the carboplatin would be mostly diminished)

     

    As you are all seeing, there are many different thoughts about metronomic protocols, and this is what makes it so incredibly difficult. There isn't a lot of data about most of the various protocols, that is why I decided to keep things relatively simple, and go with what OSU was recommending at the time (they were a couple years into a study involving the protocol at that time).

     

    Not that anyone asked, but if I were starting this all over again knowing what I know now, I would definitely do artemisinin, add the fish oil (I've forgotten to mention that she was getting this - I had to discontinue it because her system wouldn't tolerate it at some point during her treatments), and I'd probably still do the cytoxan, Metacam, and (maybe, but on a lower dose) Palladia, but I would be much more sensitive to any sign of side effects and discontinue the drugs as soon as any appeared.

     

    I've said this before, I "fired" the oncologist who administered Twiggy's iv chemo. There were some differences of opinion along the way, but the big thing was that they sent her home from her last treatment with a very severe physical reaction, didn't tell me about the extent of it, and pretended that I was making up symptoms when I called them about the symptoms (her urine looked like pure blood, and later in the day like dark, strong brewed tea - and her stool was indistinguishable from her urine; she definitely needed treatment, but they refused to acknowledge it, they just said that I must be mistaken about what I was seeing). So, I guess the important thing to me is that I am on the same page with the oncologist who is treating my dog. In retrospect, I wish I had sought out Twiggy's current onco when I just had some minor differences of opinion with the first one. Maybe Twiggy could have been spared the bad incident if I had.

     

    Sorry all, I wrote another novel here!

    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    tempo has reached the point in this recovery where it is time to cautiously come up with a hopefully long-term strategy. today was his 5th carboplatin treatment. as per the evolving course of previous treatments, he has, as of this treatment, shown zero side effects. in fact, this time he wasnt even tired, and demanded to go out and play fetch just hours after we got back from the vet. in any event, next month, if all is still well, he will have his sixth chemo, but he will also have his second chest x-ray. if his lungs are clear, i need to come settle on a plan going forward. the two options i am aware of are the metronomic chemo protocol, artemisinin, and/or a potential combination of the two. i am fairly certain that i want to continue with the oral chemo dosage, but the lack of meaningful data for any of these post-chemo treatments is worrisome, and makes me feel like we'll perhaps just be flailing around in the dark.

    I think deciding on a metronomic protocol was the hardest part of this process for me. There's a lot less long-term data out there on protocols, and so many different protocols. And the last I heard, OSU is no longer recommending a metronomic protocol post-iv chemo, just artemisinin (100mg once a day). Other oncologists (including Twiggy's) still do recommend various metronomic protocols.

     

    We did the protocol that OSU (at the time) recommended: Palladia 3 days/week, cytoxan 3 days/week, Metacam every day, and artemisinin every day. We had to stop those bit by bit due to intolerance, until Twiggy was left with just the artemisinin.

     

    I would talk to your oncologist, see what he/she feels comfortable with, and go with that. Then, if there are signs of intolerance to one or another of the components, you can adjust timing dosages, or eliminate components entirely to get the best quality of life. I would encourage you to use the artemisinin no matter what, though - I don't know of anyone who has had any side effects at the 100mg/day level. A lot of oncologists aren't familiar with it, but hopefully yours will agree to using it.

     

    P.S. Tomorrow will be two months since Gunner left us. His spirit has been here all morning. I actually thought I heard him in the kitchen with me today as I made Dawson's breakfast. I had to remind myself he wouldn't be standing there when I turned around yet that's how real the feeling was. I'm happy and sad about it. Happy he's nearby yet sad he's gone from the physical form. I sill miss my little man. :sad1

    I am sure it still must be terribly difficult. How nice of him to keep sending you signs to let you know he is OK.

     

    Hugs to you :grouphug

    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    For those with smaller females / front leg amp, Twiggy was 58.5 pre-amp, and I maintain her at 53.5 post-amp, so a 5 lb loss for the leg. Fortunately, she is a food monster so I haven't had trouble getting her to eat (she even ate in the hospital).

     

    She did look quite gaunt, however, for the first few weeks post-amp. The surgery just took a physical toll on her for a while.

     

    Your girls (and Casper, too!) should start bouncing back weight-wise before long.

     

    Twiggy had her 23-month post-amp anniversary last Tuesday! I grilled her a steak and some carrots, and got some watermelon for her for dessert. Last weekend we had another nice outing at the big dog beach - I'll try to upload some photos in a separate thread later. She had a blast, and the photos show it!

    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    The clinical trial that she's in is exploring the same thing. They are given salmonella-IL2 at the same time as their chemo treatments. The theory is probably the same. The way our oncologist explained it is that the body is very good at fighting cancer but that cancer is really good at convincing the body it's "normal" so their hope is to induce an infection so the body fights it and the cancer as well. She has only had one dose of the salmonella at her initial biopsy (about 10 days ago) and will then get them at each of her chemo treatments.

     

    So glad to read your comment, it reminded me why I'm doing this :)

    Wow, that's very interesting. I wondered whether there could be a study involving inducing infection, but it seemed that it would be hard to control something like that. Will the infection Python has interfere with their results, or will she be classified in a different group of the study?

     

    I do hope that a definitive correlation between infection and survival rates can be found. When I first read about the theory (this was just before her surgery), a thought flashed through my mind hoping that Twiggy would get an infection, I was immediately horrified at myself for thinking that, and then blamed myself when she actually got one. Fortunately, she survived it (survival was questionable for a while), and now maybe it is extending her life!

     

    Lana 3 days 9 hours post amputation

    img_0812.jpg?w=500

     

    Lana looks fantastic! Her incision looks so clean and neat, and she seems to have very little bruising! How's the edema doing? It's hard to tell from the picture, but I don't really see much of that, either.

     

    I'm sorry she (and consequently the rest of you) had such a rough night. Hopefully the fentanyl patch will keep her pain control pretty even. The pain should be starting to get a bit better for her over the next few days.

    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    Python has pretty much stopped crying constantly since her patch was removed and we have some anti-anxiety meds now too.

     

    The new bad news is that she has an infection and the incision is trying to open up a bit and there might be some necrotic cells which will need to be debrided... we're on bandage number three since Wednesday because of the seepage.

     

    She seems blissfully unaware of any of these complications though. More energy and mobility every day. She's eating well again and seems to be in little to no pain.

     

    It's a toss-up I guess

    I'm glad that it was the fentanyl patch causing the crying and that it was able to be removed.

     

    I specifically wanted to comment on the infection. First, it sounds like it was caught pretty early, which is great. Hopefully it will turn out to be a strain that will be easily treated with antibiotics. There is evidence that dogs who incur an infection while healing from their amp actually have longer survival times than those who heal without infection. It sounds crazy, but apparently the thought is that the infection somehow "wakes up" the dog's immune system and enables it to fight the cancer better. So, while this is a rough patch that I know you'd rather not go through, there may be some benefit to it in the long run.

     

    I've mentioned this quite a few times in here, but you might not have read it - Twiggy had a terrible infection in her incision, she had to be hospitalized for 5 days to cure it. This may be a contributing factor to why she continues to do so well. The first thing Twiggy's new oncologist said to me when I told him this part of her story was: "well, you know that dogs who get infections have longer survivals, right?"

     

    Steve - that is just a beautiful picture of Katie. She looks so happy to be relaxing out in the yard!

    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    Shoot, I'm sorry to hear the the OSU chemo won't work with UM administering it. I never knew about those restrictions. What study is Python in? Hopefully, there are also some financial benefits to participating - maybe that will make up somewhat for not being able to take advantage of OSU's chemo.

     

    How is Python doing otherwise? Has her crying settled down some?

     

    Victor, I'm glad to hear Lana has started eating some for you. You guys have quite the recovery room for her! She looks quite comfy with her leg propped up and her head on an extra pillow. How nice of Duke to keep her company!

    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    I'm glad to hear that Lana is home!

     

    Right now, sleeping is what she really needs to do. (But eat a little more, OK Lana?) This is going to be a tough road for all of you for at least the first week, and it still won't be quite back to normal for several more weeks after that.

     

    If she doesn't start at least drinking a bit of water, you may want to try to syringe a bit over her tongue to stimulate her to drink some. Since she isn't on iv fluids any more, you do want to be sure she is staying hydrated.

    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    The Pawz booties are a great idea!

     

    I agree that Python could be whining both because of the meds. I also think amputations are really confusing for dogs at first. Humans *usually* have advance notice about major surgery, but our hounds go to sleep and wake up, try to stand and WHOA! there's no leg there!! That would scare the crap out of me! I imagine it must be hard to remember for a while too.

    Shake Shake Shake?

    in Health and Medical discussion

    Posted · Edited by TwiggysMom

    I think that the full body shake is an extension of a good stretch. Sort of like the way you see Olympic sprinters stretch and then shake out their arms and legs. (Our hounds are the canine version of Olympic sprinters, after all!)

     

    Twiggy loves a good shake. Hers is especially comical now that she only has one front leg. As her shake moves from her nose all the way back to the tip of her tail, she half rears up on her hind legs, and her only front leg waves wildly in front of her ! (it took her a while to learn that technique!)

    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    Victor, I was emailing you as you were posting here!

     

    I think she looks about like what I would expect. Keeping in mind that her amputation took the entire hind leg and that there is no stump, I think her bruising and edema might be more like what you usually see in a front-leg amp (where they remove the entire leg and the scapula).

     

    P1010586.jpg

     

    Here is a picture (about 8 days post amp) of Twiggy. Lots of bruising and some edema in her belly area still.

     

    Bruising especially will continue to get worse before it gets better.

    Osteo Thread Part Vi

    in Health and Medical discussion

    Posted

    Casper is suture-less :mexi2 ! Glad they gave him a lighter dose of chemo, and I hope his values stay where they belong! I wonder if his panting starts at night just his previous round of meds is starting to wear off?

     

    Aww, Berkeley videos make me smile!

     

    Bozicj - I'm sorry you and Python are going through this! Wow! home just 2 days post-amp - it sounds like she is doing great! If you start back at about page 35, you should see a lot of posts about what to expect post-amp, we've had an awful lot of new "members" here lately, and you'll probably find much of the info you're looking for.

     

    As for the harness, I tried a regular harness with Twiggy (front-left amp), and it just slid around, plus I felt like she would be able to slip out of it. The only one I've seen that I think might stay on is the spook harness from Majestic Collars - it has an extra loop that goes around their tuck, I still think it would slip around, though. For what it's worth, nothing stays on well, coats, jammies, etc. all won't stay in place.

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