Osteo Thread

[KF_in_Georgia]

Question that I know the answer to but need some validation and maybe some trade secrets...our group's Christmas party is on the 11th. I shouldn't feel bad taking Pinky, should I? As long as I make sure she's got a spot to lay down if she gets tired?

 

I just feel like she should be treated as if she is "normal"...right?

 

Guess I'm worried that maybe people will think I'm mean for bringing her. But I know there are also a lot of people who will be so happy to see her too.

 

Absolutely take Pinky! There might be a toeless dog or two there. If no one fusses about a dog that's missing a toe or two--or a couple of inches of tail--there's no reason anyone should fuss about a leg. Her incision is healed, and she's "new-normal."

[BauersMom]

Question that I know the answer to but need some validation and maybe some trade secrets...our group's Christmas party is on the 11th. I shouldn't feel bad taking Pinky, should I? As long as I make sure she's got a spot to lay down if she gets tired?

 

I just feel like she should be treated as if she is "normal"...right?

 

Guess I'm worried that maybe people will think I'm mean for bringing her. But I know there are also a lot of people who will be so happy to see her too.

 

I'm bringing Berkeley to our group's upcoming reunion. He's not in pain and worst case scenario is he might get tired (but we'll have a bed) so there's really no reason to not bring them! He usually enjoys the doggie events, too, so it's good for him to get out and socialize.

 

Unfortunately, the response I usually get when people see him is "Aww, poor thing" type stuff. I try to get them to see that he's happy and living life fine with three legs and there's no need for pity.

[krissn333]

I think that's exactly where my worry comes from. I don't want people to pity her, I want people to be proud of her for being such a fighter.

 

She has taken everything life has handed her in stride - when I got her, her nose was dry, cracked, and bleeding. Her toenails were so long she could barely walk. Her ears were full of crusty sores and her snout was peeling. She had red skin and no hair around her eyes. The track vet told us when we (the group) took her that she had lupus, but, if we just put some foot cream on her nose she would be fine She required a burst and taper course of prednisone and takes vitamins every day. For a while she was also on tetracycline long term too. She frequently had her toenails just snap in half (this still happens but not nearly as often), bleeding everywhere and sometimes requiring a bandage for a day or two.

 

And now the osteo was handed to her - she came home 24 hours after she woke up from surgery and has never looked back. She figured out how to stand up from laying down very quickly and TOWED me around the yard in the pouring rain through the mud to go potty. Her incision has healed beautifully and she's growing her hair back pretty quickly (her vitamins may be helping with that). She has never shyed away from pushing her way through the pack, even on her second day home. Full speed ahead is the only thing she knows. She is back to playing with Ace in the yard and runs after her barking as she always has. She is just minus a leg, that's all And yes, it looks funny, but if she's wearing her jammies, I bet most people wouldn't even notice.

 

I'll just make sure we've got her bed with us so she can lay down if she gets tired. I am tempted to make her a shirt or something that says "I'm kicking osteo butt" or something to that effect

[NeylasMom]

Regarding Sam, I would consider taking him off the Valium and seeing what happens. What you're describing between the stumbling/falling and the eating is exactly what I saw with Violet on too high of a dose of Xanax. You're also really low on the spectrum in terms of pain management. My guess is the inability to settle was from pain and the Valium won't help with that. I respect your decision no matter what and I really don't think there's a "too soon" when it comes to osteo, but I'm just throwing it out there if you feel like it's worth trying.

[krissn333]

Pinky's pathology report...can anyone translate?

 

The marrow cavity has been extensively filled and trabeculae focally effaced by an infiltrative population of plump spindle cells arranged in intertwining streams and bundles supported on a fine collagenous matrix with focal islands of osteoid and bone formation. Spindle cells have moderately-sized, oval vesiculate nuclei. Nuclear pleomorphism is moderate and mitotic figures are uncommon. Spindle cells have scant amounts of eosinophilic cytoplasm and indistinct cytoplasmic boundaries. Focally there are small islands in which both spindle cells and bone are necrotic. There is focally extensive subperiosteal new bone formation.

 

Comments:

The prognosis with osteosarcoma is generally poor. These tumors progress rapidly, are locally invasive, and pulmonary metastasis is common. The 1 year survival rate following amputation of the affected limb is reported to be only 11.5%, with a mean survival time of 19.2 weeks.

 

To me, with my minimal understanding of some of the big words in the first paragraph, it sounds like yes, they are seeing some abnormalities that confirm osteo, but, there was still new bone formation occurring...the marrow cavity itself seems to have been mostly overtaken by the cancer, but the bone remained mostly intact and the remaining marrow was still working to create new bone.

 

This corroborates Dr. Less's feeling that we caught it early and the cancer hadn't had a chance to start eating through the bone yet. Given that information, the comments section seems pretty harsh and generic...guess that means we'll just have to shoot for being part of that 11.5%!

 

Sorry I'm a chatterbox tonight...I've been at the computer working on some other things and then I sat down to write an email to Dr. Marin and send her Pinky's report.

[KF_in_Georgia]

Regarding Sam, I would consider taking him off the Valium and seeing what happens. What you're describing between the stumbling/falling and the eating is exactly what I saw with Violet on too high of a dose of Xanax. You're also really low on the spectrum in terms of pain management. My guess is the inability to settle was from pain and the Valium won't help with that. I respect your decision no matter what and I really don't think there's a "too soon" when it comes to osteo, but I'm just throwing it out there if you feel like it's worth trying.

 

Is 20mg a high dose? Actually, I started with 10mg two or three times a day (plus 200mg/day of gabapentin), and he wasn't sleeping any better. (And tramadol has never been helpful for him, although the tramadol dose I had for him was only 50mg.) After the first week or so, when he was sleeping fine, restlessness was the only indication that anything was wrong. Since we don't know where the primary cancer is (beyond believing that it's not osteo), we can't tell what hurts...and whatever it is isn't hurting enough to keep him from trying ill-advised zoomies. (He's also getting his regular dose of methocarbamol and meloxicam for his spinal arthritis. Neither of those has ever produced bad coordination; I suspect they're what has made him feel well enough for zoomies.)

 

I can cut back the valium (or cut it out completely--I only gave him 10mg at dinner tonight, and I can skip the bedtime dose), and boost the gabapentin--maybe give 200mg at breakfast, then 100mg in the evening, and 200mg at bedtime (when his being able to sleep would be helpful for both of us). If I start that now, by Tuesday at 6:40pm, the vet might be able to get a good read on whether he's hurting. The fall last night left him limping for a bit (but no swelling). When he walks now, he's not putting his rear feet down cleanly; one or the other often winds up partially knuckled over, which he corrects when he stumbles. And he wobbles tremendously at the hocks when he's standing still.

[TwiggysMom]

I hope Sam can get comfortable. I don't know much about the pain management end of it, but getting the mix right certainly has made all the difference for some of the hounds here (although it sounds like it can be so much trial and error, and I certainly understand if someone would not want to put their dog through the "error" part of that). I've been thinking about Sam, and sending my best wishes for his comfort and happiness!

 

How wonderful is it that Faye Oops had such a fantastic Thanksgiving! You all must be thrilled!

 

Kristen - First, I'm sorry to hear about Ace's tumor recurrence. My fingers are crossed for Wednesday! For Pinky's lab report, my eyes just glazed over on the medical terms, but regarding the prognosis, they didn't state anything about iv chemo, and the statistics seem about right for a dog with amputation but no chemo (just according to what I've heard). I don't think those are the stats for amp + chemo. As for the get-together, I think you should bring her. The only real caution I would make is that if she has started her chemo before the event, take her in for a CBC the day before to make sure her immune system can handle any potentially sick dogs there. I know greyhounds in general, and those at a gathering like that tend to be better cared for than your average dog, but sometimes dogs are sick before showing any real signs. Then, once there, be prepared for telling and re-telling her story. Some may ask if she was born like that (yes, even at a greyhound reunion), and some may not realize that amputation does not equal cure (yes, even at a greyhound reunion). But, overall, I've taken Twiggy to 2 different reunions since her amputation, and Twiggy and I both thoroughly enjoyed them.

[krissn333]

Wendy, thanks for the point about worrying about things if she's just had chemo. Guess my babbling was not all for nothing because that hadn't occurred to me. If things work the way I have them planned, she will have her first chemo treatment the week of December 5th. The party is on the 11th.

 

Many of the people that will be there are friends in some capacity or another and know her, so they'll be excited to see her. But, there are some people that I don't know and I'm sure I'll have to answer some questions. We already get questions from other clients at the vet's office if we're there waiting, so, I'm used to that part of things.

[krissn333]

How often do they usually do chemo treatments?

[TwiggysMom]

Wendy, thanks for the point about worrying about things if she's just had chemo. Guess my babbling was not all for nothing because that hadn't occurred to me. If things work the way I have them planned, she will have her first chemo treatment the week of December 5th. The party is on the 11th.

 

Many of the people that will be there are friends in some capacity or another and know her, so they'll be excited to see her. But, there are some people that I don't know and I'm sure I'll have to answer some questions. We already get questions from other clients at the vet's office if we're there waiting, so, I'm used to that part of things.

 

That's 6 days post treatment, which is in the nadir range for many dogs, but I think she will be fine, especially since this is her first (I think???) treatment. You'll have peace of mind by getting the CBC though. I thought I could tell by Twiggy's behavior how she was doing, but we had to postpone her #3 treatment due to low neutrophils one time (and she was taking me on daily 1+ mile runs at the time, so the result surprised me).

 

One of the things I really enjoyed by going was to be able to show everyone who knew about her situation just how well she was doing - everyone was really supportive.

[BauersMom]

How often do they usually do chemo treatments?

 

Ours were every three weeks, assuming blood work is OK. But almost half have been postponed due to low platelets or low WBC counts... so some every three weeks, some every four weeks.

 

Wendy, thanks for the point about worrying about things if she's just had chemo. Guess my babbling was not all for nothing because that hadn't occurred to me. If things work the way I have them planned, she will have her first chemo treatment the week of December 5th. The party is on the 11th.

 

Many of the people that will be there are friends in some capacity or another and know her, so they'll be excited to see her. But, there are some people that I don't know and I'm sure I'll have to answer some questions. We already get questions from other clients at the vet's office if we're there waiting, so, I'm used to that part of things.

 

That's 6 days post treatment, which is in the nadir range for many dogs, but I think she will be fine, especially since this is her first (I think???) treatment. You'll have peace of mind by getting the CBC though. I thought I could tell by Twiggy's behavior how she was doing, but we had to postpone her #3 treatment due to low neutrophils one time (and she was taking me on daily 1+ mile runs at the time, so the result surprised me).

 

 

I could never tell how Berkeley was feeling - even the times when the vet was like "Whoa, that's low." he was acting totally normal. Only the little bit of nausea within the 24-48 hours after chemo was obvious, otherwise, he acted fine!

 

So the bloodwork is more 'trustworthy' for some, I'd say.

[Batmom]

You might want to check her WBC count before heading off to a party with a bunch of other dogs. Different meds, but the sole dose of chemo that I gave Batman tanked his. I wouldn't've wanted to take him anywhere in that condition.

[NeylasMom]

Sorry Kathy, I forgot you aren't sure if you are dealing with osteo. I'm not familiar with Valium dosages, only Xanax. The only thing I can say is that I believe it could cause issues, but reading about the feet knuckling sounds neurological to me. Gapapentin can also cause stumbling and falling - if you've been following Faye Oops's story you've seen that already.

 

It's unfortunately often really difficult to tell what's going on when people post in here because we don't have clear timelines. Tramadol also causes restlessness and could have been the cause of the nighttime problems, but I don't know when you had him on that compared to when he was having those symptoms. Can you outline chronologically when you started and stopped each med (include dosages), along with when the various symptoms appeared and disappeared? I did keep a journal with Neyla and if you decide to keep going, it might be helpful to do that.

 

Is Sam the one who has spots on his lungs? Did you ever x-ray his spine? Reading your last description about the knuckling, I am wondering if he has osteo in his spine that has metastasized to his lungs.

 

 

 

Kristin, bone growth is part of osteosarcoma. It's called lytic growth.

Edited November 28, 2011 by NeylasMom

[Batmom]

I can cut back the valium (or cut it out completely--I only gave him 10mg at dinner tonight, and I can skip the bedtime dose), and boost the gabapentin

 

In your position, I might be inclined to cut out the valium and keep the gabapentin as is, and see what happens over 24 hours or so.

[krissn333]

 

Kristin, bone growth is part of osteosarcoma. It's called lytic growth.

Well, crap

[BauersMom]

 

Kristin, bone growth is part of osteosarcoma. It's called lytic growth.

Well, crap

 

But, you knew it was osteo, though. All signs point to catching it early, so don't read too much into the report as far as a prognosis. Just keeping putting up the good fight and take it day by day.

 

Edit to change what I wanted to say!

Edited November 28, 2011 by BauersMom

[tbhounds]

 

Kristin, bone growth is part of osteosarcoma. It's called lytic growth.

Well, crap

Actually, osteo is seen in two forms lytic (bone loss) and prolific. I would interpret the path report to be the latter. Either way IMO I feel you made the right decision to go forward with the amp- looks how way she's doing!!

[NeylasMom]

 

Kristin, bone growth is part of osteosarcoma. It's called lytic growth.

Well, crap

Actually, osteo is seen in two forms lytic (bone loss) and prolific. I would interpret the path report to be the latter. Either way IMO I feel you made the right decision to go forward with the amp- looks how way she's doing!!

My bad, got my terms swapped - Dr. Couto's actual words when explaining Neyla's x-rays: Black is bone destruction (lysis); white is an attempt at new bone formation (proliferative).

 

So wrong term, but same point - that bone growth is part of how osteo presents. Like Bauersmom I don't really think it's worth trying to read into the path report much. You knew she had osteo, you made the choice you felt was best, now you give it your best fight. The path report won't change your plan of action.

[KF_in_Georgia]

Sam has spots on his lungs. We figure that's a cancer from elsewhere that has metastasized to his lungs. He's had spinal x-rays. The latest showed a slightly herniated disk at L5, but no signs of osteo. He fought the techs on the spinal x-rays, so we haven't pushed him for anything else.

 

• 
   
  
• Monday, 11/14: x-rays and diagnosis; at this point, he's been getting methocarbamol 3x daily and that doesn't change going forward
  
• Tuesday, 11/15: to this point, he's gotten meloxicam only when he seemed to be in pain from his arthritis; from here on, he gets meloxicam (and pepcid) every morning
  
• Saturday, 11/19: first restless night
  
• Sunday, 11/20: gave 50mg Tramadol at bedtime; restless night
  
• Monday, 11/21: 50mg Tramadol morning and bedtime; restless night
  
• Tuesday, 11/22: 50mg Tramadol morning; 10mg Valium, 100mg gabapentin at bedtime; better night
  
• Wednesday, 11/23: 10mg Valium + 100mg gabapentin morning and bedtime; better night
  
• Thursday, 11/24: 10mg Valium + 100mg gabapentin morning and dinner; he was fidgety in the evening, so he got another Valium and gabapentin at bedtime; bad night
  
• Friday, 11/25: 10mg Valium + 100mg gabapentin morning and dinner; after fidgety evening, 20mg Valium + 100mg gabapentin at bedtime; bad night
  
• Saturday, 11/26: 20mg Valium + 100mg gabapentin morning and dinner and bedtime; fell Saturday evening; bad night
  
• Sunday, 11/27: 20mg Valium + 100mg gabapentin morning; 10mg Valium + 100mg gabapentin dinner; fell this morning
   
  

Sunday morning's fall wasn't as bad as Saturday night's. He hasn't moved well since Saturday's fall; he limped a bit Saturday night, but not for long, and there was no swelling. At eleven and a half, he's had wobbly legs for a while, and an occasional stumble on walks, but he's been much worse for the last 24 hours. Both falls have been on carpeted floors, where he was doing zoomies in hopes of luring Silver into playing.

 

 

I'm home with the dogs every evening; Sam normally would stretch out after dinner and sleep pretty soundly until I get him up for a bedtime snack and a last trip outside. On his restless nights, he only dozes rather than soundly sleeping in the evening; often, he'll just lie in his bed and watch me instead of sleeping. Today is the first day I've been home with him since last Sunday; he's slept pretty soundly some of today, but he's had several fidgety spurts where he just paces from dish to dish to trashcan to bed--and around the circuit again and again.

 

The one thing he hasn't shown signs of is any back pain. In the past, back trouble was indicated by lots of shaking as if he had water in his coat (or an aborted shake if his back was really bad); also by yelping when he tried to stand up or lie down. We're getting none of those symptoms, and considering how up-and-down he is all night, and the fact that he stretches comfortably, I don't think his back is bothering him. (If it bothered him just a little more, he'd probably stop trying zoomies.)

 

P.S. The coughing that originally prompted the chest x-rays is a little worse, but it's not bad. He's not coughing up blood (or anything else), and the coughing spells don't last long. The coughs are just a bit more frequent.

 

P.P.S. Faye Oops and her experience with gabapentin is why I didn't want to start Sam out on lots of gabapentin. I have 100mg capsules for him. Oh--and if it matters--Sam's not a big boy. He still weighs 65 pounds--his normal weight.

Edited November 28, 2011 by KF_in_Georgia

[NeylasMom]

If it were me, and this is just my uneducated opinion, based on what you just detailed I would back off the Valium, probably completely and leave the Gabapentin where it is and see what happens.

 

Eta: I also don't know which meds are best for helping with discomfort from lung mets (pred maybe?), but some people on here have dealt with it. I might investigate that as a next step if you see some progress.

[JJNg]

Like Bauersmom I don't really think it's worth trying to read into the path report much. You knew she had osteo, you made the choice you felt was best, now you give it your best fight. The path report won't change your plan of action.

I agree with this too. The details of the path report just describe all the microscopic features of the cells that lead up to the pathologist's diagnosis. For some types of cancer, it may provide info that assigns a 'grade' to the tumor that indicates how aggressive it is. But as far as I know, osteosarcoma is not classified into grades, so they are all treated the same.

 

I also wouldn't pay much attention to the comments section on the path report. That is just general information about the tumor type, not specific to your case. And in the case of Pinky's report, it doesn't even look like they are quoting very complete or current information.

 

I also don't know which meds are best for helping with discomfort from lung mets (pred maybe?), but some people on here have dealt with it. I might investigate that as a next step if you see some progress.

Most of the dog's I've seen with lung mets don't seem to be painful. Usually the signs are coughing, shortness of breath, and sometimes a decreased appetite (possible associated with discomfort?). So I'm wondering if Sam's restlessness may be unrelated to the lung lesions? I've seen some older dogs get restless at night due to cognitive dysfunction or age-related sensory changes. It's always possible there's a source of pain/discomfort that we're unable to identify, but most observant owners can tell if their dog is in pain.

[Texasgreys]

Clark looks good! I am surprised to hear that with a diagnosis of chondrosarcoma, he has a poor prognosis. I would get a second opinion (hopefully OSU can help) or ask for chemotherapy + amputation prognosis. Usually it is good when they do not have osteo...is this also considered a very aggressive cancer?

One of the reasons for the poor prognosis for Clark is that he is so young (~18 months) and cancer in a young dog is generally very aggressive. I'm waiting to hear back from the OSU, but I did send the pathology report to my former vet in Dallas and he agrees with the prognosis.

 

Chemo is not an option for two reasons - (1) from what I have read there is not a good chemo protocol for chondrosarcoma and (2) the adoption group can't afford chemo. I'm not in a position to pay for chemo for a foster dog, so I'll keep Clark comfortable and happy and see where this road takes us.

 

The only thing I'm going to look for, for his care, is something for his terrible skin itching. That was his initial problem on intake, for which he's been on various antibiotics with no relief. I'm going to talk to the vet about whether something like Pred might help his itching.

[krissn333]

Might try something as simple as vitamin E caplets too...they helped Pinky a lot.

 

Jjng...yeah, I guess what I was looking for in the report was some information indicating how advanced it is, etc.

 

All we can do is keep breathing.

[MaryJane]

Clark looks good! I am surprised to hear that with a diagnosis of chondrosarcoma, he has a poor prognosis. I would get a second opinion (hopefully OSU can help) or ask for chemotherapy + amputation prognosis. Usually it is good when they do not have osteo...is this also considered a very aggressive cancer?

One of the reasons for the poor prognosis for Clark is that he is so young (~18 months) and cancer in a young dog is generally very aggressive. I'm waiting to hear back from the OSU, but I did send the pathology report to my former vet in Dallas and he agrees with the prognosis.

 

Chemo is not an option for two reasons - (1) from what I have read there is not a good chemo protocol for chondrosarcoma and (2) the adoption group can't afford chemo. I'm not in a position to pay for chemo for a foster dog, so I'll keep Clark comfortable and happy and see where this road takes us.

 

The only thing I'm going to look for, for his care, is something for his terrible skin itching. That was his initial problem on intake, for which he's been on various antibiotics with no relief. I'm going to talk to the vet about whether something like Pred might help his itching.

 

 

Check with OSU - he might be eligible for free chemo

 

If it were me, and this is just my uneducated opinion, based on what you just detailed I would back off the Valium, probably completely and leave the Gabapentin where it is and see what happens.

 

Eta: I also don't know which meds are best for helping with discomfort from lung mets (pred maybe?), but some people on here have dealt with it. I might investigate that as a next step if you see some progress.

 

 

Just a note that Valium can be addicting and there might be a protocol that you can't simply stop, you might need to cut back gradually. Best to check with vet before stopping.

[KF_in_Georgia]

 

Just a note that Valium can be addicting and there might be a protocol that you can't simply stop, you might need to cut back gradually. Best to check with vet before stopping.

 

Sam took Valium for five days. At this point, it's already been 24 hours since his last dose.

 

 

I had to work late last night on a freelancing job. I went to bed at 1 am, and set the alarm for 5 am (due at my other job at 7 am). During my four hours of "sleep," fidgety Sam woke me at least three times, mostly wanting me to cover him back up so he could nap for a bit until he got restless again.

 

Tonight is likely to be another four-hour night...