Osteo Thread Part 8

[Guest fastcasper]

I'm so sorry to hear about Wrigley. Words are not enough to express the sorrow we all go through with this disease.

Why do some Oncologist do 6 rounds of chemo and others do 4 rounds of chemo. What are the benefits, differences, pros, cons to this?? My guys does 6 rounds.

Thanks for you insight on this.

 

Kim

[greysmom]

There is some disagreement as to whether additional rounds of chemo are "useful" or not in controlling the spread of cancer cells. Dr Couto only recommends 4 rounds, but some vets still do 6.

[Teensy]

We lost our Irene on Sunday to osteo. She had just turned 11. Unfortunately, because she was already limping due her spinal cord injury, we could not spot the problem. Because of this she suffered a spontaneous fracture and we let her go. It was the hardest thing I have ever done in my life. The lung X-Ray did not show any metastasis, but because she was in so much pain we really needed to make a decision quickly. We knew that she already had pain in her shoulders, from limping for the last 3 years. She was also very tender in the rest of her spine from disc degeneration. I miss her so much, and I can't help questioning my decision. Even with the limp and the painful cancer that was growing in her leg, she never seemed like an old dog, but that is the nature of cancer. They don't necessarily get to be old. I couldn't think about prolonging her pain so that I could have her prognosis for amputation worked up. My poor sweet angel is gone forever. I am so grateful for this thread. It is good to read the stories of others who have dealt with this and decided not to treat. Somehow I really need to hear that it's okay.

Edited February 2, 2016 by Teensy

[45MPHK9]

It's ok.

[Batmom]

I'm sorry for your loss, Teensy.

 

Under the circumstances, and with your girl's other challenges, I think you made the best decision.

 

We decided not to treat. It was the best decision for our girl. She was young and hale and hearty apart from the cancer, but ... it was the best decision for her.

 

Many many hugs to you.

[Rickiesmom]

Teensy please don't second guess your decision. Cancer and its excruciating pain are the villains. You took your Irene's full condition into account and made a decision that took her pain away, and began yours. My heart goes out to you.

[Teensy]

Thanks, folks. I really can't hear it enough. It is getting easier to bear. The first 24 hours were just brutal.

[MP_the4pack]

She was beautiful. Of the 7 I have at the Bridge, I've second guessed 5. It's just human nature.

 

But you did the right thing.

[NeylasMom]

Thanks, folks. I really can't hear it enough. It is getting easier to bear. The first 24 hours were just brutal.

You absolutely did the right thing. It's the kindest act we get to do for our pets, and by far the most difficult. I know how hard this is right now, but I do hope you take some comfort in the fact that you provided a long happy life for her and when the time came, did what was selfless and best for her. There really wasn't anything you could have done for her at that point given her other orthopedic issues. I do also get the "old dog" thing. Neyla was also 11 when I had to let her go to osteo and you would have never known her age. Aside from a wonky toe, she was healthy and happy - still running and playing, taking long hikes, going on camping trips, etc. I was bitter about osteo stealing what could have been many good years for a long time. So I have some idea of what you are feeling. Hang in there.

[Teensy]

Thanks again everyone. I am feeling better. Every last word of empathy and support has helped make this lighter.

 

Some things are still puzzling me, though. I have been reading some of the other threads, including the one about poor Tilly, and all the stories from those folks who were dealt this diagnosis after noticing their dogs were in pain. Irene had been limping for 3 years, since her spinal cord injury (she had suffered a high velocity low volume disc extrusion while running), so we couldn't have spotted a limp, but she also wasn't showing the signs of pain that the others are reporting (constant pacing, whining, unable to settle). A couple of years ago she after too much walking she was showing those signs of pain, but a course of prednisone got that under control, and if that ever happened again, one dose tramadol and some rest shut it down. I saw the X-Ray. I saw the moth-eaten bone. I know she had cancer. We know she had some neuropathy in that leg, a couple of the reflexes were slow or missing, but I don't remember her showing any signs of loss of sensation, and she was certainly in pain when she fractured, but is it possible that the tumor wasn't causing her that much pain? This is probably unknowable, but has anyone else ever gotten to the point of fracture not knowing that their dog had cancer or even suspecting that anything was wrong?

[dante2zoe]

I did not know that Dante had cancer until I came home to a broken leg. He had corns on several feet and those would cause him to limp at times. Obviously, in hind sight, some of that limping was probably due to the cancer, but I would dremel his corns and the limp stopped. So, who knows. I do know that they are incredibly stoic, unless a blade of grass gets between their toes and then all bets are off . I continue to second guess myself with Dante and it has been 3.5 years. I just hope that he forgave me for missing something. Gah.

 

Many hugs.

[greysmom]

Thanks again everyone. I am feeling better. Every last word of empathy and support has helped make this lighter.

 

Some things are still puzzling me, though. I have been reading some of the other threads, including the one about poor Tilly, and all the stories from those folks who were dealt this diagnosis after noticing their dogs were in pain. Irene had been limping for 3 years, since her spinal cord injury (she had suffered a high velocity low volume disc extrusion while running), so we couldn't have spotted a limp, but she also wasn't showing the signs of pain that the others are reporting (constant pacing, whining, unable to settle). A couple of years ago she after too much walking she was showing those signs of pain, but a course of prednisone got that under control, and if that ever happened again, one dose tramadol and some rest shut it down. I saw the X-Ray. I saw the moth-eaten bone. I know she had cancer. We know she had some neuropathy in that leg, a couple of the reflexes were slow or missing, but I don't remember her showing any signs of loss of sensation, and she was certainly in pain when she fractured, but is it possible that the tumor wasn't causing her that much pain? This is probably unknowable, but has anyone else ever gotten to the point of fracture not knowing that their dog had cancer or even suspecting that anything was wrong?

 

Yes. We had no indication our boy had anything wrong with him until he suffered a broken leg after running in our yard - no limping, no whining, no pacing, no panting, no pain behaviors at all. None. And we were on watch for them because he had had a shoulder/neck pull about 5 months previously. Looking back, we *thought* he might have been licking that leg a little more the last week or so (before the fracture), but neither DH or I could ever say for sure. He was, like most dogs, extremely stoic about pain.

[krissn333]

Carrie's came on so fast. She went from running in the yard to trying to figure out how to walk using only her front legs. I couldn't even figure out what was up - I thought something was up with her toe on that leg.

 

She was fine one day and the next in so much pain I had to let her go.

 

I had three others who had it come on slowly and we knew and had time. I had 6 months with Sutra (palliative care), a year with Pinky (amp and chemo), and 3 months with Fritz (palliative care, his tumor was in his ulna near his elbow-tiny bone. Had it been elsewhere I think we would have had longer).

[Teensy]

Good to know. Irene's tumor was in her right tibia. It was pretty big. The entire distal end up and at least a quarter of the way up were visibly moth-eaten, and spiral fracture just started at the top of the visibly moth-eaten part and went up from there. I didn't think there was any chance it hadn't metastasized, even though they didn't see anything on the lung X-Ray.

[greysmom]

bumping

[Guest asaccamora]

We got word on Friday that our Buffy has a likely primary bone neoplasm in her left humerus. She is 7.75 years old. The radiologist wasn't able to confirm a diagnosis of OSA. We need a biopsy to confirm but the doctor worries about the hit rate. Her chest is clear. We have an appointment with an oncologist on Wed.

 

We took her out for a long walk a couple of weekends ago and she limped the next day. The limp got better but I took her to the vet anyway. A course of rimadyl had the limp gone away but it returned a few days after the Rimadyl ran out. We took X-rays and got the diagnosis.

 

She is back on Rimadyl and Tramadol and her limp is gone and she is in good spirits, she eats, wants her scratches and even wanted to get her a duck or two on her walk.

 

We have been researching the data and if we decide to go with an amputation, the chemo looks to be necessary. The question I have been wondering is how outcomes relate to how early we catch the disease? Any opinions would be appreciated.

Edited April 18, 2016 by asaccamora

[greysmom]

Earlier is always better. And the survival rate between doing chemo and not doing chemo is very clear - the better survival rate usually accompanies a course of IV chemotherapy. The last I heard, the Ohio State Vet School was still providing free chemo for retired racing greyhounds. It's worth looking into.

 

See the first post of this thread for Dr Couto's consutling service. You or your vet can email (or send) xrays and lab results and he will get back to you with his opinion. He is an expert in the field of greyhound osteosarcoma and does hundreds of consults a year. He can also advise you about future treatment options.

 

Your post doesn't say where you are located but there are also several studies going on at various vet/research schools around the country for canine cancer vaccines and treatments that your girl might qualify for. Make sure you talk to your oncologist about the possibility.

 

This is never an easy or clear-cut decision, and there are a lot of things to consider. A big one is how well your girl tolerates being at the vets and being handled, as there will be a lot of this if you go the amp-chemo route. Is your hoome condusive to having a three legged dog? Living in a walk-up apartment would not work well for a tripod. You also need to consider the cost. Even if you have the best pet health insurance, you will still be paying quite a chunk of money.

 

It's alos a total crap shoot. We've had dogs do the whole treatment regimen and not get three months post-op, and others are going on 4 or 5 years, or more. The average is somewhat less than a year. We got nine extra months with our boy, and for the most part, they were nine good months. He was happy and in great spirits up until the day he had to leave us due to spinal metastisies.

 

Good luck. And do keep us updated.

[Guest asaccamora]

Earlier is always better. And the survival rate between doing chemo and not doing chemo is very clear - the better survival rate usually accompanies a course of IV chemotherapy. The last I heard, the Ohio State Vet School was still providing free chemo for retired racing greyhounds. It's worth looking into.

 

See the first post of this thread for Dr Couto's consutling service. You or your vet can email (or send) xrays and lab results and he will get back to you with his opinion. He is an expert in the field of greyhound osteosarcoma and does hundreds of consults a year. He can also advise you about future treatment options.

 

Your post doesn't say where you are located but there are also several studies going on at various vet/research schools around the country for canine cancer vaccines and treatments that your girl might qualify for. Make sure you talk to your oncologist about the possibility.

 

This is never an easy or clear-cut decision, and there are a lot of things to consider. A big one is how well your girl tolerates being at the vets and being handled, as there will be a lot of this if you go the amp-chemo route. Is your hoome condusive to having a three legged dog? Living in a walk-up apartment would not work well for a tripod. You also need to consider the cost. Even if you have the best pet health insurance, you will still be paying quite a chunk of money.

 

It's alos a total crap shoot. We've had dogs do the whole treatment regimen and not get three months post-op, and others are going on 4 or 5 years, or more. The average is somewhat less than a year. We got nine extra months with our boy, and for the most part, they were nine good months. He was happy and in great spirits up until the day he had to leave us due to spinal metastisies.

 

Good luck. And do keep us updated.

Thanks greysmom. We are in San Jose, CA. I did email Dr Couto earlier today and we have the radiology reports and X-rays available online. Buffy is fine with being handled and we have never had any issues there. We understand the crapshoot nature which is why I really want a couple of oncological consults. We did not get her pet insurance but we are also thankfully in a position to absorb the treatment expenses if everything checks out.

 

Aside from that our house is a two floor townhouse. We can baby gate the upstairs and its all carpeted. She likes it there. Downstairs is roomy with plenty of rugs and carpets. I have been carrying her up and down the stairs the past week or so just out of precaution. She doesn't jump or try to get past barricades. This will be tough for all of us. We are just taking it a day at a time. Will keep the thread updated

[LaFlaca]

Two months ago, my 10 year old, Wendy, experienced an episode of shaky back-end after a prolonged and vigorous play time with my son's pit-mix. I took her to the vet, just in case, and x-rays showed a misaligned spinal vertebrae (which may have been there forever; who knows?). Tramadol and an anti-inflammatory seemed to take care of that. Afterwards, she was completely asymptomatic until about 2 weeks ago when she began eating inconsistently. Another trip to the vet for blood work (normal), urinalysis (normal) fecal (normal), temperature (normal) and x-rays of abdomen, lungs, legs/hips and spine. X-rays suggest that there's "something going on" in the misaligned vertebrae and the one next to it. <SIGH> Hoping it is an infection in the bone, Wendy has been prescribed an antibiotic (maybe Clavamox; can't seem to think right now)) and Tramadol for 3 weeks after which we will re-xray and access. Her lack of fever and normal white blood cell count suggests to me that there's no infection present. She seems pretty much herself right now, maybe a little dopey from the Tramadol, and eating a bit better but still inconsistently even with yummy add-ins. Last night I made a beef broth with sirloin to tempt her. This morning, she picked out the pieces of steak and left the kibble...little stinker! Took her meds like a champ encased in pieces of mozzarella cheese and ham. Wendy

 

Is bone cancer relatively easy to identify on x-ray? Does anyone have experience with spinal cancer in Greys? Anything you wish to share would be most appreciated.

 

greysmom - May you be abundantly blessed for gifting us with this thread and all of it's information and encouragement.

[TwiggysMom]

asaccomora - I'm sorry to hear your Buffy likely has bone cancer. It is something no one ever wants to hear. As said already, early intervention is better than late. My girl Twiggy is one of the very fortunate ones. She is now >4.5 years post-amp for osteo, and is her oncologist's longest surviving osteo dog (even though 2 of his own greyhounds had it).

 

We live in a 4-story townhouse with steps in/out of the unit. Until about 2.5 years ago, Twiggy had no problems with stairs at all, and she followed me all over the house. Since then, we live in the downstairs room. (who knew living in one tiny room could be so functional! lol)

 

It sounds like you have the ability to manage Buffy as a tripod very well, and I would also suggest that IF you go with amputation for osteo, you also consider chemo. Most dogs handle the chemo very well since it is used at much lower dosages than in humans (Twiggy had 6 rounds of carboplatin - for her the first 4 rounds were non-symptomatic, and the last one was difficult). Of course, you can always choose to reduce, delay or suspend it if you feel Buffy just can't tolerate it on the planned schedule.

 

LaFlaca - I certainly hope Wendy's (odd for me to type that, as it has always been my name... lol) discomfort is just from overexertion/injury that can heal with rest; no one likes to hear that "something" is going on with the bone. Again, I am no medical professional, but I have heard it said that osteo presents within a bone and not across a joint, so I hope that holds true with your girl.

 

Especially when it is early on, bone cancer can sometimes be tricky to recognize for general practice vets (and even specialists, depending on the case). Twiggy's initial xrays were interpreted by her regular vet (who is fantastic!) as "something, maybe bone infection". I know there is a cost involved, but you might want to consult with Dr. Couto. He is a wonderful resource

[LaFlaca]

Hi Wendy! Thanks for your input, it actually mirrors my own thoughts. I'm not a vet, but I've always thought that bone cancer was fairly obvious on x-ray and my Wendy's vertebrae don't have that typical osteo moth-eaten look. It looks like bone spurs to me, but maybe that's just wishful thinking! For sure I'm going to consult Dr. Couto - at least have him look at the x-rays.

[Guest asaccamora]

 

 

See the first post of this thread for Dr Couto's consutling service. You or your vet can email (or send) xrays and lab results and he will get back to you with his opinion. He is an expert in the field of greyhound osteosarcoma and does hundreds of consults a year. He can also advise you about future treatment options.

 

Your post doesn't say where you are located but there are also several studies going on at various vet/research schools around the country for canine cancer vaccines and treatments that your girl might qualify for. Make sure you talk to your oncologist about the possibility.

 

 

Thanks to your suggestion, I did look up studies and there is a UC Davis trial which is adding rapamycin to the amputation + chemo protocol and we are trying to get Buffy enrolled in that study. I believe Pogo is on the same nationwide study except at UW- Madison.

 

We consulted Dr.Couto and he was very helpful in giving a second opinion and as a sound board for the UCD study.

 

asaccomora - I'm sorry to hear your Buffy likely has bone cancer. It is something no one ever wants to hear. As said already, early intervention is better than late. My girl Twiggy is one of the very fortunate ones. She is now >4.5 years post-amp for osteo, and is her oncologist's longest surviving osteo dog (even though 2 of his own greyhounds had it).

 

We live in a 4-story townhouse with steps in/out of the unit. Until about 2.5 years ago, Twiggy had no problems with stairs at all, and she followed me all over the house. Since then, we live in the downstairs room. (who knew living in one tiny room could be so functional! lol)

 

It sounds like you have the ability to manage Buffy as a tripod very well, and I would also suggest that IF you go with amputation for osteo, you also consider chemo. Most dogs handle the chemo very well since it is used at much lower dosages than in humans (Twiggy had 6 rounds of carboplatin - for her the first 4 rounds were non-symptomatic, and the last one was difficult). Of course, you can always choose to reduce, delay or suspend it if you feel Buffy just can't tolerate it on the planned schedule.

 

Thats great to hear about Twiggy! We are definitely thinking about amputation + chemo as the protocol. Thanks for the vote of confidence .

Edited April 20, 2016 by asaccamora

[llm51807]

 

Thanks to your suggestion, I did look up studies and there is a UC Davis trial which is adding rapamycin to the amputation + chemo protocol and we are trying to get Buffy enrolled in that study. I believe Pogo is on the same nationwide study except at UW- Madison.

 

We consulted Dr.Couto and he was very helpful in giving a second opinion and as a sound board for the UCD study.

 

Thats great to hear about Twiggy! We are definitely thinking about amputation + chemo as the protocol. Thanks for the vote of confidence .

Just wanted to add another treatment option for you to explore. We are 5 months post osteo diagnosis with our 8 yr old boy. It's in the right shoulder and our vet also wasn't sure at first after X-rays. The tumor is proliferative vs lytic, so it doesn't look like typical greyhound osteo on the radiographs. Radiologist confirmed aggressive bone lesion. We did not do the FNA biopsy since multiple opinions concurred most likely osteosarcoma, including Dr Couto. All said it was likely caught early.

 

Our local ortho vet (who studied under Dr. C at Ohio State) suggested looking into Cyberknife vs amputation. We did. Not all dogs are candidates (dogs must have no fractures or even micro fractures and decent bone integrity and clear chest X-rays). Studies and stats are few, but so far outcomes of Cyberknife w/chemo are similar to amputation w/chemo. Cecil is a very large greyhound and while he was a candidate for amp, we felt based on some back-end weakness plus the cancer being in his shoulder vs a back leg, amp would be even more difficult for him. We chose Cyberknife.

 

He received one treatment (equal to about 25 - 30 traditional radiation treatments) under anesthetic on December 20, 2015. We followed up with 5 traditional chemo (carboplatin only) treatments. We could do a 6th, but I don't think we will. No side effects from ANY of these treatments so far.

 

He's on 2 tramadol per day and seems to have no pain. We haven't followed up with a chest X-ray since he started treatment because it wouldn't really change anything and wrestling him onto an X-ray table isn't worth the risk in my opinion. Follow up X-rays of the shoulder aren't recommended since once the tumor has changed bone structure, it doesn't revert back, so X-rays won't show changes even though the tumor is gone (hopefully!).

 

There is a significant risk of fracture in the tumor bone (up to 30-40%), so he will never be off-leash outside again. He goes on walks and is normal in every other way. We will consult with our oncologist about starting zoledronate therapy (bone strengthening drug) next.

 

We have no idea how long we'll have with him, but we have had 5 pain-free, excellent months. I realize that could change in a heartbeat, but we made our choice and haven't looked back. We enjoy every moment we have with him (and he's spoiled rotten!).

 

Con's

- Not removing the osteo limb can be anxiety-inspiring when you don't know for sure if "they got it all."

- High risk of fracture in the first months after treatment

- Cost - all in we're approaching $10K for everything w/Cyberknife around $5K of it (we DO have insurance - Trupanion, who has paid 90% of everything!!)

- Availability - vet clinics providing the treatment are hard to find - we are in OH and traveled 6 hours to suburban Philly for treatment

- Lack of studies and stats on outcomes - it's a bit of a leap of faith

 

Pro's

- It's not amputation

 

Wishing you the best with Buffy.

 

I'm happy to answer any questions you or anyone else reading this thread might have regarding Cyberknife. I haven't posted much on Cecil or his treatment yet, but I plan to provide feedback to our community about Cyberknife as an optional treatment for the horrible osteosarcoma monster. So far so good...5 months in.

[Guest asaccamora]

Just wanted to add another treatment option for you to explore. We are 5 months post osteo diagnosis with our 8 yr old boy. It's in the right shoulder and our vet also wasn't sure at first after X-rays. The tumor is proliferative vs lytic, so it doesn't look like typical greyhound osteo on the radiographs. Radiologist confirmed aggressive bone lesion. We did not do the FNA biopsy since multiple opinions concurred most likely osteosarcoma, including Dr Couto. All said it was likely caught early.

 

Our local ortho vet (who studied under Dr. C at Ohio State) suggested looking into Cyberknife vs amputation. We did. Not all dogs are candidates (dogs must have no fractures or even micro fractures and decent bone integrity and clear chest X-rays). Studies and stats are few, but so far outcomes of Cyberknife w/chemo are similar to amputation w/chemo. Cecil is a very large greyhound and while he was a candidate for amp, we felt based on some back-end weakness plus the cancer being in his shoulder vs a back leg, amp would be even more difficult for him. We chose Cyberknife.

 

He received one treatment (equal to about 25 - 30 traditional radiation treatments) under anesthetic on December 20, 2015. We followed up with 5 traditional chemo (carboplatin only) treatments. We could do a 6th, but I don't think we will. No side effects from ANY of these treatments so far.

 

He's on 2 tramadol per day and seems to have no pain. We haven't followed up with a chest X-ray since he started treatment because it wouldn't really change anything and wrestling him onto an X-ray table isn't worth the risk in my opinion. Follow up X-rays of the shoulder aren't recommended since once the tumor has changed bone structure, it doesn't revert back, so X-rays won't show changes even though the tumor is gone (hopefully!).

 

There is a significant risk of fracture in the tumor bone (up to 30-40%), so he will never be off-leash outside again. He goes on walks and is normal in every other way. We will consult with our oncologist about starting zoledronate therapy (bone strengthening drug) next.

 

We have no idea how long we'll have with him, but we have had 5 pain-free, excellent months. I realize that could change in a heartbeat, but we made our choice and haven't looked back. We enjoy every moment we have with him (and he's spoiled rotten!).

 

Con's

- Not removing the osteo limb can be anxiety-inspiring when you don't know for sure if "they got it all."

- High risk of fracture in the first months after treatment

- Cost - all in we're approaching $10K for everything w/Cyberknife around $5K of it (we DO have insurance - Trupanion, who has paid 90% of everything!!)

- Availability - vet clinics providing the treatment are hard to find - we are in OH and traveled 6 hours to suburban Philly for treatment

- Lack of studies and stats on outcomes - it's a bit of a leap of faith

 

Pro's

- It's not amputation

 

Wishing you the best with Buffy.

 

I'm happy to answer any questions you or anyone else reading this thread might have regarding Cyberknife. I haven't posted much on Cecil or his treatment yet, but I plan to provide feedback to our community about Cyberknife as an optional treatment for the horrible osteosarcoma monster. So far so good...5 months in.

Thanks for the information on the CyberKnife. We are now planning on taking her to UC Davis on Monday for a workup and take it from there. We will explore if Buffy is a good candidate for SRS.

 

I am happy to hear about your Boy. We were aware of the cyberknife since one of our family members works for the company that makes the robots.I will pass along your story which I am sure they will be delighted to learn.

 

Locally, UC Davis has Varian which is similar but apparently not as good as a CyberKnife. In consulting with vets locally, the closest is in LA which is a long way away. Most vets around recommend radiation as a palliative and not a curative.

Edited April 20, 2016 by asaccamora

[Guest asaccamora]

Buffy didn't get into the study due to a couple blood values being below acceptable thresholds. The folks at UC Davis were super and got Buffy in for an amputation yesterday. They are keeping her for a couple of days for recovery. We might still consider administering Rapamycin out of pocket. Thanks for all your support.