Osteo Thread

[BauersMom]

Mainly what I meant by that is that I worry that continuing with more chemo stuff will do more harm than good, know what I mean? Like we actually might have a better outcome and better quality of life for her if we forego the cytoxan.

 

 

Ultimately, that is why we chose to "only" do arteminsin. Chemo was tough on Berkeley, and I just couldn't continue on that path.

 

I will say that his quality of life improved tremendously after we were done with chemo, so I have no regrets there. If he had tolerated chemo better, maybe I would have made a different decision, I don't know.

 

Of course, you know how things ended, but given the severity of the break, I would guess (and it's just a guess) that the met must have started during or right after chemo stopped. I'm not sure a different protocol would have made any difference in its progression. (We did x-ray that leg when he was diagnosed, as a comparison... there was no visible evidence of an issue with that leg on the x-ray in July.)

Edited March 15, 2012 by BauersMom

[TwiggysMom]

What a rollercoaster we are all on. FedX has been doing so well lately, then we were walking sunday morning (luckily only a block away), we crossed behind me and at the same time let out the GSOD. I turn around and he is holding his leg up and won't put it down. So we hobble/carry him home. Of course from the anxiety/pain he has a seizure half way back so we had to wait a few minutes to let that pass. But we get home and he goes to his bed. (Thank god UPS is fabulous in these situations!)

Now similar instances have happened to him before, usually it requires upping the pain meds, and weeks of walking very very short distances just to pee/poop and back inside. So I now have him on 300mg gabapentin three times a day, 75mg carprofen in the morning and 35 at night, and tramadol as he needs it. Since it was the weekend, i decided i would wait and see how the pain meds helped.

Well we are now at wednesday and he is putting some weight on the leg (he wasn't doing more than toe touching before). He still loves to go outside and i can tell he needs to see people/animals, he LOVES any attention. And he gets super excited for treats and meal times.

So all in all it isn't his time quite yet, but all of this is soo stressfull!! If he doesn't continue to improve, i'll possibly take him for an xray. I want to wait and see if he improves any more before having another pamidronate treatment. If he doesn't improve any more in the next week, i'd rather get the xray before spending the $400 for the pamidronate because if there is a fracture it doesn't make sense to have the infusion.

I know noone can do anything for him, but it is nice to just have a place to vent everything that is happening....

 

I'm so sad to hear that FedX is having a rough week. It sounds like he is improving a little bit today so that's good. Hopefully the xrays will show things holding steady and he can get another pamidronate treatment for additional relief.

[krissn333]

I suppose we could always TRY the cytoxan protocol and see how she tolerates it, and stop it if she has side effects...

 

Jen, I am going to dive further into the different things you did with Neyla though too...so you might be seeing some more questions from me come rolling your way.

 

I know it's all a big crapshoot no matter what we do...and we all just want to do what will keep our kids happy and healthy for as long as possible. I just hate that there's absolutely NO clear cut answer.

 

Hoping that FedX has better days

[TwiggysMom]

Kristin - Twiggy's cytoxan is $53 for 12 pills (a 4-week supply), but the local compounding pharmacy discounts it to $45 because she is adopted

 

However, her dose is 12 mg, which I think is high. I feel like most other dogs are getting 10mg, even much larger males.

 

I called SBH for pricing, and while their price for the cytoxan itself was less, the shipping cost made it pretty comparable to what I pay here.

 

We are having a hard time getting her side effects from the metronomic protocol under control. We're tinkering with her dosages and she was just on a week-long chemo holiday, but if we can't get her to a level that she tolerates without constant side effects, I'll consider taking her off of the meds and just take our chances. Her feeling crappy all the time and getting infections, etc. isn't part of the bargain I made with her.

[krissn333]

That's my biggest worry too

[joejoesmom]

Ah, okay thanks. I'm trying to work all of this out in my head. OSU sent me their metronomic protocol, but, it includes Palladia, which is really pretty cost-prohibitive for me, and our vet wasn't terribly excited by it when I asked his opinion.

 

So I wonder if it's worth it to do the cytoxan only (Along with artemisinin)?

 

In so many ways this is more confusing than everything else we've been through so far. I'd almost prefer to just do artemisinin and quit pumping her full of toxic stuff. We've been really lucky that the IV chemo hasn't phased her at all...

 

But then I wonder if we just do artemisinin and nothing else, if I'd be dropping the ball and we'd have a greater chance of the cancer returning. It was caught SO early that it didn't even have time to eat the bone away much, if at all...just the marrow cavity...so I sort of feel like we don't necessarily *need* to keep doing a bunch of stuff. Aargh, this is very frustrating.

 

First of all, there are many metronomic protocols out there. The Palladia protocol just happens to be one that OSU is using in a study. It has not been proven effective and not been proven ineffective either. In theory, it should help, but we know that theories don't always pan out.

 

Another common metronomic protocol uses cytoxan, artemisinin, and a NSAID (such as piroxicam) I think piroxicam is the old standby --Brand name is Feldene I think. Some are now using Deramaxx as this component. You can certainly ask OSU for some non Palladia based protocols.

 

If your dog is in the 10 percent who don't have microscopic cancer metastases, then (my opinion here) it would seem that a low dose chemo protocol is not necessary and could reduce the quality of the dogs life or even put additional strain on liver/kidneys/etc. If your dog is in the 90 percent who do have microscopic mets, then a metronomic protocol may slow down the growth and prolong the dogs life. This prolonged life could be significant. Since Joe has now developed a second primary tumor and a single small lung met, I believe that the IV chemo (for sure) and the metronomic protocol (very likely) extended his life to his current almost 20 months post amputation. He did well on his low dose chemo, with few side affects. He has been a very happy boy throughout his post amputation life. Remember, since it is a low dose, the chances for significant side affects is less than with IV chemo. Even when the drugs are relatively low cost, there is still the cost of blood work to check the immune system.

 

Jane

Edited March 15, 2012 by joejoesmom

[joejoesmom]

Mainly what I meant by that is that I worry that continuing with more chemo stuff will do more harm than good, know what I mean? Like we actually might have a better outcome and better quality of life for her if we forego the cytoxan.

 

Granted, she has had ZERO side effects from the carboplatin, so maybe she'd have no issues with the cytoxan either, but, with her having the lupus on top of everything else, I just don't know if I want to tax her kidneys anymore.

 

This is just really difficult and I hate it. Choose to do it, risk her being sick and unhappy. Choose not to do it, risk another primary tumor and/or lung mets (which really are a risk even WITH the chemo). Either way I am sure that when I lose her (which will hopefully be a very long time from now), I will feel like I should have made a different choice

 

I really understand wanting your first two sentences to be true--let me have my dog, healthy but three legged, live a normal and extended life without putting her through anything else. But in reality, in the vast majority of cases, chemo does extend the life. Only you can say how much it affects your budget (a very valid reason) and whether its the right thing for you. Your vets should be able to help you decide whether it makes sense given her lupus. Removing her leg removed her pain. She is happy. She doesn't understand about the future. So an argument could be made that prolonging her time on earth is more for you than for her. I tend to be a person who believes in trying any and all reasonable treatments. But that is me -- I would never judge someone harshly who decides otherwise.

 

As to kidney effects, you would probably need to spend more money than typical to get renal panels more often. You could also look into a kidney support neutraceutical like Azodyl.

 

Whatever you decide, I wish for everlasting peace in your choice. You will make this choice out of love for her, therefore it will be the right choice.

 

 

 

I called SBH for pricing, and while their price for the cytoxan itself was less, the shipping cost made it pretty comparable to what I pay here.

 

 

 

I forgot about that. I just stop by and pick them up (but I do have to pay 7 percent sales tax).

 

Jane

[Charlies_Dad]

Thinking good thoughts for FedX! He has been a real trooper through everything and I hope he continues to improve and doesn't need to go in for an x-ray. I

 

Kristin, you are at a place we have all been who chose amp & chemo. There is no easy decision. We chose Palladia and Artemisinin for Charlie along with a host of supplements, herbs and herbal teas. It all costs a lot of dollars and we have not regretted our decision but we also don't know what has truly helped him either. We are essentially trying everything in the hope that it provides him a good life and for us, extra time with him. We have no doubts about the future, some day he will leave us due to something and we can only hope it's not cancer. Charlie has overall handled Palladia very well and the only thing I wish was that it was cheaper so others could try it. As to Jane's point, it's currently being studied by OSU, there are no hard facts behind success or failure at this point. We have spoken to a few vets and those that know Palladia hold out hope just like we do as they see so much cancer in so many breeds but again, it's too soon to tell. Whatever decision you choose for Pinky is the right one. There are no guarantees in this and you need to know that you have done a lot for Pinky and will continue to do what YOU CAN. She will love you for it no matter what path you choose.

[BauersMom]

It is a hard decision, harder than the amp, because with the amp you know for sure you are at least removing the pain. With the post-chemo treatment, you don't know what the future holds. There have been people who have done no metronomic protocol and have made it 1 year post-amp. And then there are others who don't make it to a year with a low dose chemo. I know it's hard to know what to do when there is no clear prognosis (at least it was for me). There are pros and cons in both directions.

 

Just like anything with this disease - you just have to do what makes sense for your situation and your dog. There is no right or wrong.

Edited March 15, 2012 by BauersMom

[NeylasMom]

Jane's comment about Azodyl reminded me that fish oil is also strongly recommneded for kidney disease so there's another reason to consider giving it even if you proceed with a metronomic protocol.

[giadog]

Kristin, I'm not sure exactly how far into IL you're located, but if cost is the only reason you're not considering Palladia, the University of WI in Madison is doing a clinical trial that offsets the costs of the meds... Just an option!

[krissn333]

Pinky had her last chemo this morning!

 

She already gets some fish oil caplets with her vitamins for her lupus, but, I've thought about buying that fish oil on Amazon that you recommended quite a long time ago, Jen. She will eat just about anything so there's no way she would be picky about having it on her food. She also takes vitamin E and niacinamide for her lupus.

 

I'm in the Quad Cities, right on the border of Iowa and Illinois (Davenport, IA/Moline, IL) - would I have to travel to U of WI, or would sending bloodwork results, etc. be sufficient? I think it'd be about a 3 hour drive for me to get there. Any idea what needs to be done in order to be considered for the study?

 

Kyle, are you also doing cytoxan, or just the Palladia with the artemisinin?

 

I know it's all a very delicate balancing act - keep the cancer at bay while trying not to affect the body's other systems with the treatments that are actually used to keep the cancer at bay.

 

I do have a few weeks to mull this over and see what we want to do. When Dr. T brought her out to me after her chemo this morning, he just said that he wants to do xrays in 3 months So, if I decide I want to pursue the cytoxan, etc., I will give him a call.

 

Thank you all for your input. This is such a daunting thing to deal with right now.

[Charlies_Dad]

 

 

Kyle, are you also doing cytoxan, or just the Palladia with the artemisinin?

 

 

Kristin, we are only giving Charlie Palladia. At the time discussing it with our local vet, he felt it was better if did not give Charlie everything as Cytoxan has some side effects as well and we wanted to judge how he did on Palladia first. In the end we decided against it as we felt we may be pushing our luck with all the medicines Charlie was getting (he also take kidney meds).

[Guest snakes]

Well FedX is doing a bit better, he is still limping but he is putting more weight on that leg. He is still limping noticably. I am going to have to tone down some of his pain meds though. I came home from work last night and he tried jumping up on me and doing his spinning, then this morning he tried running a very short distance in my friends back yard just to pee on something!

He has always been tricky to medicate because if he gets too much he forgets he is fragile and has pain and quickly overdoes it causing even more pain. I think i will decrease the gabapentin a little and if needed turn to the tramadol (i try to avoid tramadol if i can to protect the kidneys and because gabapentin works wonders with him). I am also talkign to the vet this afternoon to see if she has any better recommendations for dosages or frequency of the meds...

I swear this dog will either put me in a padded room or the cardiac unit!

[joejoesmom]

So good to hear that FedX is doing a bit better.

 

I wasn't aware that U of Wisc was also doing a Palladia study on bone cancer. OSU has done several studies with Palladia and osteo. The one that Joe was in was one of the protocols they currently recommend for those who want to try Palladia:

 

Palladia on M,W,F

Cytoxan on Tu, Th, Sa

Artemisinin every day

 

They are also using a protocol that replaces the Cytoxan with a NSAID (deramaxx maybe?)

 

Of course I don't know about UW's study, but here is info on how OSU handles visits for Joe's particular study. Initially (for the first 2 to 3 months) I came in each month for bloodwork, whatever other tests were necessary, and a full exam. I am just 25 to 45 minutes away from OSU though. I believe I know of someone who was about 2 hours away who just brought their dog to OSU every 3 months -- even at the beginning but I am not sure.

 

Once OSU was comfortable that Joe was stable on the protocol (i.e. not likely to have anything weird pop up), I would take him to my low cost vet and email the test results. I went into OSU every 3rd month for a checkup and more medicine. Although technically Palladia is not a chemo agent, and the cytoxan dose was small, there is still a risk of some significant side affects. Fortunately, all Joe had was a day or two of diarrhea every 2 to 3 months (on average) -- quickly controlled with Flagyl. Oh, and the palladia caused his hair to turn white. So he is now more of a blue brindle than a dark brindle.

 

Kristin, all this would lead me to believe that U of Wisc might let you come every 3 months with a check up every month at your local vet or oncology vet. If you think you want to try Palladia, its definitely worth a phone call. I have a very good, greyhound owning, vet tech friend who lives in the Madison area. She doesn't work at UW though so I'm not sure what help she would be able to be.

 

Jane

[greysmom]

Dude was on the second of OSU's metronomic protocols:

 

cytoxan and piroxicam alternating days for dinner

artemisinin every morning before breakfast

 

He tolerated this protocol very well and had no overt side effects for the time he was on it. We got our cytoxan from a compounding mail order pharmacy in AZ called Diamondback.

[JJNg]

Ah, okay thanks. I'm trying to work all of this out in my head. OSU sent me their metronomic protocol, but, it includes Palladia, which is really pretty cost-prohibitive for me, and our vet wasn't terribly excited by it when I asked his opinion.

I'm curious why your vet "wasn't terribly excited" by the Palladia option? Also, was this your regular vet or oncologist? The biggest issue, and often the determining factor, with Palladia is the cost. But from a scientific/medical standpoint, I find it one of the more exciting and promising medications for cancer treatment at this time. Cancer vaccines look to be another really promising area. Even though Palladia is only labeled to treat mast cell tumors in dogs, the mechanism by which it works should apply to many different types of cancers, and oncologists have been seeing good results many cases. While it hasn't been shown yet to be effective against osteosarcoma, I'm glad there are now studies to look at this.

 

Medications in the same class as Palladia have been around in human medicine for a much longer time, and they are even more cost-prohibitive. On the factor of around 10 times the cost of Palladia. I briefly looked into it as the type of cancer Corey has (gastrointestinal stromal tumor) is one that is treated with a drug in this class (Gleevec) in humans. While by no means a 'safe' drug, Palladia is less likely than traditional chemo to cause side effects because it is more specifically targeted toward cancer cells. Corey has been on Palladia for almost 2 years now with no major problems, just a few episodes of diarrhea lasting less than 24 hrs.

 

I wish you the best in your decision on how to proceed with Pinky's treatment. Many dogs tolerate the metronomic protocols with no side effects at all. You won't know unless you try it, and there is always the option of stopping or adjusting meds if she develops any issues.

[TwiggysMom]

I may be confusing some things, but I think that UW is a participating institution in the OSU study, which technically would make it the same study. Although it's been a while since I was looking up all of the various Palladia studies, so I could be mistaken.

 

Jane, who could the "very good, greyhound owning, vet tech friend who lives in the Madison area" possibly be???

 

For what it's worth, Twiggy's new oncologist thinks that Palladia is "going to be the game-changer" in terms of survival rates for osteo. He did some of the original research on Palladia, and recommends it as part a metronomic protocol. (His recommendation is very similar to OSU's).

 

A question for those with hounds on cytoxan: What is the dosage, and how much does your hound weigh?

 

Twiggy is back on her metronomic protocol after a week's holiday due to infection and low blood counts, and her nausea is coming back pretty strong. Twiggy now weighs 53.5 lbs and is on a 12mg dose Tu Th Sa. I feel like it is the cytoxan that is the trouble-maker more than the Palladia (reduced to 50mg from 60mg M W F) I'm not entirely sure why I think it's the cytoxan, but I do.

 

Any thoughts?

[joejoesmom]

I may be confusing some things, but I think that UW is a participating institution in the OSU study, which technically would make it the same study. Although it's been a while since I was looking up all of the various Palladia studies, so I could be mistaken.

 

Jane, who could the "very good, greyhound owning, vet tech friend who lives in the Madison area" possibly be???

 

For what it's worth, Twiggy's new oncologist thinks that Palladia is "going to be the game-changer" in terms of survival rates for osteo. He did some of the original research on Palladia, and recommends it as part a metronomic protocol. (His recommendation is very similar to OSU's).

 

A question for those with hounds on cytoxan: What is the dosage, and how much does your hound weigh?

 

Twiggy is back on her metronomic protocol after a week's holiday due to infection and low blood counts, and her nausea is coming back pretty strong. Twiggy now weighs 53.5 lbs and is on a 12mg dose Tu Th Sa. I feel like it is the cytoxan that is the trouble-maker more than the Palladia (reduced to 50mg from 60mg M W F) I'm not entirely sure why I think it's the cytoxan, but I do.

 

Any thoughts?

 

Yes, I bet you know who my "very good, greyhound owning, vet tech friend who lives in the Madison area" is.

 

Joe was on 10 mg of Cytoxan, so less than your Twiggy. He was 75 lbs before amp. I think he is 32 kg or about 70 pounds post amp. I think Joe was also on more Palladia than Twiggy. Unfortunately I learned the dosage by color (one rust one, one orange one and one blue one). I think that it might be 65 mg but wouldn't swear by it.

 

Jane

[greysmom]

Dude weighed right around 70 lbs post-amp and his dose was 10mgs (I think).

[TwiggysMom]

Jane and Chris - thank you for this. This makes 3 significantly larger male hounds that are getting 10mg that I know of, and seems to me like Twiggy could be getting less. I did question the dose with her oncologist before, but he feels it is appropriate for her m2.

 

If her side effects don't ease up, I'll see if I can talk to him about lowering the cytoxan at least to 10mg, and possibly even lower.

[Guest kellygreyhound]

Does anyone have any experience with pressure sores?? Kelly dog is finally home now, but she has a big pressure sore on her front elbow (on the leg opposite her amputated leg) from her initial stay post-amputation. One of her vets recommended I get a Dogleggs harness thing (dogleggs)but didn't mention it was $150 I wouldn't mind getting it, but our vet bill so far is frightening.... Thoughts?? Worth it or just keep treating it and keep it clean?

 

I've been trying Manuka honey but it near impossible to wrap that elbow...

[tbhounds]

Does anyone have any experience with pressure sores?? Kelly dog is finally home now, but she has a big pressure sore on her front elbow (on the leg opposite her amputated leg) from her initial stay post-amputation. One of her vets recommended I get a Dogleggs harness thing (dogleggs)but didn't mention it was $150 I wouldn't mind getting it, but our vet bill so far is frightening.... Thoughts?? Worth it or just keep treating it and keep it clean?

 

I've been trying Manuka honey but it near impossible to wrap that elbow...

You might try a human wrist sweatband. They are usually just the right size to fit over an elbow. They are thick allowing plenty of cushion.

Glad your baby is finally home. Hugs

[Guest snakes]

Does anyone have any experience with pressure sores?? Kelly dog is finally home now, but she has a big pressure sore on her front elbow (on the leg opposite her amputated leg) from her initial stay post-amputation. One of her vets recommended I get a Dogleggs harness thing (dogleggs)but didn't mention it was $150 I wouldn't mind getting it, but our vet bill so far is frightening.... Thoughts?? Worth it or just keep treating it and keep it clean?

 

I've been trying Manuka honey but it near impossible to wrap that elbow...

You might try a human wrist sweatband. They are usually just the right size to fit over an elbow. They are thick allowing plenty of cushion.

Glad your baby is finally home. Hugs

 

 

Or even the top of a tube sock, a thick winter sock works well too if you want more padding.

[djsgreys]

Just looking for some advice on what I need to tell the vet to convince her to do x-rays. Sam had a significant tear injury at the beginning of Jan so the vet first said his limping was due to overcompensating for that injury and did I chiro treatment. He was a little better for a couple of days, but the limp reappeared. Back to the vet, asking again for an x-ray, told again that it is not necessary and Sam had another chiro treatment.

 

I have told the vet that the limp is intermittent. That Sam seems to be in pain (heavy panting at times) but I have not found any tender spots on his leg. She keeps telling me to put my pretend DVM away - that it is not osteo. But something is telling me it is and I want x-rays done.

 

Any advice - short of changing vets that is?