Pain Management - Osteosarcoma

[Guest AussieWilma]

I am writing this post on behalf of another grey owner here in Houston whose beloved greyboy Trip has just been diagnosed with osteo.

 

I've copied Susan's posts from GPA Houston's bulletin board.

 

We're hopeful that based on people's experiences Susan can avoid some of the trial and error in trying to get the right mix of medications to ease Trip's pain.

 

Thank-you in advance for your help.

 

Natalie (for Susan - Trip's mom)

 

The initial diagnosis

I got some devastating news yesterday, that my beautiful, sweet Trip has osteosarcoma in his left rear leg. He was noted to be limping a week ago on Tuesday, and the vet originally thought he had torn a ligament. We had an appointment to go see Dr Herron, but in the interest of saving time, I decided to ask for some x rays before making the trek up there. Sadly the news yesterday was that he has an aggressive form of osteosarcoma, and the surgical option would be to amputate and do chemo. Unfortunately Trip fractured his right hock when he was racing and it's made that right leg unstable and weak, so an amputation for him is out of the question. The vet estimates any where from 3 weeks to a few months of time left, and I'm just devastated. He's being kept comfortable at this time with tramadol and deramaxx, but I don't know how long this will help him. How does one begin to deal with this type of news? I am at a total loss.

 

The first night of pain management

Thank you all for your words of support and encouragement. We are struggling to find the right dose of pain meds and it's only two days into pain management. Last night was a very restless night for Trip. He had two tramadols at 4 pm, a Deramaxx at 5 pm, and then another tramadol at 8:45 pm, 9:15 pm and again at 10 pm. Finally around midnight he got a little bit of rest and then three more tramadols at 4:30 this morning. I'm visiting with our vet today about further pain control and then I will have to make the decision to release Trip from his pain or continue more aggressive pain management. His spirit & will is still so strong and upbeat, and he is right there with Rudy and Libby to go on our walks, no matter how brief they are right now. It just kills me to see him in so much discomfort and the trial and error of his pain management seems to be going so slow at the moment.

 

 

[Guest KTsGreytPups]

I have lost 3 to osteo in the last year and my experience is LOTS of pain meds and be realistic about how much your baby is suffering. Unless you are planning to treat the end is what it is. What I did is I spent the time preparing myself and when the pain meds did not seem to be doing their job I made that horrible decision. The best advise I got was to remember when it is terminal it is never too early and too late really sucks.

 

I hate to be the one to post this, but this has been my experience. I heart goes you to you on this journey. All I can say to love them with all your heart.

[Burpdog]

I used tramadol (100mg every 4 hours) and pred for one. Tramadol and morphine for another. You must combine drugs. You can also add neurontin.

 

Sending prayers.

[Guest MorganKonaAlex]

Osteo. is very painful. We had to keep increasing Alex's pain meds and adding additional ones until we maxed out at the following. Alex weighed 85 lbs. Adding Neurotin helped.

- 75 mg Rimadyl x 2 day

- 50 mg Tramadol. Can increase up to 100 mg. 4 x day.

First increase the number of doses per day.

- 100 mg Neurotin x 1 day

 

[Guest 4crazygreys]

Please tell your friend I am sorry. I have lost two to Osteo. The only med we used for pain was Metacam and it worked well. Actually, my last grey that died from Osteo was spunky right up till she broke her leg. She was playing with her toy when it happened. Metcam gave us 9 good weeks with her.

[Guest rockwegreys]

Thank you for all your support and good information. We are going to try the 100mg Tramadol tonight and see how that works. I am just astounded at how rapidly Trip seems to be worsening. I was hoping for another three weeks to a few months but as it seems right now, I may be loosing him on Monday, if he can go that long. I had no idea it could be so aggressive. What a horrible lesson to learn. I am so sorry for all of you that have been down this road before me.

Susan

[Guest Naty]

I am so sorry. I lost one last year. We used Rimadyl but did not get to the point of combining drugs because there were other issues and we didn't have him long after the diagnosis.

 

My thoughts are with you.

[Guest longdogs]

The pain just gets worse until it becomes too much or the limb is amputated or irradiated. Amputation is as much about pain relief as attempting a cure. Generally a mix of drugs is needed, with something heavy-duty like Fenatyl and an anti-inflammatory like Meloxicam.

[msjpk]

I am so sorry you both are going through this. It is a tough time. Been there and time becomes a whirlwind.

There is a greyt community that is available at this time for you "circle of greys", I suggest you join and you will get plenty of support and advice now.

Good luck and whatever decision you make is right for your pupper.

 

[Guest sirsmom]

So Sorry--we lost a large breed non grey to osteo recently. The vet put him on prednisone b/c we chose pallitive route of non amputation or chemo. He did pretty well at first (i also had him on glucosamine, chondroitin, duralactin, msm and doxycycline for tumor shrinkage) Then after about 2 months the tumor grew to the size of a baseball and I could see he was in severe pain. He was healthy in every other way and people thought he was years younger than 8. I'm glad we did not increase pain meds and let the suffering go on too much longer

[Guest IrskasMom]

 

 

I am so sorry Susan I also lost my Irska to Osteosarcoma. The most painful and agressive Cancer in this

Dogs. Hugs and Kisses in this precious Time left .

[Guest MonsterMomma]

My heart goes out to Trip and Trip's mom. That's a devastating diagnosis.

 

We went through this with Diego earlier this year. He was diagnosed with osteosarcoma in his left femur, with metastases to his hips and lungs. Amputation and chemo wouldn't have helped him. We were able to keep his pain under control with tramadol (50-100 mg every 4 hours around the clock, doubled in the last few days) and prednisone. I also massaged his back, hip and leg muscles which were spasming badly. The most important thing was staying ahead of the pain.

 

When he could no longer breathe while laying down, we knew it was time to let him go. He was in good spirits and fighting until that last day when his eyes begged us to make the pain stop so he could rest.

[feemandvm]

Some Greys will not respond to pain medication no matter what combination you use... the pain can just be that severe. With that in mind you will need to use a combinatino of the following:

 

1. NSAID: Rimadyl/Deramaxx/Previcox/etc. Pain reliever and anti-inflammatory. Unless your dog has a direct reason NOT to take an NSAID this should be drug #1. Avoid true steroids like prednisone as they are weaker pain relievers and have a much higher incidence of side effects.

 

2. Tramadol: a opioid like pain reliever. Dose is dependent on the size of the dog but for most Greyhounds I'd start at 100mg 2x/day and increase up to 150mg 4x/day.

 

 

If the above are not working you can consider the following:

 

3. Gabapentin

4. Amantadine

5. Acupuncture

6. Pamidronate (may slow the bone destruction of osteosarcoma)

7. Artemisinin (may slow the spread or growth of the cancer but will do nothing for pain)

 

Realize that all of these meds are palliative only and a decision will need to be made sometime soon.

 

 

[Guest rockwegreys]

It breaks my heart to report that Trip passed away on Monday, June 23rd, 2008. Our vet came to our home to euthanize him so that Trip would not have to make a dreaded visit to the office....he was so frightened whenever he had to go there. Early on Sunday morning his leg became very edematous, dark red, and very warm to the touch, so the decision was made to end his suffering on the following day. His pain seemed to be well managed by Tramadol 200 mg every 4 hours in his final two days. He has left a huge hole in my heart and in our home. I think my two other greys miss him terribly as he was the Boss! I would like to thank you all again for your suggestions and your kind words and support.

 

Susan

[Guest HeatherDemps]

I'm very sorry to read of Trip's passing. Osteo is such a terrible disease....

[Devotion]

Susan,

 

I am so sorry of Trip's passing. I saw your post in Health on GPA Houston and have been keeping Trip in my prayers. He is pain free now. As you begin your healing and begin your journey remember the love you and Trip gave each other. He will live on in your heart forever. Prayers of peace and comfort to you during this time.

 

Pam

[ahicks51]

6. Pamidronate (may slow the bone destruction of osteosarcoma)

 

I seem to recall a number of the anti-osteoporosis drugs have been tried, including ibandronate (Boniva).

 

Gleevec (imatinib mesylate) has been tried in the lab to slow osteosarcoma cells in vitro, and I think it's in a few trials with humans- but would probably cost far too much for use in dogs as it's still under patent.

 

It would be interesting to see if Coley's fluid had any effect on osteo.

[Jackandgrey]

I'm so sorry for the loss of your sweetheart. I wish this horrible monster disease would leave us alone.