Osteo Thread Part Vi

[JJNg]

Stewart was just diagnosed, osteo in the front shoulder. Non-amputatable. I'm going to send the xrays to either a specialist in Southern California, or to OSU

 

Sorry to hear about Stewart's diagnosis. I'm wondering why they are saying amputation is not an option? I'm glad you're getting a 2nd opinion from a specialist. There is certainly nothing wrong with choosing not to amputate and to just manage pain with palliative care. However, if you're interested in considering more aggressive treatment, I wouldn't just take one vet's word that it's "non-amputatable". Most cases of osteosarcoma affecting limbs can be amputated, and it's more a factor of whether the dog is a good candidate based on overall health, and soundness of the other legs. Best wishes for you and Stewart, and I hope you still have a lot of good, quality time with him regardless of how you decide to proceed.

[Valencia]

Stewart was just diagnosed, osteo in the front shoulder. Non-amputatable. I'm going to send the xrays to either a specialist in Southern California, or to OSU

 

Sorry to hear about Stewart's diagnosis. I'm wondering why they are saying amputation is not an option? I'm glad you're getting a 2nd opinion from a specialist. There is certainly nothing wrong with choosing not to amputate and to just manage pain with palliative care. However, if you're interested in considering more aggressive treatment, I wouldn't just take one vet's word that it's "non-amputatable". Most cases of osteosarcoma affecting limbs can be amputated, and it's more a factor of whether the dog is a good candidate based on overall health, and soundness of the other legs. Best wishes for you and Stewart, and I hope you still have a lot of good, quality time with him regardless of how you decide to proceed.

 

It's not an option because of the location of the osteo, because of existing issues with his lower back and back leg stability, because he lashes out when he is in pain and not feeling well and we'd never survive even a bandage change after the surgery, because going to the vet is so incredibly traumatizing for him, for a lot of reasons.

[JJNg]

Definitely sounds like surgery would not be the best option for Stewart, and I hope I didn't sound like I was questioning your course of action. I feel that it's important for owners to know all the options in order to make an informed decision for their pet. Just wanted to make sure that the vet hadn't told you that it was non-amputatable just because of location. If the osteo is in his shoulder, location in itself wouldn't preclude amputation. The proximal (upper) humerus is the most common location for osteo and is often treated with amputation, if the owner wants to go that route. Even if the cancer is in the scapula (shoulder blade), amputation is possible.

[Valencia]

Stewart was just diagnosed, osteo in the front shoulder. Non-amputatable. I'm going to send the xrays to either a specialist in Southern California, or to OSU

 

Sorry to hear about Stewart's diagnosis. I'm wondering why they are saying amputation is not an option? I'm glad you're getting a 2nd opinion from a specialist. There is certainly nothing wrong with choosing not to amputate and to just manage pain with palliative care. However, if you're interested in considering more aggressive treatment, I wouldn't just take one vet's word that it's "non-amputatable". Most cases of osteosarcoma affecting limbs can be amputated, and it's more a factor of whether the dog is a good candidate based on overall health, and soundness of the other legs. Best wishes for you and Stewart, and I hope you still have a lot of good, quality time with him regardless of how you decide to proceed.

 

Although I very rarely post in the H&M forum, I'm not new to greyhounds or their medical care. I've been actively involved at the board level with my local group for years, and have been involved with a lot of the medical issue dogs, as well as researching the diseases and conditions and treatment protocols. However, it's much different when it's my own beloved greyhound I have to make decisions for (plus I just sometimes need a bit of emotional support from people who understand).

 

Stewart isn't a candidate for amputation or even the other drug therapies because he is extremely fearful and anxious at the vet, to the point I struggle to get him out of my vehicle, and he paces, pants, and does his best bucking bronco impersonation when I try to move him anywhere except to the exit. He growls and snaps at me if I try to change a bandage on him from any routine injury, so caring for him after an amputation would be traumatic at best, and god forbid there were any issues. And finally, he has back end issues that preclude him from having only three legs; I suspected LS, but it doesn't appear to be that. I didn't push for a better diagnosis since it's a bit of a moot point with the osteo.

 

I got digital copies of the xrays from my vet, and have sent them on to Dr. Couto. I can confirm that there is now a mandatory $50 consultation fee for non-members, if using the consultation form on the website. The confirmation form and email both state a response will be given within 3 days.

 

I picked up Stewart's tramadol today, and will start him on it tonight. He is still limping with the Metacam, although he is in much better spirits than he was after the exam and xrays. You never realize how much even just a few dogs jostle each other until one has an injury...

[KF_in_Georgia]

Larger doses of tramadol can produce anxiety-like symptoms in some dogs (panting, pacing). For Stewart, consider gabapentin for pain (as a supplement to low doses of tramadol). Gabapentin is available in 100mg capsules, and you can increase his dose easily. I'd probably start with 100mg given three times a day, then up the dosage at certain periods; find out a maximum dosage from your vet, but many dogs can take 300mg, three times a day. Gabapentin isn't narcotic and doesn't make a dog too drowsy or groggy, although a large dose at the beginning can make the dog wobbly, so you want to start slowly. It sometimes takes about 48 hours or so for gabapentin to get up to speed in the dog. Some vets aren't aware of the advantages of gabapentin (easy dosing--get 100mg capsules and there's no pill splitting; no grogginess; easy on the stomach; works well with other meds), so you may need to mention it to your vet. Since gabapentin is a people-drug, it's available at most drug stores. (You can get refills in the middle of the night on the weekend. Tramadol also is a people-med.)

 

One thing: find out from the vet what is the absolute maximum dosage of all of Stewart's meds. If Stewart's in pain some night or weekend, you need to know how high you can go and you may not be able to reach his vet. Heaven forbid you have to try to convince an ER vet to tell you a maximum, while you try to explain why bringing Stewart to the ER is a rotten idea. And, you're on a pain-management course. While many vets naturally worry about side-effects and problems with long-term usage of various meds, those aren't things you need to worry about. You'll want to keep ahead of his pain; not try to play catch-up on a bad night. You might want to make an appointment with an oncologist for the best advice on pain management.

 

I'm so sorry you and Stewart are facing this.

[Valencia]

Okay, thank you so much for the info. I was aware not all dogs did well on Tramadol, and he has had issues with morphine, so I'll be extra vigilant with the Tramadol. The vet did give me the dosages for 'when things are going badly'. I do have the option of seeing an oncologist, but since it seems like the advice for pain management care seems to use the same drugs and the same dosage ranges, and my vet seems to be very well versed in all of it and the side effects, I haven't really seen a good reason to drag the poor dog into yet another clinic and freak him out again.

[CleosMom]

Can I join? Stewart was just diagnosed, osteo in the front shoulder. Non-amputatable. I'm going to send the xrays to either a specialist in Southern California, or to OSU, does anyone know how long it takes for OSU to review films and get back? I know there's a consult fee, I don't mind that.

 

I am so sorry. Our Cleo was diagnosed with osteo on November 24th in, what sounds like, the same location. Amputation was not an option due to her age (she was 13) and not something we were willing to consider (again, due to her age).

 

I have no doubt you will do what is right for Stewart. Hugs to you and Stewart.

[vjgrey]

I haven't really seen a good reason to drag the poor dog into yet another clinic and freak him out again.

 

I said this somewhere recently - possibly on the previous Osteo thread - but my Gabe was also totally vet-phobic, but I found that the Oncology clinic was a completely different thing. He LOVED the vet techs there and was always happy to go see "his girls," something I never, ever saw at any other vet's office. It was a totally different atmosphere - much less clinical and much more focused on Gabe's comfort and happiness. They really fussed over him, and he LOVED it. It may just be that I really lucked out. The oncologist we saw was worth his weight in gold (and more). But my suspicion is that vets and vet techs who work with terminal dogs approach their jobs differently. If you have any questions about the care he's getting at the general practice vet, it might be worth at least a consultation with an oncologist to see whether you have a similar experience. If not, I'm thrilled that you've found a great general practice vet. It's so, so important to trust whoever you're seeing.

Edited December 7, 2012 by vjgrey

[KF_in_Georgia]

Actually, I was thinking you could have a consultation with an oncologist--taking Stewart's records along, but not necessarily Stewart--although I, too, have heard that spooks often are more relaxed at an oncologist's office.

[greysmom]

Depending on how aggressive Stwewart's cancer is, an oncologist may be able to help you with specific treatments like palladia infusions, adding artemisinin, and the efficacy of rediation in his case. It also depends on how aggressive you want to be.

 

I'm always sorry when another person and their dog has to join this group, but we are here to help and support anyone who needs it.

[Valencia]

OSU got back to me this morning, I JUST filled out the consult form yesterday in the late afternoon! Unfortunately, the images of the xrays aren't clear enough for Dr. Kellogg to decisively say if it's osteo, so I have asked if I can mail her the actual films (my vet has already said this would be fine). Also, Dr. Kellogg is asking for comparison films for the other shoulder, scans of the chest, and has also suggested doing new bloodwork. (How did I not think to have this stuff done at the previous visit?) I am going to get a script for Xanax for Stewart so that I can hopefully alleviate some of his anxiety when I take him back, because I would really like to be able to get these tests done for my own peace of mind, and to track the progression as needed...

 

Have any of you needed to treat with Xanax for vet visits? Normally I wouldn't be so quick to medicate, but he's gotten much more anxious with each visit, and the contact pacing, panting, and whining just breaks my heart. And, I have had to carry him into the clinic and / or the exam room the last few visits, otherwise he bucks and freaks out and tries to escape, and I don't want him getting hurt. If I try to hold him steadily by his collar, he gets really agitated and growls and whips his head around (I have him muzzled to prevent him from biting).

[NeylasMom]

I don't think the Xanax is a bad idea at all. You might want to try it out at home first when you can observe the effects because occasionally it can heighten anxiety from what I've heard. That will also allow you to figure out how far in advance to give it (the peak efficacy may be more like a few hours in) and what dosage is best.

 

As far as the additional testing, I'm not sure you need to do all of it. If you have some reason to doubt the diagnosis, then the comparison x-ray and/or a clearer view of the affected shoulder may not be a bad idea. The lung x-rays are to check for mets, which would only be something you'd need to know about if you are considering something like IV pamidronate (this involves several hours at the hospital while fluids and the drug are administered) or palliative radiation (requires anesthesia) because you might choose not to opt for those procedures if mets are present. Otherwise, until you see symptoms that make you suspect mets, I don't see the point (unless you are reconsidering amputation).

 

Bloodwork - if he hasn't had it recently, then yes, it would be good to if nothing else have a baseline since he will be on meds, but if he's had it in the past couple of months I'm not sure I'd bother (again unless you're considering one of the treatments I mentioned above as those would both require a basic profile to check major organ functions, specifically kidney in the case of the pamidronate).

 

Only saying this because I know even palliative treatment for osteo can become quite expensive. If money isn't an issue, then there's no harm in doing it all in one fell swoop.

[Valencia]

Okay, thank you, I really appreciate it. I have to think more about this. My heart hurts.

[Guest snakes]

 

Only saying this because I know even palliative treatment for osteo can become quite expensive. If money isn't an issue, then there's no harm in doing it all in one fell swoop.

 

I will second this.

I only did necessary bloodwork as needed to track FedX's kidneys due to pamidronate treatment and even that simple bloodwork could run $40 each time, xrays were often $80-90 each (we only did three total over the whole diagnosis time).

The meds and pamidronate were costly over time and i always personally decided against any testing that was unnecessary because even if it showed something I wasn't going to aggressively treat it and I wanted to save money for his supplements ect. to keep him comfortable.

I mainly treated based on symptoms.

[RedFawnMom]

I am just popping in to give a Lucy update. I was talking with Kyle about Charlie, who was our inspiration and had 21 great months post amp, and realized that Lucy may be one of the longest surviving osteo pups on GT now, at 22 months post amp, which is astonishing to me because she was only 4 when diagnosed. She's still doing great and is the happiest tripod you'd ever meet! There are no signs of recurrence and we are grateful for every day. My heart breaks every time I read about a new diagnose or bridge angel and I truly wish Lucy's outcome was the norm. I get too teary if I spend too much time on the H&M board so I'm not here much, but feel free to PM me if anyone is contemplating amp and needs someone to talk to. There's a lot of heartbreak with osteo, but there is hope, too.

 

Hugs to everyone.

[greysmom]

I am just popping in to give a Lucy update. I was talking with Kyle about Charlie, who was our inspiration and had 21 great months post amp, and realized that Lucy may be one of the longest surviving osteo pups on GT now, at 22 months post amp, which is astonishing to me because she was only 4 when diagnosed. She's still doing great and is the happiest tripod you'd ever meet! There are no signs of recurrence and we are grateful for every day. My heart breaks every time I read about a new diagnose or bridge angel and I truly wish Lucy's outcome was the norm. I get too teary if I spend too much time on the H&M board so I'm not here much, but feel free to PM me if anyone is contemplating amp and needs someone to talk to. There's a lot of heartbreak with osteo, but there is hope, too.

 

Hugs to everyone.

 

OK. That was weird. Hope this works now.

 

Jess, this makes my heart happy! Lucy and Dude had their amps around the same time I think, and knowing she's doing great is just wonderful!

 

{{{{HUGS!}}}}

Edited December 8, 2012 by greysmom

[NeylasMom]

So happy for another great Lucy update. She always sticks in my mind, maybe because she was so young when she was diagnosed and I'm so glad she is doing so well. I hope she has a LONG cancer free life.

[RedFawnMom]

Yes, I remember following Dude's updates while Lucy was also recovering from surgery. I remember how Dude refused to be kept off the stairs. :-) And how happily he greeted his massage therapist. He was such a character, and the way you described him always reminded me of Lucy. I wish they had had the chance to meet. (((Hugs)))

Edited December 9, 2012 by RedFawnMom

[dmswartzfager]

Today is Symbra's 10-month ampiversary. She continues to do well and acts like her usual nutjob demanding self. I finally broke down and took her in to work right after Thanksgiving and cleaned her teeth. Since it was only a cleaning, no x-rays or anything else, we did her on injectable sedation, though I placed a catheter and ET tube just in case... and that little stinker stressed me out by trying to wake up while I was scaling her teeth... and then again while I was rinsing her mouth out after polishing... and then falling right back to sleep after I gave up on the rinsing.

 

We are opting not to do the chest rads every three months, as it will not change anything - we will not be pursuing a rescue protocol when the lung mets appear. So, I see no reason to stress her out with the vet visit even though she has accepted her bed in the treatment room as a "safe place" - when she starts coughing or not acting like herself, we will know... and we see no reason we need to know the end is near any sooner than that.

[TwiggysMom]

I'm so glad to hear the great Lucy & Symbra updates!

 

Twiggy is almost 16 months post-amp now (coming up on the 16th). She hasn't been on anything but artemisinin for several months. It's nice to not have to worry about side effects. I'm continuing to plan on x-rays every three months, even though I don't plan to do any additional chemo when mets show up. I just like to know, I guess. I think I probably should x-ray her front leg, because she won't be able to limp on it if a new lesion starts there.

 

In the meantime, she is still her happy, nutty, energetic self!

[greysmom]

Twiggy and Symbra!!!!!!!!

[krissn333]

Kisses to our sweet girls hanging in there!

[greysmom]

On page 2! Can't have that!

[Charlies_Dad]

Great to read of the great updates on Lucy, Symbra and Twiggy!!! I hope they all have many, many more months of good health and

happiness.

[MachosMom]

Oh yay!! Congrats to Lucy, Symbra, and Twiggy! Keep it up!!! I also wish them long, healthy, fun filled years.

 

I follow this thread as I can, and send my support to all going through this. You all were such support for me and for that I'm ever grateful.