Osteo Thread Part Vi

[tydyelady]

After reading all the above, I am more confused and depressed than ever. Opie ate some yesterday, cookies, (lots!), hamburger, canned food. This AM, he ate some chicken sandwich meat, and some cooked hamburger.. Now with this new (and growing) lump on his back leg towards the top (more in muscle, than on bone), and the swollen lymph nodes, I started thinking maybe we should go back to the oncologist and just do some radiation, and chemo. I know without surgery to remove any and all of these lumps it is only a matter of time, But to see that Nube got that, to the tune of $5000, and got a few months - do I want to do that? Is it worth it? To have him sick, with treatments, for the time he has left?

Even OSU is baffled by his case, can't determine exactly what it is. They have been in contact with me since yesterday. Xrays inconclusive - suggesting CT scan if I want clearer pics? Will any of this matter to him, all these tests, just to tell me EXACTLY what it is? He has a tumor on his rib - that we know. He has another lump on his back leg, lymph nodes big on underside of leg. Do I keep testing and testing to put a name to it, and will the end result be the same anyway? I am at such a loss as to what to do any more, so exhausted. Oh, and the night coughing/hacking - not as bad last night, but am sure this is all related. (Of course he didn't do it at the vets, so she couldn't hear it). I wish I knew exactly what to do, but its so speculative.

[Batmom]

Do I keep testing and testing to put a name to it, and will the end result be the same anyway?

 

I would not.

 

I did not. For Batman's cancer, I did have a fine needle aspirate. I could have gotten a CT scan same day, cheaply; I turned it down. There was no need to know more about his tumor -- I wasn't going to do surgery for the type of cancer that he had (malignant histiocytosis), regardless of whether it appeared to be operable or not.

 

I did give one dose of oral chemotherapy that was said to *temporarily* shrink his type of tumor in a small percentage of dogs. The chemo didn't make him sick, but it lowered his white count so far that he needed antibiotics. And, for the first time in his many years with me, the antibiotics made him sick. For his type of cancer, we had an unusually long time after diagnosis, but I will forever remember that a decision of mine made my dog miserable for several of those remaining days. I won't do that again.

 

YMMV. I hope your boy has much comfortable time left. Hugs to both of you.

[KF_in_Georgia]

If there's unusual activity at home at night--like Opie's coughing and hacking--try to video-record it on your phone or camera for the vet to see.

[4My2Greys]

After reading all the above, I am more confused and depressed than ever. Opie ate some yesterday, cookies, (lots!), hamburger, canned food. This AM, he ate some chicken sandwich meat, and some cooked hamburger.. Now with this new (and growing) lump on his back leg towards the top (more in muscle, than on bone), and the swollen lymph nodes, I started thinking maybe we should go back to the oncologist and just do some radiation, and chemo. I know without surgery to remove any and all of these lumps it is only a matter of time, But to see that Nube got that, to the tune of $5000, and got a few months - do I want to do that? Is it worth it? To have him sick, with treatments, for the time he has left?

Even OSU is baffled by his case, can't determine exactly what it is. They have been in contact with me since yesterday. Xrays inconclusive - suggesting CT scan if I want clearer pics? Will any of this matter to him, all these tests, just to tell me EXACTLY what it is? He has a tumor on his rib - that we know. He has another lump on his back leg, lymph nodes big on underside of leg. Do I keep testing and testing to put a name to it, and will the end result be the same anyway? I am at such a loss as to what to do any more, so exhausted. Oh, and the night coughing/hacking - not as bad last night, but am sure this is all related. (Of course he didn't do it at the vets, so she couldn't hear it). I wish I knew exactly what to do, but its so speculative.

I'm so sorry that your having to go through this with your boy. This is what "I" would do, mind you it is not the right or wrong thing to do. First, I would make sure he is on enough pain meds to be comfortable. Second, I would forgo anymore expensive testing. I would use the money instead on chemotherapy treatments, if you can afford them. Please don't beat yourself up though if you can't. I know in some areas they can be quite expensive. Also, try not to worry about how the chemo will make him feel. Most dogs have very few problems tolerating it. Bruiser went through 5 rounds of doxorubicin with minimal problems. Beanie is currently going through a modified Wisconsin protocol and aside from a significant weight loss over this week is doing well. She hasn't lost her appetite so I'm pretty sure that her weight loss is a combination of the prednisone she's on and me changing her diet and not giving her as much as she needs. If you would like to try the artemisinin I have a bottle I started Bruiser on which I would be happy to send you if you like. I only used a few out of the bottle. And lastly, I would take each day like Opie does, one at a time. If you keep him comfortable and pain-free he won't know he has a terminal illness. He is living for the moment, try your best to enjoy him for those moments

[Guest BaxtersMom]

After reading all the above, I am more confused and depressed than ever. Opie ate some yesterday, cookies, (lots!), hamburger, canned food. This AM, he ate some chicken sandwich meat, and some cooked hamburger.. Now with this new (and growing) lump on his back leg towards the top (more in muscle, than on bone), and the swollen lymph nodes, I started thinking maybe we should go back to the oncologist and just do some radiation, and chemo. I know without surgery to remove any and all of these lumps it is only a matter of time, But to see that Nube got that, to the tune of $5000, and got a few months - do I want to do that? Is it worth it? To have him sick, with treatments, for the time he has left?

Even OSU is baffled by his case, can't determine exactly what it is. They have been in contact with me since yesterday. Xrays inconclusive - suggesting CT scan if I want clearer pics? Will any of this matter to him, all these tests, just to tell me EXACTLY what it is? He has a tumor on his rib - that we know. He has another lump on his back leg, lymph nodes big on underside of leg. Do I keep testing and testing to put a name to it, and will the end result be the same anyway? I am at such a loss as to what to do any more, so exhausted. Oh, and the night coughing/hacking - not as bad last night, but am sure this is all related. (Of course he didn't do it at the vets, so she couldn't hear it). I wish I knew exactly what to do, but its so speculative.

can you record his coughing and let her hear it?

[PAWsPups]

Our sweet, sweet Gracie was diagnosed with Osteo in the rear leg on Thanksgiving. She's not a candidate for amputation since her other rear leg does not work due to a racing injury. We are doing pamidronate treatment in addition to codeine for pain.

 

She is doing greyt...you would never even know she has cancer! I'm wondering if anyone here has any experience with the pamidronate treatments?

[tydyelady]

I am so sorry to hear about Gracie. This is just so damn sad. If you could elaborate, what is pamidronate treatment??

[Charlies_Dad]

Opie's Mom, I am so sorry that the news is not better. You are asking all the right questions and unfortunately too many of us have had to ask. Going though additional testing which will cost some monies and also may stress Opie some is only something you can answer. Each pup is different and if Opie is fine being at the vets and getting poked and prodded then she will be fine as the tests are not invasive. The question you have to answer is can you afford to do so as yes, there are no guarantees and the tests may only confirm the worst case or they may provide insight into other possible treatments, one does not know ahead of time. Everyone has their own personal opinion on when to say enough. Personally I would do the consult however again no guarantees that a confirmed diagnosis will come from it and likely the Oncologist will ask for more tests. He/she will again your options though in detail which may be helpful.

 

For Artemisin, this can be sources from Holly Pharmaceuticals online. It is a holistic approach to treating cancer and has shown some benefits however nothing truly conclusive I don't believe. We used it for our Charlie who had Osteo (and also amp & chemo). Continued good thoughts for Opie and you.

 

Lucy, I am sorry to read of Gracie's diagnosis. I am glad she is happy and doing well right now.

Edited December 19, 2012 by Charlies_Dad

[joejoesmom]

Our sweet, sweet Gracie was diagnosed with Osteo in the rear leg on Thanksgiving. She's not a candidate for amputation since her other rear leg does not work due to a racing injury. We are doing pamidronate treatment in addition to codeine for pain.

 

She is doing greyt...you would never even know she has cancer! I'm wondering if anyone here has any experience with the pamidronate treatments?

I'm so sorry to hear about Gracie. Here is what Dr. Couto at OSU recommended for my Joe when he developed a second primary tumor. He had already had an amputation of a front leg when 18 months later another tumor showed up in his rear leg. So obviously, another amputation wasn't possible:

 

1) Do radiation treatments to reduce the pain in the leg. The primary risk is that the pain will be reduced enough that there is no warning that the leg is about to break. Of course, we all know of dogs whose first sign of osteo is a broken leg. So I decided to do this, while monitoring with x-rays. They do need to lightly anesthetize so the dog doesn't move during treatment. So if your dog is not healthy enough for anesthesia, this may not be the option for you.

 

2) Follow up with pamidronate when needed for pain. Dr. Couto feels that the primary reason for using pamidronate is for pain control. He is not convinced that it does much to strengthen the bone. For the person who asked, this is a drug similar to Fosamax. It is administered as an IV infusion. I believe that the primary concern with this drug is kidney damage. I'm sure that others who have used it will post more. Unfortunately, Joe's pain escalated exponentially about a month after finishing radiation. Dr. Couto didn't feel that pamidronate would do much good at that point so we made the decision to let him go.

 

3) IV chemotherapy with either carboplatin of doxorubicin. The goal of this is to reduce the rate of growth of the cancer. Side affects are reduction in production of blood cells and possible nausea. Rare side affects include kidney or heart issues. Joe received doxorubicin after his amputation. The stats said this would increase his median time of survival from about 4 months to about 14 months. Unfortunately, without the amputation, chemo would only increase his survival time by 1-3 months. Add that he would have extra stress on the leg with a tumor because he was a tripod, I elected not to do this treatment.

 

4) Pain management. Joe received a combination of an NSAID (we used Deramaxx), tramadol, and gabapentin. This is the typical pain cocktail for osteo. Dr. Couto let me know the maximum amount that I could give of each drug if he had breakthrough pain. In addition, I requested an injectible, quick acting pain killer should he break his leg. Dr. Couto prescribed to me a single hypodermic of butorphanol. This is a synthetic opioid so your doc might not be willing to prescribe it as it could be abused. It may also be more controlled in your state / country than in Ohio.

 

I should also mention that I made plans should Joe break his leg. Since I live alone and couldn't lift him by myself, I had to plan to get help from others. I had three neighbors and also a friend with vans who were on my speed dial. I had a box of stuff sitting next to the door to my garage: the butorphanol injection, a blanket to help move him, a muzzle in case his pain was so bad he would bite, an extra set of car keys, a copy of my van-owners phone numbers, a copy of my driver's license/registration/insurance, and a copy of my credit card. Joe's pain started to increase on Friday. After talking with Dr. Couto, I made an appointment for at-home euthanasia on Monday. As it turned out, the next morning (Saturday), Joe was not able to walk. He didn't have a catastrophic break, but overnight the pain got bad enough that he was not willing to put weight on the leg. It is possible he had a fracture, but I didn't do x-rays. I injected him with the butorphanol and called my oncologist (works for Dr. Couto). I started speed dialing and it took the 3rd number to find someone at home. They came and helped me get Joe into the back of the van and took me to OSU. My oncologist met me there. I am so glad that I made all these preparations. I was in such a state that I'm not sure I could have held it together for him otherwise.

 

If I had owned a van or an SUV, I probably would have invested in a dog gurney. I would have been able to roll him on to it, strap him down, and get him into the van/SUV by myself if needed. There was something about this in another thread. I can't remember where though.

 

I should note that if I wasn't able to be home almost 24/7, I may have let him go much earlier. I wouldn't want to have a risk of his hurting his leg and not being able to help himself. I had visions of him lying on the floor, with only two good legs, and being in excruciating pain. Since I don't work, I was able to be at home with him almost all the time. When his pain started to increase, I cancelled all plans and stayed home 24/7.

 

I know that this is far more than you asked for. I just thought it might help someone plan for the worst.

 

Jane

[NeylasMom]

Our sweet, sweet Gracie was diagnosed with Osteo in the rear leg on Thanksgiving. She's not a candidate for amputation since her other rear leg does not work due to a racing injury. We are doing pamidronate treatment in addition to codeine for pain.

 

She is doing greyt...you would never even know she has cancer! I'm wondering if anyone here has any experience with the pamidronate treatments?

I'm so sorry for Gracie's diagnosis.

 

There are now quite a few of us who have tried pamidronate treatments, most with good success. I would search both this thread and the previous osteo thread for "pamidronate" and you will find a lot of information. The main thing to note is that you may not want to do them if your pup has compromised kidneys, and your vet should run blood work to check this in advance. Also, they will give IV fluids before, during and after hte treatment to help mitigate any potential damage to the kidneys so the treatment can take a few hours.

 

Side note - I find the choice of codeine for pain management a bit odd. That sort of drug is typically reserved for "when all else fails" situations. Typically a combination of Tramadol, Gabapentin, and an NSAID like Deramaxx, Rimadyl, or Previcox is used for bone cancer pain management. There's a nice article on the various palliative treatment options that explains the reason for using multiple types of drugs to address different types of pain related to the cancer that's linked to in the first post of this thread.

[joejoesmom]

After reading all the above, I am more confused and depressed than ever. Opie ate some yesterday, cookies, (lots!), hamburger, canned food. This AM, he ate some chicken sandwich meat, and some cooked hamburger.. Now with this new (and growing) lump on his back leg towards the top (more in muscle, than on bone), and the swollen lymph nodes, I started thinking maybe we should go back to the oncologist and just do some radiation, and chemo. I know without surgery to remove any and all of these lumps it is only a matter of time, But to see that Nube got that, to the tune of $5000, and got a few months - do I want to do that? Is it worth it? To have him sick, with treatments, for the time he has left?

Even OSU is baffled by his case, can't determine exactly what it is. They have been in contact with me since yesterday. Xrays inconclusive - suggesting CT scan if I want clearer pics? Will any of this matter to him, all these tests, just to tell me EXACTLY what it is? He has a tumor on his rib - that we know. He has another lump on his back leg, lymph nodes big on underside of leg. Do I keep testing and testing to put a name to it, and will the end result be the same anyway? I am at such a loss as to what to do any more, so exhausted. Oh, and the night coughing/hacking - not as bad last night, but am sure this is all related. (Of course he didn't do it at the vets, so she couldn't hear it). I wish I knew exactly what to do, but its so speculative.

I am so sorry that you are having to make these difficult decisions with practically no firm information. If you had a diagnosis and prognosis, your decisions would be so much easier. Can any of your vets be more specific about what the possible diagnoses are, what the treatments are for those possibilities, what the median time of survival is for those treatments, what side affects those treatments have, and how much they would cost? Perhaps they could write it down in a small table. I have not heard anyone say that enlarged lymph nodes could be caused by osteo -- have your vets indicated that they could be?. Is the second lump on his leg in his bone? What is the best case explanation for all of these symptoms? If treating the best case scenario doesn't make sense to you, then I no further testing is needed.

 

Assuming that no one can provide the above information, the best thing you can do is listen to your instincts. My favorite oncologist at OSU (next to Dr. Couto) told me that she gives a lot of credence to the owner's gut instinct. The owner might not have medical training, but they know their dog.

 

It is also not wrong to take into account your family's needs. I am sure Opie would not want you to suffer undue financial hardship to gain him a little extra time. I believe that a dog really has no sense of how long he has to live and they don't worry about the future -- at least not past their next meal or when their owners will be coming home.

 

What Opie cares about is that he is loved and well taken care of while he is here. I have no doubt that you are doing this.

Edited December 19, 2012 by joejoesmom

[Guest snakes]

Our sweet, sweet Gracie was diagnosed with Osteo in the rear leg on Thanksgiving. She's not a candidate for amputation since her other rear leg does not work due to a racing injury. We are doing pamidronate treatment in addition to codeine for pain.

 

She is doing greyt...you would never even know she has cancer! I'm wondering if anyone here has any experience with the pamidronate treatments?

 

FedX had pamidronate treatments, i think it was 8 or 9 in total. It was an IV infusion given at a local animal oncologists office. it took a total of about 4 hours as they had to give a lot of fluids afterwards to protect the kidneys. The total cost here was about $400 with the accompanying blood test to check his kidneys prior to treatment. The cost does vary regionally. (FYI, they pee like crazy for the next 8-10hrs after treatment)

I really do believe that the pamidronate was one of the primary reasons I had FedX for so long after diagnosis (22months). i did nothing but palliative (pain control) treatments including artemisinin and chinese herbal mixtures. I would often see drastic improvement within 24-48 hours after treatments, for quite some time he had no limp at all.

 

I generally say if a pain control medication is working, stick with it. Saying that though, we had amazing results with gabapentin and it has very few side effects. i used it with a generic rimadyl and tramadol as needed. I was able to get the gabapentin (100mg capsules) and tramadol A LOT cheaper from a human pharmacy. I got my artemisinin from Swanson herbs online. The chinese herbs i had to get through one of my vets who is trained in those.

With palliative care there is no one way that works best, each dog on here has responded slightly differently to medications and treatments.

 

To all the newly diagnosed pups, I hope you get a good amount of pain free time together

 

Our sweet, sweet Gracie was diagnosed with Osteo in the rear leg on Thanksgiving. She's not a candidate for amputation since her other rear leg does not work due to a racing injury. We are doing pamidronate treatment in addition to codeine for pain.

 

She is doing greyt...you would never even know she has cancer! I'm wondering if anyone here has any experience with the pamidronate treatments?

 

FedX had pamidronate treatments, i think it was 8 or 9 in total. It was an IV infusion given at a local animal oncologists office. it took a total of about 4 hours (each time) as they had to give a lot of fluids afterwards to protect the kidneys. The total cost here was about $400 (each treatment) with the accompanying blood test to check his kidneys prior to treatment. The cost does vary regionally. (FYI, they pee like crazy for the next 8-10hrs after treatment)

I really do believe that the pamidronate was one of the primary reasons I had FedX for so long after diagnosis (22months). I did nothing but palliative (pain control) treatments including artemisinin and chinese herbal mixtures. I would often see drastic improvement within 24-48 hours after treatments, for quite some time he had no limp at all.

 

I generally say if a pain control medication is working, stick with it. Saying that though, we had amazing results with gabapentin and it has very few side effects. i used it with a generic rimadyl and tramadol as needed. I was able to get the gabapentin (100mg capsules) and tramadol A LOT cheaper from a human pharmacy. I got my artemisinin from Swanson herbs online. The chinese herbs i had to get through one of my vets who is trained in those.

With palliative care there is no one way that works best, each dog on here has responded slightly differently to medications and treatments.

 

To all the newly diagnosed pups, I hope you get a good amount of pain free time together

[tydyelady]

Snakes - was that $400 total, or $400 each treatment?

[NeylasMom]

Snakes - was that $400 total, or $400 each treatment?

I can answer that for you. It's per treatment. I paid almost $700 for Neyla's single treatment. It depends a lot on where you live. The fee is going to include any consult or exam fee, blood work to check kidney values (needs to be done before each treatment but you can do it with your regular vet a day or two beforehand if that's less expensive), as well as the treatment, fluids, any charge for "hospitalization", etc. My oncologist also wanted to do lung x-rays again to check for mets since we hadn't done them since she was diagnosed about 5 months before (because you might not proceed with the treatment if there are mets) but I decided to forego that.

 

Palliative radiation will be similarly priced. If you are considering it, just ask the vet you want to use for an estimate that includes everything required to see if it's in your price range. Vet treatment here is very expensive so my cost is likely on the very high side. FYI, pamdironate is generally done every month or so although it depends a lot on the dog.

[Guest snakes]

Snakes - was that $400 total, or $400 each treatment?

 

As Neylasmom already replied, yes it is per treatment. If memory serves it was about $350 for the actual treatment and "day boarding" and another $50-$60 for the blood test to check the kidneys.

I opted to have my regular vet do the blood draw a few days before each scheduled treatment so if the values were way off I could reschedule without making the early morning trip out to the oncologist who with traffic was at least an hour away from me. I was lucky to be working evening shift at the time as well and could make it back for work if need be and hence didn't have to take any time off.

The oncologist wanted to do one treatment every two weeks for 6 treatments. Personally I couldn't afford that, so I did two treatments at two weeks, then one a month later, then one two months alter, then we just did it "as needed". eventually I found the cost to be prohibititive, and I had a bad experience with the oncologist for the 2nd or 3rd time. Unfortunately the only other location around here wanted $500-$550 per treatment and that would have jeopardized both my health care and UPS's vet care, so i never got any more infusions. In the end it didn't matter much as FedX then had problems with edema in the cancer leg. I only relay this story to show that often with this cancer your treatment approach is constantly changing.

 

We did do one radiation treatment which cost $750 which was high because of the initial "set-up" fee, following treatments would have been about $250. unfortunatly the radiation actually made FedX's pain worse (it has greatly helped other pups on here) so we didn't pursue it.

 

Any more questions, feel free to ask You can always PM me too in case i don't check in for awhile.

[krissn333]

We did the treatments with Sutra...here it was around $250 per treatment.

[tydyelady]

Opie is not doing well. He seems to have gone downhill so quickly, in the past week when he stopped eating. He is in pain, so we have upped his tramedol to 2 tabs every 8 hours now. We will be seeing the vet on Wednesday to see what else we can do.

[JJNg]

If Opie's not on gabapentin, I would definitely ask about adding that in. It can help a lot with pain management, but it needs to be given at a high enough dose. Many vets who aren't familiar with it start too low, I think because one of the popular veterinary drug references lists a really low dose for pain. For the average-sized greyhound, I'd start with 100 mg every 8-12 hours, and that can be increased to 300 mg every 8 hours. It can cause some sedation in the beginning, which is why most vets start low. But when pain management is critical, or if the pain is severe, I've gone straight to the 300 mg every 8 hours, and some dogs don't even get sleepy on that dose.

[teri_d]

i am so sorry that opie is not doing well -- i second the gabapentin suggestion - hugs to you and opie -

[tydyelady]

I've written this down, and will ask when we go in tomorrow. This AM he is actually not too bad, and he decided he was hungry last niht - another wing and neck piece, and 5 cookies - Costco, and TJ's peanut butter ones. One day at a time .....

[tydyelady]

Going to the vet this AM. He is very weak from not eating (didn't eat much again yesterday). I don't think he has much time left.

[Batmom]

Sending hugs and best thoughts for you and your boy. I'm sorry he isn't eating (and feeling) better.

[RaineysMom]

I'm so sorry to hear about Opie I hope he can rally I would definitely up his meds a LOT -- Nube was on 150 mg of Tramadol (3 pills) AND 300 mg Gabapentin three times a day plus 75mg of Rimadyl 2 times a day and at the end we upped the Tramadol to 4 pills each time.

 

if he's in a lot of pain that could cause him to not want to eat. With Nube, he slowed down with meals until he finally would not eat at all (and this was a dog that was a TOTAL food hound, so he was telling us).

 

sending hugs to Opie, Gracie and all the pups going through this.

[tydyelady]

Vet did prescribe the gabapentin. Starting with 1 every 12 hours, going to 1 every 8 hours, then evaluate for pain. This was added to the Tramadol 50mg, 2 pills, 2X) and Rimydyl(100mg 1X).. We also bought some green lamb and beef tripe in cans, and some prescription food high in calories. DH just made some chicen pieces and beef liver slightly sauted up, and putting in blender to chop. We will mix with baby good, and spoon feed to him.

Also getting some boost or ensure tomorrow.

Imperative that we get some food and nourishment down him to help him get some strength back.

I'll let you know how he does on all this.

Edited December 27, 2012 by tydyelady

[Charlies_Dad]

Good thoughts for Opie. Ensure will definitely help keep some weight on him. I hope the change in meds makes him more comfortable.