This info is intended to help others understand the treatment we used, and why, and how it turned out, possibly to help them decide for their own cases.
Remington's tumor is in his right atrium. The diagnosis is hemangiosarcoma, although they couldn't biopsy it for several reasons:
But the location, symptoms, its behavior make them certain it's hemangiosarcoma, and from what I've discovered since, I agree with that.
We discovered Rem's tumor when it ruptured enough to fill his pericardium with fluid, which put tremendous pressure on his heart. Biggest risk at that time was heart failure because of the pressure. They temporarily relieved it by needle aspirating 500 CC of fluid. But it could keep recurring.
So our treatment first consisted of an operation to open a permanent window in the pericardium to allow fluid to drain into his chest cavity. This is not harmful in itself, although I'm sure it doesn't feel great, and the additional advantage is that his body can resorb the blood and make use of it.
The operation to open a window in the pericardium is apparently often used in this situation, but until recently it was an open-chest major heart surgery. The vets here were able to perform a thoracoscopy, in which they did all the work through a small incision in his abdomen. As I understand it, there are still very few places where this can be done--my vet and somewhere in Los Angeles are among the very few or only ones in all of CA, I've been told. This was good because he was home in a day, he was active and normal within a couple of days, and the stitches were out in just a week or 2.
Without doing this, it's not clear whether doing the adriamycin would have helped a lot, because the major risk would still have been fluid in the heart. Not sure about this.
The adria has done a couple of things: After the first 6 weeks, the tumor had shrunk dramatically. Also, a couple of times when the tumor has bled seriously, a slightly early dose of adria seems to have stopped it. But that can't be done often.
Mostly the adria didn't bother Rem, although sometimes he's had a very little tummy upset--one out of the 5 times he actually vomited and couldn't keep food down, and we gave him some stomach-settling meds. That didn't seem to bother his attitude, though. He has also had a little diarrhea from it some of the time. My big concern at the beginning was that I didn't want to give chemo if it made him miserable, and pretty much he was oblivious to it (except for the several hours he had to spend in the vet's office getting it IV).
Also it would knock his white blood cells low for 1-2 weeks after each dose, and when it went on too long, the vet prescribed preventive antibiotics because the risk of secondary infections was higher.
About a week after we saw that the tumor had shrunk so much, he started bleeding again for the first time. Less than a month later, ultrasound showed that the tumor was back to where it had started. So we possibly gained a couple of months. It's hard to know whether it also slowed down any possible metastasizing--last ultrasound also showed some nodules in his lungs and a few other places. If he hadn't had the adria, would they have appeared sooner? No way to know.
We also took Cytoxan between doses of adria.
My friend's dog whose spleen was removed with hemangiosarcoma is also on adria and appears to be suffering no ill effects. They are not getting Cytoxan. I don't know what the deciding factor is on this. I hope that this gives you enough additional info to help decide whether to try the adria. Every dog's experience will be different, too.
Here's what the handout from my vet says about these chemo treatments:
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