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
and PSK in ,
are government registered anticancer drugs, commonly
used as a supplement to surgery, radiation and chemotherapy. Here is a link to a 2012 research paper using
I’m-Yunity as treatment of hemangiosarcoma in dogs. To quote from the results “While
there was no statistically significant difference in the survival curves
amongst the 3 dose groups, the two highest dose groups had median survival
times longer than the longest median survival time reported in the literature
to date, which is 86 days, as compared to 117 days in dogs receiving
50 mg/kg/day I’m-Yunity and 199 days in dogs receiving 100 mg/kg/day.” 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. . .