To do a 5th chemo treatment or not to do a 5th chemo treatment – That is the question

Butchey Hudson’s Mom Nancy here.  Tough to write this one from Butchey’s point of view ;0)

Background:  At the time Butch was diagnosed with HSA in right rear knee joint, the oncologist recommended amputation and 4 to 6 treatments of chemotherapy (Adriamycin).  I hope I am quoting her correctly (will review all specifics with her on Tuesday’s appointment), but she had told us that 4 treatments is standard and if he was doing well he could get a 5th and 6th.  But definitely no more than 6 treatments. 

So we have now completed 4 treatments.  Our 4th treatment was 3 1/2 weeks ago.  This upcoming Tuesday we meet with her again and Butch gets an ultrasound of his heart to see if there has been any damage.  If there is any signs of damage to the heart, then obviously chemo is out of the question.  If the ultrasound comes back okay, then we have a decision to make on doing a 5th treatment.

We decided to have our regular vet and holistic vet check him out.  We trust them both very much and just wanted to rule out any obvious signs (to them) of any health issues.  They both think he looks good.  To me, although his spirits are great, he looks a bit haggard.  He has lost a ton of coat and has that skin discoloration that apparently is a side effect of adriamycin.  He has also lost about 5 pounds in the last 3 weeks, which visibily (to me) includes a lot of muscle mass in his front shoulders.  I would have thought his muscle mass would increase in his front shoulders, given the rear leg amputation. 

He has also had a big issue with skin allergies.  About a week or so ago, we finally made the decision to put him on Temaril-P (prednisone).  This has made a HUGE improvement in the allergy department.  He hadn’t been able to be out of his “cone of shame” since the surgery in June, really.  Where before you couldn’t get him unfocussed off of chewing his paws, now he barely pays them any notice.  We had to compromise with the prednisone aspect to give him a better quality of life, and we are very glad he is doing better with that.

So now what to do about a 5th treatment?  If you asked us 3 weeks ago, we would have definitely have said no – given the allergy issue.  Now that the allergies are so much better, we are on the fence.  The weight loss really concerns me.  And I am of the mindset, that if all that (including my perception of his haggard appearance) is happening on the outside – Then WHAT is happening on the inside?  Or more aptly phrased – “How bad is it on the inside?”  Otherwise, his appetite is great.  He had a bout of diarrhea around his 4th treatment.  Flagyl along with a hamburg and brown rice diet cleared that up and he has been okay in that department.

I am very interested in hearing from any of you who have found yourselves at this impass before and what was involved in your decision making process.  I know regardless of what route we choose, hindsight is 50/50 and we could have regrets and What Ifs either way.

Of course we still have our appointment for the heart ultrasound and a consult with the oncologist first.  Our decision might be made for us, and she could have additional info that could sway us in either direction.  I wonder if I am making too much of the decision and should just go with it if we get the clear.  But something in my gut just tells me to be cautious….

Here’s a recent picture taken about a week ago.  This one even includes Lola!

Lola (left) and Butchey (right) Fall 2011
 
 
Well gotta go…Big Boy is nudging me to let me know that he wants his supper.  For some reason I keep seeing an Egg…  I told you his appetite was fine!  =)

13 thoughts on “To do a 5th chemo treatment or not to do a 5th chemo treatment – That is the question

  1. LOVELY photo of the two of them Nancy! 🙂

    As you know, I haven’t done chemo on Maggie, so I can’t offer any advice in that department but I can just second your comment about your “gut feeling”…. if anyone knows Butchey it is YOU(and Brett) more than anyone or any vet IMO.

    Hugs to you and Brett and that Butchey Hudson!

    Tracy & Maggie

  2. Nancy you know Butchy the best, it is all a gut feeling. When I saw him the other day he looked good to me he looks happy and content. Maggie Laura and I are thinking of you guys and offer all out love and kisses to you and your husband.

    You are in our thoughts and prayers, give Butchy a big hug for us

  3. I agree, go with that Mother’s intuition! 🙂 But, remember, the allergies are not gone, they are suppressed. Meaning if you stop the medication they will come back….so if that is why you wouldn’t do the chemo last time…..

    I love this picture of them! Calendar material!!!! Good luck with the decision making!
    Hugs to the Butchster! oh, and that smarty pants sister too! 😉

  4. I’m with Tracy, go with your gut. Maybe on Tuesday your gut will say “Go!” but if it doesn’t then don’t. Clinically, the vets are the experts. But you’re still the expert on Butchey and they are not going to notice if he looks haggard.

    You’re not making too much of the decision. We had the same “minimum 4, up to 6 depending on how he does” advice and Tate did pretty well but not well enough to go past 4. None of us had the will for it. So now he’s on metronomics and it is such a pleasure to be past all the hard stuff.

    But whatever you decide if right for Butchey, by definition!

  5. That’s a good-looking pair!

    We didn’t deal with the same kind of cancer or that type of chemo (Abby has OSA and we did carboplatin), and we did 6 treatments, but I’ll just offer some tidbits that might help inform your decision. With the carbo, our onc said the same – at least 4 but no more than 6. He said studies do not definitively (so far) show which is the optimal number but it is somewhere in that 4-6 range.

    With Abby, she did really well on the carbo, but she was noticeably more tired by the 5th and 6th treatments. The onc said that was not surprising as their is a cumulative effect. So, that might be something to ask about/consider – will #5 (and #6?) effect him more than the previous treatments?

    Anyway, as others have said – mother’s intuition will help. Go with your gut. And have NO REGRETS. You are making your decision all out of nuthin’ but love, so should have no regrets.

    just as aside… by any chance do you give him pills in peanut butter? My sister’s corgi was having terrible allergies and licking his paws all the time. She was giving him his kidney pills in p.b. everyday, and I just happened to read that many dogs have bad allergies to p.b. They switched to giving him the pills in a hotdog chunk, and his allergies went away.

    Good luck with your decision! Whatever you decide, hope he keeps doing well!
    Jackie, Abby’s mom

  6. we did five rounds of doxorubicin (adrimyacin). after three and four, we were concerned due to GI issues, but we ‘ran the course’. that was last spring. gayle had a soft tissue sarcoma grade 3 in her wrist, and is still going as we approach 20 months. we do not regret the chemo, but then we didn’t have allergies to deal with either. our english shepherd boy sam, was very itchy when we adopted him in march. we started using honest kitchen’s ‘sparkle’ which is a herbal suppliment for his food – we mix a teaspoon with three fish oil tablets (squeezed into it) into the food. we do open feeding of kibble, so gayle and sam both eat it. sam’s itching and foot chewing has really REALLY diminished with the sparkle. we ran out, and it returned, i ordered more, and now he’s back to being rarely itchy. good luck with your decision, you’ll know what’s best – follow your heart.

    charon & gayle

  7. We faced this dilemma several times with Zip. First on the carboplatin, then on the doxyrubican, then on the mitoxitrone. The carbo was usually about 6 doses but we did 10 because she was doing well on it and the reason most stop at 6 with it is that is how long the insurance companies had funded the research. They were so pleased with the drug that it went straight to market, but then the met to her spleen came and we switched to the doxy which is also known as the ‘red devil’ for good reason. Ironically, the met was from a different bone cancer than the first one. The doxy was horrible. She had 5 days of not so good then 4 days of miserable diarrhea and some vomiting[just the first round] then she was gaining her energy back for about 3 days and was wonderful for a week till we did it all over again. I was so happy we did not go for 6 rounds of that but stopped at 4. She only had one dose of the next one . My point in telling you this is if he is doing well on it and other things are being managed then consider staying with it and start really supplementing him with holistic meds and other support meds. If you stop it then really make certain his diet is good, he is getting all that you can for him holistically and enjoy him. Cancer is a disease that is so irrational that all you can do is try to out flank it and you do your best, pray for guidance and go with the best advice you can get. Too much information can be as bad as not enough in terms of making you more confused and feeling guilty. I am with Charon and Gayle, trust your instincts and follow your heart.

  8. Hi Nancy,
    Hugs to all of you–haven’t seen you in a while (but that’s not a bad thing!)
    Here’s a couple of things that came to my mind.
    When have the allergies been the worst in past years?? Spring and Summer? or in the Fall? If its more in summer, than he would be winding down for his worst allergy time.
    Also although the Temaril-P has pred in it, its a very low dose because of the combo with antihistamine. So its not like you are giving really high doses of Pred.
    If you decide against doing chemo #5 or 6, will you look back and have regrets? Or will you know in your heart you made the best choice?
    I think you have come so far, I would lean towards doing the next treatment personally.
    Are you still seeing Luis for PT? He might have exercises for you to work on to help build the muscle back up-ball work comes to mind.
    Anyway, let us all know how it goes. Give me a call if you need to talk!

  9. I agree with the others. this is a decision that you have to talk to the doctors about and then go with your gut. Spencer started on Adria; but only had one dose of it. He started having some weakness issues that prompted us to check his heart and we found it isn’t functioning as well as it should be, so no more adria. When we were originally planning to do the adria he was going to have 4 doses of it and cytoxan and then 8 doses of vincristine. Our onc said that normally he would recommend 5 three week rounds; but due to the adria heart issues and him being a doberman (much higher risk of cardio myopathy) they were only doing 4. (so, IV adria and cytoxan on weeks 1, 4, 7 and 10, vincristine on weeks 2, 3, 5, 6, 8, 9, 11 and 12). Now that we are changing him to a new drug to replace the adria and cytoxan he is back to doing 15 weeks, so same schedule as before; but with one extra cycle.

    It has been a hard decision for me. Spencer really SEEMS fine. He doesn’t seem sick at all. So then I wonder if the chemo is just putting him through something he doesn’t need. But the onc says with a grade 3 tumor (his was fibrosarcoma, a soft tissue sarcoma) that we have to assume it was spreading at the cellular level already. And so I had to think… I would really kick myself if it came back in a few months and I hadn’t tried the chemo.

    For you… you have already done the 4 weeks. Find out from the onc if one more week would be likely to really increase his odds. Talk about the side effects. Really look at the cost vs. benefit. One thing our family vet said to me was basically that if Spencer could feel mostly fine; but a little puny for 15 weeks, and that would buy him months… would it be worth it. The answer is YES. BUT… if he is puny feeling for 15 weeks and then only has a few weeks after that… my answer is different. But there is no way to know. So I’m having to try playing the odds, though so far they have not gone in our favor. ugh

  10. To echo everyone else, go with your gut. If your gut tells you the day you meet with the oncologist to go with it, then do it. If not, don’t. You know Butchey the best. Have no regrets- you are doing the best for your dog.

    That picture is adorable! If Chili Dawg were still here, he’d be “gaga” for Lola- he always had a soft spot for pretty golden girls-LOL.

    Jenna

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