Osteo Thread Part V I I

[kmtgolf1]

Sorry to hear about Mimosa. We are with you in spirit as we deal with my Chloe's same diagnosis. She was diagnosed a few weeks back.

 

She has done pretty well with the meds, although we've been increasing the gabapentin on occasion from 1 pill (300mg) to 2 pills in the morning. I guess that would be 900 mg total if she gets another pill in the evening. Is this too excessive? I suppose it only matters if it is controlling the pain or not. I was glad to hear that Bee Wiseman's owners gave 900 mg at some point. I know we can consult with the vet on this.

 

Such a sad journey. She still exhibits much of her perky personality which makes it so hard to know if the pain is getting to be too much. Yesterday she was jumping up and down when I got home from work, ready to go out for a walk and potty. I hope we will know when it is getting to be too much for her.

 

We have banned stairs, although I was thinking of trying once a day, but now think I won't. My lovely wife has been sleeping on the couch for several weeks so that Chloe is not alone. Our other hound, Clifford, just goes along with the flow . I probably need to take my turn doing that.

[KF_in_Georgia]

It should be fine for Chloe to get 900mg of the gabapentin a day, but you want to spread it out. It doesn't last more than about 12 hours in the system, I think, so small doses more often are better than large doses just once or twice a day.

 

You might want to see if your vet can give you a script for 100mg capsules (available at reasonable prices from people-pharmacies). That would let you break up Chloe's doses. My boy was taking 2 of the 100mg capsules four times a day, with an extra 100mg we could use in a bad patch (such as after he'd had a fall).

[greysmom]

for Kim and Casper

Edited January 31, 2014 by greysmom

[Guest fastcasper]

Thank you everyone! You guys are awesome!!! And Casper and I REALLY appreciate your support and words of encouragement. He's a toughie. This morning was his first dose of Palladia. Dr. Couto suggested Palladia and Cytoxan together BUT my onco "respectfully disagrees", he think it would be too much for Casper (too toxic), we may "layer" into his program but he wants to see how Casper does on Palladia alone. Victor, that is encouraging to hear Lana had a dry cough for some time before it progressed. Casper just started it about 5 days ago but I also think, in part the dry air isn't helping. The dry air is also making him and his sister shed like mad!! He is going to be bald pretty soon! We will see how he does on his new protocol. I really didn't want to put him back on the Doxo.

 

Kim and Casper

[greysmom]

Kim, you and your vet know Casper the best. And Dr Couto, despite being an expert, doesn't. So you do what you feel is best for your dog in his particular situation. It sounds reasonable to me, since all treatment is basically an unknown at this point.

 

{{{hugs}}}

[Guest fastcasper]

I do agree. I guess one gets desperate and wants to try it all. I am going to see how he does on Palladia. I am not terribly optimistic at this point but at least Casper is still a happy boy and that is all that matters. I just get selfish with wanting more time. Admittingly I am scared, sad, and disappointed.

 

Kim and Casper

[TwiggysMom]

Kim, I am so sorry about Casper's mets, and hope that the Palladia is well-tolerated and effective. Twiggy was only able to handle Palladia for about a month, but she was also taking Metacam and Cytoxan at the time, so the combo was just too much.

 

I hope that Casper does well with the Palladia (Twiggy had a harder time with it than most). You'll probably want to give him omeprezole or something similar to help curb potential stomach issues (if you're not already).

[Victor]

We received the results of Lana's autopsy last week. I thought I'd post a quick summary in case it's of help to anyone.

• Lungs: Lana had "dozens" of "pinpoint to 1cm in diameter" mets scattered throughout her lungs. There was one large met that was 2.4"x2.4"x0.75". The tissue around the mets was compressed or collapsed, and the alveolar spaces contained hemorrhage or edema.
• Liver: There were "dozens of pinpoint to 1cm in diameter" mets scattered throughout Lana's liver. There were two large mets, both approximately 1.5"x1.2"x0.75".
• Kidneys: There were two mets on Lana's right kidney (each approximately 0.4"x0.4"x0.4") and one on her left kidney (also 0.4"x0.4"x0.4").
• Spleen: There was a large 7.9"x9"x4" met on Lana's spleen. It appears to have ruptured at some point, leaving a large blood clot. Much of the tissue in the mass was dead.
• Skin: The two masses that had appeared on Lana's hind leg were mets, as we had suspected.

The three days before we made the decision to say goodbye, Lana's breathing had become increasingly labored (30-40 breaths per minute at rest), but we had no indication of the other issues (aside from the two skin nodules that had appeared suddenly on 12/15, one of which ruptured on 1/3). The only change in Lana's behavior was that she started coming to wake us up much earlier than usual and insist that one of us come lay next to her on her bed. Then the morning of the day before we said goodbye she had a bad coughing fit that lasted 10 minutes. Still, we agonized over whether we had made the right decision after she was gone. Now we know we did. Although she must've been in pain, she never showed it. In fact, she seemed really happy and content in her last weeks. She ate well, she enjoyed going on short walks (even in the -20° F weather!), and she roached all the time. Fortunately I was on winter break, so I was able to spend nearly every waking hour by her side. She was such a little trooper. My wife came across a quote that we think Lana would've liked:

 

"Fearlessness may be a gift, but perhaps most precious is the courage acquired through endeavour, courage that comes from cultivating the habit of refusing to let fear dictate one's actions, courage that could be described as 'grace under pressure'—grace which is renewed repeatedly in the face of harsh, unremitting pressure." —Aung San Suu Kyi

 

Lana was nothing but courageous to the very end.

 

Victor

[TwiggysMom]

Wow, Lana sure put up a fight, didn't she?

 

I love the quote - it fits Lana perfectly.

[a_daerr]

Wow, hearing about all those mets is so sad... Though, I'm glad the report gave you some solace that you made the right decision for Lana.

 

We are TWO MONTHS post-amp today, and Henry had had a few big milestones recently. He is now going up the second floor stairs on his own! I wasn't going to start pushing him to do stairs until his chemo treatments were over, but the other night, I saw him come up on his own. I was shocked! Since then, I've been getting behind him and giving him a little push to get started. But now, he's a stair-climbing fool! He went up and down half a dozen times today, totally on his own. I have a feeling that he had been snowing me this whole time (presumably because he enjoys being carried). We had a little break in the weather yesterday, so we had some off-leash adventures. He was in all his glory, running and exploring... If I had any doubt whether amputation was the right choice, seeing how much fun and joy he still has totally diminishes them.

 

He had bloodwork last week, following his second round of Doxo. Everything, including the WBC count, was in the normal range. He also gained two pounds, which is good because he'd been looking especially ribby the last few weeks. Round 3 is this Saturday, and that means we'll be over the chemo hump. I know that the last few rounds may take a heavier toll, but I'm staying optimistic that he'll come through just fine. Once we get all this chemo crap over with, we'll be free to do all kinds of greyhound events in the spring. We have a busy year ahead of us!

[greysmom]

Wow. You know you did the right thing for Lana. This just confirms it. I do love the quote, as well. It seems to fit our cancer dogs to a T. They show unbelievable courage and heart in the face of such pain and challenging circumstances.

 

For Henry!!!

[Victor]

Thanks, Wendy, a_daerr, and greysmom.

 

Keep up the good work Henry!

[Guest Greytblackdog]

I'm so sorry to hear about Mimosa and Chloe's dx. It knocks the wind right out of you when you hear the words you don't want to hear. This thread is amazing and while I'm not happy you're here, I hope you're here for a long time to come.

 

Reading Lana's report made me realize that I really may not know how sick my girl might be. Right now she's happy, eager to be with us, loves to eat and even plays in the evening after a hard day's rest. Thank you for sharing.

 

I'm currently sitting at a Panera Bread while my girl gets her second palliative radiation treatment and her first chemo. I never thought we'd do the chemo route, but after our oncology consult at Auburn University last week they suggested that it would not only help the spread but also help with pain control as well. There was little to no change from her x-rays in December and that's why they suggested that even though she isn't an amputation candidate, as slow as her cancer is growing she would benefit from chemo at this point. So.... here we are. If she doesn't tolerate it well, we can stop mid-course.

 

At Auburn, they do 4 palliative radiation treatments over 4 weeks instead of the 2 back-to-back. The radiation oncologist told me that every office is different in the protocol, and they do offer the 2 dose option, but he sees much more long-term success at their office with the 4 treatments. I will say that her limp has improved over the past week. So that is very encouraging considering a week ago I wasn't sure she could stand much more pain. She hates being at the vet's office, but lives to ride in the car, so the 4 hours we spend together in the car is a big treat for her. I hope it outweighs the time she's getting treatment.

 

The oncologist wants to switch her to piroxicam for pain management going forward. Anyone have experience with this med?

[greysmom]

Piroxicam is an nsaid that has been proven to have some reduction effects on cancerous tumors. It used to be recommended as part of OSU's metromonic protocol following IV chemo treatments. We used it with little to no side effects.

[Guest fastcasper]

Victor,

Thank you so much for sharing that info on Lana. And, yes, you truly made the right decision at the right time. I can't believe how big some of those tumors were. Casper's biggest one (right now) is 3 cm in diameter. He has a few other that are 1.7 cm in diameter. Did Lana's voice and bark ever sound "raspy"? Casper is hacking and very occasionally a gag happens, but when he plays or runs around in the yard, his breathing sounds raspy. He hasn't barked in about 2 weeks but I think that is probably raspy too. Today is took is 2nd round of Palladia. Friday is got his first. He did fine that day but on Saturday he was pretty out of it. He ate, pooped, peed, took a very short walk but mostly wanted to rest. I could tell he didn't feel good but he was still engaged. On Sunday he was coming around and getting back to himself. He and Wynnie played in the yard a little too. I removed some of his supplements from his diet (just keeping I4P, fish oil, and Arte). Today I gave him his next dose with some hesitation, but I have to give it a try. So, far he is fine.

 

He is on Omeprazole (sp), and Sucralfate/Carafate. I make a "slurry" in a syringe and give it to him orally. It is suppose to coat his stomach. I give it every 12 hours, even on off day of the Palladia.

[Victor]

Kim, I don't recall Lana sounding raspy, but then again she rarely barked or talked, so it's hard to know. Also, the last month or so she didn't want to go into the yard (she only wanted to go on walks with me), so she wasn't running around much. After she'd had the dry cough for some time she did start gagging and/or swallowing after coughing. Then on Christmas we saw her cough blood onto her bed. She may have been coughing up blood before then but swallowing it right away; I don't know.

 

Did Casper have diarrhea after his first Palladia? If not, that's a good sign. Lana had bad diarrhea after each dose. Keep an eye on Casper's stools. You especially want to be on the lookout for blood (or digested blood, which makes the stools look tarry). The omeprazole and sucralfate should help protect his GI tract. Did your oncologist tell you to do anything different with the dosing of Casper's NSAID? Ours had said to only give the NSAID on non-Palladia days, since NSAIDs are also hard on the GI system. (Gabapentin should be okay.)

 

If you think the Palladia is making Casper too sick—or you notice GI problems—your oncologist can adjust the dose. Unfortunately Lana couldn't tolerate even the lower dose, but it's apparently an option for some. Also, some people do MWF dosing instead of every other day just to give the body an extra day to recover over the weekend.

 

One more thing—you might ask your oncologist about mixing in some EN or I/D kibble to help with GI upset. Also, you might ask about a probiotic. The one Lana liked best was Prostora; it's expensive, but she'd eat it like it was candy!

[Guest fastcasper]

Super helpful information! I think we are mostly at the hacking phase (or kind of like clearing the throat). Casper is pretty verbal when I come home. He barks and barks! His hacking/gaging is non productive so far.

His stool is pretty good but I have him on Metronidazole as a preventive measure. His stool is soft but formed. #2 and #3 of the day is a little more soft but not running at all. It also is a med. brown color. They did tell me to look for blood in the stool.

Doctor took Casper off Deramaxx and after two days I think Casper was moving more stiffly. Over the weekend I gave him 25 mg at night and I think it helped. I may take your suggestion and do it on non Palladia days. He does very well on Deramaxx.

 

Casper is on 80 mg right now. Doc said that is slightly lower than normal for his weight. He wanted to see how that went.

I give Casper some plain yogurt to help with probiotics. He likes the yogurt.

 

Thank you Victor!

 

Kim and Casper

[Victor]

You're welcome, Kim and Heather.

 

Heather, I hope Seka's radiation + chemo treatment goes well. Is she getting pamidronate too? That's great that the radiation is helping with the pain.

 

Victor

[mimosasmom]

Lots of really good information here, and lots of different treatments I see! We are now almost 1 week post diagnosis. Mimosa continues to be her happy self. I think she is actually feeling better since we started her on pain meds. She is on 50 mg Rimadyl and 50 mg Tramadol, twice daily for both. She roaches a lot. I wonder if that position is more comfortable? Her tumor is on her left femur. We are giving her lots of treats. Just got a sample bag of Waggin' Train jerky duos. She LOVES those. She is putting more weight on the affected leg, so that is good. Sometimes she barely limps.

My kids now know and are of course upset, but understand, and also do not want to put her thru amputation. (No disrespect intended to those who choose to amputate).

Thanks everyone for all the good information. it is comforting.

[greysmom]

None taken. Treatment for our dogs with this horrible disease is an entirely personal decision, based on many factors that no one can know who isn't living with you. What would be invasive and extremely hard on one is a piece of cake for another. And despite everything we do, we can never cure them.

 

Glad you are able to have some really good times with her still.

[a_daerr]

Henry had Round 3 of Doxo today. Getting closer to the finish line!

Anybody planning on doing Greys Rock Fredericksburg this year?

[Guest cas0673]

I have a dilemma. About 3 weeks ago my grey girl Sadie started limping. A few days later a lump appeared at her front left wrist. I took her to the Vet that afternoon. They did xrays of that area. Showing what looked like osteosarcoma, they did X-rays on her lungs etc. area. No masses were there. I made an appointment at a Vet Clinic, 1 hr away, after checking out pricing for an amputation in my area. The Vet Clinic recommended a biopsy to be sure it was cancer. The Vet said that Sadie didn't seem to be in a lot of pain and when she sees dogs with osteosarcoma, it is extremely painful. Sadie has good days where she only slightly limps. And other days, like today where she has a very pronounced limp. Regularly when she lays, she curls her wrists. After the lump appeared, she kept that leg straight out. But now it seems like she bends it when laying down. She is on Rimadyl and Tramadol. But the Vet said those meds wouldn't cover up the major pain from osteosarcoma. Anyway, the results of the biopsy. It didn't show any cancer! Which is good and bad. I am very skeptical of biopsies. I feel it is possible the sampling just didn't get the cancer. I am going on Tuesday to have them re X-Ray her to see if there are any changes in her wrist area. The thing is I don't WANT her to have osteosarcoma, but I was looking for the biopsy to confirm our hunch. And instead , it made all these decisions even harder. I read a post here that Dr. Couto told them basically if it looks like it is osteosarcoma, what else could it be. And that's how I feel, but we also don't want to take her leg if it is something other than cancer. I am even hoping it is another type of cancer instead of osteosarcoma. Which is a low possibility, but a possibility just like it being an infection or mitosis(?). I just want to stay ahead of the osteo because of how aggressive it is. I am also planning on doing the chemo and trying to see if she qualifies for the study in Philly, I am only a little over an hour out of Philly. Any ideas for me on any of this?

[a_daerr]

 

The Vet said that Sadie didn't seem to be in a lot of pain and when she sees dogs with osteosarcoma, it is extremely painful... But the Vet said those meds wouldn't cover up the major pain from osteosarcoma.

I hate when vets make observations like this, because as we all know, every case is different. My boy limped on and off for awhile prior to being diagnosed. Sometimes it was barely noticeable. At first, I was told the same thing... "Oh, there's no way it could be cancer, he'd be in more pain than this." And lo and behold, he DID have cancer. So while I do agree that any cancer affecting the bone is extremely painful, using "pain" as a basis for diagnosis is extremely unreliable.

 

I'd recommend getting a second opinion, either with a specialty clinic that is equipped with an oncology department or with Dr. Couto himself (who is now at Metzgar Animal Hospital near State College, PA). Dr. Couto does consultations by phone and email. Do you know what type of biopsy was done? I'm trying to remember how everything played out for us at the time of diagnosis... I believe the e-vet did a FNA (fine needle aspirate) for Henry, and they confirmed the presence of a generic, malignant tumor. However, the exact pathology wasn't determined until the amputation surgery when the tumor was sent out to the lab. That's when we found out his cancer was spindle cell sarcoma, not osteosarcoma. Anyway, I would also be skeptical at this point too, purely based on your girl's symptoms and the high prevalence of osteo in greyhounds (especially in the wrist area). Even though rare, it could be infection or another type of cancer (which is exactly what happened to us). But I believe the initial biopsy would have at least shown malignant vs. benign cells... someone correct me if I'm wrong on this.

 

As for the osteo vaccine at Penn, I looked into it for Henry, and there are a lot of requirements. The dog has to first be diagnosed with a specific type of osteosarcoma (HER2-NEU) to be eligible. They won't do anything until they get slides from the lab of the biopsy that confirms osteosarcoma. If you do get confirmation of osteo, your next step would be to contact Dr. Nicola Mason for further instructions.

 

Keeping my fingers crossed for your girl and hoping you get some definitive answers soon.

[greysmom]

My boy never limped at all before breaking his leg, and the only signs of pain he exhibited prior to that was some very minor licking at the spot where the break occurred (which we only realized in hindsight). So using pain to diagnose osteosarcoma is unreliable. Most general vets do not have the expertise to do so. I would recommend an exam from a competent veterinary oncologist who is familiar with greyhounds.

 

Even a FNA (fine needle aspirate) can be inconclusive, just because of the reasons you state. If you don't hit the exact spot you don't get any cancer cells to diagnose. And a larger bone biopsy is usually not recommended as it takes too much bone in the sample and can weaken what remains.

 

You can send digital copies of your xrays to Dr Couto and he will read them, usually fairly quickly. And if you take newer ones, they should show significant changes. Osteo is notoriously fast moving. Even if it is another type of cancer - such as what happened with Alicia and Henry - often an amputation will be, if not curative, at the very least it will drastically reduce the exposure for mets and reoccurence.

 

On the other hand, if the rimadyl and tramadol are helping, and the swelling is going down, it may not be cancer. There could be an infection or some sort of foreign body such as a bone chip. This is where an oncologist can really help.

 

Good luck!

[Charlies_Dad]

Sadie's Mom, I'll third that you get Dr Coutu's second opinion on the films ASAP. The cost is minimal for the advice given and he has seen enough Osteo to know whether it is or is not that. As for the biopsy, I hope it was a FNA and not a bone biopsy as the latter is very painful from what I understand. A FNA can also be inconclusive and we chose no FNA for our angel Charlie as I just knew it was Osteo so chose amputation without firm diagnosis but did have Dr. Coutu's second opinion that the films indicated it was. We eventually did have a biopsy on the leg after it was removed and it was confirmed Osteo. I hope Sadie does not have it and rather it's something treatable but it's better to know 100% as you state in your post as the unknown means you don't know what protocol to follow. Good thoughts for your girl.