Osteo Thread Part 8

[Guest HoundSmitten]

Hi everyone,

 

I'm fairly new here, was referred over to this thread from the Health and Medical discussion. My vet found a bad lytic lesion on my Bodhi's right front leg yesterday, at the site where he had broken it badly 3 years ago. The wrist joint is pretty well destroyed. Vet says it's either OS or Valley Fever, took blood to rule out Valley Fever and we won't get the results back for 3-5 days, though he seems to be leaning toward OS. I'm heartsick and terrified, and trying to figure out what to do next. At the advice of folks on the other thread I have emailed Dr. Couto, but haven't heard back yet. Does anyone here know what kind of information he will need for a consultation? So far we only have the one xray of the joint. I know we'll need a chest xray, what else does Dr Couto want?

 

My vet is very discouraging. He said I might have to put Bodhi to sleep as early as next week. He also said that dogs of this size and age (7 years old) don't do well with amputations, but I've read lots of posts from people whose dogs have done pretty well as tripods, so I don't know what kinds of things my vet has seen that make him say this. I've known him for years, and have always trusted him, but he seems to really be rushing to euthanize before we have explored this very much at all. He did say that the bone could break at any minute, so I am keeping Bodhi confined to one floor of my (small) condo, and am carrying him downstairs to the yard just for toileting and carrying him right back in again. I'm so scared that I will hurt him more.

 

He hasn't tolerated NSAIDs well in the past, we just have him on Tramadol right now while we are waiting to get test results. It keeps him pretty well knocked out. He won't stand at his food bowl, but he eats readily when I hand feed him while he is lying down. I'm worried he won't eat or drink enough because it's painful to walk to the bowls on his own. He is a good weight right now, it's only the last day or two that he has shown any disinclination to eat. He's definitely enjoying all the treats I'm spoiling him with!

 

I read that I should switch him to a low-carb diet if it is OS--can anyone recommend specific good quality foods I can look for? Treats?

 

I don't know what I should be doing for him during this waiting period. Does anyone have any suggestions? I'm so scared and upset, but I'm trying to think as clearly as I can and do what needs to be done. I just don't know what that is. I know most of you have probably felt what I'm feeling now. My heart is breaking. But I want t make sure this is about what Bodhi needs, not what I need.

 

Please, if anyone has any advice, suggestions, anything that can help, I'd be very grateful. Thank you so much,

 

Ann

[vjgrey]

I need to find some time to sit down and write a full update, but Diamond, my ten and a half year-old is ROCKING life as a tripod. It's absolute nonsense to say they can't do it at seven.

 

For what it's worth, our Oncologist says there's no evidence that a low-carb diet helps at all.

 

The most important part right now is to control his pain (I agree with others that Tramadol isn't enough) and to limit his activity so you lessen his risk of a break.

 

So sorry you're facing this awful diagnosis.

[greysmom]

Research is changing so fast, and even things that were standard procedures only three years ago when our greyhound went the amp route have now been shown to not make that big a difference. The low carb diet is one of these things. If he's on a food right now that he's doing well on and will eat, I would not change it until you have a clearer idea of what you're going to do.

 

Seven isn't that old for a greyhound. I'm also wondering what kind of experience your vet has that leads him to say this, because it certainly is not our experience here. I would venture to say that the number of dogs who have been treated for osteo who are eight years or older is more the norm than younger dogs. Our Dude was nine when he was diagnosed. Greyhounds seem to adjust very well to life as a tripod, after an initial adjustment period. If your dog is generally healthy otherwise - no problems in his other legs or hips or spine - he could be a good candidate for amputation surgery. This surgery isn't curative, it only takes away the hideous bone pain that osteo causes, and give them, on average, another 6-9 months of good quality life.

 

Don't be stingy with the pain meds. Tramadol has a wide safe dosing range, and if he tolerates it well, you should watch him carefully for any panting, limping, or reluctance to get up. Current osteo pain management usually consists of tramadol, the nerve pain drug Gabapentin, and an nsaid. Which nsaids has he tried that he has not done well on?

 

As I believe I suggested in your other thread, look up a veterinary oncologist in your area. This doctor should be able to better help you decide on a way forward.

Edited June 19, 2014 by greysmom

[JJNg]

My vet found a bad lytic lesion on my Bodhi's right front leg yesterday, at the site where he had broken it badly 3 years ago. The wrist joint is pretty well destroyed. Vet says it's either OS or Valley Fever, took blood to rule out Valley Fever and we won't get the results back for 3-5 days, though he seems to be leaning toward OS. I'm heartsick and terrified, and trying to figure out what to do next.

 

Your comment that "the wrist joint is pretty well destroyed" makes me wonder about the diagnosis. There are other types of cancer or tumors that can affect joints, but osteosarcoma typically does not cross joints. It's usually confined to the bone itself. Can you get a digital copy of the x-ray to post here? I'm glad you're consulting with Dr. Couto. He should be able to start the consult with just the x-ray that you have now, and any other medical history you can provide.

 

Does your vet have a lot of experience with greyhounds? Most greyhounds do quite well with amputation. Is there a physical reason your vet things Bodhi will not? Any other problems, like obesity, severe arthritis in any of his other legs, or any other spinal or orthopedic issue? If not, and chest x-rays are clear, I don't see why amputation wouldn't be an option.

 

Regardless of what the Valley Fever test comes back as, I'd consider getting a 2nd opinion locally in addition to Dr. Couto. If you have a referral center within a reasonable distance, it would be best to consult with a internal medicine or oncology specialist.

[Guest HoundSmitten]

Thanks everyone. This all just happened yesterday and I was so shocked, I wasn't thinking very clearly and hadn't done any research on it yet. I will talk to my vet tomorrow and see if he can phone a prescription for more pain meds to my local drugstore. I live quite far away from him. I really don't know what his experience with sighthounds is. I used to live in this area years ago, and had gone to him with other (non-sighthound) dogs and he was always very good, I trusted him a lot. Sighthounds aren't very common around here, so I don't know that any of our local vets have seen many. seeh2o gave me a contact for a vet her friend has used about 40 miles from me.

 

I definitely plan to find a local oncologist, if that is possible. I live 30 miles from Las Vegas, so there should be one in a city that size. When I lived there several years ago I was referred to an itinerant oncologist for another dog, a vet who came in one day a week from Phoenix AZ. If that guy is still coming around, I might seek him out. I would expect a Pheonix vet to have more experience with greyhounds. My current vet had given me that referral, so he will know if the guy is still available.

 

Bodhi is a very healthy dog, otherwise. He has had a lot of trouble with this leg. He broke it quite badly just above the wrist 3 years ago. Both ulna and radius snapped in an open fracture. He had an external frame on it for several months, and there was at least one infection during the healing process. He eventually recovered well, had physical therapy and seemed pretty sturdy, always favoring that leg slightly. 2 years ago he got into a fight with a neighbor cat who clawed that same leg (at about the same spot) very badly. He had a lot of stitches, a splint to keep the stitches from pulling out, antibiotics, and Tramadol, and it all healed very well within the normal time frame for something like that. No other problems, but then over the past year we've seen arthritis setting in at the site. As far as I know he doesn't have arthritis anywhere else. He's a good weight, and has not had any other illnesses or problems.

 

The problems he had with NSAIDs were when he had the broken leg. He was on a lot of meds then, 2 antibiotics, a couple of different NSAIDs at different times, an anti-nausea med, Tramadol, and maybe something else. I will try to look up those records. I remember he lost his appetite entirely and I had to work really hard just to get enough food down him to give him his meds with. He was very stoic the whole time, but I know he was unhappy and in some pain for at least part of the time.

 

I could be mistaken about it being the joint that is destroyed, it may be just above the joint, but so close to it that it looks like the joint to me. I don't know how to read an xray. Will the vet just give me a digital copy to share here and with Dr Couto?

 

I just now had slipped out for a much-needed yoga class. When I got home Bodhi was all happy to see me and excited about going outside to pee, I had to physically stop him from breaking into a run at one point. He came in after and ate a big bowl of food, so he seems to be doing okay with the Tramadol right this minute. It is close to time to give him the next one.

 

I am wondering whether it is possible to splint the leg to keep it from breaking until we take whatever the next step is. Does anyone know if that is ever done? Or is that not effective?

 

Thanks so much for your support. It really is helping me cope with this. There's so much to sort through.

[Charlies_Dad]

Yes your vet should be able to provide you a digital copy of the x-rays. You will need those for Dr Coutu plus there are vet and vet techs on this forum, Jjng is a vet.

 

As for going the amputation path, it's to remove the pain, it does not cure anything but if one is lucky your pup can have many months of quality life pain free. It is a gamble but as long as your pup is healthy otherwise and financially you can handle it, it's a viable solution. There are other treatments other than amputation that can also help extend your pups life and ease the pain somewhat and they are less expensive however the time your pup has will usually be less than going the amp path.

 

Good thoughts for your boy and you as we know what you are going through as our angel Charlie was diagnosed in his left rear leg at 7 yrs old and we chose amp and chemo for him. He was healthy and we could afford it and ended up with another incredible 21 mths with him. He loved life as a tripod and had no problems keeping up with his four legged brother.

[a_daerr]

The x-ray from your vet should be on a CD as a picture file. If it's a PDF or something, you can take a screenshot and make it a photo. Then, that's what you'll send to Dr. Couto. I'd start with that, and he'll tell you if there's anything additional needed. I will actually be seeing Dr. Couto this weekend at the NAGAP Conference in Pittsburgh, where he's doing a speaking engagement. It may take him a few extra days to respond because he's traveling.

 

As for diet, I think it would be a bad idea to switch foods at this point. Doing that could be very hard on the stomach. Factor in the nausea and diarrhea that come with whatever combination of pain meds he's on, and he could become very ill. As someone else said, the research is changing all the time. I haven't seen any well-documented research that says kibble with carbs makes any difference during cancer treatment. FWIW, my boy ate IAMS through his treatment (still does), and he did just fine.

 

I don't want to discredit your vet in any way, but I think it's absolutely ridiculous to suggest a 7-year-old otherwise healthy dog would not do well with amputation. My boy got his amp at 5-years-old, but I think we're the exception. Most tripawd greys I've met are 8, 9, 10, 11, 12+ I would consider a 7-year-old a pretty young dog, unless there was some other mobility issue in the spine or the remaining legs. Very odd that he'd say that.

 

Lastly, there is a chance you may not be dealing with OS. It's a bit coincidental (although not impossible) that OS would pop up in the exact same spot where the bone broke, given that this injury occurred several years ago. I'd wait to see what Couto says to confirm what you're seeing on x-ray is in fact an osteolytic lesion. There's a possibility it could be a shadow or some inconsistency in the bone based on the prior injury. Many people on this board have needed two or three sets of films before a decision could be reached. In other less-common cases, osteolytic lesions have turned out to be Valley Fever, bone infections, and other types of cancer (as in the case of my Henry, who was originally diagnosed with OS, but ended up having a rare type of fibrosarcoma, which was much more treatable). These are all reasons not to rush to euthanasia before you have complete answers.

 

Obligatory tripawd photos up next! This is what helped me through Henry's cancer journey, because sometimes you need a reminder of how well they do on three...

 

The day of the amp, our friends came to the vet and threw Henry at 'tripawd to be' party.

 

 

And after. Here he is at the GIG Blur of Fur. He ran 29 MPH, which was three miles FASTER than his four-legged greyhound brother.

 

Edited June 19, 2014 by a_daerr

[greysmom]

Henry!

[Guest HoundSmitten]

Oh, Henry's beautiful! You must be so proud of him for his courage and his brilliant recovery.

 

Thank you for your input. I have been reading about chronic osteomyelitis, and if ever there was a candidate for that, it's Bodhi. But I also think I've read that OS can occur at the site of a prior iinjury. I will just have to push for the rule-out, but it may be that we won't know what it is until surgery. If he's lucky enough to be a candidate for surgery.

 

And thanks, a_daerr, for letting me know about Dr Couto's travel schedule, I won't look for an immediate reply. That gives me time to gather up whatever he needs and write up a good history of Bodhi's injuries and recoveries.

 

Everyone is so helpful, thank you all so much. I will update as I can. Am waiting for a callback about more pain meds.

[Guest cas0673]

Charlie's Dad, after the chemo treatment, did Charlie go on some sort of drug/pill that they want to put them on? I have been waiting for a long while to hear from the Doctor at the University of Penn to see my girl would get into the osteo study there. But I am tired of waiting, and was thinking about calling the oncologist about starting her on the drug.

 

Also, my girl is doing great with three legs! But I also said that if this happened to our other grey, we probably would think long and hard about having his leg amputated. He isn't as spry and I don't think he would enjoy life. Our girl was always very light on her feet. I knew she would be able to do it!!

[JJNg]

The problems he had with NSAIDs were when he had the broken leg. He was on a lot of meds then, 2 antibiotics, a couple of different NSAIDs at different times, an anti-nausea med, Tramadol, and maybe something else. I will try to look up those records. I remember he lost his appetite entirely and I had to work really hard just to get enough food down him to give him his meds with.

 

If he was on a lot of meds at the time, are you sure it was the NSAIDs that caused him to lose his appetite? Might have been the antibiotics as well. If a loss of appetite was the only issue, and possibly not even due to the NSAIDs, I wouldn't rule out their use for the current problem.

 

Regarding splinting the leg, that's not typically done, but could be considered if the dog tolerates it well and you're careful to watch for pressure sores. A removable brace would probably be more convenient than a standard splint. Something along these lines might work, but it would have to go high enough to support the affected area. Incorrect fitting could actually make things worse by putting pressure on the weak area.

https://www.orthovet.com/product/orthovet-carpal-splint/

[Charlies_Dad]

Charlie's Dad, after the chemo treatment, did Charlie go on some sort of drug/pill that they want to put them on? I have been waiting for a long while to hear from the Doctor at the University of Penn to see my girl would get into the osteo study there. But I am tired of waiting, and was thinking about calling the oncologist about starting her on the drug.

 

Also, my girl is doing great with three legs! But I also said that if this happened to our other grey, we probably would think long and hard about having his leg amputated. He isn't as spry and I don't think he would enjoy life. Our girl was always very light on her feet. I knew she would be able to do it!!

We put Charlie on Palladia which at the time showed some positives in research about controlling/reducing mets but I believe now the research shows it has no benefit. It is also a very expensive drug costing us $350/mth.

[nessa]

Hello,

 

Has anyone heard of using Alendronate ( also called Fosamax) a pill form similar to the pamidronate that is given by IV? I have huge concerns with the IV treatment, the time it takes, the emotional toll it takes in keeping my dog calm and still ( for my dog and me). I was wondering if there is a pill form and read about this Alendronate which is also a bisphosphonate drug like pamidronate?? Thanks in advance.

Edited June 21, 2014 by nessa

[Rickiesmom]

Quick update on Jaynie. Her back is much better, disc fragment is confirmed (vs. tumour), and we have been able to slowly wean down the pain meds, though she is not yet ready to stop entirely. Very happy she does not seem to need steroids.

 

We also started rehab yesterday, mainly laser to the affected area (lumbar-sacral junction).

 

My understanding with laser is that it is very local and focused in scope, so applying it to that area of her spine should not encourage growth of any cancer lesions, for example, in her lungs. Someone please tell me if this is incorrect.

 

Her third Carbo treatment was scheduled for this past Thursday but had to be deferred until next week due to low neutrophils - not terribly low, so hopefully all will be OK in a few days.

[JJNg]

Has anyone heard of using Alendronate ( also called Fosamax) a pill form similar to the pamidronate that is given by IV?

 

Most of the studies have only looked at pamidronate, so there's a lot less information about alendronate. The only published report I could find was about a couple case reports where it did seem to help. I think some oncologists have tried it as an alternative, but absorption seems to be less consistent than with pamidronate, so from a medical standpoint, the IV administration is still considered the better option.

 

Here's the one report I found. You can view the full text even if you don't register.

http://www.researchgate.net/publication/12362511_Use_of_the_bisphosphonate_drug_alendronate_for_palliative_management_of_osteosarcoma_in_two_dogs

[Charlies_Dad]

Happy to read that Jaynie is doing better! Keep it going girl.

[nessa]

Thank you so much JJNg. I wonder as long as it does not hurt her, and maybe... help her, it is an option. ?!

[JJNg]

Thank you so much JJNg. I wonder as long as it does not hurt her, and maybe... help her, it is an option. ?!

 

Since the pamidronate administration doesn't sound like it's a good choice, it might be worth a try. Talk to your vet about it, and they should be able to do some research and find a dose for her.

[greysmom]

Bumping

[Rickiesmom]

Well, after 3 chemo treatments without significant side effects, the nasty side of this has finally caught up with us. Jaynie had a Carbo treatment on Tuesday. She was feeling kind of punky yesterday, but did eat with the help of some goodies added to her food. Then during the night she vomited twice, and also has diarrhea.

I've got her on Reglan and Metronidazole. Next dose of Reglan is a little later this afternoon, and awhile after that I'll try some bland food. Went shopping this morning to get a variety of items, as kidney-safe as possible, so hopefully something among them will entice her.

Meantime she has mostly been sleeping, which is good. She has been drinking water when she's up so for now I am not too concerned about dehydration, though it's sometime I am watching. Her temperature is normal.

Please think good thoughts for my girlie, I hate seeing her like this.

[a_daerr]

Can you ask your vet for Cerenia for Jaynie ?

[Rickiesmom]

I thought Cerenia was an anti-emetic like Reglan, but have no experience with it. How will it help her? I can certainly ask for it, thank you.

[a_daerr]

Cerenia is an anti-emetic, but according to my vet, it's the first choice for prevention of nausea in chemotherapy dogs. We got packs of four pills (one given the day of chemo, then one each day afterwards for three days). It's not cheap, I want to say it was around $50 each time. But Henry had very minimal problems on it, even after his fourth and fifth rounds. You can also get it in injectable form if the dog is already really ill.

[greysmom]

(According to my vet) Cerenia was initially developed to treat car sickness in dogs, and helps with any sort of nausea. It affects the area of the brain where nausea develops.

 

We did the same thing when Dude was on chemo - a pill the morning of, and then for three days after. It really helps. Sometimes he didn't want to eat, but he never got to the throwing up point.

[a_daerr]

For the past week, Henry hasn't had much of an appetite. We also noticed a few instances of coughing that sound almost like hiccups. I hope I'm overreacting, but my first thought was lung mets.

 

He's due for chest x-rays, so we have an appointment coming this week. Is there any additional testing I should be doing? He's always been a good eater, so I'm definitely concerned.