Osteo Thread

[Guest snakes]

A few responses to different questions:

1) I do think FedX (non-amp) gets muscle cramps sometimes (today in the car for one!) i just massage him for a bit, we had a week or so where he would spontaneously do the GSOD and i think that may have been due to gas! It could have been cramps as well though.

 

2)Gabapentin - I think your course of increasing the gabapentin was exactly the right move. I always increase the gabapentin first if needed with FedX since it seems the most effective and it has relatively little side effects compared to some of the other pain meds. We have been up to 200mg 3x/day and were told we could go up to 300mg each dose if needed.

 

3)palliative radiation - We did one dose for FedX on our vets recommendation on excellent results with her pup. The treatment seemed to go well, however FedX's pain increased afterwards and didn't get any better for 2-3weeks after, therefor we never had any more treatments. His leg is extremely sensistive to any manipulation and even after a slight bump he limps for two weeks, i think the manipulation for the radiation was too much for him.

[winnie]

Faye Oops was on 500mg of Gabapentin split between 3 doses (200mg, 100mg and 200mg). That dosage seemed to work best for her. If Anna starts walking like a drunken sailor, I would consider cutting it down. Otherwise, it sounds like you're doing the right thing. 100mg once a day really isn't much.

Edited December 28, 2011 by winnie

[JJNg]

She is still bowing and doing all the normal postures, but the limp is pronounced.

Is there another med or another strategy that should or can be explored?

In many cases, I don't think you can expect to completely eliminate the limp. However, the goal is to improve comfort level and allow her to continue doing what she enjoys. If you feel that her pain control is inadequate, you have room to go up on the gabapentin. Although it sounds like you may need to have a discussion with your vet and ask her to do some more research on gabapentin if she thinks you can't give more than 100 mg once a day.

 

I'd also recommend looking into pamidronate treatments. It can help with pain control as well as improve bone density to hopefully decrease the risk of pathologic fractures.

[vjgrey]

 

 

Valerie, is palliative radiation being combined with any other modality besides pain meds for Gabe? Are the treatments "as needed" or at regular intervals? How long are the treatments?

 

 

He's also getting five doses of chemotherapy, one every third week. He'll have his third treatment tomorrow. While he's in for chemotherapy, he gets Pamidronate in an IV drip, so every third week for that as well.

 

We're doing the radiation treatment on an "as needed," basis. Our radiologist discussed with us the benefits of various treatment protocols (one a week for four weeks, etc...). She recommended "as needed," to try to stretch the treatments out longer. Once they reach the maximum allowable radiation, it can be six months or more before they're able to treat again. It's been such a "miracle cure," for Gabe that we want it to remain an option for him.

 

He's also on Gabapentin, amantadine, rimadyl, and tramadol.

[krissn333]

Pinky was supposed to have her second chemo this morning, but Dr. Thomsen wants to hold off for a week-her white count is 3500, neutrophils are at 1600. Bummer. Next try will be Saturday the 7th.

 

He also told me that while they did receive the chemo from OSU, it was only enough for two treatments with a little bit left over. I sent an email to Dr. Marin to find out what the deal is. They sent 400some ml, and her treatments are 200some ml each. Very confusing. The chemo was delayed in getting there due to backorder, so I wonder if they parted it out differently so they could send to more patients right away and then send the rest later?

[krissn333]

Heard back from Dr. Marin already That's a new speed response record-I didn't expect to hear back for a day or so since I know how busy they are.

 

My suspicion was correct-in order to get more patients started, they sent out smaller amounts. She asked me to send her a note once Pinky has her second treatment and they'll send the other two doses.

 

I know they recommend 4-6 treatments...how many of you did more than 4?

[vjgrey]

Must be one of those kinds of days - Gabe's white blood count isn't right for chemo today, either. He'll get the Pamidronate drip, anyway, and we'll try again next week.

 

His oncologist thinks the episodes are breakthrough pain and gave me a very negative speech - "He's already on large amounts of pain meds, we may want to consider whether we're really managing it effectively..." etc.

 

Aside from these very brief episodes (30-45 seconds, once a day for the last several days), he's trying to charge around our house like a bull in a china shop, so I don't necessarily agree that they're breakthrough pain. Especially since they're not always in the osteo legs, and i can actually watch the muscles cramp. He's walking mostly without a limp, eating great and is still generally a happy boy.

 

He's also not at a max dose of gabapentin (currently 300mg twice a day) or tramadol (two pills, twice a day).

 

I love our oncologist, but it's very discouraging to be getting a "throw in the towel" speech when I don't feel we're anywhere near that point. *SIGH*

[Guest snakes]

I love our oncologist, but it's very discouraging to be getting a "throw in the towel" speech when I don't feel we're anywhere near that point. *SIGH*

 

Hang in there, i imagine that was very discouraging but you know in your heart what is right for Gabe and it sounds like he is very happy

[NeylasMom]

I love our oncologist, but it's very discouraging to be getting a "throw in the towel" speech when I don't feel we're anywhere near that point. *SIGH*

 

Hang in there, i imagine that was very discouraging but you know in your heart what is right for Gabe and it sounds like he is very happy

 

I can't tell you how much I felt like I was on my own in my fight with Neyla. The oncology team didn't want to touch the topic of holistic medicine with a 10 foot pole, my regular vet didn't feel knowledgeable enough to discuss treatment options, etc. etc. In the end, you have to go with your gut.

 

And frankly, in this case, I don't see how they could be describing it as breakthrough pain. It really sounds like muscle cramps. I would consider massage and/or chiropractic and see if it helps. Both my chiropractor and holistic vet were willing to show me how to do the massage and stretching myself, which I then did on a daily basis with Neyla. Our issue was that before she was diagnosed she had lost some muscle in one of her back legs because of a toe issue so on days when she was up for walking more, that leg would get tired and shake. So we mostly used it for that, a bit different than what you're dealing with, but I'm thinking it could still help.

[BauersMom]

 

I know they recommend 4-6 treatments...how many of you did more than 4?

 

Sorry to hear chemo had to be postponed. We faced that several times, and it's discouraging but of course in their best interest. We did 6 treatments, and the last two were spaced a month apart to give him additional time to recover. The OSU drugs lasted for all 6 for us, since they lowered his dose to try to not beat up his immune system.

 

 

I love our oncologist, but it's very discouraging to be getting a "throw in the towel" speech when I don't feel we're anywhere near that point. *SIGH*

 

Definitely go with your gut.

 

I would imagine that the vet likely sees a good number of patients who do wait far too long to make "the decision" and so maybe is erring on too early vs. too late when he/she gives advice. I don't entirely fault them, since they have to be the dog's advocate in cases where emotion is clouding the owner's judgement.

 

That all said, we know you have Gabe's best interest at hand and only YOU really know how well he's doing. Keep doing what you think is best for him.

[krissn333]

I'm sorry you're having to deal with a "throw in the towel" attitude...what you've described definitely sounds like muscle cramping to me, and if he's fine otherwise, I don't see any reason to worry! I'd definitely recommend the massage, maybe acupuncture? And maybe ask about robaxin (methocarbamol)...it's a human drug and it's not expensive.

 

I'm sitting here trying to think about muscle cramps in humans...hydration is important, as is potassium (I think cramping results from too little potassium but I honestly can't remember). Of course it could just be happening because he moves a bit differently and relies a bit more on the non-osteo legs. In any case, I hope that he won't have much trouble from them.

 

When I told my mom that Pinky couldn't have her treatment today, she was really worried about what that means, etc, and I told her that it's pretty common, so I'm not worrying.

 

Even if we only get 4 doses from OSU, I will likely go for more treatments and pay for them myself. While receiving the chemo from OSU is definitely a money saver, I think I can swing a couple of treatments (I just couldn't swing 6 of them). I was surprised to learn that the price of carboplatin has come down significantly.

[winnie]

I love our oncologist, but it's very discouraging to be getting a "throw in the towel" speech when I don't feel we're anywhere near that point. *SIGH*

 

I'm sorry. You see Gabe a lot more than your oncologist, so I don't think it was right of him/her to make that assessment.

 

I used to always tell people with a terminally ill or aged animal that they'd let you know when it's time. To be honest, I'm not sure I always believed it. The two animals DH and I had put down before Faye Oops were quick and fatal illnesses. There was no time to "wait and see." I was so worried about keeping Faye Oops going for us and causing her unnecessary suffering. BUT... Faye Oops was so determined to live and make the best of each and every day. On her final day, she really did let us know it was time. There was a definite change in her attitude. We didn't hesitate to call the vet. I even said to DH that we got the timing exactly right.

 

Bottom line... you know Gabe. He will let you know. In the meantime, continue to do what you feel is in his best interests. He sounds like a fighter too.

[Batmom]

vjgrey, I suspect your oncologist simply wanted you to consider that at some point -- which may come very quickly and probably not at the vet's office -- there won't be anything more you can do. And to consider that absent a significant structural defect (fused joint, one leg shorter than the other, etc.), if a dog is limping, the dog is in pain.

 

 

 

Vets do sometimes see things that we don't. We see the dog every day, and that makes it hard to notice subtle changes that are not so subtle to someone who sees the dog at intervals. On the flip side,often the vet sees the dog when the dog is at his or her worst and doesn't have a feel for what proportion of the dog's day is comfortable versus not comfortable.

 

 

 

None of my own dogs, nor others I have cared for with terminal illnesses, have let anyone know when it was time. The people have had to make the decisions. Rotten and cruel and hard, but there it is.

 

 

 

Hugs and hopes your sweet boy has good, comfy, happy days with you yet.

[vjgrey]

I have considered that. Really, I have. But he shows no signs of pain or discomfort 99% of the time. He's not limping, and he'd still be running around and jumping if we'd let him. If he didn't have a visible tumor, I might think he'd been misdiagnosed.

 

He may not tell me when he's ready, but right now I know he isn't.

 

Thank you for the advice, though. I do understand your point.

 

And thank you all for telling me it's okay to trust my judgment.

[KF_in_Georgia]

Let me second the suggestion of methocarbamol. Sam has spinal arthritis, and when his back bothers him, he clenches up the muscles and really puts himself in a lot of pain--crying out as he tries to stand or lie down. He takes meloxicam as his NSAID, and he takes methocarbamol three times a day to relax those spinal muscles. It's made a world of difference.

 

We saw a chiropractor for his back pain. The adjustments were extremely painful and he screamed bloody murder. Less than two weeks after the last treatment, he was in pain again--on a Friday night, with the chiropractor halfway across the state and unavailable on the weekend. I told my vet I needed something more "accessible" for emergencies with Sam, and he prescribed the pills. We haven't gone back to the chiropractor again because Sam no longer gets the kind of pain that had him crying out. I honestly don't think Sam would still be around if we hadn't gotten the back pain under control--and the methocarbamol is what did the trick.

 

The methocarbamol doesn't make him groggy and does not complicate administration of gabapentin.

 

Unless your vet has seen one of Gabe's episodes, I'm not sure he should be trying to diagnose what kind of pain Gabe's having. If he thinks it's break-through pain, he should give you a script for something like methocarbamol to prove his point: if Gabe's not better on the methocarbamol, then you'll know it's more than muscle spasms.

 

(Sam takes one 500mg methocarbamol 3x daily. A bottle of 30 pills runs about $12 at Walgreens.)

[vjgrey]

Hmm...I did ask about methocarbamol/robaxin tonight when I picked Gabe up, but it was via a vet tech, because his oncologist was on a phone call. She checked with him briefly and said he'd said no, because it was a "bad idea" on top of Gabe's other meds. He didn't elaborate, and she didn't know, so I'm not sure which of his meds he thinks it would conflict with. I'll ask him to elaborate when I speak to him next.

[krissn333]

As far as I know it shouldn't interact with anything. : Sutra had zero side effects from it...it just kept his muscles relaxed. I have my own script as well for when my back is acting up. Doesn't give me any unpleasant side effects either-not even grogginess.

[KF_in_Georgia]

My vet quite likes methocarbamol for Sam because it DOESN'T react badly with anything else Sam is taking (meloxicam and gabopentin).

[krissn333]

I made some hard boiled eggs for Pinky last night...for breakfast I just tossed one into her bowl with her kibble. She was so excited that she pulled the egg out and took it to a bed to eat it I should probably at least break it in half for her next time

[Guest snakes]

I made some hard boiled eggs for Pinky last night...for breakfast I just tossed one into her bowl with her kibble. She was so excited that she pulled the egg out and took it to a bed to eat it I should probably at least break it in half for her next time

 

 

What and ruin all her fun?

 

FYI, if it is two pieces just be careful she doesn't take each piece to her bed separately, you'll have cooked egg yolk pieces all over your floor!

[Guest tmgukcatfan]

I didn't know you'd lost Bee Wiseman. I am so very sorry! She was a sweetheart. I'm new to the osteo thread--Thalion was diagnosed on November 17th and had his right front leg amputated on the 23rd of November. He's now getting chemo.

 

My heart goes out to you over the loss of Bee. Please accept my belated condolences.

 

Teresa

[krissn333]

Oh, egg yolk pieces are no big deal-we have ceramic tile, plus, on the off chance she were to leave anything behind (not likely-she's the one who cleans up the cookie crumbs ), my iggies and one of my kitties would hoover up the pieces that got missed

[45MPHK9]

I didn't know you'd lost Bee Wiseman. I am so very sorry! She was a sweetheart. I'm new to the osteo thread--Thalion was diagnosed on November 17th and had his right front leg amputated on the 23rd of November. He's now getting chemo.

 

My heart goes out to you over the loss of Bee. Please accept my belated condolences.

 

Teresa

 

Thank you for your kind words, Teresa. We lost Bee on October 13. I saw your post about Thalion. I'm so sorry to see you here in this thread but so glad to hear that Thalion is hanging in there post amp! Continued good wishes for your handsome baby, Teresa.

[krissn333]

Question: at what point have your vets decided not to do a chemo treatment based on white count?

 

As I mentioned, we didn't do Pinky's yesterday - her white count was 3500, neutrophils were at 1600.

 

In my chatting with Dr. Marin, she said that they will still treat when a dog has a white count as low as 2000.

 

Curious to see what others' experiences have been - IIRC most are skeptical around the 3000ish mark, but it seems that our vet pays more attention to the neutrophil count rather than total WBC.

 

Given that Pinky's total WBC before her first treatment was in the 5000 range, and a week after treatment we were sitting around 3500 but with a higher neutrophil count than 1600, his concern was that we are still seeing a decline after the first treatment - things haven't bounced back yet. I also wonder if she WILL have a harder time bouncing back given her lupus.

 

Just lots of thoughts swirling around...

[joejoesmom]

Question: at what point have your vets decided not to do a chemo treatment based on white count?

 

As I mentioned, we didn't do Pinky's yesterday - her white count was 3500, neutrophils were at 1600.

 

In my chatting with Dr. Marin, she said that they will still treat when a dog has a white count as low as 2000.

 

Curious to see what others' experiences have been - IIRC most are skeptical around the 3000ish mark, but it seems that our vet pays more attention to the neutrophil count rather than total WBC.

 

Given that Pinky's total WBC before her first treatment was in the 5000 range, and a week after treatment we were sitting around 3500 but with a higher neutrophil count than 1600, his concern was that we are still seeing a decline after the first treatment - things haven't bounced back yet. I also wonder if she WILL have a harder time bouncing back given her lupus.

 

Just lots of thoughts swirling around...

 

I don't remember what OSU said about IV chemo and blood counts. If I were more organized I would go to my "Joe folder" and pull out his records from that period and look at what his counts were. Unfortunately, it is only in my dreams that I am this organized. Joe never had to postpone his IV chemo. However, he is on a long term metronomic protocol (Palladia/cytoxan/artemisin) that does reduce blood counts. They look at both WBC and Neutrophils each month, but they seem to place more weight on neutrophils. They do not have Joe take a break unless either gets close to the 1000 mark or if he has a bout of diarrhea. Of course, this is not IV chemo so I'm not sure how they correlate.

 

Jane