Paraneoplastic Syndrome and Hypercalcemia

[Rebecca]

Our 11 year old bitch Luna had blood tests on Friday as she was drinking and urinating quite a lot.  Unfortunately the blood tests revealed that her calcium levels are above normal (7-12 is the normal range, apparently, and she had a reading of 13.6).  As she had anal sac adenocarcinoma almost two years ago (resulting in the surgical removal of the anal gland), the vet thinks it will almost certainly be related to the return of the cancer.  She describes it as paraneoplastic syndrome, and didn't advocate any further treatment... meaning we have to watch Luna deteriorate as her calcium levels rise and the cancer grows.

 

I can't stand the feeling that she's being "written off".  While we were only given three months as a prognosis when the initial tumour was discovered nearly two years ago, it's still come as such a shock.  We thought she'd beaten it.  Perhaps it is better not to know where it has spread to, but I feel we know nothing about what is going on with her.  Does she have a tumour in the other anal sac?  Could it be removed... and would or should we put her through that since it's a ghastly operation, and there is no guarantee that this very aggressive cancer hasn't spread into her spine, lungs or brain?  Chemo and radiotherapy are out - even if it was agreed to (the vet said it wasn't an option at this stage), we wouldn't but her through those.  Dialysis was mentioned as a way of getting her calcium levels down, but the vet hasn't had much success with that, and Luna is so petrified of going to the vet that I don't think spending 4 hours on a drip every few weeks would be fair.  We don't want her last weeks or months (if we are lucky) being purgatory for her.  There is another test that could be done to confirm the raised calcium is being caused by cancer, but the vet didn't feel there was much point.  I understand it involves taking more bloods using a special kit sent up from a lab in Birmingham, and then they have to be sent by courier down to Birmingham (within a certain time frame).  Then again, from what I've read, the other possible causes of hypercalcemia are parathyroid related or bone disease, neither of which have non-evasive treatments or good outcomes.

 

At the moment she is very happy - besides the excessive drinking and urinating, you wouldn't know there was anything wrong with her.  Some of the other symptoms of paraneoplastic syndrome and hypercalcemia make of very unpleasant reading (lack of appetite, vomiting, decreased gastrointestinal function, constipation, confusion, depression, bladder stones, anemia) but she has none of those.  Her appetite is very healthy indeed, she's positively delighted to get out on her walks in the stubble fields, and still enjoys a good game.  Perhaps that's in part down to the daily dose of Metacam she gets for her arthritis!  Also, the vet said that all of her other blood results were good, including her kidney function.  So at the moment her body is coping pretty well with the rise in calcium, and the Metacam.

 

I don't know what I am asking for, but if anyone has any advice, from homeopathic remedies that might help to support her, to ideas for reducing calcium, or anything else for that matter.  At the moment we aren't  even sure how excessive the 13.6 calcium reading is, or how quickly it might rise, or whether we should get Luna's bloods checked every few weeks. Nor do we know what we might do to reduce the risk of dehydration as this gets worse.  So all comments and advice are much appreciated. 

 

- Rebecca

 

[Howard Glansfield]

I am sorry to hear of the diagnosis.I understood that calcium levels above normal does not neccessarily mean that cancer cells are present.It is true to say that not all cancer patients will have rasied calcium levels.It might be worth doing the test from Birmingham then you will know if it is or is not caused by cancer.

I suspect your vet is acting on the information that she knows and of her knowledge of your dog and her previous condition.

I hope that you can have a lot more time with Luna .

I wish you and Luna well and Joan and I am thinking of you both.

[Howard Glansfield]

Sorry,

Joan and I ARE thinking of you both.

[Susan Stone]

I'm very sorry to hear your news, Rebecca. Sorry I can't help, just wishing you and Luna a few more good months or even years. My old lady Shannon was given a couple of months to live due to liver problems when she was 12 years old and we had her another 2.5 years. At this age you never know how these illnesses will progress. Whishing you all the best!

[Rebecca]

Thank you to everyone for your kind words and messages of support. 

 

Susan, what a wonderful story about your Shannon - obviously an amazing dog.  Luna too has broken boundaries with her return to health after the original tumour was removed, and as you say, you never know how things will progress... perhaps she will surprise us again :-)

 

Thanks for the links, Rosie.  I've been doing lots of reading, and continue to look and ponder, and get emotional!  The problem is that almost everything I read about high calcium levels is very negative indeed.  It appears if it is parathyroid (which is different from the thyroid) it is likely to be a tumour, from what I understand.  The only thing that seems not to need a surgical intervention is Addison's disease.

 

Yesterday evening I decided to get the additional blood test done (the cost certainly isn't prohibitive - £140-£150 ... not claimable on insurance as we had so many exclusions that we cancelled the policy a couple of years ago, but that isn't a problem).  However, my other half is against the additional test, and this morning when I shared my decision with my mum, she begged me not to do it.  But most of the comments here seem to agree it should be done, so I'm still considering it even if it means a family rumpus! 

[Rebecca]

Just wanted to give you an update on Luna.  We had the blood tests done (thanks to all of those who commented on that aspect - it made the decision easier to make) and unfortunately the Parathyroid hormone-related protein (PTHrP) result was elevated (0.5 or less is okay, but Luna's was 2.5).  This means it is hypercalcemia of malignancy. :-(

The vet who took the bloods messed up on the samples, so we didn't get ionized calcium done - that doesn't matter as the PTHrP says everything we needed to know, but I mention it here in case anyone else gets ionized calcium, PTH and PTHrP analysed.  Make sure your vet knows one should be refrigerated, and one frozen, before transport to the testing lab!

We are now concentrating on keeping Luna comfortable.  She's still a very happy dog, but a bit more lethargic than a couple of weeks ago, and drinking more (although it's difficult to judge).  We had the original blood analysis repeated on Monday, and her liver enzymes and her calcium are both about the same as they were 3 weeks ago, so no massive changes. 

Anyway, thanks to everyone for your support.  I dare say I will post again as I'm currently researching low protein diets (and becoming horrified at the ingredients) and also liver supplements.

[Rebecca]

How sad, Sara.  Very sorry to hear about your friend and her setter. It makes me appreciate how lucky we have been to have the extra 2 years with her after her original tumour was removed, and that we still have time with her yet (hopefully weeks or even months to come), and time to prepare.

Luna is getting thoroughly spoilt.  She's always had a thing about vegetables, brussel sprouts and asparagus in particular.  I was worried about the calcium in the sprouts, but ultimately, if she doesn't get enough from her diet, I understand she will take it from her bones, so.... she gets what she likes!

Tomorrow we are making her a lovely bed out of a thick memory foam mattress topper for when she can't quite be bothered jumping on our bed :-).  I dare say her brother Murphy will spend more time on it than she will, but you never do know!

[Sue and Cash]

I am so sorry to read about Luna.  My thoughts are with you and hope you get more good time with her.  My mother had developed hypercalciumia when her breast cancer had spread to her lungs.  She also had it spread to her liver which overloaded her with ammonia.  She was delusional from it.  Making no sense for her final couple weeks.  It can do that often in humans and I wonder what effects he can have on dogs as the levels rise?  But I do know that in animals and humans it often is a result of cancer spreading.  I can only pray for you to have more time together and that her time left is spent happily and carefree as only an irish should be.  My good friend just lost her Golden who turned 10 to cancer of the spleen which had ruptured and then removed.  They gave him 1-3 months.  He played like a pup until his final days.  They were so grateful for those last 3 months.  Hard as they are, those memories are priceless.

 

[Rebecca]

Well, despite the very poor prognosis Luna had towards the end of last year (and two years before that), she continues to defy the vet and is still thriving!  Her hypercalcemia is still very evident in the amount she drinks and pees, but she's still a happy cheeky soul, with a healthy appetite.  Her main issue is arthritis... she's on a full dose of Metacam each day, but drags her feet when she gets tired on her walks, and needs to be boosted up steps and onto the bed ;-). Our house is split level (not ideal) and my wonderful other half built a large "platform" step to slip over the bottom step of the three, so now she only has to get on to the platform and negotiate two steps, rather than three.  That made a huge difference - she was so worried about it.  She also has a bed made from memory foam and a crate blanket in just about every room (including one opposite the log burning stove), so she's always got somewhere comfy to rest.

The vet has suggested leaving her on Metacam until she isn't doing so well on her walks, and then to change her to another drug with a corticosteriod as one of the ingredients.  It's called Prednoleucotropin (cinchopen 200mg and Prednisolone 1mg).  Deciding when to change is a big dilemna, particularly because Cinchopen can be damaging to the liver.

Other than that we have her on Milk Thistle for liver support (from Denes), and Seraquin and salmon oil for her joints.  I am sure the Milk Thistle makes a huge difference, but I don't have any blood tests on liver function to back up that claim (we didn't feel there was any benefit in continuing to get blood analysed - just more stress for her at a time when she needs love and peace and quiet).  And the salmon oil seemed to make a difference to her brain - just a few days after starting it she was brighter!

We are so, so grateful for the last few months, time we thought we wouldn't have. Let's hope she has many more (she will be 12 at the end of August).  It just goes to show, as Susan said, you never know how these illnesses will progress. 

[Susan Stone]

Good to hear Luna is coping and still going strong!

Shannon wore a harness during the last year or so so that if she colapsed or needed help on the stairs we could always give her a hand. I also think treatment with painkillers and prednisolone at this age can make life a lot easier for the elderly dog.

I am sure you are enjoying the extra time just as we did with Shannon.

 

[Rebecca]

We had to say goodbye to our precious Luna on Sunday morning.  We knew the end was coming as she was off her food and had an elevated heart rate and breathing, but she had a stroke in the early hours of Sunday and we had to get the emergency vet to the house.  She was 13 years and 1 month old.  I am heart broken and destitute - such dreadful pain at her loss. 

Thank you to everyone who sent their thoughts, prayers and advice when she first became ill.  She defied the vet's prognosis again and again and again, and went on to live 4 happy and fulfilling years after the removal of the initial tumour, and two years with hypercalcemia.  She truely was amazing.  The mould was broken when Luna was born.

RIP my beautiful girl.  My best friend, my sleeping companion, my baby.x

Luna: 29/08/00 - 29/09/13

[Angela Clarke]

So sorry to hear your news. They can prove the vets wrong so often, Abbie was not expected to see Christmas 2010 and is still with us, although very poorly now.My thoughts are with you, RIP sweet lady,

[Rebecca]

Thank you, Angela.  Sorry to hear that Abbie is very poorly now.  I have just read her story on your blog.  I am full of admiration for you both.  I put part of Luna's longevity down to her home cooked diet - we took her off proprietry dog foods and onto food that I would make for her.  She thrived on it, up until about a week before she died when she became anorexic, and started to waste away before our eyes as she would eat very little of anything, even her favourites.  Prayers for Abbie.x