Treatment for disseminated histiocytic sarcoma diagnosis

[Beautifulriver]

My beautiful nine year old Irish greyhound girl has just been diagnosed with disseminated histiocytic sarcoma. The first sign of this was a mild limp about 3 weeks ago. I rested her for a couple of days and gave her pain meds, thinking she'd just pulled something, and then she was fine for a few days, even going on her usual one hour walk with no limp whatsoever. A few days later, it came back, and as I could also see she'd lost some weight too I began fearing cancer. I got her to the vet, who x rayed her leg and said she had osteoarthritis. I called two days later, expressing doubt and asking for a referral. She had a CT scan, aspirates and biopsies 6 days ago at a specialist centre, and today I was told she has disseminated histiocytic sarcoma, which means the cancer grew in various parts of her body (lungs, kidneys, lymph nodes, shoulder.... that we know of) at the same time. So basically, she's riddled with it and, the oncologist says, would have been by the time she started limping. I had no chance to stop this. She's still limping, but is on pain meds and seems to be coping okay. The disease progresses rapidly, so with pain meds alone, I am sure she'll be gone in weeks or even days. Both surgery and radiation are inappropriate due to the cancer having metastasised. The only option seems to be chemo, specifically a drug called Lomustine (CCNU). I have agreed to this, but I'm reading the potential side effects and mean survival times, and having second thoughts. In an article by Dr Couto et al 'CCNU for the treatment of dogs with histiocytic sarcoma', the results are: "Treatment with CCNU at 60 to 90 mg/m2 resulted in an overall response rate of 46% in 56 dogs with gross measurable disease. 3 dogs with minimal residual disease experienced tumor relapse but lived 433 days or more after starting CCNU. The median survival of all 59 dogs was 106 days. Thrombocytopenia (< 100,000 platelets/microL) and hypoalbuminemia were found to be negatively associated with prognosis and were predictive of < 1 month survival." Not great odds! I'm asking what her platelet / blood protein count is tomorrow. If they are low, I am, I think, with great sadness, retracting my permission as the outcome looks very poor. 

If anyone has any experience of this type of cancer or advice, I'd like to hear it.

I lost a 16 year old dog to pancreatitis last night. He and my Irish girl both started showing signs of illness at the same time. I'm not ready to lose her so soon after him, but I'm afraid I will. Totally gutted by this. 

[greysmom]

You can consult with Dr Couto directly through the Greyhound Health Initiative.  He should be able to reveiw your dog's records and give you a better idea about how this treatment would help or not.

I'm so sorry.  What a double whammy.  {{{hugs}}} 

[Beautifulriver]

On 11/13/2020 at 1:28 AM, greysmom said:

You can consult with Dr Couto directly through the Greyhound Health Initiative.  He should be able to reveiw your dog's records and give you a better idea about how this treatment would help or not.

I'm so sorry.  What a double whammy.  {{{hugs}}} 

Thanks for the hugs! Very much needed right now!  

The oncologist I'm seeing trained with Dr Couto and has 40 years experience in the area. I trust his advice, especially as he's met and assessed her. He has said her blood is good enough to proceed, and we're starting on a low dose to see how she tolerates it. My own vet also told me the only time he's seen this drug used the dog had no side effects. So, I'm going ahead cautiously. 

She's back home now, clearly relieved to be here. She hates the vets and is not a co-operative patient. Her pain is under control... for now. I'm taking her somewhere new and special every day that she's healthy. Whatever the effects of the chemo, we don't have long, so we need to pack a lot of living in. 

I'd still really like to hear if anyone's had experience of this drug and/or this type of cancer, which is not common in greyhounds.

[Beautifulriver]

The day after writing the above post, my girl developed an infection in her other front leg, so I delayed the chemo tablet and got her on antibiotics. The infection had apparently cleared up 3 days later, but she had gone off her food, so I couldn't get the rest of the course into her. I was also struggling to get pain meds into her as she was eating infrequently and little, no matter what I offered her. I did manage to syringe some meds into her, but she wasn't happy about that and bit me a couple of times. She would always have done that though; she wasn't ever the most co-operative greyhound! We were clearly now careering towards the end, so the idea of chemo went right out the window. Two days later, she lost the use of one of her back legs, meaning she had only one really good leg left! I took her to the vets that evening. They gave her a sedative before she went in as she hated the vets and would have raged against being pts, and I didn't want her to be angry as she left this world. She died in my arms, and I was able to hold her, kiss her lovely tummy, in a way that I never had in her life! She was a feisty, independent Irish beauty, and I am missing her desperately.

From the first sign of a limp to losing her, it was less than a month. The vets have told me though that as the cancer was disseminated, it would already have spread in her body when she started limping, when the first signs of it became clear. I had no chance to stop this. With hindsight, there were signs, but not ones that jumped out at me and said CANCER! Her behaviour changed, though not significantly. She became more sociable and affectionate, and she stopped trying to steal the other dogs' food. I just thought she was finally mellowing in her old age. And she was still eating well. She had lost some weight, but it seemed to leave her in not so obvious a way; her ribs were not protruding at all, more a loss of muscle tone. I just read up on cachexia, which seems to fit the bill..... and means by the time she was losing weight, the cancer was advanced and there was no going back. She was also still loving her walks, still pestering one of my other dogs (the one who died of pancreatitis recently) when she got excited as we got ready for walks. Such a mixed picture. If I had taken her to my vet a few weeks earlier and said she'd lost a couple of pounds and was being sweeter, would he have run any tests that might have shown she had cancer, could we have identified the cancer earlier, and if we had, could we have stopped it advancing? Clearly, I'll never know, but from now on, I will treat every limp that doesn't clear up in a couple of days as cancer and ALL changes in behaviour, not just the unwelcome ones, as an indication of ill health. 

[BatterseaBrindl]

 

[EllenEveBaz]

Adding more     I am so sorry.  

[MerseyGrey]

9 minutes ago, EllenEveBaz said:

Adding more     I am so sorry.  

Same from here. Sorry about your double loss but thanks for sharing your experience as I’ve definitely learned something from it.

[JaimeL]

I am so sorry for your loss Rest well Sweetie.

[Beautifulriver]

Thank you. Losing two of them so close together is hard. But he had 7 years on this earth more than her, so I'm taking her loss worse.

She leaves me with some fantastic memories though....

She was unusual in that she sat, in a very uncomfortable way, sometimes in the weirdest of places. I took her and two of the other dogs to a field last winter when it had snowed. She ran to the middle and just sat there. I had to move her on eventually as I was afraid she'd get frost bite in her bottom. She used to fly, all legs in the air, elevated several feet, from one side of the kitchen to the other, when she was excited and was running outside. She could do a jig. Sometimes when we were out walking, if I scratched her back just high of her tail, she would swish her bottom from side to side as she trotted on.

My dad died recently too, and at his funeral someone commented that he had big shoes (metophorically!). My girl had them too. Such a quirky, feisty girl. She'll always be sorely missed. 

[MP_the4pack]

Please don't second guess about testing. You'll never be able to fix it and it'll only eat you inside. I have 9 at the Bridge.  I do wonder about some of them.  Too soon? Too late? Wrong diagnosis? 

[ramonaghan]

Saw your post on another thread and came here to say how sorry I am for your losses. Your story made me cry as I know I too will only be able to kiss Sweep's tummy at the very end. Those feisty girls are something special. Many hugs to you.  

[Beautifulriver]

I just posted about another black nine year old greyhound I'm about to lose due to kidney disease. And I came back here to read my post about Roisin from 2+ years ago. Thanks for all the hugs everyone. I'll be needing some more soon.