Osteo Thread

[greyhoundlady]

Just a question though, all the gabapentin I have ever encountered with FedX and at work (i am a nurse) is always a powder in a capsule. how do you give 1/2 a pill? I wonder also if it is a tablet if maybe it isn't getting absorbed as well given dogs short digestive tract? I get my gabapentin at a human pharmacy.

Saber is on a tablet form (pill) which I cut in half at the indentation. I wasn't offered a capsule/powder - but that is a very interesting point - thanks.

 

 

I spoke to Saber's oncologist a little while ago. Last week he had told me to call him today so we could discuss how effective the meds are so far. He told me that we are pretty much maxed to the medication (as NeylasMom pointed out). Saber, btw, is 72 lbs. Vet also said that the pamidronate should have showed significant results by now. While, I don't see Saber getting worse, I can't say he is completely pain free and does show some difficulty when he tries to lay down. That is really the only painful part I see.

 

The oncologist (vet) told me he only sees amputation as the viable pain relief answer. And that would have to be followed by chemo. He said my grey is in lots of pain and he won't show it easily, and that Saber is showing discomfort when attempting to lay down indicates he is in far more pain that I can comprehend. The vet said if I won't consider amputation, the other possibility is radiation, be he doesn't really think that will help. He said the only increase in the meds would be to go to a codeine type pill but he felt that will give him no quality of life.

 

Can you hear me sobbing from here? I just can't in my heart agree to the amp - but I am beginning to almost feel like a bad person as the oncologist is saying that is the only way Saber is going to be pain free guaranteed. He said if he stays on the meds only he probably doesn't have much time and I will soon have to make the heart wrenching decision of letting him go.

 

But, in my eyes, he does not seem to be on death's door. He does get up, he goes where I go, he loves his food, listens for the car to pull in the driveway. Yes, his quality of life isn't the same because he can't go on long walks and he is uncomfortable until he lays down. I am just having such a hard time wrapping my head around a decision to take my beautiful boy, who seems so much alive and in love with life, to the vet to put him to sleep. Am I being selfish? God, this hurts so much.

 

I am going to call my regular vet later, (when I am coherent), and see what she has to say. That vet knows us well for over 7 years and I am hoping she can help with some insight.

 

Please keep us in your thoughts. As you all know, this is so, so hard.

[Charlies_Dad]

 

 

The oncologist (vet) told me he only sees amputation as the viable pain relief answer. And that would have to be followed by chemo. He said my grey is in lots of pain and he won't show it easily, and that Saber is showing discomfort when attempting to lay down indicates he is in far more pain that I can comprehend. The vet said if I won't consider amputation, the other possibility is radiation, be he doesn't really think that will help. He said the only increase in the meds would be to go to a codeine type pill but he felt that will give him no quality of life.

 

 

Unfortunately the oncologist is correct. The only way to relieve the pain even for a short amount of time is amputation. While it is major surgery, pups recover very quickly and the initial tumour is gone = no more pain. Pain management masks the pain only it doesn't remove it. Dogs in general can handle a lot more pain that us humans can so if Saber is uncomfortable, then he is likely experiencing some pain but the difficult question is how much. From your description, it sounds like he still likes many of things that make him happy still so it is a very tough call to determine the pain level. Usually pain is accompanied with other things such as panting, restlessness, going off their food, etc. The worse the pain the worse these will be. Has he been experiencing any of these?

 

As for the decision to amputate or not, this is a very personal decision. It is not easy one no matter which path you choose. I am sorry you are going through this as I know it's heartbreaking to see our pups in pain and having to say goodbye. I hope that Saber will be around for a long time to come.

Edited August 30, 2011 by Charlies_Dad

[Batmom]

Regarding pain control, it is certainly true that longterm side effects aren't an issue when you're dealing with a terminal disease. But I'm not sure that maxing out dosages on all pain meds is the answer either.

 

When I asked my vet about the possibilities for extreme pain control should my terminally ill dog need them in the future, he didn't say anything for a moment. And then he said, "When you get to that point, you really need to think about what you are doing."

 

It has been several years now. I can still see his face and hear his voice. I can still feel the warmth of the dog who, at that point, didn't know he was ill, by my side.

 

I promised my dog that I wouldn't let him suffer. That meant not allowing him to experience the kind of pain that would lead me to give him high doses of a cocktail of medication. There was no point in that.

 

The day he was not comfortable, I let him go.

[robinw]

Regarding pain control, it is certainly true that longterm side effects aren't an issue when you're dealing with a terminal disease. But I'm not sure that maxing out dosages on all pain meds is the answer either.

 

When I asked my vet about the possibilities for extreme pain control should my terminally ill dog need them in the future, he didn't say anything for a moment. And then he said, "When you get to that point, you really need to think about what you are doing."

 

It has been several years now. I can still see his face and hear his voice. I can still feel the warmth of the dog who, at that point, didn't know he was ill, by my side.

 

I promised my dog that I wouldn't let him suffer. That meant not allowing him to experience the kind of pain that would lead me to give him high doses of a cocktail of medication. There was no point in that.

 

The day he was not comfortable, I let him go.

That is the same conversation I had with my vet after Phoenix was diagnosed with osteo and he said almost the exact same thing. Luckily he confirmed what I was already thinking. Osteo cannot be treated, unless you go the amputation/chemo route, which has been successful for several hounds here That route isn't always feasible and / or some of us have reasons for not doing it. My feeling was that if you have to raise pain meds, you're not really doing the dog any favours. You may have some more time with him, but who does it benefit? Not the dog, who is probably in pain regardless of meds. A dog with osteo is going to experience huge amounts of pain. I couldn't do it. I know I'm in the minority, but for me letting Phoenix go at the first sign of extreme pain was the right thing to do. I miss him terribly, but I know that he never had to suffer again.

 

I don't mean any disrespect to those who increased meds and gave their dog cocktails. We all do what we think is right.

[Charlies_Dad]

 

When I asked my vet about the possibilities for extreme pain control should my terminally ill dog need them in the future, he didn't say anything for a moment. And then he said, "When you get to that point, you really need to think about what you are doing."

 

 

Couldn't agree more. Even though it is heartbreaking to say goodbye, a pup just wouldn't want to live in pain or totally incapacitated on meds....neither would I.

[KF_in_Georgia]

Greyhoundlady, when you talk to your regular vet, ask her what she'd do if Saber were her dog.

 

In the meantime, take lots of pictures of Saber and indulge him with the things he likes to eat (that won't upset his stomach and make him miserable).

[joejoesmom]

I haven't written here in a while. I just wanted to say that I am thinking of all of you who are struggling with this. It is a horrible disease. My heart goes out to you all.

 

Jane

[krissn333]

There certainly is a fine line between using meds to make them comfortable so they can continue to enjoy life and using meds in a quantity that causes them to be loopy. The latter, IMO, does not qualify as "pain management" because the pain is not really being managed.

 

I think that most people here can recognize that difference, and often when the circumstances move away from meds being able to manage the pain, we've come to the heartbreaking realization that there's nothing else that can be done

[Batmom]

Panting, pacing, inappetence, limping, refusal to get up on the beloved sofa, turning away from a cherished toy, inability to settle into a delicious nap -- those are all signs of pain. It is one thing when the pain is transient and part of a recovery, part of something that will pass. It is one thing when there are no signs of breakthrough pain, when a few hours' change in medication time or an accidental half-dose doesn't matter. It is a different thing when the condition is not transient, when there are signs of pain, continuously or in frequent breakthroughs, when medications have to be timed exactly and dosed high, or else. "When you get to that point, you really need to think about what you are doing."

 

 

I didn't use any pain medication. The point where it would have been needed is the point where I let my dog go.

[45MPHK9]

Post deleted.

Edited August 31, 2011 by 45MPHK9

[greyhoundlady]

I truly appreciate all your very sobering words. I know you are speaking from your hearts and your experience. I absolutely agree, logically, but it is the emotional part that is tearing through me. I won't let my boy suffer, though. Right now he has not reached the stage of listlessness, panting, refusing food/water. He gets up to go outside to do his business and if I am not in the room with him, he gets up to look for me.

 

I am not fooling myself, though. I know I don't have much time. I won't increase the pain meds and I will be smart enough to let him go when it is in his best interest and not mine.

 

I haven't called my own vet yet. After talking to the oncologist, I just couldn't have a conversation again about this today. It was a good suggestion about asking her what she would do. I know she will be honest with me. I'll try to talk to her tomorrow.

 

Thank you again for all your support. I know that even as other's read this, they are learning things too. Even if it is upsetting, it is important to know the reality.

 

Bless you, and all your hounds. You have helped me in so many ways. Now I will go spoil Saber rotten (as if I haven't already!) and do what is best for him for whatever time he has left.

 

Thank you.

[robinw]

You're in an awful situation. If you're anything like me, you may still be feeling numb and feeling like it's impossible to make an informed decision. You will, and you'll do whatever is best for both of you. I sincerely hope you have lots of quality time with Saber.

[45MPHK9]

Post deleted.

Edited August 31, 2011 by 45MPHK9

[NeylasMom]

We all have our opinions about what's best for our dogs, but let's try to remember that we each walk our own path and that each dog is different in his needs, personality, prognosis, reaction to disease and medication, etc. Some dogs do in fact do well on a combination of medication for a longer period of time. If I had chosen to let Neyla go at the time of diagnosis/the first sign of pain, she and I both would have missed out a half a year of quality life together.

 

Let's also try not to forget that sometimes a cocktail of meds for a period of time is what allows us to come to grips with the reality we face as owners of dogs who have suddenly been stricken with a terrible and usually fast-progressing disease. We all want nothing more than to not let our dogs suffer. And we often also have to come to terms with the fact that we will have to make that decision suddenly and/or far sooner than we anticipated. In some cases, the diagnosis is the first time we are faced with this harsh reality. And sometimes medication gives us the time we need to process it.

 

This thread is first and foremost a place for support, no matter what path we choose. While it's also a place for information, and honesty, both should be tempered with compassion. No person should feel judged for the treatment options they choose, or especially for when they choose to let their beloved dog go.

Edited August 31, 2011 by NeylasMom

[joejoesmom]

We all have our opinions about what's best for our dogs, but let's try to remember that we each walk our own path and that each dog is different in his needs, personality, prognosis, reaction to disease and medication, etc. Some dogs do in fact do well on a combination of medication for a longer period of time. If I had chosen to let Neyla go at the time of diagnosis/the first sign of pain, she and I both would have missed out a half a year of quality life together.

 

Let's also try not to forget that sometimes a cocktail of meds for a period of time is what allows us to come to grips with the reality we face as owners of dogs who have suddenly been stricken with a terrible and usually fast-progressing disease. We all want nothing more than to not let our dogs suffer. And we often also have to come to terms with the fact that we will have to make that decision suddenly and/or far sooner than we anticipated. In some cases, the diagnosis is the first time we are faced with this harsh reality. And sometimes medication gives us the time we need to process it.

 

This thread is first and foremost a place for support, no matter what path we choose. While it's also a place for information, and honesty, both should be tempered with compassion. No person should feel judged for the treatment options they choose, or especially for when they choose to let their beloved dog go.

 

 

Once again Jen, you said what I think better than I ever could.

 

Jane

[JJNg]

I hope no one minds some comments from an observer. While I haven't had to personally deal with this issue, as a vet, I've guided many clients through cancer diagnosis and treatment options. As others have mentioned, each case is very individual and the course taken depends on both the human involved as well as the patient.

 

As I read through the comments, I'm wondering if everyone is on the same page when they refer to pain and pain management. Pain can range from mild discomfort to excruciating agony. Pain is also subjective in that each individual's pain threshold is different. The same amount of pain on a physiologic level can be experienced as mild discomfort by one person (or dog) but as significant pain by another. Since our dogs can't talk and tell us how much pain they are experiencing, we can only do our best to assess their pain level based on their behavior and responses.

 

With osteo, the only ways to completely eliminate pain are with amputation or euthanasia. Medication can effectively control pain, but I don't believe it ever completely eliminates pain. However, I also don't believe that one has to be totally pain free to have a good quality of life. Many people deal with chronic pain such as arthritis or back problems, which is always there to some degree, but are able to be happy and enjoy life despite this. But again, this depends on the individual, and pain threshold will dictate whether a particular dog can have a good quality of life even with some degree of pain present.

 

I don't think there's anything wrong with the philosophy of not wanting a dog to experience any pain at all when the diagnosis is terminal. With osteo, this would probably mean euthanasia at the time of diagnosis. If a dog is limping - it is in pain.

 

However, for those who choose palliative care or are not ready to 'let go' yet, there's nothing wrong with using the medications available to us to manage pain as much as possible. Maxing out on dosages and using cocktails does not mean a dog will be 'drugged' or incapacitated by the meds. With the pain meds available, many can control pain without a lot of side effects. If the dog is handling the meds well, I don't see any reason not to increase the dose or add in additional medications if they are needed to help keep the dog more comfortable and allow more quality time.

 

It is true that if an increase in meds or additional meds needs to be contemplated, it means that quality of life has decreased. An astute owner will probably recognize the need when signs are very subtle though. And yes, there's the possibility that additional meds won't help, at which point the dog may have suffered for a couple more days while this conclusion is reached. But I've also seen dogs do remarkably better and get back to a great quality of life with minor tweaking of medication or the addition of a new med.

 

As others have mentioned, each case is different and each owner can only make decisions they feel comfortable with for their dog. I feel for each and every one of you here, and wish you all peace and the best outcome possible.

[Guest suzanne]

I'm more and more confused after reading the last few pages. I KNOW Freya is in pain but I also know she is having fun/enjoying herself as well. Where do you draw the line? How do you know it's time? With my last dog, a lab x, he had to be put down at age 17 in April 2010. He wouldn't eat, had a large tumour, wasn't comfortable etc. We KNEW but then at the same point on our last little walk just before going into the vet he chased a squirrel!! We still knew though. With Freya, i don't know.

 

She is in pain but she is also happy. The pain is not constant, i don't think.

 

i.e.

 

- she does not use her hind leg AT ALL anymore. Carries it in the air and has gotten very good on three legs.

- she has difficulty getting up the 3 small steps in the garden (our garden is divided into 2 sections, by steps unfortunately) I know on the one hand I should stop her climbing them but when my OH isn't home I can't lift her there alone and she LOVES the grass more than anything.

- She has less energy than she did - can't go on long walks, needs rests on small walks, sleeps more.

 

BUT

 

- is as happy and hyper and wiggly as ever to see us when we come in the door

- barks and plays with her younger sister when y.s gets too playful

- tail wags and kisses us

- goes crazy when it's walkie time - even though she can't do much of a walk now

- great appetite

- at night time takes INTENSE pleasure is running (yes running) out of the kitchen knowing that the other 2 hounds have to sleep downstairs and that daddy will carry her upstairs to sleep in our room!

 

My OH and I picked three things that make Freya 'Freya' and decided that when two of these go, it's time. Our three things are 1) her hyper excitement at walk time 2) appetite and 3)general bounciness when we come in the door.

 

They haven't gone yet.

[Batmom]

It is relatively easy to talk about giving pain medications -- how much you can give, what you can give, what side effects you might see. We are very fortunate here on GT that we have owners as well as vets with much experience those areas.

 

It is harder to talk about when not to give pain medications.

 

My feeling was that if you have to raise painmeds, you're not really doing the dog any favours. You may have some more timewith him, but who does it benefit? Not the dog, who is probably in painregardless of meds. A dog with osteo is going to experience huge amounts ofpain. I couldn't do it.

 

 

Since our dogs can't talk and tell us how muchpain they are experiencing, we can only do our best to assess their pain levelbased on their behavior and responses.

 

With osteo, the only ways to completely eliminatepain are with amputation or euthanasia. Medication can effectivelycontrol pain, but I don't believe it ever completely eliminates pain. .... If a dog is limping - it is in pain.

....

It is true that if an increase in meds oradditional meds needs to be contemplated, it means that quality of life hasdecreased.

It is much harder to talk about those things, but that is also an area where people need support. Deciding when to let a dog stay and when to let a dog go is miserably difficult. Of course nobody can make that decision for any one else, but we can surely listen and share.

 

I'm more and more confused after reading the last few pages. I KNOW Freya is in pain but I also know she is having fun/enjoying herself as well. Where do you draw the line? How do you know it's time? With my last dog, a lab x, he had to be put down at age 17 in April 2010. He wouldn't eat, had a large tumour, wasn't comfortable etc. We KNEW but then at the same point on our last little walk just before going into the vet he chased a squirrel!! We still knew though. With Freya, i don't know.

 

She is in pain but she is also happy. The pain is not constant, i don't think.

 

Suzanne, Freya is a lucky girl, to have you on her side. I'm sorry you're having to think about her pain at all but glad that she has someone with her best interests at heart. I hope she has many more happy days with you.

 

[Charlies_Dad]

Suzanne, please don't be confused. Everyone has their opinions however as for Freya, only your opinion counts. You have already noted what you feel are indicators of when she is no longer happy and she has NOT shown you the signs. Enjoy every day and every moment with her. She is very special, please give her a hug from me.

[robinw]

Suzanne, with Phoenix it was obvious when it was time. I had to go out of town for a few days for work. He was happy and bouncy when I dropped him off at my friend's house. When I picked him up a few days later, he couldn't stand without help, even with meds. I sent him to the bridge that day.

 

Your experience is going to be different than mine, just as Freya is different than Phoenix. You'll know when it's time.

Edited August 31, 2011 by robinw

[Guest Betsy]

Wow, so much to consider, so much to think about. With our first grey that we lost to Osteo, King's Ransom, it was such a quick loss that we didn't go through all this. We saw him limping one day, went to the vet the next day, was referred to a specialist 3 hours away. Went there the next day and was told that we should consider amputation and chemo after he confirmed the diagnosis. Took King home that night and was going to the local vet the next day with the specialist's report to discuss the diagnosis, but when we got up that morning King wouldn't eat, was acting funny and didn't want to even get up. Took him to the vet and they said it had already spread to a second leg. Amputation was out and so was chemo, we ended up going home with just a leash. When we lost Dixie in July, she had been showing signs of pain - panting, inactivity, lessening appetite since end of January. Everytime I took her to the vet, he said NO, it's not time yet and kept trying to treat her arthritis and manage the pain. We were going to the vet every 2 weeks. When we went July 1, she actually seemed better as far as the pain and arthritis but we took her because there was a very sudden extreme weight loss in her back hips and legs. She was diagnosed immediately with the hemangiosarcoma and again we went home with just a leash. King was 10 years old at time of passing, Dixie was 12 1/2. When Taylor was recently diagnosed, my mind flashed back to King and I just started bawling and said to the vet, Does this mean Taylor is not going home with me? He said absolutely not. He is going home and we will try to manage the pain and the symptoms but we just don't know for how long. He said to me "Betsy, you will know when the time has come." Here it is 2 weeks later and Taylor seems much better, almost normal. I watch his every move, every bite of food -almost too analytical. But I know in my heart, the vet is right - I will know. It won't make it any more easier but I will know. I will err on the side of sooner than later but I will know.

 

In short, we all have to do what is right for our hound and ourselves. It is much easier when you are on the outside looking in and can make quick judgements. But just remember that you gave this hound a home and love and you are both lucky for it.

[Guest carla7]

Hi all:

 

Can I ask of those using Pamidronate..........did you begin it immediately or did you wait? I just heard from my regular vet who says he will be able to administer it in his office (which is much closer to us than where we have to go if we end up doing radiation) so I don't know if we should just start it now or wait till later? Currently Persephone is still doing great on just the rimadyl and tramadol.......still pulling to go for walks, showing no s/s of pain, etc. I imagine that beginning it asap would be best?

And then w/radiation..........start now?? Or wait??

 

Thanks in advance!

Carla

[Guest carla7]

I'm more and more confused after reading the last few pages. I KNOW Freya is in pain but I also know she is having fun/enjoying herself as well. Where do you draw the line? How do you know it's time? With my last dog, a lab x, he had to be put down at age 17 in April 2010. He wouldn't eat, had a large tumour, wasn't comfortable etc. We KNEW but then at the same point on our last little walk just before going into the vet he chased a squirrel!! We still knew though. With Freya, i don't know.

 

She is in pain but she is also happy. The pain is not constant, i don't think.

 

i.e.

 

- she does not use her hind leg AT ALL anymore. Carries it in the air and has gotten very good on three legs.

- she has difficulty getting up the 3 small steps in the garden (our garden is divided into 2 sections, by steps unfortunately) I know on the one hand I should stop her climbing them but when my OH isn't home I can't lift her there alone and she LOVES the grass more than anything.

- She has less energy than she did - can't go on long walks, needs rests on small walks, sleeps more.

 

BUT

 

- is as happy and hyper and wiggly as ever to see us when we come in the door

- barks and plays with her younger sister when y.s gets too playful

- tail wags and kisses us

- goes crazy when it's walkie time - even though she can't do much of a walk now

- great appetite

- at night time takes INTENSE pleasure is running (yes running) out of the kitchen knowing that the other 2 hounds have to sleep downstairs and that daddy will carry her upstairs to sleep in our room!

 

My OH and I picked three things that make Freya 'Freya' and decided that when two of these go, it's time. Our three things are 1) her hyper excitement at walk time 2) appetite and 3)general bounciness when we come in the door.

 

They haven't gone yet.

 

Hi Suzanne:

 

I think you will know when it's time. Until then it sounds like you are continuing to love and enjoy Freya as much as she loves and enjoys you! I am also struggling w/when will it be time and I think that in our hearts we will know. Meanwhile I am trying to spend as much time loving Persephone as well as indulging her in her enjoyments to the fullest. Hang in there.

Carla

[NeylasMom]

Suzanne, please don't be confused. Everyone has their opinions however as for Freya, only your opinion counts. You have already noted what you feel are indicators of when she is no longer happy and she has NOT shown you the signs. Enjoy every day and every moment with her. She is very special, please give her a hug from me.

 

Cherish the time you have left with her and don't forget to take lots of photos and video if you can as well. I bought a new compact digital camera when Neyla was diagnosed because my dSLR doesn't have video and those videos of her running and playing and opening gifts are some of the things I treasure most.

 

Hi all:

 

Can I ask of those using Pamidronate..........did you begin it immediately or did you wait? I just heard from my regular vet who says he will be able to administer it in his office (which is much closer to us than where we have to go if we end up doing radiation) so I don't know if we should just start it now or wait till later? Currently Persephone is still doing great on just the rimadyl and tramadol.......still pulling to go for walks, showing no s/s of pain, etc. I imagine that beginning it asap would be best?

And then w/radiation..........start now?? Or wait??

 

Thanks in advance!

Carla

There is some evidence that IV pamidronate does promote bone growth/repair so if you believe that, then that might support starting the pamidronate now. However, it's main purpose is pain management, in which case it makes sense to wait until you're starting to see signs of increased pain. I think the deciding factor for me would be the risk of kidney side effects - for that reason, I would probably wait since she's managed on a reasonably low dose of meds.

 

I think I said this earlier, but Neyla's pain was managed for 5 full months on a minimum dosage of Deramaxx and Tramadol. She had some off days during that time, but for the most part she ran, played, went for walks or hikes up to a mile or even a little more on a reall good day, was hanging with me on the couch, all her normal stuff. It was in November, at month 6 when I saw signs of her pain increasing and not being as controlled as I would like on meds that we finally did the pamidronate treatment.

 

I do think - and this is only my own personal theory - that the pamidronate when it works, does a better job than medication. I saw a pretty drastic change after her treatment, for the better.

[Guest snakes]

Hi all:

 

Can I ask of those using Pamidronate..........did you begin it immediately or did you wait? I just heard from my regular vet who says he will be able to administer it in his office (which is much closer to us than where we have to go if we end up doing radiation) so I don't know if we should just start it now or wait till later? Currently Persephone is still doing great on just the rimadyl and tramadol.......still pulling to go for walks, showing no s/s of pain, etc. I imagine that beginning it asap would be best?

And then w/radiation..........start now?? Or wait??

 

Thanks in advance!

Carla

 

Carla,

FedX was diagnosed in january, we didn't start with pamidronate until (i think) April or May. After the original diagnosis we were doing fine with just pain meds, then he tweaked his leg a couple times and the pain was significant (he could barely walk for a few days), we added/adjusted meds, then we tried the palliative radiation and he seemed to get a tiny bit worse after 1 treatment. That was when i decided the next week to do pamidronate and he started getting better, the second (3 wks alter) pamidronate he was a lot better, the third three wks later he was doing great and i started tapering meds back down! The medical side of me says starting earlier will be better so as to offset further degeneration of the bone. The pet owner side of me says that i am doing palliative care and if he isn't showing major signs of pain then i won't do it since i am doing treatments to alleviate pain and not "fight" the cancer (i know it is a very fine grey line of difference).

Do what you think is best, there is no "right" answer, chances are like many of us you will second guess yourself. I have to keep reminding myself the goal is to keep my pup happy