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Hemangiosarcoma treatment
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alysoun posted:
My dog was diagnosed with hemangiosarcoma after a spelenectomy on Nov. 22. His energy level and appetite returned to normal by about the third week after surgery, but I understand that dogs live on average only 2-3 months after surgery with this diagnosis, and he could suddenly collapse at any time. I have spent thousands of dollars and driven hundreds of miles in an effort to find treatment that can give him extra months of good-quality life. The first oncologist said it was hopeless after $1000 worth of tests. The second oncologist originally said there was hope of extending life by 6-9 months with 4-5 doxorubicin treatments, then said my dog was not behaving well and stopped after the first treatment. So he is now just taking meds at home - Previcox 113.5 mg one per day, Doxycycline 150 mg twice per day, and one Yunnan Baiyao capsule twice per day. Did the single doxorubicin treatment help him at all? Is this drug combo a good one? Is there something else I should do? Thanks for any advice!
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AMERICAN VETERINARY MEDICAL ASSOCIATION
Sandy Willis, DVM, DACVIM responded:
Hi there,

Thank you for your patience. You provide an excellent history and I applaud you for considering chemotherapy options post splenectomy.
I am an internist, not an oncologist and there are so many new protocols to better treat even some of the aggressive cancers while giving our pets the best quality of life.
Doxorubricin remains the mainstay of therapy but there are other options. The info you have been provided re. prognosis seems reasonable, 6 months with chemo. You never know, depends on the individual pet and the disease. Less than 10% go beyond a year. But, you seem to still want to explore options. Is his temperament not amenable to chemotherapy? I was confused why treatment with Doxo stopped. Sounds like you are taking a more holistic approach which is fine. I hesitate to recommend another oncologist, and there may be only two in the area, but they are the best resource for treating your dog's disease short term even tho the long term prognosis isn't good. But it does sound like you are trying to give your dog the best chance. Dr. Sandy
 
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alysoun replied to Sandy Willis, DVM, DACVIM's response:
Thank you, Dr. Willis. My dog Fox had one complete Doxorubicin treatment at VCA Southpaws in Fairfax VA. Fox and four other companion animals of mine had previously received great care there, so I had high hopes that this would work out. However, when I brought Fox back for the second treatment, the practice said he tried to bite a nurse and they could not continue to treat him. They sent Fox and me home with a doxycycline prescription, and we're basically on our own from here. I'm combining that with the previcox that The Oncology Service in Leesburg had prescribed and the yunnan baiyao that had also been recommended. I don't know what else to do.
 
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AMERICAN VETERINARY MEDICAL ASSOCIATION
Sandy Willis, DVM, DACVIM replied to alysoun's response:
Hi,
Thank you for writing back.
I spoke with an oncologist in my area and she gave me some additional insights.
Did you dog only have disease in the spleen or was there metastasis? This would help us determine if looking at different options because, with metastasis, the prognosis is not good despite treatment and perhaps it might not be worth considering options which could be done to facilitate treating your dog. Doxyrubricin can be caustic to tissues and the injection needs to go well . With dogs that are difficult to handle, an individual oncologist may use options such as muzzling, sedation and even anesthesia to make treatment easier. I think you would do best to talk to your oncologist, not the clinic or receptionist, but the veterinarian and explain your desire to treat your dog and discuss with them the options. We don't want staff to get hurt but there may be other options to work with a pet that is difficult to restrain for a treatment that needs restraint. The at home therapy you are doing sounds reasonable to the oncologist that I spoke with. Dr. Sandy
 
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alysoun replied to Sandy Willis, DVM, DACVIM's response:
Thank you again, Dr. Willis.

Unfortunately, oncologists, like other specialists, do not do phone consultations - so if they can't or won't see the animal, they can't or won't provide advice to the animal guardian.

I have been able to get a bit of advice from the surgeon who performed Fox's splenectomy, and from my family vet. Neither of them are experts in oncology, of course, but they seem to agree with your assessment that what I am doing seems reasonable.

There is no concrete evidence of metastasis. The surgeon tells me that when a spleen bleeds as Fox's did, it's virtually certain that the cancer spreads this way. She also said, though, that his liver looked reasonably normal at the time of surgery. My $1000 investment in an ultrasound produced conflicting analyses from the two oncologists who looked at it. The first oncologist thought it showed evidence of significant metastasis, the second thought not.

Thank you for being there. It is a great service that WebMD provides. I hate to say this, but you should charge for it. There has got to be demand.
 
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AMERICAN VETERINARY MEDICAL ASSOCIATION
Sandy Willis, DVM, DACVIM replied to alysoun's response:
Thank you for the followup.
Well, specialists won't really consult with pet owners over the phone as they need to see the pet, but you are already a client and we do, and should, either talk to clients over the phone or meet with you in the clinic to discuss options. If that is not the case with your oncologist, I am sorry because especially with oncology, specialists need to keep in touch with owners and not just by appointment. I would encourage you if you haven't tried to contact them; if you have and they will not come to the phone, I am not sure what else to say. Another oncologist? Vet school?
Thanks for the update on the status of possible metastasis. I agree with your surgeon, and perhaps at this time there is no gross metastasis.
Thank you for your kind words. I mostly hope to open up communication with pet owners and their veterinarians by spending a moment over the internet to explain disease and support owners. We love our pets, and disease gets complicated as you know. Thank you for trying to do so much for Fox. Dr. Sandy


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