About Dr. Tatiana Yatsenko, PharmD Expertise I can provide very useful information on a variety of different topics, however, my specialty lies in Home Infusion Therapy.
1. Nutrition therapies: parenteral nutrition, enteral nutrition and hydration.
2. Anti-infectives (antibiotics)
3. Chemotherapy
4. Pain management and miscellaneous therapies
Experience Initially, I worked as a pharmacy technician while doing undergraduate work. I then went on to receive my Doctor of Pharmacy degree and now specialize in Home Infusion Pharmacy.
Education/Credentials Biochemistry (University of California Riverside)
Doctor of Pharmacy (Western University of Health Sciences)
Question QUESTION: Last year my dog was treated for lymphoma using cytoxan, prednisone and vincristine. Two weeks after treatment was started he had to be euthanized. Week one of treatment consisted of cytoxan, vincristine and prednisone all in the same day. The prednisone continued and week two he received IV vincristine. After this treatment he never ate again and was euthanized a week later. He was a 150 pound dog. I read chemo side effects are dose related. On the vet bill he received 2.6 cc (cost 78.00). Week two he received 2 cc (cost 60.00). Dose for dogs is .75mg/m2. His BSA I think would be about 1.75. His dose should have been 1.3mg. In researching vincristine I read there is 1 mg in every ml. If this was the case did he receive 2.6 mg week one and 2 mg the second week. If I half the 2.6 cc ans 2 cc on the vet bill then it does come out to 1.3 mg and 1 mg. This has driven me crazy for a long time. Is 2.6 cc of vincristine 2.6 mg or 1.3 mg. Any help you can give will be gratefully appreciated. Thank you so much for your time. Margaret, New Orleans
ANSWER: Dear Margaret!
I'm sorry for the loss of your dog. I love dogs as well, and just recently lost mine.
Let me try to shed some light into the situation. Chemotherapy side effects can be dose related, however, they can also cause side effects even if they are dosed appropriately since chemo is a "poison." In the pharmacy world, the 1mg/ml Vincristine is used to compound chemo. The maximum adult dose is 2mg! You have to remember that sometimes the drug is diluted, however, it does not have to be in order to be administered. If the clinic does NOT dilute their chemo, if vincristine 1mg/ml was used and BSA was calculated correctly, then the dose was unfortunately miscalculated. Is there any way you could find out if they dilute their vincristine?
Hopefully you found the information helpful. Please feel free to follow up with any questions.
Dr Tatiana
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QUESTION: Dear Dr. Tatiana,
Thank you so much for your quick response to my question. I am so sorry for the loss of your dog. When we lose our pets it really is hard. Sometimes an understanding as to what might of happened does help in the grief process.
I have not spoken to the vet who treated my dog "Nicky" with chemo since his death. Looking back I realize we should have seen an oncologist. Our vet said she could refer us to one but she could treat him with the COP protocol only as this was the only drugs they used at their clinic. If we were interested in other chemo drugs used for treating lymphoma we would have to see an oncologist. She believed the other drugs would be too strong for Nicky. After a lengthy discussion with her we chose to let her treat him. She thought she could buy him 6 months. When we asked about side effects she said dogs don't experience the same as humans as the dose is much lower and if side effects would occur should would handle them. Of course we had hope. Unfortunately hope is part of the equation and when hope is dashed it really hurts deeply.
I thought about meeting with the vet or sending her a letter. I do have some questions regarding Nicky's treatment. The problem is she was very kind to us and Nicky. She had treated him for years for various aliments. During the chemo she called every day to check on him even on Sundays. She even came to my home to euthanize him. For me to confront her with my questions I would come across of accusing her of killing Nicky which I am not sure she deserves. What do you do? On one hand you have a caring person which you don't want to ruin for others. On the other hand if there is anything I have learned it may help someone else. Whether or not to confront the vet has been a delima for me. I do believe in my heart she did what she thought was in Nicky's best interest. In my opinion 90% of good medicine is in caring. You are a professional and what would you do? Confront her or let it go?
As far as the vincritine dose this is what I know. Vincristine was administered IV which took about 15 minutes. In researching cost of the drug I think 2.6mg would cost more than the 78.00 I was charged for the drug. I know there is a bit of a mark up on the drugs the vets use. Example would be .12 to .15 cents per prednisone pill at cost and I paid .51 cents a pill. Cytoxan cost me 9.50 for one 50mg pill. If I had to guess I would think vincristine must have had to been diluted according to the cost, or at least I hope so.
You have been very kind to me and you most certainly are an asset. In some kind of way you will be rewarded for the time you give in helping people. I really believe this.
Thank you so very much and have a great weekend!
Margaret
Looking back we really should have seen an oncologist. Having the vet administer chemo we be like asking your family doctor to do open heart surgery.
Answer Hi Margaret!
Thank you for your kind words. I have 2 uncles that are veterinarians and seeing how they love what they do and the care they provide for the animals they treat I can definitely see that your vet was also sincerely compassionate. I also agree with you that "good" medicine is showing compassion, care, sensitivity to both the animal and the family. Unfortunately, you do not know "for sure" that a mistake was made. It is apparent that the vet did do all she could...if it was me...I would let it go and forgive her for the possible mistake that she could have made. I see your frustration and inner battle with the issue, but you are right, it might sound "accusatory" if you bring up the issue to the vet and might put a dent into your relationship with her.
The best of luck with everything...sorry my reply was a bit late, I was out of town. If you have any other questions, please ask.
