Osteo Thread

[robinw]

Thanks, Chris

[EllenEveBaz]

Phene

[NeylasMom]

Well we don't really want you in here either Robin.

 

Is your x-ray digital? You could always post it so we could take a look, not that we can do any better than Dr. C. Or if you look back, I posted mine at some point - you can find them in my photobucket album - in case you want to compare. Not sure how useful it will be, but thought I'd throw it out there. The originals are right before the Johnny Iuzzino pics, drool. The thing that was helpful for me is that my vet took a photo of her healthy leg for comparison (it's the one marked NeylaRight..., the cancer was in her left shoulder). When you look at that compared to the one next to it (the one Dr. C. diagnosed her on), it's pretty obvious imho.

Edited May 25, 2011 by NeylasMom

[RedFawnMom]

Oh Robin, I am so sorry to see you in this thread. I had a similar experience with Lucy's diagnosis, so I know how it feels to be in your shoes, when you are expecting something like arthritis and are totally caught off guard by the news. I'm so, so sorry. This sucks.

 

Needle aspirates can be inconclusive. If you'll choose palliative care either way, maybe it's not even necessary to do one.

 

Huge hugs to you. Let me know if there's anything I can do.

 

 

An update on Lucy for those who asked - she's doing better. She ate a small dinner around midnight yesterday and has been eating fine today, though she seems just a bit more tired than normal. I don't know exactly what was going on yesterday, but I think it was a combination of nausea and stress. I think that me not being with her at the hospital made her nervous. My husband takes good care of her, but I do think she needs me there. My husband said she wouldn't even take cookies from him and was stressed the whole time, which is so NOT like her. But when we go, I sit on the floor with her, she puts her head in my lap and I love on her and talk to her.... I guess she's a momma's girl.

[Charlies_Dad]

Robin, I just saw your update in your thread. There is no 'welcome' to this club as we do not want new members but we will none the less be there for you and Phene. The FNA may confirm things as Jess is correct, they can often be inconclusive. When we got word the same day that Dr. Coutu thought Charlie had Osteo, I decided to amputate without the FNA as I was confident that our orthopaedic surgeon and Dr. C. were right. The biopsy of his leg came back two weeks later confirming it.

 

 

Jess, that is good news about Lucy! I am sure it was because you were not there.

Edited May 25, 2011 by Charlies_Dad

[robinw]

I'm sorry, I'm going to keep bugging you guys. Phene is scheduled for a FNA tomorrow, but I received another email from Dr. C this morning and he's pretty confident that it's osteo. Should I put him through the FNA? I received an email from my vet, also, who said that he would support me if I didn't, and this was before it occured to me not to do it.

 

thanks

[NeylasMom]

I'm sorry, I'm going to keep bugging you guys. Phene is scheduled for a FNA tomorrow, but I received another email from Dr. C this morning and he's pretty confident that it's osteo. Should I put him through the FNA? I received an email from my vet, also, who said that he would support me if I didn't, and this was before it occured to me not to do it.

 

thanks

Are finances a consideration? Does Phene get stressed at the vet? Is taking time off of work for the visit a hardship? If the answer to any of those questions is yes, then I would skip it. If money isn't an issue and Phene enjoys the vet, then I would say there's no harm in getting it done as long as you realize that a negative result could cause confusion for you.

 

Honestly, in my case, I would have liked to have done the FNA if only to shut up my oncologist who for 5 months after Dr. Couto diagnosed Neyla infuriatingly continued to tell me it might not be osteo, even though it clearly was. Unfortunately, neither my oncologist nor my orthopedist who initially saw the suspect area on the x-ray would do the FNA without anesthesia. I have no idea why as I've never heard of ANYONE else doing that, but they wouldn't so it was cost prohibitive, not to mention I didn't want to anesthitize my dog who had a known history of reaction to anesthesia.

 

Anyway, I'm coming from a place of hindsight is 20/20 sort of, but I would be shocked if Dr. Couto was wrong, but I can't tell you what to do. The FNA could give you peace of mind (in the f'ed up way that you'd at least know that's definitely what you're dealing with), but it could also leave you more unsure if you get a negative and don't knwo whether it's false or not. And you don't want to do a biopsy, especially if you're not considering amp.

 

There is one other option - set up a consult with a radiologist and get a 3rd opinion on the x-ray (or see if your vet knows one who will just take a look for free). Or wait a couple of weeks and re-xray to see if there is progression (although again, in our case, that didn't do anything to secure a dx because there was virtually no change in the lesion for 5 months).

[robinw]

Thanks, Jen. He's terrified at the vet. I will talk to him today about a third opinion, but Phene is having a very bad day today.

[NeylasMom]

Thanks, Jen. He's terrified at the vet. I will talk to him today about a third opinion, but Phene is having a very bad day today.

 

How is your vet on pain management for osteo? Or have you read the posts in here on pain management?

 

If there is anything I can't stress enough the more I read through posts of diagnosed pups, the more I think regular vets are not aggressive enough in providing their patient's owners with the drugs they will need and instructions on how to increase the meds if pain appears at a time when the vet is unreachable, as well as letting people know that osteo if very painful and if you can see signs of pain, your meds likely aren't high enough. My suggestions:

 

1) Get a decent supply of all 3 of the following (decent meaning that even if you had to max out dosages, you would have a few days worth of each): Tramadol, Gabapentin, & an NSAID of your choice (keep in mind that once on it, you cannot switch without a 10-day washout period(!)) and use all 3!

 

2) Know the maximum dosages allowable for Phene of each - these should be cancer dosages, not general long-term use dosages (for instance, the vet might start you out on 100 mg of Gabapentin a day when in actuality you can likely go up to something like 500 mg 3x/day).

 

3) Know how to incrementally increase - ie. you probably don't want to increase Tramadol and Gabapentin at the same time b/c they have similar side effects, and you probably want to increase one of those before the NSAID because the NSAID is more likely to have nasty side effects. You also need to know by how much - what amount, 1 dose or all doses in a day, etc.

 

4) Stay ahead of the pain. Treat breakthrough pain immediately and increase overall dosages as needed to maintain good pain relief. IMO, that means that your dog is weight bearing and is able to get up and down comfortably, but your standard may be different.

 

5) Read the article I linked to in the first post of this thread on pain management

 

Gentle massage and warm compresses on the tumor site may also provide some pain relief, or just be enjoyable for Phene. And of course you have the options of palliative radiation and pamidronate for further pain management, but if Phene is that scared at the vet, pamidronate probably isn't going to be for you (it requires a 4-5 hour stay at the vets for each treatment, about monthly).

 

I hope I don't sound bossy or condescending, I've just seen people posting in H&M over and over that their pup is in pain and they don't know what to do and they think their pup is maxed out on 50 mg of Tramadol 2 or 3 times a day, or haven't even heard of Gabapentin.

[mom2four]

I'm sorry, I'm going to keep bugging you guys. Phene is scheduled for a FNA tomorrow, but I received another email from Dr. C this morning and he's pretty confident that it's osteo. Should I put him through the FNA? I received an email from my vet, also, who said that he would support me if I didn't, and this was before it occured to me not to do it.

 

thanks

 

Robin, I don't come here much, but wanted to answer a question you had. Our Jamey had 3 FNA's and all were inconclusive. The OSA was only diagnosed 2 weeks after his front leg had been amputated (after it had broken at the vet's) and the path. report had come back. From end April 2009 through June 4th, 2009 we were never really sure, even Dr. C's team wasn't.

To encourage you, if you are thinking of amputation, on June 4th Jamey will be 2 years post amp.

[NeylasMom]

To encourage you, if you are thinking of amputation, on June 4th Jamey will be 2 years post amp.

That is so awesome!!

[robinw]

I'm sorry, I'm going to keep bugging you guys. Phene is scheduled for a FNA tomorrow, but I received another email from Dr. C this morning and he's pretty confident that it's osteo. Should I put him through the FNA? I received an email from my vet, also, who said that he would support me if I didn't, and this was before it occured to me not to do it.

 

thanks

 

Robin, I don't come here much, but wanted to answer a question you had. Our Jamey had 3 FNA's and all were inconclusive. The OSA was only diagnosed 2 weeks after his front leg had been amputated (after it had broken at the vet's) and the path. report had come back. From end April 2009 through June 4th, 2009 we were never really sure, even Dr. C's team wasn't.

To encourage you, if you are thinking of amputation, on June 4th Jamey will be 2 years post amp.

Thank you! That's fantastic news about Jamey!

 

Phene is 11.5 years old and I suspect he's been ill for a while. It's becoming increasingly difficult to get him to eat and I can see the discomfort with his right rear leg. My vet kept thinking it was arthritis until I insisted on the x-rays. Earlier diagnosis wouldn't have made a difference, as he's been on metacam as needed for a while now. I guess the good thing about this is that my vet is learning a lot about greyhounds and osteo

[Batmom]

I hope I don't sound bossy or condescending, I've just seen people posting in H&M over and over that their pup is in pain and they don't know what to do and they think their pup is maxed out on 50 mg of Tramadol 2 or 3 times a day, or haven't even heard of Gabapentin.

 

I don't think you sound bossy. I think you've given a good primer of pain management.

 

At the same time, I think people should consider alternatives. When the dog is in unremitting, incurable pain such that ordinary doses of ordinary drugs are not effective, you really need to think about what you are doing and why.

[robinw]

I hope I don't sound bossy or condescending, I've just seen people posting in H&M over and over that their pup is in pain and they don't know what to do and they think their pup is maxed out on 50 mg of Tramadol 2 or 3 times a day, or haven't even heard of Gabapentin.

Not at all. I'm extremely grateful for your help. Thank you

[NeylasMom]

I hope I don't sound bossy or condescending, I've just seen people posting in H&M over and over that their pup is in pain and they don't know what to do and they think their pup is maxed out on 50 mg of Tramadol 2 or 3 times a day, or haven't even heard of Gabapentin.

 

I don't think you sound bossy. I think you've given a good primer of pain management.

 

At the same time, I think people should consider alternatives. When the dog is in unremitting, incurable pain such that ordinary doses of ordinary drugs are not effective, you really need to think about what you are doing and why.

Thanks.

 

And, I agree, but often you have a period of considerable length where the pain is managed quite well and then suddenly things change (and of course, most of the time it's on the weekend!). I think the best plan is to be prepared with the meds and instructions on hand so you can treat immediately and then process what is happening and make the best decision. Sometimes it's just breakthrough pain and you can back down off of the meds again. Sometimes it's not, but it buys you some time to process it and make the hard decision if necessary.

[greysmom]

Just a quick Dude update!

 

He had his first massage therapy session today! The lady that came to our house and worked on him was just awesome! Dude got almost a whole hour of massage and he loved every second. Plus, he seems to be feeling better after it this afternoon - brighter and more bouncy - than he was before. We'd been a bit worried as he seemed sort of down and tired, so this is a wonderful result. We'll be having her back in two weeks to see how he does with that time frame, and we might go to every week if it seems to help him. I would highly recommend it for amputees.

 

Also, we'll be starting his metronomic protocol either tomorrow or Friday. Sort of freaked out that the cytoxan says to handle with GLOVES!

 

Hugs to all!

[krissn333]

I hope I don't sound bossy or condescending, I've just seen people posting in H&M over and over that their pup is in pain and they don't know what to do and they think their pup is maxed out on 50 mg of Tramadol 2 or 3 times a day, or haven't even heard of Gabapentin.

 

I don't think you sound bossy. I think you've given a good primer of pain management.

 

At the same time, I think people should consider alternatives. When the dog is in unremitting, incurable pain such that ordinary doses of ordinary drugs are not effective, you really need to think about what you are doing and why.

Thanks.

 

And, I agree, but often you have a period of considerable length where the pain is managed quite well and then suddenly things change (and of course, most of the time it's on the weekend!). I think the best plan is to be prepared with the meds and instructions on hand so you can treat immediately and then process what is happening and make the best decision. Sometimes it's just breakthrough pain and you can back down off of the meds again. Sometimes it's not, but it buys you some time to process it and make the hard decision if necessary.

Yes to all of the above Jen, you are a pain management guru!

 

Also Robin, you might try Robaxin (methocarbamol). It is a muscle relaxant and was quite helpful for Sutra when his muscles were having issues.

 

Sutra took Deramaxx as his NSAID...I don't have experience with Metacam, but if it is working for Phene, I'd just keep with it.

 

Very sorry to have you join this club, but, we're all here to support you

 

Glad that Dude loved his massage session

 

And congratulations to Jamey!

[LadyGrey]

My sincere condolences to all the Bridge Babies who have lost the battle to this thing here on earth. My prayers to those still fighting. I lost a girl to cancer back in 2004. My decision is such that I would NEVER advise anyone as it is a personal decision and I felt it was better for my baby. I chose not to have her leg amputated at all. I thought it was way way too much trauma for her, and when it is that bad, it ususally is elswhere in the body anyway, and in most cases, it is inevitable. I chose to let her go with dignity and not trememdous suffering pain. I have personal opinions about this that I would never post but it is all personal. She went in one piece and with dignity. She was not so degraded that she could not get up to poop or pee, or eat. She was not whining, yelping, or showing excruciating pain in her eyes. It was time enough. I feel good about it, very good about it. The way I handled it. I did get lots of support.

 

[NeylasMom]

Just a quick Dude update!

 

He had his first massage therapy session today! The lady that came to our house and worked on him was just awesome! Dude got almost a whole hour of massage and he loved every second. Plus, he seems to be feeling better after it this afternoon - brighter and more bouncy - than he was before. We'd been a bit worried as he seemed sort of down and tired, so this is a wonderful result. We'll be having her back in two weeks to see how he does with that time frame, and we might go to every week if it seems to help him. I would highly recommend it for amputees.

 

Also, we'll be starting his metronomic protocol either tomorrow or Friday. Sort of freaked out that the cytoxan says to handle with GLOVES!

 

Hugs to all!

Go Dude! Glad his massage therapist was able to help him. on the metronomic protocol.

[robinw]

I have a question for all of you...Phene still wants to take little gallops around the yard and play soccer. He loves his soccer ball. Do I still kick it around with him and let him gallop (with supervision) or do I stop all play in case he breaks a leg? What did you all do?

[krissn333]

Robin, my thought would be that he'll know when he shouldn't run, but, every dog is different and not all of them are good at regulating themselves. If he were mine I think I'd allow it, at least for right now. Part of quality of life is being able to do the things that make them happy. Maybe just keep your games short if you're concerned.

 

With it being in the back leg, I'd think he'd be less prone to breakage, but, Sutra's was in his shoulder so I don't have experience with rear leg osteo.

[robinw]

Thanks, Kristin. I agree. Sorry about the dumb questions. I'm feeling kind of lost here.

[NeylasMom]

Robin, it's really your call. I think you were going to ask Dr. Couto about how progressed the lesion is so far, did he answer you? I would base my decisions on that if it were me. While I've been told that a dog with osteo can fracture his leg at any time, it obviously makes sense that the more damage to the bone (as the cancer progresses), the higher the risk of a break. Like I said earlier, for Neyla, we had 5 months with no progression and very little damage to the bone so I didn't worry too much and let her run her little heart out in the condo, I just stopped our trips to the dog park (or kept her on lead) because there I was afraid she would take off in an all out race track run and Zuri would knock her down. When the cancer started to progress, so did her pain and while we were managing it, she no longer had as much interest in full on running.

 

You really just have to make the best choice for Phene. If that's one of teh things he loves most, then you have to decide if you're willing to deprive him of it, risk a break, or make a tough call. None of this is easy, hang in there.

[greysmom]

Just FYI, Dude had absolutely no limping or any indication of any problem before he broke his rear leg. I had him out in the yard doing zoomies by himself. He was on the last lap of about 5 or 6 when his leg simply snapped right below the hock. I would think his lesion was not particularly advanced as they had problems diagnosing osteo from just the xrays.

 

Only you can decide what kind of risk you're willing to take with him. If you've decided to not consider amputation, what will you do if he's still "fine" and breaks his leg? Are you ready to make a final decision for him? I'm not trying to be harsh or anything, but I think all the time (and try NOT to think all the time) about what happens when the end comes for Dude.

[robinw]

I did ask Dr. couto. His reply was to highlight the words "strongly consistant" with osteo .