First Line Chemo Treatment: A Retrospective

Although I haven’t written here about my chemo treatment, I kept a journal throughout the process and now that I am moving to yet another line of treatment, I thought I’d transfer what I’d written here in case it might help someone going through their own process.

It’s important to note, however, that every cancer, every treatment, and every person is different. There are somethings common to chemotherapy such as nausea, vomiting, constipation and hair loss, but how a patient responds is very much individual. So I share my experience not as an example of what someone else might endure, but as my individual journey.

I don’t know what I expected undergoing chemo would be like. For my first cycle, I knew I’d be there most of the day with an IV hooked into my port and different drugs moving through my body, and I knew I might have reactions to some of the medications. Thankfully, I didn’t. I’d read others experiences and learned about bringing a chemo bag, so I brought snacks, books, my iPad to play games, read, email, text and watch Netflix. They also had goodies, magazines, and tablets for patients to use. My husband was my chemo companion throughout the day as he was for each of my 6 treatments. He’s been my rock. I don’t think I would have survived this ordeal without him.

To my surprise, my biggest gripe that day was having to maneuver my IV pole to get to the bathroom, and having to do so again, and again and again because in addition to all the other stuff being pumped through my veins, they were filling me with saline.

My most pleasant surprise, however, was that I never felt ill during the process. Not once. I was tired but otherwise fine. When I awoke the next day, I was tired, but I otherwise felt fine. Then came Day 3–an awful day. First I awoke with severe bone pain in my sternum, pelvis and thighs and had no appetite whatsoever. I lay in bed crying until I could take a mega dose of ibuprofen. But that didn’t help, so the agony continued. In addition to the bone pain I developed severe gastric upset. I couldn’t keep anything down, and nothing was moving. Chemo causes constipation and it doesn’t fool around about it. After what seemed FOREVER, there was a rapid change from little to no movement to the runs. The bone pain, diarrhea and lack of appetite lasted about 5 days, then was followed by extreme fatigue for another 4-5 days. After that I felt fine, but it was a hard road to get to feeling fine.

Three weeks later my second cycle went much the same, but this time I’d been prescribed Percocet for the bone pain. It brought great relief. It didn’t eliminate the pain, but it lessened it quite a bit. The other side effects I experienced from the first cycle followed, but they were much less severe. However the fatigue was worse and hanging around longer. There were days on end when I didn’t have the energy to get out of bed, and when I did, I could do very little. I started watching the Crown and found I had to keep rewinding episodes because I would fall asleep several times throughout each one.

Not long after cycle 2, my hair began falling out. I cried as each handful of it went down the shower drain. I knew this was coming, and it was one of the things I most dreaded. It continued to fall out for several weeks, and watching my appearance change each day was daunting.

ChemotherapyBy the time cycle 3 came along 3 weeks later, I had lost much of my hair and was so fatigued that just walking into our garage and getting in the car necessitated time to rest. Once again the day of treatment went well, and I felt fine. Then as before I awoke with severe bone pain. This time I took the Percocet as prescribed rather than waiting until the pain was unbearable. That was a good strategy as it kept the pain under control. Unfortunately the digestive issues were more severe than after cycle 2 and lasted longer. Meanwhile the fatigue was like moving through molasses.

After cycle 3, I got a 4 week break of no chemo then had surgery—a radical hysterectomy and debunking. Surgery just added to my fatigue, and the pain was tough for a couple of weeks, especially when I first awoke after surgery. After 5 days in the hospital I was able to return home to recover further. I then had another 4 weeks after surgery with no chemo. Although I was in some pain and exhausted from the surgery, without the chemo for 8 weeks my strength was coming back, and I was feeling quite well considering all I’d been through thus far. My mood improved as the fatigue abated, and I started to actually accomplish little things around the house. I almost felt like myself again.

That good feeling didn’t last, though, because cycle 4 was horrendous. My doc warned me it would be tough since I was still recovering from surgery, but I had no idea how awful it would get. Side effects began the morning after chemo, and they were severe: the Percocet didn’t even touch the bone pain; the nausea and vomiting seemed like it would never end, and in the meantime at the other end, there was an epic battle between no movement and a 100 yard dash. I wasn’t able to eat or drink anything for 5 days, and I don’t think I got out of bed all that time. Recovery was slow, and the fatigue had more than quadrupled. I was barely strong enough to even get to my cycle 5 appointment and not at all sure I wanted to continue.

But, before that cycle was scheduled, I knew I needed some alternative treatment options. The nausea drugs and Percocet caused constipation, and I didn’t need anything to make that worse. Besides, they weren’t really working. So I gathered all the research I’d done on medical marijuana and met with my oncologist to talk about whether it might be a good option for me. She was very supportive, so I made an appointment to get a card and was able to have a small package of gummy bears for pain and a tincture for nausea for cycle 5. The gummies didn’t do squat for the pain, but I had almost no nausea or vomiting, and I only went one day without eating. And, my tastebud were back! Food tasted normal again, and I wanted to eat it. I was overjoyed. By now, however, the fatigue was overwhelming, and my platelets were extremely low. This exacerbated the fatigue and caused my last cycle to be postponed twice.

Finally my labs were sufficient for a go ahead for cycle 6. But 2 nights before my appointment, I began vomiting and couldn’t stop. Finally awakening my husband at 5 am, we headed off to the ER. After an x-ray, blood work and IV anti-nausea and pain meds, I was diagnosed with a bug and sent home. Exhausted, I slept much of the day and night. The next day, about mid-day, I began vomiting again and the pain returned. As the pain increased and the vomiting continued and sensing a repeat of the previous night, we headed back to the ER. This time they did a CT scan. It wasn’t a virus; instead I had a  hernia that was strangling my bowel and needed surgery. I’ll write more about this surgery in a later post, but here I’ll note that while it was a painful set back, hernias following major abdominal surgery are not uncommon.

Still recovering from my surgery, I went in for my 6th cycle of paclitaxel + carboplatin + bevacizumab and perhaps atezolizumab if I was indeed in that arm of the clinical trial. Recovering from this treatment was particularly trying since I was also recovering from surgery and a bout of acute colitis. In fact, I’m still recovering some 4 weeks later.

I hope some mind find this information helpful. If not, at least it will serve as a reminder for me about just how difficult this process has been.

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A New Twist in My Life with Cancer

As many of you know, just a few weeks ago–June 19, 2018 to be exact–I was reveling in having wrapped up my last chemo treatment. Six cycles of atezolizumab + paclitaxel + carboplatin + bevacizumab or a placebo + paclitaxel + carboplatin + bevacizumab, and I was done. I’d had surgery in March after which I was determined to be virtually cancer free, so the plan after this final chemo treatment was to move to maintenance therapy with atezolizumab and bevecazumab.

Unfortunately, there’s been a development that’s thrown that plan out the window, at least for now.

When I was told I was virtually cancer free in March, I was informed that the term fuck_cancer.jpg“virtually” is used because there is always the chance that there is some remaining cancer that cannot yet be detected. In my situation, that turns out to have been the case. The CT scan I had on June 22, 2018 showed my para aortic lymph node(s), which lie in front of the lumbar vertebrae near the aorta and receive drainage from the gastrointestinal tract and the abdominal organs, were double their normal size due to a tumor that had previously been undetectable. The good news, and it’s important to look for good news, is that this is not a recurrence of my cancer. Rather it is a progression of the same cancer I was diagnosed with in November 2017. Unlike my other tumors, however, for some as yet to be determined, this tumor hasn’t responded to standard of care treatment of paclitaxel + carboplatin + bevacizumab. This means it is classified as platinum-resistant, and so will need to be treated with a different chemo cocktail.

So in a week or two, I will begin a new treatment plan which will entail treatment every 2 weeks and alternate between bevacizumab, a.k.a. Avastin and doxorubicin liposomal, a.k.a. Doxil for a total of 3 cycles each. I will also receive all the anti-nausea and blood supportive drugs I’ve been receiving and Neulasta, and for the first treatment I’ll also get dexamethasone, a steroid to ensure I don’t have an allergic reaction to the doxorubicin liposomal.

From everything I learned in my chemo class today and have read since, this treatment will not be as nearly as hard on my body as has been my last. The most common side effects of chemo: vomiting, nausea, constipation, diarrhea and compromised immune system will be less severe, and I won’t experience any additional hair loss.

My doctor was very clear that this is a set back and not a death sentence, and that she is still optimistic that I can achieve remission. She says she has lots of options available to her if this particular treatment doesn’t work and will be doing a biopsy of this tumor to determine what targeted therapies might address its particular make up. Additional clinical trials may also be options.

Of course I am angry, disappointed, and sad. I was so happy to have reached the end of the first stage of treatment and looking forward to moving to maintenance therapy, but I am determined to get through this just as I did the first line treatment.

Let the new battle begin.

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Clinical Trials Save Lives

clinical_trials

On average, 50% of women diagnosed with ovarian cancer will live for at least five years and about one in three will live at least 10 years, according to the NHS. Those are not great odds, so new treatments and ways of detecting ovarian cancer are essential to improve them.

There are three types of ovarian cancer: epithelial, germ cell and sex-cord stromal. About 90% of ovarian cancer tumors are epithelial, meaning they originate in the thin tissue surrounding the ovary.

I was diagnosed with epithelial ovarian cancer, stage IIIc on November 21, 2017 and started chemo on January 11, 2018.

Currently there are more than 1,350 clinical trials for ovarian cancer, including a vaccine trial aimed at preventing recurrence. Clinical trials are an important step in discovering new treatments for diseases as well as new ways to detect, diagnose, and reduce the risk of a disease. They are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans; they show researchers what does and doesn’t work in people; and they help researchers and doctors decide if the side effects of a new treatment are acceptable when weighed against the benefits offered by the new treatment.

The clinical trial I am in is designed to test the effects of TECENTRIQ™ (atezolizumab), a cancer immunotherapy drug designed to work with the body’s own immune system. The study is designed to compare the efficacy and safety of atezolizumab + paclitaxel + carboplatin + bevacizumab versus a placebo + paclitaxel + carboplatin + bevacizumab. It’s being carried out by the GOGFoundation (Gynecologic Oncology Group), and has a goal of 1300 participating patients who are either in the primary surgery group or the neoadjuvant group (I’m in the latter).

The neoadjucant group gets either a placebo or atezolizumab plus carboplatin, paclitaxel, and bevacizumab for the first two cycles, while in cycles 3 and 4 the bevacizumab will be omitted. In Cycles 5 and 6  I’ll get either a placebo or atezolizumab + carboplatin, paclitaxel, and bevacizumab.

After completing 6 cycles, I’ll move to maintenance therapy that includes atezolizumab or placebo plus bevecazumab. After 22 cycles of treatment, the trial ends.

As part of the study I’ll also have follow up visits every 3 months for the first two years following the end of my chemo treatment a.k.a cycle 6, then every 6 months for 3 years after that, and then annually for as long as I agree to them.

I also will do questionnaires every 3 months post chemo for a year; then every 6 months in year 2, and then annually for 3 more years.

In the meantime, I have had regular blood work and CT scans, and have filled out a number of questionnaires.

Currently, TECENTRIQ™ is FDA approved to treat a type of bladder and urinary tract cancer called urothelial carcinoma and a type of lung cancer called non-small cell lung cancer (NSCLC).

While I may or may not benefit from this trial, I wanted to be a part of it for several reasons:

First, because for every medicine and intervention that people have ever taken, there are thousands of patients who have volunteered to participate in clinical trials, which have led to many breakthroughs in disease prevention and treatment in the last half-century. Without the willingness of these individuals, many would have suffered.

Second, clinical trials also can contribute invaluable information about the benefits and safety of existing therapies, providing doctors and patients with reliable information for choosing between alternative treatments.

Third I may benefit from my participation, and even if I don’t other women will. 

To say I was gobsmacked when I received my diagnosis is an understatement, but being able to be part of group of people who have helped to develop the new drugs, devices, biologics, and treatments for the future, means I am improving the care of my fellow humans, and while having ovarian cancer is awful, knowing I might be helping others is  something I can do as I battle my disease.

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Four Life Altering Words

I’ve been sitting on some not great news for over a month now and not knowing what to do with it. I’ve told family and close friends, but I wasn’t sure whether I wanted or even how to tell my extended network of friends on Facebook. But by not doing so, I felt like I was withholding something that has or will soon come to define me. Four life altering words that are almost as hard to write as they are to say: I have ovarian cancer.

I was diagnosed a week before Thanksgiving. I’d been struggling what I thought were symptoms of gastroesophageal reflux disease for months, and they had grown increasingly difficult to treat with multiple handfuls of Tums throughout the day and night. I now know all the things I was experiencing–heartburn, upset stomach, difficulty eating, nausea, vomiting, bloating, loss of appetite, fatigue–taken together are symptoms of ovarian cancer. But it wasn’t until they began to  persist, and when normal interventions didn’t help that I took them seriously enough to make an appointment with my GP. And even then I thought I just needed a prescription for acid reflux. I was wrong. Test results showed something entirely different.

So here I am several weeks, many tests and a diagnostic surgery later waiting to learn when I’ll begin chemo–within the next 2 weeks is what they’re saying. The diagnostic surgery indicated the best course of action would be 3 chemo treatments over a 9 week period, surgery, and then a repeat of the chemo.

In the past several weeks I’ve moved from deer in the headlights denial to a desire to get started with treatment. I’m frightened, and I’m worried, and I still find it difficult to wrap my head around this reality. There’s no history of cancer in my family, so I never imagined I would hear the words: you have cancer. Now that I have, I’m not sure how to proceed other than to take the pragmatic course and prepare as much as I can for what my immediate future holds.

Yesterday I had my hair cut really short so there is less of it to fall out when that process begins. Thus far, that’s been one of the most difficult things to accept. Cultural scripts are tough to escape. I’m hoping to have the new do hang in there long enough to get used to it!

I’m sharing this information now because I feel the need to express myself, my fear and my determination. And I know I will need the support of my family and friends, those here and those in cyberspace, and my sense of humor to get through this. I have always been an extrovert. I like people and from daily living to my profession, my life is mostly talking to people.

I’m trying to keep a brave face and have fun with the hand I’ve been dealt. My friend Sharon gave me a card that perfectly sums up how I feel:

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The unknown is the hardest, but I have an excellent gynecological oncologist and a great team working with her. She’s optimistic, and while there are no guarantees, she feels confident that I’ll leave treatment in remission and will stay so for a good many years. I’m counting on that and entering the New Year with her optimism, my determination, and the love and support of family and friends. And let’s not forgot the Princess Pooch who has wrapped up her months of chemo and is doing well. She’s my role model.

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The Princess Pooch’s Cancer Treatment

Although I had planned to document the Princess Pooch’s cancer treatment, a number of things conspired over the summer to make that difficult to do. Now that I have some time I want to share her and our experience.

As I last wrote in  July, we had a consultation appointment with Dr. Hershey at Integrative Veterinary Oncology and upon her recommendation, began treatment on July 21, 2017. The treatment plan was as follows: treatments of Carboplatin every 3 weeks for a total of 6 treatment and blood work and chest x-rays at specific times during this treatment to monitor her white cell count and to look for metastasis in the lungs. These are ways of assessing the effectiveness of the treatment.

Although the Princess Pooch experienced some nausea a few days after her first treatment, she had no such reaction during her subsequent treatments. In fact, if not for the bandage over the IV site, no one would suspect she’d had any treatment at all. Now, 5 months since her initial diagnosis and just a little over a month out from her last chemo treatment, the Princess Pooch is tumor free and living the life of a happy senior pup. She’s as active, playful, and loving as ever. We couldn’t be happier!

She had her first post-chemo exam on December 5th, and since all was well, her next examine will be in early February. Although the cancer will eventually return, our goal is to keep her as healthy and happy as possible for her remaining days.

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FHO Recovery, Osteosarcoma and the Path Forward

I haven’t written since sharing the results of the Princess Pooch’s bone biopsy. I was in a kind of fog for awhile, and then I began doing what academics do: reading everything I could find on osteosarcoma in dogs. In addition to all that’s available on the internet–general veterinary publications and people sharing their own experiences with their dogs–I am fortunate to have access to a university library and all the wonderful databases that are available. I found a number of studies published in the journal of Veterinary & Comparative Oncology particularly informative.

After getting recommendations for veterinary oncologists from our regular vet, I called the folks at Integrative Veterinary Oncology. When the person I spoke to said their first available appointment was August 16th, my heart sank, but she then informed me that the doctor held times open for urgent cases and once she received the necessary records from our vet and the hospital where the Princess Pooch had surgery and had time to read them, I would get a call about finding an opening much sooner. True to her word, I received a call that evening. The doctor had received all the necessary records, taken the time to read them, and could see the Princess at 3:00 on Thursday. Whew!

By Wednesday I had read everything I could wrap my mind around, so I decided to make a list of the things that brought the Princess joy. I wanted to have this list when we spoke to the doctor so I could be clear about what “quality of life” meant for the Princess. Also, and anyone who knows me will not be surprised by this, I wrote up a list of questions and concerns. I did this so if I fell apart during our discussion with the vet, I could hopefully return my focus to what the Princess needed.

Thursday was a big day for us and for the Princess. First, we had an 8:30 am appointment with her surgeon for a post-op visit and to remove her staples. She’d been such a good dog about leaving her incision alone. I’d caught her licking it a few times, but as soon as I said “leave it,” she’d stop. I also was diligent about keeping an eye on her throughout the day, then putting the e-collar on her overnight. So that morning, Mr. Desert lifted her into the car and onto the bed we had there for her and off we went. She was excited to be in the car but was a good girl and mostly stayed in her bed which we appreciated because we didn’t have to worry about her slipping and sliding around.

Once we arrived at the hospital, we didn’t have to wait more than a few minutes before a tech took her back to remove the staples while we waited in an exam room. When the surgeon brought her back, he told us there were no staples to remove! We were both shocked; in fact, I think we both asked if he was sure. I knew the staples were there when I put the e-collar on her and tucked her into bed the night before, so where the hell did they go? Thankfully, her incision was healed and the surgeon was pleased with her progress, so we headed home. 20140181_10155343574666071_5728962414438881682_nHere’s a photo of her happy on her sofa for the first time since her surgery.

After we got home and got her settled, I decided to dig around in her bed: sure enough, I found five staples! I don’t know how many were in the incision, but she’d clearly pulled them out as we drove to the hospital. The little sneaker took advantage of the fact I wasn’t really paying attention anymore because we were on the way to get the things out! She’s one smart pup!

Oncology Consult
We arrived for our appointment a bit early, and the vet ended up running a bit late, so we spent some time in what is a lovely waiting area with big comfy sofas and chairs, cold bottles of water, coffee, a table with jigsaw puzzles, and a big glass door that opens into a room where the house kitties available for adoption. Yesterday there were 4 young adult tuxedo cats romping around, playing, and flying up and down the cat tree. We also met a couple of folks whose animals were being treated. One woman had an 8 year old cat who had been undergoing treatment for a year, and another woman said her dog had been undergoing treatment for 4 years and was now 11 years old. She couldn’t say enough about how fabulous Dr. Hershey is and how much she’d helped her dog. Her dog finished up his treatment before we went in to see the doctor, so we got to meet him. He’s a handsome grey and white pitbull. He ran up to his person with a big smile and a powerful tail wag. So by the time we were called back, we were feeling more hopeful.

We were taken to a huge room with more comfy sofas and easy chairs, and when the doctor came in she introduced herself, shook our hands then sat down on the floor to greet the Princess. She checked her out as she talked to us about her observations and what she’d learn from reading the records she’d received. She was very down to earth and clear, so much so I didn’t even open the notebook I’d brought!

In some ways, she said, the hip fracture was good because it drew attention to the bone which in turn helped them diagnosis the cancer early. She was clear that there is no cure for oseosarcoma, and that the goal of any treatment is to address pain and provide extended quality of life. She talked about recent studies, confirming what I’d been reading; answered my questions about the various drugs used to treat the cancer; and explained why she was recommending a particular treatment plan. Essentially there are 3 drugs used to treat oseosarcoma in dogs: Carboplatin, Doxorubicin and Cisplatin. Although Doxorubicin is the cheapest of the 3 drugs, it can cause irreversible injury to the heart, so it’s not a good choice. She explained that Cisplatin used to be the drug of choice because the cost of Carboplantin was prohibitive–often exceeding $1,000 per treatment while Cisplatin cost between $300 to $500 per treatment. The problem with Cisplatin, however, is that it is distributed widely into the liver and kidney and so requires tests on renal concentrating ability, azotemia and presence of abnormal numbers of granular casts in urinary sediment; because of the effects on the liver and kidney, a fluid diuresis pre treatment of several hours is required. Fortunately, the price of Carboplatin is no longer prohibitive, and studies show it is as effective if not a bit more so in treating Oseosarcoma. And, it doesn’t require fluid diuresis pre treatment; this is particularly important for the Princess Pooch because last year she was diagnosed with early renal disease.

So, the treatment plan is as follows: treatments of Carboplatin every 3 weeks for a total of 6 treatment and blood work and chest x-rays at specific times during this treatment to monitor her white cell count and to look for metastasis in the lungs. These are ways of assessing how effective the treatment is. In addition to being a board-certified veterinary oncologist, Dr. Hershey has also studied traditional Chinese veterinary medicine with Dr. Xie at the Chi Institute in Reddick, Florida and combines conventional Western therapies with acupuncture, herbal medicine, nutrition, ozone therapy, ultraviolet therapy and other therapies. Here a video of an interview with Dr. Hershey where she talks about this training.

The Princess Pooch had her first treatment yesterday afternoon, and other than some lethargy has had no side effects. The good news about chemotherapy and dogs is that side effects such as vomiting and diarrhea are rare, and if they do occur usually last a day or two.

In the meantime, her recovery from the FHO surgery is progressing well, and we’re hopeful this treatment plan will give her good quality of life for at least a year. Given her age, 12, that would be a wonderful gift.

 

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The Worst Possible News

Yesterday we received the worst possible news, something we knew was a possibility but were hoping wouldn’t be the case: the Princess Pooch has osteosarcoma, an extremely aggressive cancer that generally spreads rapidly to other parts of the dog’s body; in fact, the cancer has often metastasized by the time it is discovered. The National Canine Cancer Foundation reports that

Osteosarcoma is the most common primary bone tumor found in dogs. It accounts for up to 85% of all malignancies originating in the skeleton. It mostly occurs in middle aged to older dogs, with a median age of 7 years. Primary rib OS tends to occur in younger adult dogs with a median age of 4.5 to 5.4 years. Larger breeds have a high propensity for the disease. Dogs like Great Dane, Irish setter, Doberman pinscher, Rottweiler, German Shepherd and Golden Retriever are at greater risk of contracting osteosarcoma because of their size and weight. Intact males and females are also highly predisposed. Osteosarcoma can occur in any bone but the limbs account for 75%-85% of all affected bones and is called ‘appendicular osteosarcoma’. The remaining affects the axial skeleton comprising maxilla, mandible, spine, cranium, ribs, nasal cavity, paranasal sinuses and pelvis. Osteosarcoma of extraskeletal sites is rare, but primary OS has been reported in mammary tissue, sub-cutaneous tissue, spleen, bowel, liver, kidney, testicle, vagina, eye, gastric, ligament, synovium, meninges and adrenal gland. It develops deep within the bone and can become excruciatingly painful as it grows outward and the bone is destroyed from inside.

We knew this was a possibility when her fracture was diagnosed, and they used the bone removed during the surgery for the biopsy. The surgery, however, was necessary to address the fracture and, since the pre-surgery x-rays of her lungs were clear, this was the best first step. Often in the case of “appendicular osteosarcoma,” the limb where the cancer is located is amputated; we’re hoping the FHO surgery will stand in for the amputation and have decided we’re not going to put her through another surgery even if that’s not the case.

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Princess Pooch, July 15, 2017

We’re devastated by this news but are doing our best to think about what’s best for the Princess. We’re waiting for an opportunity to talk with our own vet before moving forward, but our most likely next step will be to consult a veterinary oncologist. We’re lucky to live where there are a number of such specialists and facilities. A standard treatment for this cancer, in addition to amputation, is chemotherapy which apparently can present very few to no significant side effects in dogs. So, we’re open to that course of action if our vet and the oncologist believe it will help. From what I’ve learned, the surgery addresses the pain of the cancer, and in the Princess Pooch’s case the fracture, and the chemo provides additional time during which the dog doesn’t suffer the effects of the cancer.

According to the Princess Pooch’s surgeon and echoed by this canine osteosarcoma fact sheet, the prognosis is as follows:

  • without any sort of intervention, the average survival time is approximately two months after diagnosis;
  • if amputation is performed the average survival time is increased to six and a half months with 2% of patients alive after two years;
  • if amputation is combined with chemotherapy the average survival time is increased to one year with 20% of dogs still enjoying a good quality of life two years after surgery.

So, if she’s a good candidate for chemo and we can afford it, that appears at this time to be our best option. In the meantime, she’s doing really well and is more active and more like herself everyday. She’s putting that foot down when she walks more often than not now, and she’s back to being aggressive toward Reilly, spinning at the door, and her other routines.

For now we’ve decided to be cautiously optimistic and give her all the love and care we can until we know what’s best for her.

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