Two iron dextran injections (20 mg/kg IM) were administered approximately one month apart at 2 weeks and 2 months postsplenectomy (Table: CBC Value Results of Importance), and a nutrition plan was instituted. The nutrition plan was formulated by a boarded veterinary nutritionist and included a complete and balanced homemade diet of cooked skinless chicken breast, sweet potato, vegetables, canola oil, and a vitamin-mineral supplement. The owner was given specific instructions for preparing the diet using cooked gram weights of each ingredient and was educated on the importance of adding the vitamin-mineral supplement. To ensure adequate intake of the homemade diet by the patient, the owner was given a computerized spreadsheet food journal to record daily gram intake. Three times a day, the owner offered the recommended gram amount of the recipe, weighed any food remaining, recorded the gram intake of each meal, then calculated total gram intake per day. The nutritionist reviewed the food journal weekly to ensure Kelsey was not only consuming the homemade diet but consuming adequate kcals for weight gain. Body weight was also reported to the nutritionist biweekly. Follow-up examination was conducted at 2 weeks and 1, 2, and 3 months after diet implementation to assess patient and owner compliance with the homemade diet. Food intake gradually increased, and at the 3-month recheck, the patient weighed 14.3 lb (6.5 kg) and BCS had improved to 4/9, although MCS remained at 2/3.
Follow-up CBCs showed a marked regenerative response and resolved anemia. The owner declined a repeat serum iron panel due to financial constraints but reported that the dog’s appetite had improved after the iron injections and implementation of the nutrition plan.
Repeat diagnostics and imaging after 9 months of lomustine therapy showed no evidence of histiocytic sarcoma; thus, the oncology service recommended discontinuing treatment. The owner was counseled to continue the homemade diet as outlined and to contact the nutrition service if there were any changes in the patient’s medical condition. Two and half years after cancer diagnosis, Kelsey was euthanized for poor quality of life with no specific diagnosis.