Although at one time I was on low doses of the chemotherapy
drug methotrexate for my RA, I have been lucky in that no one close to me has
had chemotherapy for cancer treatment.
Talk about cognitive dissonance!
Purposefully injecting the body with something so toxic just seems
insane! On the
other hand, to do nothing felt as if I was giving up on Holly. Low dose oral (metronomic) chemotherapy
sounded like a compromise.
I really liked the oncologist at the university vet clinic. She sat on the floor
with us and handed out treats and discussed our options extensively. Here are some of the numbers she gave me;
93-95% of pets do not have any significant side effects from doxorubicin
treatment; the most common side effects of diarrhea, nausea, vomiting and low
white cell count occur in only 5-7%, are usually mild, and are prophylactically
treated with medication. She emphasized
that her goal was not just to extend Holly’s life, but also that Holly have a
good quality of life. She reiterated
that the best standard of care was doxorubicin chemotherapy (again,
limited to 5 treatments due to heart toxicity), followed by metronomic
chemotherapy. She also emphasized that
she would support my decision, whatever I chose to do, including deciding to
forego treatment. She also did some
blood work and Holly was still slightly anemic, although not, in her opinion,
low enough to preclude a chemotherapy treatment.
I went to our appointment determined to use metronomic
chemotherapy. But after talking with the
oncologist, I wasn't so sure of my decision; I went out to the car and called my mom, I
walked around trying to think, I went into the clinic and
got a cup of coffee. While I was in the waiting room, the oncologist
brought a print out to me of this University of Pennsylvania press release . After debating for some time, I
decided to go with doxorubicin treatment and see how things went; I felt so
uncomfortable with my decision, but I wanted to give Holly the best chance.
As I had taken a ½ day of vacation for our appointment and we
were coming into a holiday weekend where I could be home with Holly and monitor
her (please note that you do NOT want to have chemotherapy treatment right
before a holiday weekend, as will become evident), we went ahead with a doxorubicin infusion that
afternoon (Wednesday, August 31). Holly received
15.5 mg doxorubicin by IV and she was also given an injection of the
anti-nausea medication Cerenia (16 mg).
We were sent home with a 4 pack of Cerenia (60 mg) to be given once a
day (starting the following day) and metronidazole (250 mg) (aka Flagyl) for
diarrhea, also to be started the following day.
I was also instructed to get a rectal thermometer and if Holly acted
sick/her temperature went to 103o or greater, to take her
immediately to my vet/an emergency vet, as any infection could be life
threatening. I set an appointment for
the following Wednesday for a follow-up to check Holly’s white cell count.
Holly was perfectly normal that evening. I had more than a few moments of alarm when I
fully read the handout; yikes! guess I should have asked about any special
precautions I should take since I am on an immunosuppressant, but it never
occurred to me. . . Holly ate as normal the next morning, and took her mid-day
snack, but that evening she gave me the side-eye when I put her dinner down,
and I ended up hand feeding her. The
next morning (Friday) she wouldn’t take her food even by hand. By the evening, I realized that she was not
drinking either. The following day I
began to offer Holly small portions of a variety of bland foods, along with broth, but she continued to refuse all food and liquids. I also began checking her temperature a
couple of times a day; it remained normal.
I called the emergency number the university clinic had
given me around 6 am the following day (Sunday). The emergency vet on-call suggested a few
more foods to tempt Holly with, and asked if I could wait until 8 am for her to
call the on-call oncologist, as it was both a Sunday and a holiday weekend. I received a call back from the emergency vet (not the on-call oncologist) around 9 am and was
told that if Holly continued to refuse food and water I should take her to an
emergency clinic on Monday (remember, holiday weekend) and that she should be
given subQ fluids and the drug mirtazapine to stimulate her appetite. I continued to offer Holly small portions of
both bland and stinky foods, as well as broth, water and ice chips. I tried using a syringe to get water or broth down her, but she just let the fluid trickle back
out of her mouth. The last time she had
anything to drink was, at best, early Friday morning.
Instead of waiting for Monday morning, we went to the
emergency vet late afternoon Sunday.
Holly was given a relatively small amount of subQ fluids (400 ml) and a
prescription of mirtazapine (15 mg). I
gave her the mirtazapine as soon as we got home. About an hour later, Holly began having
explosive, liquid diarrhea, which continued through Monday (Labor Day).
I called the university clinic first thing Tuesday morning
and requested and immediate appointment.
Holly’s weight had dropped by 2 pounds in six days and blood work showed
her to be slightly more anemic than at our previous appointment (now down to
31%), decreased neutrophils (as expected), and elevated protein levels
consistent with dehydration. They gave
Holly 900 mls of subQ fluids, and another package of cerenia (which I did not end up using) and additional
metronidazole. The fluids helped A LOT;
Holly began drinking voluntarily when we got home, and ate a scrambled egg that
evening; the following days she continued to eat small portions of scrambled
egg as well as chicken. Although she no
longer had urgent diarrhea, she continued to have loose stools.
I took Holly in to our regular vet that Friday to recheck
her anemia and neutrophils; both had come up to borderline normal values. I also brought a copy of the University of
Pennsylvania press release (see link above) for my vet, and let him know that I
was going to use this as treatment for Holly’s hemangiosarcoma going forward –
no more chemo for Holly.
I’m-Yunity is a supplement derived from Coriolus versicolor (turkey tail mushroom or
yun-zhi). Since the full Latin name is a mouthful, I've taken to calling this supplement Holly's Magic Mushrooms :) Specifically, the active agent
is a polysaccharopeptide (PSP), which has been shown to have in vitro antitumor activities, without having inhibitory
effects on normal cells. An isolate derived from Coriolus
versicolor, known as polysaccharide-K (PSK or PSP), is used in some countries
as a therapy for patients undergoing chemotherapy for cancer; it is intended to
counteract the negative effect that many chemotherapeutic agents have on the
immune system. In addition, PSP in China
and PSK in Japan
Our fist order of I’m-Yunity arrived on Thursday, September
15. Out of an abundance of caution, I
gave Holly ½ dose that evening and the following morning, and then upped her to a
full dose (100 mg/kg/day), which I have continued to this day.
Some changes I have noted following Holly’s
splenectomy and doxorubicin treatment. Holly’s digestion
continues to be ‘delicate’; she still occasionally has loose stool, and I only
recently have been able to get her to reliably eat her previous diet. I continue to give her small portions of
scrambled egg or chicken next to her portion of Honest Kitchen food (see link in side bar); it seems
to stimulate her appetite to start each meal with one of these preferred
foods. I have noticed that giving her
metronidazole seems to negatively affect her appetite, so I don’t automatically
give it when she has an isolated loose stool.
Holly’s hearing has become really poor.
She seemed to have some slight age related hearing loss prior to chemo,
but her hearing is pretty bad at this point.
Following doxorubicin treatment, Holly stumbles and trips quite a bit; she has fallen right on her face several times. Holly’s arthritis is
considerably worse, however, I have not been able to get her back on carprofen
at this point. Every time I have given
her a dose she has diarrhea, so I am using Gabapentin alone to treat her
arthritis (she only inconsistently will take the chewable joint supplement I
use).
Other than the above noted issues, Holly seems to feel
pretty good. She’s back to her sassy,
saucy self most of the time; her 13th
birthday is less than a month away. I will try to update regularly with how Holly is doing with her magic mushrooms. .
.
