Osteo Thread

[NeylasMom]

I got my info from the artemisinin group as well. We did a cycling regimen along with curcumin, but we weren't doing chemo. Most oncologists probably aren't going to know much and I would say with rare exceptions your best case scenario will be the vet doesn't object to it.

 

I got all my artemisinin information from the artemisinin yahoo group. http://pets.groups.yahoo.com/group/artemisinin_and_cancer/

 

As others said, it is often not used while a pup is on chemo and DEFINATELY not while they are on radiation.

 

Personally I found the Nutriscience and Swanson brands to be the ones I found most effective, OSU recommends Holley Pharm. but I didn't see as good results with FedX (every pup is different). Remember we are doing palliative care as well.

Do you actually see FedEx get pain relief from the arte? I sometimes thought maybe Neyla did better after getting it, but never enough that I could be certain. I didn't think it was thought to provide palliative relief, just to delay the progress of the cancer, so I'm curious if you are seeing noticeable effects immediately after giving it?

[Guest snakes]

Do you actually see FedEx get pain relief from the arte? I sometimes thought maybe Neyla did better after getting it, but never enough that I could be certain. I didn't think it was thought to provide palliative relief, just to delay the progress of the cancer, so I'm curious if you are seeing noticeable effects immediately after giving it?

.

 

Sometimes I wonder if it is just my imagination, but once in awhile I do a week without it and I swear he seems much more sensitive on that leg. I give it Mon-Thurs and I tend to see him be more sensitive on sundays and much more perky on thursdays.

[NeylasMom]

Do you actually see FedEx get pain relief from the arte? I sometimes thought maybe Neyla did better after getting it, but never enough that I could be certain. I didn't think it was thought to provide palliative relief, just to delay the progress of the cancer, so I'm curious if you are seeing noticeable effects immediately after giving it?

.

 

Sometimes I wonder if it is just my imagination, but once in awhile I do a week without it and I swear he seems much more sensitive on that leg. I give it Mon-Thurs and I tend to see him be more sensitive on sundays and much more perky on thursdays.

That's interesting. That's how I would have described it, that she seemed more perky after having it.

[dmswartzfager]

Well, we had our consult today. We don't have the drugs from Ohio State yet, since I just got their protocol on Thursday and answered back on Friday... so I said that I would be more than willing to pay for the first dose, just to get things moving. So, despite the fact this isn't a normal chemo day for them (Tues, Wed, Thurs usually), they went ahead and administered her first dose of carboplatin.

 

We'll see how she responds, and I have an injectable Cerenia dose measured out and ready to go as well as oral Cerenia, so we can treat any nausea immediately if needed.

 

Otherwise, except for a little seroma at the butt end of her incision, she's doing well, and did a little more playing yesterday. I'm going to take her out for a short walk in a few minutes.

[tbhounds]

Well, we had our consult today. We don't have the drugs from Ohio State yet, since I just got their protocol on Thursday and answered back on Friday... so I said that I would be more than willing to pay for the first dose, just to get things moving. So, despite the fact this isn't a normal chemo day for them (Tues, Wed, Thurs usually), they went ahead and administered her first dose of carboplatin.

 

We'll see how she responds, and I have an injectable Cerenia dose measured out and ready to go as well as oral Cerenia, so we can treat any nausea immediately if needed.

 

Otherwise, except for a little seroma at the butt end of her incision, she's doing well, and did a little more playing yesterday. I'm going to take her out for a short walk in a few minutes.

Little tip-- keep the Cerenia in the fridge-- it will reduce the sting from the injection (Cerenia stings like a bugger).

[dmswartzfager]

Little tip-- keep the Cerenia in the fridge-- it will reduce the sting from the injection (Cerenia stings like a bugger).

 

*nod* One of our newer nurses mentioned that a few months ago, and so we (the clinic at which I work) have been keeping it in the fridge since. In fact, today I had to explain to our practice manager why it was in there and not on the cabinet shelf...

 

Back from our little walk - it was breezy today, so lots of noises and stuff getting blown around, and a few people out walking, so there was lots for the girls to stop and watch and make sure everything was okay before we could proceed. We'll be pulling the cart out of storage within the next few weeks and seeing if Symbra will tolerate being in it while it's moving, otherwise I don't see how we'll manage greyhound events without her getting too tired.

[krissn333]

She may not get tired at all! A few weeks after her surgery, Pinky schmoozed at a Christmas party for about 3 hours with no problem at all (she wouldn't lay down at all). A couple of weeks ago we took a walk for about an hour in a park and she was fine too.

 

If she won't do the cart, you can still do events with her...just have a spot to go sit down and chill for a little while if she needs it.

 

I have been really big on seeing this from the side of "living with cancer" instead of dying from it...and as part of that, I think it's important to keep activities as normal as possible for them. We just plan ahead in case she gets tired, but, she never does

[dmswartzfager]

Whoops - Symbra has an infection now - I noticed her belly was red and warm when I got home today. Monitored her temperature, asked Brian when he got home if he was seeing the same redness I was, and then took her in to work to have Dr. Kortney look at her. Her white blood cell counts were actually double what they were yesterday before the chemo treatment.

 

So, she's on an antibiotic, I'm monitoring her temperature to make sure she doesn't spike a true fever, and Dr. Kortney will be in touch with the chemo doc first thing in the morning to make sure we have the best possible plan for Symbra.

[TwiggysMom]

Whoops - Symbra has an infection now - I noticed her belly was red and warm when I got home today. Monitored her temperature, asked Brian when he got home if he was seeing the same redness I was, and then took her in to work to have Dr. Kortney look at her. Her white blood cell counts were actually double what they were yesterday before the chemo treatment.

 

So, she's on an antibiotic, I'm monitoring her temperature to make sure she doesn't spike a true fever, and Dr. Kortney will be in touch with the chemo doc first thing in the morning to make sure we have the best possible plan for Symbra.

 

I'm sorry to hear this, BUT, there is some indication that an infection after amputation increases survival times. I found some info about this online, and while skeptical, the first thing Twiggy's second oncologist said to me after I told him about Twiggy's awful infection following her amp was that this is the prevailing school of thought these days. It seems that the infection somehow wakes up their immune systems to help fight off the cancer. So, maybe this isn't a bad thing?!?

 

(Twiggy was re-hospitalized for 5 days to treat her infection w/o antibiotics using a VacTherapy bandage - it was an extremely antibiotic-resistant strain).

 

As far as I'm aware, there aren't any clinical studies on this - I don't know how they'd do one, since to formally study it, it seems like they would have to induce infections in post-amp dogs, which doesn't seem ethical.

 

I hope Symbra's infection is controlled and wiped out quickly!!

[vjgrey]

I could use some prayers/positive thoughts for Gabe. He's still showing pain and is struggling more to get up. We're going to increase his tramadol and change his Deramaxx to...can't remember. Something else. So I hope that'll help.

 

He's also showing signs of compromised kidneys. Our oncologist initially disagreed with that assessment (made by our radiologist), but now he sees it, too.

 

The oncologist thinks that, at this point, the need to control the pain outweighs the need to maintain his kidneys, so we're going ahead with the pamindronate. But he said we should start watching him carefully for signs of kidney failure.

 

Last night, DH and I had a very hard discussion. We're not at the point yet that we really need to let him go, but I feel we're headed there much faster than I'm prepared for.

[Guest snakes]

for gabe and family.

[krissn333]

[NeylasMom]

I could use some prayers/positive thoughts for Gabe. He's still showing pain and is struggling more to get up. We're going to increase his tramadol and change his Deramaxx to...can't remember. Something else. So I hope that'll help.

 

He's also showing signs of compromised kidneys. Our oncologist initially disagreed with that assessment (made by our radiologist), but now he sees it, too.

 

The oncologist thinks that, at this point, the need to control the pain outweighs the need to maintain his kidneys, so we're going ahead with the pamindronate. But he said we should start watching him carefully for signs of kidney failure.

 

Last night, DH and I had a very hard discussion. We're not at the point yet that we really need to let him go, but I feel we're headed there much faster than I'm prepared for.

Valerie, I'm so sorry.

 

Oddly enough, I was just rereading the section of the osteo thread when Neyla's pain was increasing and we did her pamidronate treatment to get info for a friend. I had pushed the memory of the turmoil of dealing with cancer pain management on a daily basis to the far corners of my mind, but it's all there, quite evident in my posts. You may recall that we did end up with the kidney failure issues as a result of Neyla's only treatment, I believe because her kidneys were already compromised when we did the treatment. My best advice is to be prepared with a plan of action if you do have to deal with it. Kidney failure can make dogs feel really crappy and also leads to a lot of inappetance so you might want to know what you're willing to try if you get to that. There is a supplement called Azodyl that is supposed to help (it's a probiotic combined with fiber to get it specifically to the gut to help filter toxins). Fish oil is supposed to help with kidney failure, as is pepcid. Those are all things you could consider starting now if his numbers are creeping.

 

Or feel free to disregard all of this.

 

Again, I'm so sorry Gabe is struggling a bit.

[winnie]

to Gabe and his people. Only you can make the decision when it's time to let Gabe go. Please listen to him though. There is no winning with this awful disease.

[krissn333]

My friend's girl was on Azodyl for a long time. It was a miracle drug for her!

[vjgrey]

Thank you for the hugs/advice/positive thoughts. I don't know what I'd do without this outlet.

 

The pain management is really my biggest concern right now. He's not quite limping but definitely not walking normally, and I'm worried about how fast that may go downhill. Both times he's actually limped, it's turned into almost total lameness and obvious, visible pain, literally overnight. Both nights were horrible experiences for all of us, and I do not want to let it get to that point ever again. And since he has osteo in front and back limbs, standing off one puts more pressure on the other, which also makes me worry about a fracture.

 

It's hard, though, because otherwise, he's pretty normal - a little lethargic (which I've tended to think was because he just had his fifth chemo) - but still eating well, begging for treats, and wagging his tail when we pull out the leash.

 

It seems like if we don't want to let him reach the lows he's hit twice now (total lameness, clearly horrible pain), then we're going to have to let him go while he is still basically "normal." And somehow that seems so much harder and uglier, even though I know this is a disease we can't beat.

 

Does that make any sense? The thought that he might wag his tail when we pull out the leash for "that," car ride makes me want to just curl up and die.

Edited February 29, 2012 by vjgrey

[joejoesmom]

We're not at the point yet that we really need to let him go, but I feel we're headed there much faster than I'm prepared for.

 

Valerie, I am so sorry. I don't think there is any way we can really be prepared for losing a loved one. All you can do is take it a day at a time, make the necessary practical plans, and spend as much time as possible with him.

 

If you do decide to use azodyl, be sure that it is always kept refrigerated (at your house, at the vets, or during transport if you order it on line).

 

Jane

[joejoesmom]

The thought that he might wag his tail when we pull out the leash for "that," car ride makes me want to just curl up and die.

 

My vet came to my house for Twister. She had lymphoma but ultimately the kidney failure is what got her. When the vet and vet tech came to the door she got up and greeted them with a wag and some special Twistie kisses. I almost fell into a sobbing heap right there. Luckily my vet recognized this and moved us all quickly into the living room where I had set up her favorite bed in a ray of sunshine. The vet told me again that I was doing the best thing that I could do for my Twistmas. I was able to hold it together until she passed, then I totally fell apart.

 

If you have had a loved one who struggled with pain and anxiety during their final days or weeks; you likely had the thought "I wish there was some way I could spare my loved one this agony". For me it was my mother. Her last 9 days were painful and the cancer had invaded her brain so she wasn't able to communicate. She went from being able to tell stories and to ask for pain meds to speaking gibberish in about 36 hours. I wish so much that I could have spared her that pain and indignity.

 

We have the ability to do that for our furry loved ones. With Twister, I tried to remember how much I wanted to spare my Mom the agony of her terminal disease. I can't say that it helped with my overwhelming sadness at losing her, but it did help me make the decision to euthanize her.

 

Jane

[vjgrey]

The thought that he might wag his tail when we pull out the leash for "that," car ride makes me want to just curl up and die.

 

My vet came to my house for Twister. She had lymphoma but ultimately the kidney failure is what got her. When the vet and vet tech came to the door she got up and greeted them with a wag and some special Twistie kisses. I almost fell into a sobbing heap right there. Luckily my vet recognized this and moved us all quickly into the living room where I had set up her favorite bed in a ray of sunshine. The vet told me again that I was doing the best thing that I could do for my Twistmas. I was able to hold it together until she passed, then I totally fell apart.

 

If you have had a loved one who struggled with pain and anxiety during their final days or weeks; you likely had the thought "I wish there was some way I could spare my loved one this agony". For me it was my mother. Her last 9 days were painful and the cancer had invaded her brain so she wasn't able to communicate. She went from being able to tell stories and to ask for pain meds to speaking gibberish in about 36 hours. I wish so much that I could have spared her that pain and indignity.

 

We have the ability to do that for our furry loved ones. With Twister, I tried to remember how much I wanted to spare my Mom the agony of her terminal disease. I can't say that it helped with my overwhelming sadness at losing her, but it did help me make the decision to euthanize her.

 

Jane

 

This is so, so helpful. Thank you.

 

If the med change/pamindronate can make him more comfortable, I think he still has some fight in him, but if not, I'll try to keep this in mind. He deserves to go peacefully.

 

I'll also look into having someone come to our home. That would be calmer for all of us, I think.

[NeylasMom]

Valerie, for what it's worth I do understand. Living with the constant ups and downs of pain management with a terminal cancer is incredibly difficult and at least for me involved a lot of second guessing, worrying, questioning whether it was time, etc. The two pieces of advice I will give to you based on my experience are to not hold back on increasing meds if you think he's in pain, and two, if you are running out of room to increase before you reach max doses, really think about what your next steps might be.

 

I made the mistake of thinking that doubling Neyla's Deramaxx dosage would give her significant pain relief toward the end. We were already at the limit of what she could tolerate of Tramadol and Gabapentin. It turns out that at that point, the cancer was basically exploding and I was very wrong, the Deramaxx barely made a dent. That left me with very few choices - basically let her go immediately, or try a stronger medication like a Fentanyl patch or an opiate like Codeine. I wasn't mentally prepared for those choices so I tried Tylenol w/codeine. If I could do it over again, I would have let her go. It was only the difference of a few days, but it was a few days where she wasn't doing the 3 things we had identified as signs I should let her go - her appetite waned, she couldn't play, she even only half-heartedly attempted to open a present I had wrapped for her, she could no longer climb onto the furniture to snuggle with me. But at that point, I had scheduled when the vet would come and I couldn't bring myself to call the vet and tell her to come immediately and cut short my time to say goodbye even though I had been trying to prepare myself for that moment for months. Basically, I failed her.

 

I don't think I've ever shared all of this. I'm not sharing it to pressure you into letting Gabe go. I guess I'm just saying it's not cut and dry. It's incredibly difficult to make the call because even though you want more than nothing else in the world to do what's best for your dog, you also want more than nothing else in the world to not have to say goodbye. And unfortunately osteo's course can change so dramatically so suddenly that you can't always prepare yourself for what's coming.

 

Gabe has hit some rough patches and bounced back and that's a part of osteo, breakthrough pain that you can address so I really hope that's all this is. And I hope that I haven't totally depressed or upset you or if I have, if it's any consolation know that I've depressed myself at least as much.

 

Jane, the same thing happened when the vet came to our house for Neyla. After a couple of pretty rough days, she got right up and greeted her with her tail wagging away. This from my dog who once was so terrified of people that she'd run and hide in our bedroom. It killed me, not just because you are constantly questioning whether the time is right, but because it felt like such a betrayal.

Edited February 29, 2012 by NeylasMom

[winnie]

I don't think I've ever shared all of this. I'm not sharing it to pressure you into letting Gabe go. I guess I'm just saying it's not cut and dry. It's incredibly difficult to make the call because even though you want more than nothing else in the world to do what's best for your dog, you also want more than nothing else in the world to not have to say goodbye. And unfortunately osteo's course can change so dramatically so suddenly that you can't always prepare yourself for what's coming.

 

DH and I made the decision to have Faye Oops euthanized - even had the appointment scheduled several days in advance so that we could say our goodbyes - and then she bounced back to her old self. We listened to what she was telling us and cancelled the appointment. We had a wonderful final 10 days with her. She was back snuggling on the couch, playing, etc. Then, within a span of less than 12 hours, she went downhill. We did not schedule in advance this time - we took her to the vet that same day. Something changed that we just knew she was done fighting. I can only hope that Gabe will let you know too. Unfortunately, even the best laid plans don't work the way we want them too with this awful disease. Her passing was peaceful. The events leading up to her passing in many ways were way worse.

 

[vjgrey]

Thank you, Jen. It didn't depress me (any more than I'm already depressed), and it does help just to know it's not just me. With all of the ups and downs, I feel like a crazy person half the time. While I'm really sorry that you've been through this to know what it feels like, it makes me feel a lot less crazy, which is nice.

 

He has had two amazing rebounds, but what worries me is that both were the result of radiation treatments. While we can try that again in an emergency, both the radiologist and our oncologist feel like we're approaching the point where there's more risk than benefit in it. His last x-rays showed some weakening of the bone without significant tumor progression, so they think that may be a result of the radiation.

 

I need to speak to our oncologist about how high we can go on his meds. He's currently on 900mg Gabapentin (300 x 3), 200mg Amantadine, 100 mg Deramaxx (changing that this week, though), and we're upping him to 300mg of Tramadol (100 x 3).

[NeylasMom]

What is Amantadine? I'm not familiar with that medication. I suspect Gabe is heavier and thus you have a bit more room, Neyla's max dosages were 125 mg Tramadol 3x/day, we could go up to 500 mg Gabapentin 3x/day but at 400 she got woozy so we had to stay at 300 3x/day, and 50 mg Deramaxx daily.

[vjgrey]

Apparently Amantadine is fairly new. But according to that article it's not recommended (or a decreased dose is recommended) for dogs with compromised kidneys, so we may have to back off/stop that one.

 

He is a big boy - 88 pounds this morning, which is fairly heavy for him (although you can still see ribs). It sounds like we still have some room to up the meds.

Edited February 29, 2012 by vjgrey

[NeylasMom]

Apparently Amantadine is fairly new. But that article it's not recommended (or a decreased dose is recommended) for dogs with compromised kidneys, so we may have to back off/stop that one.

 

He is a big boy - 88 pounds this morning, which is fairly heavy for him (although you can still see ribs). It sounds like we still have some room to up the meds.

Interesting, and very good to know about.