Osteosarcoma Pain

[Guest jv2g3s]

Hello, I am new to this list.

 

One of my Greyhounds was just diagnosed with osteosarcoma and the pain seems to get harder to control daily.

Previously, I had a Greyhound with a soft-tissue sarcoma. As he was young & otherwise healthy, I preceded with amputation & chemo. Traditional pain meds controlled his post-op pain and, when he developed phantom limb pain (I believe), this was well controlled with Amitriptyline. Although pain became an issue again when the sarcoma recurred, I generally felt that I was able to keep it reasonably well controlled until pulmonary complications led to our decision to end his suffering.

 

Gandhi, however, is 11 yo and has a history of liver and spine problems. I do not think amputation is the right decision. If I can improve his comfort, I would like us to have more time together. He is on Tramadol 100-150 mg 3-4 times a day (admittedly this is slightly more than my vet said to use). He also gets Rimadyl 75 mg twice a day and Amitriptyline 100 mg 3x/day (I don't know that he has any nerve pain, but it is also an antidepressant and is sedating). I put drops of Nature's Remedy and Astragalus in his food.

 

I am looking for new ideas/options.

[Charlies_Dad]

Have you asked your vet about Gabapentin? It has been used by many of us who have hounds with Osteo and it can work wonders. I sorry to read of Gandhi diagnosis.

[MaryJane]

Nothing to add except that I'm sorry that you're going through this.

[robinw]

I'm sorry you're going through this. I was in the same situation last month. Everybody has different philosophies on how to handle this. I've heard good things about gabapentin. I sent Phoenix to the bridge when I started to have difficulty controlling his pain, but like I said, other people might have handled it differently.

[Guest juliagulia630]

What kind of symptoms is he showing you? Before his amputation surgery James had a bad reaction to tramadol. He would pace, pant and drool. He looked like he was in pain but I found out that Tramadol makes some greys really anxious which makes them look like they are in pain. We had to slowly increase his tramadol until I found a good medium. He was only able to tolerate 50mg and was a big 80# guy!

Good luck to you! Check out the osteo thread, it has a ton of information!

[Guest jv2g3s]

Have you asked your vet about Gabapentin? It has been used by many of us who have hounds with Osteo and it can work wonders. I sorry to read of Gandhi diagnosis.

 

Thank you all for getting back to me.

My vet has mentioned Gabapentin, but I admit that I requested trying Amitriptyline first. In humans with neuropathic pain, amitriptyline often works as well as the gabapentin for humans. You don't here about it because it is an old, cheap drug. No drug companies will sponsor studies using it. On the other hand, humans often don't tolerate the high doses needed for it to be effective (dry mouth & sedation), but this was not an issue for my Phoenix. Since this drug worked so well for Phoenix and is SO much cheaper than Gabapentin, I wanted to try it. Maybe I will switch.

[Guest jv2g3s]

What kind of symptoms is he showing you? Before his amputation surgery James had a bad reaction to tramadol. He would pace, pant and drool. He looked like he was in pain but I found out that Tramadol makes some greys really anxious which makes them look like they are in pain. We had to slowly increase his tramadol until I found a good medium. He was only able to tolerate 50mg and was a big 80# guy!

Good luck to you! Check out the osteo thread, it has a ton of information!

 

I don't think he has a problem with the Tramadol. He certainly pants and appears more painful before I give him a dose. Initially 50mg seemed helpful, but now I usually give 100mg to start and then add another 50mg if it doesn't seem to help enough. There are certainly stronger opioid medications, but a tramadol dose should last longer. That is a plus since I am working. I may need to ask the vet for something stronger though.

[Guest jv2g3s]

I'm sorry you're going through this. I was in the same situation last month. Everybody has different philosophies on how to handle this. I've heard good things about gabapentin. I sent Phoenix to the bridge when I started to have difficulty controlling his pain, but like I said, other people might have handled it differently.

 

Oh. My dog who had the soft-tissue sarcoma was named Phoenix; he had just turned 4yo when diagnosed. I am sorry to learn of your Phoenix's passing. In the picture beneath this post, Phoenix looks like a fawn; my Phoenix was a blue fawn. If I cannot control Gandhi's pain better, I may have to escort him to the bridge sooner than I would like. He is not a brave dog, and I do not want him to suffer.

[robinw]

I'm sorry you're going through this. I was in the same situation last month. Everybody has different philosophies on how to handle this. I've heard good things about gabapentin. I sent Phoenix to the bridge when I started to have difficulty controlling his pain, but like I said, other people might have handled it differently.

 

Oh. My dog who had the soft-tissue sarcoma was named Phoenix; he had just turned 4yo when diagnosed. I am sorry to learn of your Phoenix's passing. In the picture beneath this post, Phoenix looks like a fawn; my Phoenix was a blue fawn. If I cannot control Gandhi's pain better, I may have to escort him to the bridge sooner than I would like. He is not a brave dog, and I do not want him to suffer.

My Phoenix was also a blue fawn. He had beautiful amber eyes. Did your Phoenix, also? I'm sorry if I upset you when I posted about my Phoenix, who was 11. Remember, everybody is different and every dog is different. My tolerance for seeing Phoenix in pain was absolutely nonexistent.

Edited July 17, 2011 by robinw

[Xan]

J., I'm glad to see you've found your way over here.

Not having had to go through this yet, all I can offer is my sympathy. I hope you can get a little more quality time with Gandhi. If it turns out you can't, it won't be for lack of love, that's clear.

 

:bighug

[greysmom]

You might also discuss a fentanyl patch. It has it's own set of side effects, but should be longer lasting than a dose of tramadol.

[Guest jv2g3s]

I'm sorry you're going through this. I was in the same situation last month. Everybody has different philosophies on how to handle this. I've heard good things about gabapentin. I sent Phoenix to the bridge when I started to have difficulty controlling his pain, but like I said, other people might have handled it differently.

 

Oh. My dog who had the soft-tissue sarcoma was named Phoenix; he had just turned 4yo when diagnosed. I am sorry to learn of your Phoenix's passing. In the picture beneath this post, Phoenix looks like a fawn; my Phoenix was a blue fawn. If I cannot control Gandhi's pain better, I may have to escort him to the bridge sooner than I would like. He is not a brave dog, and I do not want him to suffer.

My Phoenix was also a blue fawn. He had beautiful amber eyes. Did your Phoenix, also? I'm sorry if I upset you when I posted about my Phoenix, who was 11. Remember, everybody is different and every dog is different. My tolerance for seeing Phoenix in pain was absolutely nonexistent.

Yes, he was quite striking. Although it has been 5 1/2 years since got him from a regional rescue group, he is still the 'model' Greyhound on their brochure. I can certainly empathize with your feelings about seeing him in pain; it tears you inside.

[Guest jv2g3s]

You might also discuss a fentanyl patch. It has it's own set of side effects, but should be longer lasting than a dose of tramadol.

oh, I may really like that idea. I worry about Gandhi's medication wearing off when I am at work. For example, I knew today would be long, but have 'gaps' in the schedule. It is cool & rainy, so I brought him him in the car and ran out every few hours to give him medication & walk him around the block. I won't be able to do that during the week. I am familiar with fentanyl.

[NeylasMom]

You are pretty much maxed out on Tramadol and Rimadyl. You could add Gabapentin to the combo, but you might have to back off of the Aimtriptiline first in order to do it. I do understand where you're coming from with that choice, although it's a bit unconventional. I did a lot of research and as Neyla's osteo progressed I considered using a similar (but even older) anti-anxiety medication in the same class as amitrip that had some research to support it's use for pain, but I decided against it.

 

I'm going to be honest. If you are struggling to control his pain on those dosages, you might consider how far you want to take the pain management. Switching to Gabapentin may actually make a significant difference and I think it's probably worth a try. Otherwise, you are looking at adding in opiates, which can have their own side effects or really dope him up.

 

Unfortunately bone cancer is very painful and I often think our pups don't let on how much pain they're truly in. If he is not able to rest comfortably and get up and down relatively easily, he is uncomfortable.

 

I'm truly sorry you are going through this. I know how gut-wrenching it is to get the diagnosis, and often people don't find out about it until the osteo has progressed pretty substantially, leaving little time to process the diagnosis. Please feel free to join us in the osteo thread and read through the old posts. yoU will find a lot of helpful information and support there. Hang in there and give your pup some kisses from me.

[joejoesmom]

Have you asked your vet about Gabapentin? It has been used by many of us who have hounds with Osteo and it can work wonders. I sorry to read of Gandhi diagnosis.

 

Thank you all for getting back to me.

My vet has mentioned Gabapentin, but I admit that I requested trying Amitriptyline first. In humans with neuropathic pain, amitriptyline often works as well as the gabapentin for humans. You don't here about it because it is an old, cheap drug. No drug companies will sponsor studies using it. On the other hand, humans often don't tolerate the high doses needed for it to be effective (dry mouth & sedation), but this was not an issue for my Phoenix. Since this drug worked so well for Phoenix and is SO much cheaper than Gabapentin, I wanted to try it. Maybe I will switch.

 

Gabapentin is no longer an expensive drug. It is available on some $4 prescription programs (in the US). At my Giant Eagle Pharmacy, you can get 90 (100 mg) capsules for $4. So you might want to call around. I have found that cash prices (i.e. non-insurance) vary greatly. For one drug for Joe, I have been quoted prices from $20 to $198 for generic! Quite a wide range. I just checked the Costco website for you. 100 (100mg) capsules of gabapentin is $16.09 and 100 (300mg) is $14.68.

 

Fentanyl (Duragesic) patches can be fairly expensive. A while back OSU had some problems with one particular generic when used on Greyhounds (it caused nervousness and anxiety). I'm assuming that problem has been fixed. They last for 3 days and can be very effective.

 

I don't know if they have a time release opiate for use in dogs, like oxycontin. That might be a possibility.

 

I'm going to be honest. If you are struggling to control his pain on those dosages, you might consider how far you want to take the pain management. Switching to Gabapentin may actually make a significant difference and I think it's probably worth a try. Otherwise, you are looking at adding in opiates, which can have their own side effects or really dope him up.

 

Unfortunately bone cancer is very painful and I often think our pups don't let on how much pain they're truly in. If he is not able to rest comfortably and get up and down relatively easily, he is uncomfortable.

 

I'm truly sorry you are going through this. I know how gut-wrenching it is to get the diagnosis, and often people don't find out about it until the osteo has progressed pretty substantially, leaving little time to process the diagnosis. Please feel free to join us in the osteo thread and read through the old posts. yoU will find a lot of helpful information and support there. Hang in there and give your pup some kisses from me.

 

I have to agree with this. Osteo is just so painful and such a cruel disease.

[lothianjavert]

Neylasmom gave great info. My experience with gabapentin was very positive. Adding it to the tramadol/deramaxx combo brought Diesel's pain levels down. my vet was not cooperative about the gabapentin (had never used it or even heard of it being used), but yours sounds like he/she is familiar with it.

 

The gabapentin gave us time with Diesel that we would not have had otherwise. With D, when it was time, the change was sudden. He had been fine all weekend, but late sun/ early mon he was really hurting. We couldn't get his pain under control and made the decision to let him go that mon. We had a vet (not the one mentioned earlier) come to our house to let D go. Just be prepared if you cant get his pain under control that it may be time.

 

Lots of hugs for you and your boy. :

[Guest snakes]

I am another strong supporter of gabapentin, it has done wonders for FedX, so much so we don't have to use the tramadol nearly as much. it is cheap too, i get a script for the local pharmacy and get 400 100mg capsules for about $18.

 

He takes anywhere from 3-6 a day depending how his pain is and I know that isn't the max dose. His pain varies due to the timing of his pamidronate infusions (there is some recent info of this in the osteo thread).