Osteo In A Foreleg, Questions

[macoduck]

A friend's greyhound (age 11) has osteo in his foreleg near the "wrist". He is being treated with pain meds (liquid metacam) and chinese herbal products. This is an extremely difficult dog to give pills to or to even sneak them in.

The leg lesion is now the size of an small orange. Drastic measures will not be taken given his age. Medication has kept him pain free and he still appears to be a happy boy.

 

My question is, with a lesion that size how imminent is a fracture?

[Guest Downtownhoundz]

Oh gosh, I'm so sorry to hear this! I hate cancer! When will they EVER find a cure !!!

[tbhounds]

Sorry to say-with a lesion like that I doubt there is any normal bone left. I'm afraid a fracture would be very likely. See page 2...

https://ckm.osu.edu/sitetool/sites/greyhoundpublic/documents/About/Newsletters/ghwpNewsletterWinter2008.pdf

[Saharasmom]

Sahara's wrist swelled to a similar size, though she had a soft-tissue tumor that invaded the joint. Pain was well-controlled with meds, but we found out she had a hairline fracture when we had updated x-rays. The vet said she was in danger of a catastrophic break at any time. We put her down the next day. It is really hard to make the euthanasia decision when the dog still seems happy. I'm sorry about your friend's grey!

[greyhndz]

I'm sorry for your friend, Ducky. It's now a quality of life decision, as far as pain control and keeping him quiet to try to prevent fracture, and how he'd deal with limited activity.

 

As far as pain management, if there's no way at all that his owners can pill him, I can think of two alternatives for when meloxicam no longer controls his pain: the cheaper alternative is codeine (or tylenol with codeine) elixir which can easily be dosed appropriately. The more expensive option would be having a veterinary compounding pharmacy create a tramadol liquid formulation. Her vet should be able to offer options.

 

My broodie Charming had a similar distal radius OSA, and did develop a pathologic fx (I never knew how -- I came home from work to find her in severe pain). As I was getting ready to carry her to the car, I gave her as much benadryl and tramadol as she could tolerate to keep her more comfortable (with my vet's blessing). I think nowadays, if one of my pups developed osteo, I'd ask the vet for an IM dose of buprenephrine or other potent narcotic to keep on hand for just this type of catastrophic event.

 

I hope his final weeks are quiet and comfortable, for him and for his parents.

 

 

 

[45MPHK9]

Gabapentin is a great pain relief drug for osteo. As I recall, it was a capsule.

Edited January 13, 2013 by 45MPHK9

[cleptogrey]

once the limp and signs of osteo became evident on emily- oct 29th(my birthday was her last run then she went really lame and was in pain)..... she could no longer stand the pain, no matter what she was given and our decision to not let her suffer was of course right before new years eve. emily lost her battle jan 2- so, that's about 8 weeks. 2 friends who both lost dogs to osteo told me it's around 8 weeks and that it was.

 

i'm still angry at myself for not having her euthanized when the xrays were taken. but it wasn't my vet who took them and the referral refused and tried to talk me into amputation. that's the problem w/ going to a referral- my vet's xray machine was down.

Edited January 13, 2013 by cleptogrey

[macoduck]

Jordan, I think that having buprenephrine on hand is a very good idea. I live a couple of hours away from my friend. She may not like this advice but I will share it with her.

 

Tbhounds, thank you for the link. I will send her that as well.

Edited January 13, 2013 by macoduck

[Batmom]

You can't tell for sure without seeing the x-rays but as tbhounds notes, in most cases like that, the risk of a fracture is high -- even from doing just normal things. If I were the owner, I would want to spare the dog a catastrophic and monstrously painful break and would schedule that last appointment today or tomorrow.

 

I'm sorry your friends are facing this.

[cometdust1]

Cleptogey, that's terrible that that vet refused to let your dog go !I too have been guilted by vets into having surgery on old dogs that I knew in my heart would not do well with and now I have those memories of of their miserable life ends to remember them by.Macoduck, I'm going to steal a quote from somebody else on this site because it's a motto that I will always live by and have used several times since:Better to let them go a day too early than a day too late.I feel for your friend,it's so hard to let go when they walk up to you with a toy in their mouth when you pick up the leash.

[JJNg]

While I would agree that theoretically, there is probably very little normal bone with a tumor that size, I really don't think we can realistically predict when and how likely a pathologic fracture will occur. Some bone tumors are more lytic (eating away normal bone) while others are more proliferative (producing more abnormal bone). An x-ray might tell you how much calcified, structural bone was there, but I'm not even sure that would give you a reliable indicator about fracture.

 

I've seen dogs break their leg just from standing, with no obvious tumor and bone that looks completely normal on x-rays, as well as dogs with huge boney tumors that never fracture and are euthanized due to lung mets. The best approach is to keep pathologic fracture in mind as always being a possibility with any case of OSA that isn't amputated.

i'm still angry at myself for not having her euthanized when the xrays were taken. but it wasn't my vet who took them and the referral refused and tried to talk me into amputation. that's the problem w/ going to a referral- my vet's xray machine was down.

I'm sorry you had that experience with your hound, but I wouldn't make this generalization with all referral centers. Just like regular vets, they vary greatly. I'm lucky to have an excellent local referral center that is good about providing the owner with all the options and letting them decide without pressure. They will also provide euthanasia services, including at an initial consultation visit.

 

Whether a referral vet is willing to provide euthanasia can also be affected by their relationship with the local general practice vets. If many of the general practitioners they work with do not want the specialty center providing services that the vets can do themselves (such as euthanasia and other non-specialized procedures), they may be reluctant to do so and risk hurting their relationship with the vets who send them business. In some areas, general practice vets and specialists have a precarious and not very cooperative relationship.

[cleptogrey]

JJNg thankyou for your insightful comment, but i was very specific w/ both my back up vet who referred me- it wasn't a speciality center, it's just that my back up vet's machine was repaired 3xs and still down and my long term vet's machine was also down. the practice that i went to is excellent, knowlegable and greyhound savy. it's just that they could not understand how someone who loved their dog that much had/has such strong feelings.i knew the options, knew the pain(my friend the back up vet just lost her female to osteo- same shoulder and i went thru all of the alternative meds and amputation w/ her). i wasn't about to argue, just cry. in the end i'm so glad that my long long term vet was able to euthanise emily and be there. but it was 8 weeks of unnecessary suffering.

 

i agree with: better to let them go a day to early than a day too late.