Osteo Thread V

[NeylasMom]

I found and I think others have that Neyla was sometime more painful on rainy days. Inflammation is a part of bone cancer and the weather affects inflammation I believe (am thinking of all of the people whose arthritis acts up on rainy days) so I would think bumping up the Rimadyl (which is an anti-inflammatory) on days you know storms are coming would be a good idea. Or keep him on the higher dose. One thing I learned about bone cancer pain is that it's easier to manage if you stay ahead of it.

[MachosMom]

Thanks NeylasMom! So I could give him (to start) 1 Rimadyl three times a day, instead of just two? And can keep the tramadol the same unless he seems in pain? I think I am struggling with knowing which medicine to do what with!

 

He was on more tramadol, but I could tell it was too much - he had this spaced out look, and the minute I backed him down from the prior dosage to the 1 two times a day, he immediately was more alert.

 

Thank you so much for answering my questions It's so tough ! I am constantly watching him like a hawk!

[NeylasMom]

NSAIDs are usually given once per day, although I split Neyla's dosage in half and gave it 2x/day because I thought it might help so I would probably increase the dose you're giving rather than add a 3rd dose. You do have to be careful with NSAID dosage, they're the most likely of the 3 pain types of pain meds used for osteo pain to cause side effects including stomach ulcers and liver/kidney issues (although they tend to be rare) with long term use. You can help potentially mitigate those by giving pepcid 20-30 minutes beforehand and making sure you are only giving them with food.

 

I assumed you have room to increase since you've said you backed down recently, but you need to consult with your vet on appropriate dosage increases and how best to administer them.

 

ETA: You might also consider switching to Piroxicam. I've read some info on it supposedly being more effective for osteo pain than other NSAIDs and it is being used now in most metronomic protocols because there's some theory that it has anti-cancer properties. I don't know details as it was sort of "new on the scene" when I was dealing with this. You are in theory supposed to have a washout period of at least a few days between NSAIDs so later on when he's really reliant on the meds it would be harder to switch. Although if the Rimadyl is working, there's something to be said for that. Just food for thought as you figure out what's best for Macho.

Edited July 12, 2012 by NeylasMom

[MachosMom]

Thank you!!! I will ask the vet about Piroxicam, especially since we are still at a low rimadyl dose. The rimadly from the vet currently says 1 every twelve hours, which is where we are at. These afternoon thunderstorms are just very rough on him

[NeylasMom]

Oh, I missed the other potentially obvious explanation - is this only since he was diagnosed, or could he be a little fearful of storms? You could try giving him a dose of melatonin to see if that takes the edge off.

[MachosMom]

Macho has always been laid back, easy going. We are very lucky in that nothing affects him. Thunderstorms, fireworks, loud cars, vacuum cleaners.... he doesn't bat an eye. This is definitely since diagnosis.

[krissn333]

Kristin, how old is she? Any chance fireworks made her nervous and this is just residual? If its not age related or something that scared her, I'd remove one thing at a time from her protocol and see if her behavior changes. Might actually try the Piroxicam first - upset stomachs can cause really odd behavior believe it or not.

She's 9. We also didn't really have much in the way of fireworks. A few snaps and pops here, some of which happened while we were out in the yard - she's never batted an eye though.

 

Not sure if the Piroxicam is causing tummy upset - she has a cast iron stomach, I haven't heard any gurgling from her and her poop looks just fine. I may cut it out for a bit though as you suggested and see if that changes anything.

 

Originally I wondered if maybe any of the meds she's on can cause thyroid wonkiness...

[NeylasMom]

I would just try eliminating them one at a time, give her sufficient time off for it to be out of her system fro a few days, if no change, add it back in and move on to the rest. I would do the arte last since I think it's least likely to have wonky side effects, but that's just me.

Edited July 12, 2012 by NeylasMom

[Guest snakes]

FedX tends to get sore when we have a series of rainy days, not with quick passing storms though.

To me it sounds as if maybe the meds are just making him a bit more sensitive/anxious. No big ideas here except to maybe try the melatonin, my girl doggie recently became afraid of fireworks and it helped her take the edge off a bit.

[tbhounds]

Just thought I would chime in here. Rimadyl can be given once or twice daily. It's a1mg/lb twice a day or 2mgs/lb daily--always given with food.

I find piroxicam to be one of the hardest NSAIDs on the tummy.

My girl is on a prescribed metronomic chemo protocol (for thyroidcarcinoma). Dr Couto has her on leukeran and Deramaxx--he claims that Deramaxx has anti cancer properties. I have heard the same claim regarding Metacam so, perhaps there's studies supporting anti cancer properties with all NSAIDs?

[Guest cashie]

I have an appointment with my vet on Saturday to talk about putting Cash on some additional meds and I am soooo confused about all of the ones available for our palliative care pups. What are they and what are they for? I don't want to load him up with a lot but I really need his pain to go away. We had a few bad days this week where I felt like it was time:(

 

Today was a good day-he is really happy!:)

 

Good luck tomorrow Tristan!

[krissn333]

We haven't heard back about Symbra yet, have we?

 

Hoping no news is good news...

[Guest cashie]

https://sphotos-a.xx.fbcdn.net/hphotos-snc7/428510_3459636251385_1775017297_n.jpg

https://sphotos-b.xx.fbcdn.net/hphotos-snc7/406299_3459633891326_618624015_n.jpg

 

Not sure if this worked. These are of the happy guy today.

Edited July 13, 2012 by cashie

[NeylasMom]

My girl is on a prescribed metronomic chemo protocol (for thyroidcarcinoma). Dr Couto has her on leukeran and Deramaxx--he claims that Deramaxx has anti cancer properties. I have heard the same claim regarding Metacam so, perhaps there's studies supporting anti cancer properties with all NSAIDs?

I looked around a bit recently to see what I could find out about Piroxicam, but it was a very cursory glance. What I gathered was not that it was necessarily a better choice, but that the research has been focused on it (maybe because it's already used for osteo in humans?) so that's why you see it recommended in metronomic protocols, etc. There was also a good bit of anecdotal evidence that it was more effective at reducing pain in dogs with osteo, but that obviously isn't necessarily reliable.

 

Having said that, it was just a cursory glance so I just did another and found this article that seems to support Deramaxx is a better choice. And you're right that Piroxicam is known to cause GI issues so maybe it's not the best choice. If I had a dog with bone cancer right now, I would do a much more in depth search, but I don't, which is why I encourage people to talk to their vets about it.

 

I have an appointment with my vet on Saturday to talk about putting Cash on some additional meds and I am soooo confused about all of the ones available for our palliative care pups. What are they and what are they for? I don't want to load him up with a lot but I really need his pain to go away. We had a few bad days this week where I felt like it was time:(

 

Today was a good day-he is really happy! :)

 

Good luck tomorrow Tristan!

Did you read the article on pain linked in the first post of this thread? It gives a really good overview of the types of pain involved with bone cancer and you're various treatment options. But the gist is that you usually use a combination of 3 types of drugs:

 

Tramadol - an opiate like drug; tends to have limited to no side effects except that some dogs don't tolerate higher doses well (they feel anxious)

Gabapentin - addresses neurological pain; better to give more frequently at lower doses and build up doses slowly, but can have a fairly high tolerance level

NSAID - Rimadyl, Deramaxx, Metacam, Piroxicam, etc.; Anti-inflammatory, can have higher risk of more serious side effects with long term use (stomach ulcer, organ issues) so may be best to increase dose of this drug last

 

You also have radiation and IV pamidronate as options to manage pain. Those are more expensive, require longer vet visits, can have side effects although risks are generally low, and with radiation, anesthesia is required. Treatment is generally repeated every month or so, but can be spread out further depending on pain.

Edited July 13, 2012 by NeylasMom

[JJNg]

My girl is on a prescribed metronomic chemo protocol (for thyroidcarcinoma). Dr Couto has her on leukeran and Deramaxx--he claims that Deramaxx has anti cancer properties. I have heard the same claim regarding Metacam so, perhaps there's studies supporting anti cancer properties with all NSAIDs?

I looked around a bit recently to see what I could find out about Piroxicam, but it was a very cursory glance. What I gathered was not that it was necessarily a better choice, but that the research has been focused on it (maybe because it's already used for osteo in humans?) so that's why you see it recommended in metronomic protocols, etc.

 

This is exactly why piroxicam is recommended more often - there have just been more studies about it. I believe piroxicam was originally noticed to have anti-cancer effects with bladder cancer (transitional cell carcinoma) in dogs, but was then found to have an effect on other cancers as well. I attended an oncology lecture a few months ago about metronomic therapy, and some of the newer studies are showing that the other NSAIDs all seem to have some anti-cancer properties as well. So the choice of NSAID may not be that important.

[Guest patterpaws]

I have an appointment with my vet on Saturday to talk about putting Cash on some additional meds and I am soooo confused about all of the ones available for our palliative care pups. What are they and what are they for? I don't want to load him up with a lot but I really need his pain to go away. We had a few bad days this week where I felt like it was time:(

 

Today was a good day-he is really happy! :)

 

Good luck tomorrow Tristan!

 

I hope you're able to find a medication for Cash that helps him!

 

Thank you for the well wishes too. I am so nervous about tomorrow. I am having a really hard time sticking with the decision to amputate. I feel like I'm not gathering information fast enough to make enough of an informed decision. I still don't have a really solid feeling for what the odds might be, what risks are worth the possible outcomes. I have a feeling I won't be sleeping tonight.

[krissn333]

It's hard to make those decisions, and your thought process is your own, but I thought I would share MY thought processes in the decisions I made with Sutra and Pinky.

 

Sutra was 12 when he was diagnosed. He had come to me ill-a bout with pancreatitis had nearly killed him. Once he recovered, he injured his knees briefly. He was a little bit wavery in the back end but for the most part, got around just fine and my heart sang every time he would run to me after being out in the back of the yard and I'd call to him. His tumor was in his right shoulder. I chose palliative care for him because I did not think that he would tolerate the surgery, and his body might to be able to handle the chemo given his other medical issues (we still dealt with pancreatitis and GI upset). We did the pamidronate infusions. Thankfully it seems we found it somewhat early and it was slow growing. We had nearly 6 months to the day after he was diagnosed before it was time to let him go. During that time the bond we forged was so amazing...I am crying now as I write this even though it has been almost 2 years since he left. I miss him terribly-he took a very big piece of my heart with him.

 

Pinky was 8 when diagnosed. I came home from work last year on October 21st to find her limping. October 12th had marked one year since I lost Sutra, so I was having a fit. I took her for X-rays the following morning and as soon as I saw them, osteo was confirmed. I sent them to OSU, they confirmed as well. I got her an appointment two days later for a fine needle aspiration. Got the news a few days later that it was "a sarcoma of some type." We scheduled her amputation for November 7th.

 

Her tumor was in her left rear leg, proximal humerus. I decided to amputate because she was relatively young, in good health, with zero mobility problems. She does have lupus but that is well-managed. While she's a little bit of a weirdo (see my posts from the other day ), she tolerates vet visits well and is tolerant of being handled (for a few days I had to help her situate herself to rest). Dr. Less also felt that we caught it early (tumor was barely visible on X-ray). Before the surgery I tried to imagine what it would be like to see her getting around on three legs, and I watched videos of Charlie, who had the exact same leg amputated. That helped me A LOT.

 

What you need to understand is that it's a crapshoot no matter what you decide. You may choose amputation and only get a few months, you might get YEARS. You might go with palliative care and get a few months, you might get a year+ and beyond. The danger with doing palliative care is that the tumor is still there. You can slow the growth and manage pain, but there's always the risk of fracture. I was always worried with Sutra. Amputation removes that tumor, but there is also the risk that osteo will develop in another leg or the spine. I don't think it's super common, but it has happened.

 

With Pinky, I decided to roll the dice toward amputation. It's been 8 months and she's doing great, she came home 24 hours after she woke up from surgery...she didn't like being in a kennel at the vet's office and Dr. Less released her to come home because I was comfortable dealing with her medically. She was up on the couch the next day. She tolerated chemo well and is now on a metronomic protocol.

 

I don't regret my decisions with either of them...I really feel we've had the best possible outcomes, given their individual situations.

[45MPHK9]

Thinking good thoughts for Tristan today.

[Charlies_Dad]

I have an appointment with my vet on Saturday to talk about putting Cash on some additional meds and I am soooo confused about all of the ones available for our palliative care pups. What are they and what are they for? I don't want to load him up with a lot but I really need his pain to go away. We had a few bad days this week where I felt like it was time:(

 

Today was a good day-he is really happy! :)

 

Good luck tomorrow Tristan!

 

Thank you for the well wishes too. I am so nervous about tomorrow. I am having a really hard time sticking with the decision to amputate. I feel like I'm not gathering information fast enough to make enough of an informed decision. I still don't have a really solid feeling for what the odds might be, what risks are worth the possible outcomes. I have a feeling I won't be sleeping tonight.

 

Good thoughts for you and Tristan. As for amputation, unfortunately every path you choose has no guarantees. Amputation as you likely know now is to remove the pain. Yes it is a very invasive surgery however once your pup has healed which is usually 2-4wks depending on the pup, they usually do very well on three legs. The only other way to 'control' the pain is meds and those unfortunately don't really remove it altogether, they just control it for a while. The chemo protocols suggested/recommended after are hopefully what stops/controls the cancer from spreading. Likely the chances are cancer cells have already spread but you never know and the chemo can kill these cells. The chemo is generally acceptable to most pups and if one is going the amputation path, it only makes sense to do the chemo unless your pup has serious side affects after the first round. I will say this about amputation, you will be shocked at how fast your pup will be on three legs and how quickly they adapt. They are much more 'take it as it comes' then us humans. If you have questions about amputation/chemo, please feel free to PM me or send me an e-mail at kyle241_2000@yahoo.com as we made this choice for Charlie and it worked out very well for us.

 

Whatever choice you make, we are all here for you and Tristan.

[MachosMom]

Good luck Tristan!!!!!

 

***hugs*** to cashie. I don't have any medicine advice, but I can offer support. Having had a few bad days with Macho so far too, I was in tears thinking we were already at the end. I have moments where I look at what we give him and think "why am I bothering, it's not helping is it?" (<-- usually on a bad day!), but then I look at him and he smiles. The bad days are really rough, because I do wonder if that means I'm losing him already. Then we have great days. It's such an awful rollercoaster.

 

Thank you also to everyone for helping me with my questions and for understanding.

[Guest cashie]

Thank you all for the medicine advice! Another good day here although he was up all night. I got him a new bed that I thought was more comfortable for him and he seemed totally disgusted that I did that, kept staring at it, then hobbled into the living room to sleep on his comforter. (He always sleeps in our room!) He kept coming in all night long, laying down, getting up, going into the other room, then coming back into our room to see if that stupid new bed was still there. I awoke this morning to find him curled up on his pillow at the end of the new bed. Must be the Tramadol, he's usually fine with what he sleeps on. His old bedding is fresh and washed so we are switching back tonight!

 

Machos Mom, I'm right there with you. I've never cried this much in my life. Thank God I have this site because every time I try to talk to anyone about it I'm in tears. Thank you for the hugs, we need them right now!

 

Hope all is well with Tristan tonight.

[Guest patterpaws]

Kristin, thank you for your thoughtful account of your decision making process. Its funny how each situation is so different depending on the dog, owner, lifestyle, etc. Sutra was such a fighter, he had been through so much! And Pinky sounds amazing. How long was her recovery process? It sounds like she got back to being her old self very quickly.

 

I really worry about the fracture danger with palliative care, especially since I learned from the surgeon today that Tristan's bone already shows signs of micro-fractures. And like Kyle says, there's no way to totally take care of that bone pain with meds alone.

 

I wrote a huge essay in the thread I have started- cliff notes version is that I met with the surgeon today and we decided not to do the amputation today because there wasn't enough time to coordinate with oncology to get chemo right after the procedure. We'll tentatively reschedule for next week, I'll meet with oncology on Tues and then Tristan goes under the knife on Wednesday. Meanwhile I have the weekend to mull things over and agonize over the decision longer.

 

Hugs to Macho and MachosMom! I'm sorry, it must be so hard on the rough days. I hope his smiles outnumber those bad days. Emotional rollercoasters are pretty hard to take, especially when dealing with our lovely houndies.

[Guest patterpaws]

Aw silly Cash! I can just imagine his incredulous look at the bed. Maybe he'll get used to this new "invader" soon. Sounds like he has plenty of comfy sleeping nests to choose from.

 

Many hugs to you! I'm reluctantly glad to have company, at least we can come here to understand one another through these trying times. I've been in tears all week too. hugs hugs hugs!

[krissn333]

You don't really want to start chemo until staples come out after the amputation...usually 2 weeks or more.

 

MAKE SURE he has Amicar the morning of his surgery and for at least 5 days after.

 

Pinky was back to herself pretty quickly, though I didn't stop being nervous about it until she got her staples out. She had surgery on a Monday, came home Tuesday afternoon. I was working from home that week, so I was home with her all day and all night. The second week, my mom came to stay with her while I was at the office. Having a pack, I wasn't ready to leave them home alone yet. By week 3 I felt better about it (she also had her staples out by then).

 

Attitude-wise, she was up on the couch on Wednesday following surgery, and stopped needing me to support her outside by Thursday or Friday. She ran me ragged! I had to keep up with her so I could support her when she squatted to go to the bathroom. Of course it rained most of that week She was annoyed by me following her, and at some point late that week she really didn't need or want my assistance

[krissn333]

Here's a pic of her stump...no scar, just a meeting of different hair types

 

 

Here's a zoomed out pic for reference:

 

 

And here's a video of her in the yard (about 3 months old now);

 

http://s995.photobucket.com/albums/af74/krissn333/Pinky/?action=view&current=34b4a5f4.mp4