Need Input On Osteo Treatment Options

[NeylasMom]

So I've talked to a couple of specialists about specific treatment options, but Dr. Couto and I are still playing phone tag. I am really hoping we'll be able to touch base today and that he can help me put the pieces of the puzzle together so I can make a clear decision b/c right now I am feeling pretty lost.

 

In the meantime, if you chose to do only chemo or radiation or some combination for a pup dx'ed with osteo, could you tell me what protocol you used and what your experience was like (side effects, how your dog felt as time passed, how much longer you had with your dog once the treatment was over, also cost if you're willing, etc.)?

 

I guess it would be just as helpful to hear from people who chose to do only palliative care. I do not feel amputation or surgical removal is a good option for Neyla so rad/chemo or palliative care seem to be our only options (and Fosamax, but I'm lumping that into palliative in my head).

 

One piece of good news - her chest x-rays today were clear. A second vet is going to look at them to confirm, but the vet who looked this morning did not see anything. I feel like I should feel relief, but I don't, I just feel guilty for not feeling happier.

[TheFullHouse]

Good news about the chest being clear. Hopefully you and Dr. C. will connect some time today.

[Guest Energy11]

Sorry you are going through this! OSTEO SUX!

 

I did only palliative care with Max, who was diagnosed at 11.5. Because I worked for my vet in Florida, I had him x-rayed at the first sign of his limp. It was Osteo, and diagnosed very early on.

 

Max was put on Deramaxx and Tramadol, but didnt' really need too much at first. He was even able to make the trip from Florida to the mountains with us, and had another six weeks up here, too :-))

 

He did quite well on the above drugs, which seemed to control the pain. Toward the end, he stopped eating. I had to buy Science Diet AD canned, for sick and dying animals, which he ate. When he slept all the time, and started hopping on three legs, we knew it was time. He spend one final wonderful weekend with us, and was sent to The Bridge on a Monday morning. (*this was almost three months after his diagnosis).

 

I personally do just palliative care, and would not amputate with any of my dogs, BUT, this is not to say amputation is a wrong choice! It is a personal decision, as everyone knows their dogs, and what is right for them.

 

Sending you many hugs, lots of prayers and good luck, for, whatever you decide WILL be the right decision for both you and Neyla!

 

 

 

 

[Guest FastDogsOwnMe]

I agree with Energy. It is not a choice I made or would want to make, but I totally understand why people do. Follow your gut, your heart, and what your dog is telling you. I feel just horrible for you

[Guest bigorangedog]

If you haven't already, join the Circle of Grey yahoo group and ask there too. I know some people there have done radiation, and I emailed with a few of them when we were considering it for Whitey's ulna metastasis (turned out not to be an option for him after all, because he also had a spinal metastasis). They are very helpful on CoG.

 

I've had more than one dog on some version of the Metronomic protocol. The main side effect is stomach upset. You can give Pepcid and that can help. My Crisco got really bad GI upset from the doxycycline and could not tolerate it, but Whitey had no problem with it.

 

With Tanner and Annie we did pain management alone, and got 2-3 months with each. (Although if I had known then what I know now, both of these guys would have had an earlier diagnosis, and probably a different course of treatment, with Fosamax and the oral chemo drugs. Maybe even amputation in Annie's case.)

Edited May 21, 2010 by bigorangedog

[Guest MorganKonaAlex]

All 3 of mine had amputation and chemo so I can't answer some of your questions. If Neyla is an ex-racer, she would qualify for free chemo from OSU. You would still need to pay for the administration of the drug which is not trivial. I did not go that route since OSU would provide doxorubicin and I wanted to treat with carboplatin. For us, 4 rounds of carbo came to approx $2K per dog.

[mom2four]

I agree with Jen, join Circle of Grey. They have more specific questions and answers.

Having said that, when Jamey was diagnosed just over a year ago, Michael and I decided on amputation, as we thought he would do well. He broke his leg on the X-ray table at the vets as they were doing X-rays and had his leg amputated the same afternoon. He is coming up to his 1 year anniversary (June 4) and is doing very well!

Everyone has to make their own decisions based on their Grey (if they would do well with an amputation), their circumstances (financial etc).

Sending you best wishes!

 

EAT, can you email Dr C? His team got back to us within a day.

Edited May 21, 2010 by mom2four

[BootsyCollins]

Jen, I know you know our story, but I'll repeat it here just in case it's helpful.

 

Argos was diagnosed on October 5, 2008, and we made the decision to let him go on November 2. We decided against amputation because it was in his shoulder - we have hardwood floors, steep stairs outside and inside our house, and we felt it would be too invasive a surgery. So...palliative care, rimadyl and tramadol, made him very, very comfortable for most of the next 4 weeks. His last week was more uncomfortable for him, even with the tramadol dosage doubled. The vet offered a fentanyl patch, but we felt that once we were at that point it was time to stop. He started refusing his food on Thursday night. Friday night we took him out for ice cream and made the decision. Saturday morning we gave him some rotissierie chicken and he played in the yard with Guinness one last time and we took him.

 

[NeylasMom]

If you haven't already, join the Circle of Grey yahoo group and ask there too.

Thanks, I did join the other day and posted a msg there shortly after I started this thread.

 

Mom2four - I did email Dr. Couto - he's the one who was able to diagnose Neyla (there's another thread I started a few days ago that explains it in gory detail ). We're just trying to touch base via phone to discuss treatment options.

 

I am astonished at how much treatments cost. I don't want finances to be a factor in my decision making process, but I'm starting to worry about how I might make that happen. The U of Florida radiation treatment (which includes the first dose of chemo) is $5000-7000, and that's assuming you do the tests they need to do beforehand (other than the CT) on your own!

[Guest aaspenwall]

I've lost a 9 year old female, Bella, and a nearly 12 year old male, Aristotle, to osteo. I did palliative care only, based on the ages of the dogs, the financial cost of aggressive treatment, and after watching my father fight a tough, losing battle with a cancer for which there's no hope of successful treatment I just didn't have the heart to put anyone else through that. My thought was if most of their time would be spent fighting or miserable from the fight, that wasn't the quality of life I thought they deserved. With Bella, we only had about 10 days post diagnosis before the pain was not manageable. Ari had about 3 good months. I'm so sorry you're going through this.

Edited May 21, 2010 by aaspenwall

[Guest MorganKonaAlex]

Without amputation, I don't think chemo/radiation will buy much time. I'm not questioning your amputation decision; everyone has to make their own. You could ask Dr. Couto on the median life expectancy with the treatments you are considering.

[Jackandgrey]

It is okay to consider cost Jen - none of this is curative and that includes amputation. It is totally realistic to think of what your family can reasonably handle. Of course our hearts want to do everything possible in the world but that is not always realistic or rational.

 

Without amputation, it is intractable pain that will dictate when she will have had enough. With amputation, generally it is lung cancer.

 

 

I did palliative care only for Jack. We got 6 months of wonderful time after diagnosis. But I have to say that is not common and especially not with shoulders. His was a distal femur.

 

If you choose palliative care it is just important to be generous with analgesics and to enjoy every single good day. Every day is a gift.

 

There is no right or wrong decision. Just what is right for your family and your girl.

[krissn333]

I agree, Dr. Couto should be able to give you some sort of a timeline based on the specific treatments you're looking at, but, from what I understand, it's not really worth it to do CHEMO (radiation being a different thing entirely) if you're not going to amputate, and it's not worth amputating if you're not going to do chemo. The two have to go together in order for it to do any good. Radiotherapy and chemo can go hand in hand, but I don't know how effective that protocol is.

 

Because of Sutra's physical condition, I have chosen not to amputate. He's an old man who has been through a lot with his body. But, Neyla's little body is strong and is otherwise healthy. Have you seen bigorangedog's videos of Whitey and Apollo in their yard? Apollo's video is thoroughly encouraging and made me WANT to pursue amputation if it were an option for Sutra...unfortunately it's not.

It really brought happy tears to my eyes. I couldn't believe how FAST and AGILE he is! I believe he is 10 years old.

 

That U of Florida treatment: WOWZA! Don't get me wrong, I love my dogs, but personally that's not something that I could afford to try, especially if I didn't know how effective it would be.

 

In the end it's your choice, and that's the hardest part. I found myself wanting someone else to make the decision for me so I wouldn't have to. Sutra made it for me

[Guest Smiley]

I am so, so sorry you are facing this awful diagnosis. It just plain sucks. Having just done this twice, I can give you two different perspectives as we went not only went two different routes, but had two dogs who were very different. With Smiley, he was so painful so quickly that pain mgmt would not have gotten us far. He started limping and a week later was knuckling and barely able to get around. We did the surgery and well, we know how that turned out -we were just one of the unlucky few who didn't get any more time.

 

As for our Peanut, we had 10 really good weeks with her after the first sign of a limp. The first two sets of x-rays came back clean (in theory) and by chance, our vet put her on Tramadol on top of the Deramaxx about 5 weeks in just thinking it would help with what we thought was a soft tissue injury. It really did help and she did great on that (2 50 mg tabs twice a day). It was on the 3rd set of x-rays that we got the osteo diagnosis and by then she had a fracture. She was still doing somewhat okay at that point, but again we thought it was soft tissue. However, once she had that last set of x-rays, she didn't bounce back and began knuckling, etc. The last two days we combined the Tramadol and Gabapentin and that gave her what we think was some relief. But with a fractured shoulder, we couldn't let her go on like that for more than a day or so.

 

So with Smiley we had no time once we saw the limp-a matter of a week and with Peanut we had nearly 3 months. Two vastly different experiences. I think you know your baby the best and will be able to judge what's needed. One thing that did stick with me was it's better to overmedicate a bit than undermedicate as it's a very painful disease.

 

I'm keeping you both in my thoughts and prayers-I know how difficult this is and just know that whatever you decide it is from love and it is the right decision. Hugs to you both.

 

PS-I should have added that Dr. Couto is fantastic and will outline every treatment option available to you. And I believe that all chemo is free . . .

Edited May 21, 2010 by Smiley

[Guest BlueCrab]

Jen -

somehow I missed the original post and am just reading this now. No experience I can share, but plenty of prayers for you both.

[NeylasMom]

Kristin, the mean survival time for the U of Florida procedure is the same as it is with amputation and chemo (1 yr) because the high dose radiation removes the tumor entirely and the same chemo protocol is followed afterward as you would use with amputation to hopefully address any potential mets. And she would walk out of the hospital that day - there is no recovery time like there is with surgery - and keep her leg. The downside is that about 25% of their patients break their leg at the radiation site at some point. I was surprised to learn that they have been doing the procedure for 8 years so it's not like it's new. It's just not widely available, perhaps b/c of the costs involved.

 

 

Even though amputation is not for us, those of you who have gone through it can still help me with my decision - I would like to hear how your dogs have done with the chemo treatments.

[Guest bigorangedog]

I'm not sure what kind of chemo OSU might suggest as a stand-alone treatment, but doxorubicin is what they provide for free. Each administration of the chemo, though, includes the cost of vet time, blood work, a shot of benadryl... so for us each treatment of the "free" chemo was about $200 x 6 treatments. (FWIW, the amputation surgery was around $2200, plus the cost of the various take-home meds.) Also, if you do doxorubicin, you will need a thoracic ultrasound before you start, which ran us $250.

 

I know you're not considering amp, but for others reading since it was mentioned, I actually DO think it was worth doing the amp even if you are not able to do chemo (financially or otherwise). The mean survival time for amputation alone (no chemo) is 6 months. With amp plus chemo, the mean survival time is 12-18 months. With only pain management, it is 2-4 months.

 

Having done both roads, I can tell you, if you get 3 months on pain management, it is a hard road, balancing pain against side-effects until your dog tells you he doesn't want to do it anymore. With Whitey, we only got 5.5 months -- which is the amount you expect if you did not do chemo at all, and we did -- but his 6 months were FANTASTIC. After the first 2.5 weeks or so, he was totally free of pain until the last week when we found the ulna/spinal/lung mets. He was on no medications. He was at a great weight, even a tiny bit plump (when we adopted him at age 11 he was scrawny). He rocked out at running on 3 legs, and had a pain-free 5 months.

 

I don't want to talk anybody into doing an amp, like it is no big deal (it IS - just read the blog). Everyone knows their own dog best. There's certainly no guarantees either way.

 

Would love to hear more about radiation w/o amputation from anyone who has done this or is researching it. Goodness knows that we're likely to face this thing again, so I always like to know what all the options are.

[NancyB]

Having been through this with my good boy Marvin I actually regret having an amputation done. I am still tortured by the decision, I wish we had known the cancer was also in his back leg at that time.

 

We found out on May 22, 2005 Marvin had Osteo. Marvin turned 7 on May 19. His limp came out of nowhwere, he was fine in the morning and in the evening he had a swollen ankle and holding his foot up. Took him to the vet the next morning, lungs were clear, he was given Metacam and we were sent to a specialist. The specialist recommended an amputation, we didn't think Marvin would do well. They also said they could do palliative radiation on the cancer site which would help with pain. We chose to do that at first, $600. He was great for six weeks then the pain came back with a vengence, took him back to the specialist which was also an emergency vet clinic. They said the only thing they could do at that point was amputation, we decided to go ahead with it, they sent him home with Tramadol, and he had his amputation on Aug. 4, that was around $2400. They told us if we did chemo there it would be $4500 just for the chemo.

 

I contacted Dr. Couto and he said he would send the Doxorubicin to Marvin's vet at no charge. I had asked if she could administer it and she said yes. She only got to administer 4 out of the 5 treatments. He had side effects, nausea, exsplosive diarrhea, wouldn't eat, vomiting bile. He also had problems with his blood work so he wasn't able to get his chemo when it was scheduled. Also, Dr Couto said greyhounds don't usually have side effects.

 

Marvin broke his back leg, same side as his amputation on Nov. 21, 2005. In the x-ray you could see the cancer. I wish I had known he had it there, I feel like I put him through a lot for nothing, it hurts my heart to think about it and I have a lot of guilt about it.

 

Please do whatever you think is right for your girl. Don't let anyone force you into a decision you aren't comfortable with.

 

I think my last vet bill was around $600 but that also included the euthanasia and the creamation.

 

Click here to view Marvin's amputation photo album

 

Sending prayers and hugs.

[RileysLegacy]

Riley's situation was unique, I think, so I don't know if it will be of any benefit to you, but here it is just in case.

 

Riley fell down the stairs and injured his leg 6 months prior to the dx of osteo. We will never know if he fell b/c he leg was already weak or what. To be honest if I knew at that time what we were really dealing with, I probably would have made the decision to let him go then because he was in severe pain. However, we did xrays and nothing showed up, so we treated it as an injury/nerve damage, and he did make almost a complete recovery. The last 4 months of his life were happy, I hope.

 

But, because he had had this injury to his leg, when he started BARELY limping and not bearing all his weight on his leg a few months later, both the vet and I chalked it up to the old injury or arthritis. Of course osteo was always on my mind, but his limp was so slight that it didn't seem serious. He was put on Tramadol and Previcox, and didn't seem to get any worse, but not better either. Finally the voice in my head said I should get xrays just in case.

 

The xrays were devastating. You have seen them - his shoulder bone was basically gone. Everyone who looked at them agreed that there was a very high risk of a leg break. So even though Riley was still not limping severely and seemed like his normal self, I let him go exactly a week after being diagnosed. I could not take the chance of his life ending in such a horrible way.

 

I have felt a lot of guilt and regret about my decision, mostly because I just miss him so damn much, and I know I could possibly have had a few more days, weeks, maybe a month. But in reality, and as time has passed, I realize it was absolutely the right choice. I could have also waited a few more days and he broke his leg, and he would have died in pain and suffering. He had cancer, he was not going to get better, he was only going to get worse. And I'm glad he never had to get to the point of being completely drugged up and in severe pain. He was happy until the very last second, I think that's what we all would want for our babies and ourselves.

 

That is just what we went through, and the choices I made for my boy. Amputation is really not something I would ever consider unless it was a very young dog with a real chance of years more of life. But all of this is so personal and depends so much on the dog's personality and your situation, that whatever decision you make will be the right one. We will all be here supporting you.

[krissn333]

To add to what Lucy said, Sutra fell off the couch a few months before being diagnosed, and he dislocated that shoulder. He would limp off and on after overdoing it in the yard, but I finally decided to get xrays and lo and behold, there was the problem.

 

I have no idea if he had the osteo when he dislocated his shoulder, or if it came on later. Given Lucy's experience and my own, I would almost conclude that an injury had CAUSED the osteo, though it seems like scientifically that's unlikely.

[Tallgreydogmom]

We had 3 cases of Osteo between July 2009 and Dec 2009. All 3 had amputation and chemo. We are fortunate I could take the time and drive them up to Ohio State. They do have a foster home system in place for out of town greyhounds if you are interested.

[Batmom]

I know I could possibly have had a few more days, weeks, maybe a month. But in reality, and as time has passed, I realize it was absolutely the right choice. I could have also waited a few more days and he broke his leg, and he would have died in pain and suffering. He had cancer, he was not going to get better, he was only going to get worse. And I'm glad he never had to get to the point of being completely drugged up and in severe pain. He was happy until the very last second, I think that's what we all would want for our babies and ourselves.

 

Batman's cancer was different, but that is @ what we did as well.

 

The only thing I regret was the one dose of chemo that I gave him. Different drug than is used for osteo so YMMV. No chance of a cure or even of remission but there was a slim chance it would shrink his tumor temporarily, which would make him more comfortable. He had no side effects from the drug, except that it dropped his white count so low that he needed antibiotics, and for the first time in his life the antibiotics made him sick. We were able to switch antibiotics so he was only sick for a couple days and went on to spend a couple happy months with us. But I always felt that those couple days could have been good ones, and that they were stolen from us due to my lapse in judgement.

 

Hugs and best luck with your decision.

[Guest TeddysMom]

I have zero experience with osteo except what I have read here but I just want you to know that my prayers are with you and your pup no matter how you proceed. I hope you have some good quality time together and make the most of every minute.

[Guest dwolfe711]

Jen - so sorry you are going through this. We've lost 6 greys to various cancers, but our first two with osteo were both left front shoulders. Elaine was 11 at diagnosis and Red was 12 - we did not consider amp or any other treatment due to their ages and the location of the cancer. We treated with pain meds only - this was before we knew tramadol, etc. and Dr. Couto existed. Red's was very aggresive and we had to let him go five weeks after diagnosis. Elaine was a fighter and went into some sort of remission for a few months and survived for 10 months - and even then didn't want to give up! They were adopted as senior returns and were both with us less than a year. Whatever decision you make, it will be what is best for you and Neyla.

[krissn333]

Kristin, the mean survival time for the U of Florida procedure is the same as it is with amputation and chemo (1 yr) because the high dose radiation removes the tumor entirely and the same chemo protocol is followed afterward as you would use with amputation to hopefully address any potential mets. And she would walk out of the hospital that day - there is no recovery time like there is with surgery - and keep her leg. The downside is that about 25% of their patients break their leg at the radiation site at some point. I was surprised to learn that they have been doing the procedure for 8 years so it's not like it's new. It's just not widely available, perhaps b/c of the costs involved.

 

 

Wow Jen...that is REALLY interesting, thanks for sharing that information Re: patients breaking at the radiation site - I wonder if something like Fosamax could help to counteract that? That sounds VERY cool and like it might be a good option for you, if you can get your head around the cost. Is there maybe some sort of a study going on? Or maybe OSU can somehow help supplement the cost of it if you'll provide them with the information about it for their research (that reminds me, I need to find out how to send a DNA sample to them from Sutra).