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Thread: IMHA & Mast cell tumours

  1. #1

    Default IMHA & Mast cell tumours

    I have a dilemma and would like some advise, please!

    Our 8 y/o Staffy, Roxy was diagnosed 3 months ago with IMHA as well as having 4 Mast cell tumours.

    After weeks of being on high doses of drugs, her PCV is now at 40 and she was well enough to have the mast cell tumours removed last week.

    Our dilemma is the vets treating her want her to have chemotherapy, but our referring vet doesn't think it's a good idea as the tumours were all low grade and clean margins. We don't have all the pros and cons yet. We only want what's best for her.
    Last edited by Hyacinth; 08-09-2013 at 08:59 PM.

  2. #2
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    Hi Smokey

    Sorry your post didn't appear straight away. For some reason it got "moderated" which means a moderator has to approve it before the rest of us can see it.

    I put some spaces in to help with readability.

    I can't help you much with the advice.

    I don't know what IMHA is or PCV

    I know chemotherapy is pretty nasty. You probably want to get explained to you why you should do it by the vets who want to do it. I imagine it could be vaguely equivalent to having antibiotic ie it would help minimise the chance of any of the cancers coming back or lodging somewhere else in your dog.

    Mast Cell Tumours - Dog Cancer Treatment Australia

    It seems a fairly standard thing to do to help prevent the spread which seems like a good idea to me. Ie insurance against some of the cells that should have been removed - actually "escaping" and being able to spread. Surgery is a messy business and given how many of them there were...

    But you need to get each vet to explain to you exactly why they like their option over the other option.

    Sometimes it could be as simple as your dog's expected life span might be 5 years now, and doing nothing or something - wouldn't change that or your dog's quality of life - so why put your dog through chemotherapy (which generally makes people feel miserable and nauseous for months) if it won't make any difference to your dog's life expectancy or quality of life.

    I don't know if that's the answer. You need to ask the vets.

    You also need to ask each vet "If she was your dog (or your child's dog) what would you do?"

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    My mothers dog had a low grade soft tissue tumour. She was referred to a vet specialising in oncology. The tumour was removed and the margins seemed clean but it was in a difficult location so the oncologist recommended oral chemotherapy. The dog has been fine for the last 12 months but started to get urinary tract infections and just didnt seem her usual happy self. My mother decided to take her off chemo and her quality of life has increased. She is an older dog so it was an easy decision. We have no idea what the outcome will be at this point.

    The oncologist said that surgery followed by chemo was potentially the most effective strategy because although the margins seemed clean there is no knowing if a couple of cells have escaped. However he ageed that the quality of life is important and these are decisions that are made by the owner.

    If it were me and I went through surgery and my dog was reasonably young I would personally taked the advice of the specialist vets and do the chemo, particularly if they have had a lot of experience. I would then see how my dog coped and take it from there. Cancer is like that unfortunately, it can have different outcomes which can be unpredictable in some cases. The oncologists can only guide you based on experience.
    Last edited by Kalacreek; 08-10-2013 at 03:09 PM.

  4. #4

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    Thanks for that. The other problem with Roxy is she has Immune Mediated Hemolytic Anemia, which is nearly under control, and introducing another drug could set her back and make her critically again, which is what our referring vet thinks is too risky to chance.

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    chemo - doesn't that destroy the immune system and anything a body needs to be immune to - at the same time. I would want to know what the cancer specialist vets thought, but I can't see how a drug that stuffs the immune system completely could be a problem for a dog that already has a dodgy immune system.

    I could be entirely wrong about that.

    She is 8 years old and you do need to think about quality of life - is it going to be worse (for a while) with chemo - very probably. But would the possibility of cancer recurring - be worse than that? Feeling crap from the chemo is pretty much certain if you take the chemo, and much more certain than recurring tumors if you don't. But what would you do if the cancer came back. She's 8yo and sick already.

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    A good specialist vet should have seen this all before and be able to guide you by giving you the range of outcomes, probabilities and best and worst case scenarios. Then you as an owner need to weigh it all up and make the decision you think will be best for your dog. Does the referring vet have experience with this problem on which to base these concerns? Do you trust the specialist vets? You can always ask for a second opinion.

    You know your own dog best. Dogs handle chemo quite well. Maybe you could wait untill the dogs other problem has settled - is this an option? Really youir specialist vets should be answering these questions. If they cant or you have reason to be concerned - ask for another referral to a different specialist.

  7. #7

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    These are all the things we are thinking through.
    The referring vet has taken many mast cell tumours off dogs that have 3 and low grade) and she hasn't recommended chemo. The treating vets, 1 has said she wouldn't do it if it was her dog because they were low grade, she also stated that the medication team didnt think it was necessary either, the other vet has worked in a cancer clinic and is recommending it because there were 4 tumours.
    We have another appointment tomorrow, so hopefully they have more info for us.
    Roxy has been wonderful, through all her treatment, I don't think she knows she's sick!

  8. #8

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    'Smokey' - I would be following your referring vet's advice at this point. A lot of vets can be trigger happy - whereas - that may not be the best outcome for your pup.

    Interesting - that there was only 1 vet in all of this - that wants you to go ahead with chemo.

    As your pup's IMHA is still not under control - I wouldn't even contemplate bringing in chemo - if this was my pup.

    Chemo used for pups is not as drastic as it is for people - much lower dosages - but even still - as the tumours were low grade and clear margins achieved - I would be leaving well enough alone at this point in time.

    Heaps of Good Luck Wishes and

  9. #9
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    Quote Originally Posted by Smokey View Post
    These are all the things we are thinking through.
    The referring vet has taken many mast cell tumours off dogs that have 3 and low grade) and she hasn't recommended chemo. The treating vets, 1 has said she wouldn't do it if it was her dog because they were low grade, she also stated that the medication team didnt think it was necessary either, the other vet has worked in a cancer clinic and is recommending it because there were 4 tumours.
    We have another appointment tomorrow, so hopefully they have more info for us.
    Roxy has been wonderful, through all her treatment, I don't think she knows she's sick!
    I would wait then and consider all the information and options. The vet who wants you to go ahead has worked in a cancer clinic - then they should be able to give you some facts and figures as to why they are suggesting this course of action, and if they considering her other immune problem as well as the tumours.

    Could be that because there were 4 tumours they are concerned that there are other tiny tumours that are not currently able to be detected, this is probably what would concern me. They are possibly considering the fact that the cancer has already metastisised and that chemo gives her a better shot. I would want some more info.

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    I would also weight the experience of the cancer clinic vet a little more highly than the other less specialised vets.

    And I agree with what Kalacreek said - maybe it's because the cancer clinic vet thinks there is a possibility they've missed some. And has seen that before.

    However it can work the other way - you'd expect the cancer clinic vet to be much more paranoid about cancer too. I know someone who works in a breast cancer clinic (for humans) and she thinks that every woman on the pill long term will get breast cancer, like smokers get lung cancer...

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