Osteo Thread Part 8

[NeylasMom]

There are a few types of units/brands that are equipped for stereotactic radiation-cyberknife is only one-Varian Trilogy is another.....

It doesn't really apply to your case when radiating a limb but, you need to choose the correct machine when you are concentrating on a moving body part like lungs mets (breathing).

So the machines aren't delivering different strengths, number of beams, etc.? That was my impression, but I really am not clear.

 

I double-checked with my radiation oncologist's receptionist - the vet is out today, but she did reach him and he is going to call me at some point today, I just don't know when. I also tried the Cyberknife facility again with no luck so called Hope and spoke to someone there. She assured me that Julie is good at returning calls so hopefully she will respond today. She did say that the Dr didn't have a consult opening until Wednesday so I suspect it won't be a better option.

 

In the meantime, I need to get work done.

[Annette]

I never posted Pogo's update to this thread.

 

On Tuesday Pogo was back in Madison for a check-up since the mets were found on his lungs at the beginning of May. It was a long day because they basically had 2 days of appointments crammed into one day because of the holiday.

 

Pogo's oncologist was actually making rounds in the waiting room (the exam/consultation rooms were all occupied) to speak to the parents of the "fur kids" he was taking care of. As he came towards us, he had a smile on his face. At the beginning of May, Pogo had 5 mets on his lungs. On the 31st he had 4 mets. Overall 3 of the mets are gone, 2 shrunk in size, and 2 small ones appeared. For now Pogo has stabilized.

 

His oncologist also said Pogo's blood pressure was high at 202. He sent us home with Amlodipine and Benazepril. We kinda doubt he has "whitecoat syndrome" since he bounces, smiles, and loves on all the "whitecoats" he can get a hold of. Dr. Couto has emailed me information on Greyhounds and high blood pressure that I have forwarded to Pogo's oncologist at the UW.

 

We have no idea what has caused 3 of his mets disappear and 2 to decrease in size. We are now treating him with Palladia. Pogo was part of the rapamycin study (he was half way through the treatment) until the mets appeared on his lungs. Before the rapamycin, Pogo had 4 carboplatin treatments. Since the study is basically an experiment, is it possible we are experiencing some sort of delayed reaction to the rapamycin? I don't know and I don't think Pogo's oncologist at the vet school knows either. I have been keeping Dr. Cuoto up-to-date with Pogo and he has only seen mets shrink in OSA patients a couple times. We are just so happy and are hoping that this isn't just a fluke.

[llm51807]

So the machines aren't delivering different strengths, number of beams, etc.? That was my impression, but I really am not clear.

 

I double-checked with my radiation oncologist's receptionist - the vet is out today, but she did reach him and he is going to call me at some point today, I just don't know when. I also tried the Cyberknife facility again with no luck so called Hope and spoke to someone there. She assured me that Julie is good at returning calls so hopefully she will respond today. She did say that the Dr didn't have a consult opening until Wednesday so I suspect it won't be a better option.

 

In the meantime, I need to get work done.

This is a question I'd ask Julie when she calls back. I know the names are just different brands of machine, but I'm sure there's something about them that makes them different...whether that's just marketing or actual engineering/mechanics, I don't know.

 

Julie will get back to you - I left a message and then also called Hope. I think I scheduled my phone consult just to get on Dr Haney's calendar and then talked to Julie the next day when she called back.

 

 

 

I never posted Pogo's update to this thread.

 

On Tuesday Pogo was back in Madison for a check-up since the mets were found on his lungs at the beginning of May. It was a long day because they basically had 2 days of appointments crammed into one day because of the holiday.

 

Pogo's oncologist was actually making rounds in the waiting room (the exam/consultation rooms were all occupied) to speak to the parents of the "fur kids" he was taking care of. As he came towards us, he had a smile on his face. At the beginning of May, Pogo had 5 mets on his lungs. On the 31st he had 4 mets. Overall 3 of the mets are gone, 2 shrunk in size, and 2 small ones appeared. For now Pogo has stabilized.

 

His oncologist also said Pogo's blood pressure was high at 202. He sent us home with Amlodipine and Benazepril. We kinda doubt he has "whitecoat syndrome" since he bounces, smiles, and loves on all the "whitecoats" he can get a hold of. Dr. Couto has emailed me information on Greyhounds and high blood pressure that I have forwarded to Pogo's oncologist at the UW.

 

We have no idea what has caused 3 of his mets disappear and 2 to decrease in size. We are now treating him with Palladia. Pogo was part of the rapamycin study (he was half way through the treatment) until the mets appeared on his lungs. Before the rapamycin, Pogo had 4 carboplatin treatments. Since the study is basically an experiment, is it possible we are experiencing some sort of delayed reaction to the rapamycin? I don't know and I don't think Pogo's oncologist at the vet school knows either. I have been keeping Dr. Cuoto up-to-date with Pogo and he has only seen mets shrink in OSA patients a couple times. We are just so happy and are hoping that this isn't just a fluke.

 

Wow - very good news about disappearing and shrinking lung mets. Really have to wonder if the rapamycin had something to do with it.

[NeylasMom]

I talked to both Julie and my doctor. Cyberknife is always one treatment instead of 3 for osteo. The trade off is the dog is sedated for much longer during that treatment than any of the individual ones with the machine here so in the end not a huge difference in overall time spent under, but for us the fewer treatments makes the Cyberknife the better option. All other things seem to be pretty equal from what they could tell me. So SR down here is out, Cyberknife is a possibility.

 

With Cecil, what were your instructions regarding limiting activity and for how long immediately after treatment? And did they give you the same % for increase in risk of fracture? He told me for the SR here it's about a 35% increase with about half of those being in the first 6 months and the other half being later on (those ones presumably from radiation damage to bone). Julie said she thought we'd be advised to avoid jumping, stairs and running for 2-3 weeks post treatment to prevent fracture and while I can prevent running, I can't prevent the others.

 

To be honest, I thought the benefit of SR was not just increases survival time, but better/stronger palliative benefits, but what I'm hearing is that's really not true. Lots to think about, but I think I'm still going to land on the palliative option being better for us.

 

By the way, Julie knew exactly who you were when I mentioned being referred and also remembered Murray.

[45MPHK9]

By the way, Julie knew exactly who you were when I mentioned being referred and also remembered Murray.

Murray

 

Those folks at Hope and Veterinary Cyberknife Center are amazing. We were lucky enough to meet Lori and Cecil (and Jet and Gino) when they were here for the treatments. Cecil is supremely handsome. Good luck with whatever you decide, Jen.

Edited June 4, 2016 by 45MPHK9

[llm51807]

I talked to both Julie and my doctor. Cyberknife is always one treatment instead of 3 for osteo. The trade off is the dog is sedated for much longer during that treatment than any of the individual ones with the machine here so in the end not a huge difference in overall time spent under, but for us the fewer treatments makes the Cyberknife the better option. All other things seem to be pretty equal from what they could tell me. So SR down here is out, Cyberknife is a possibility.

 

With Cecil, what were your instructions regarding limiting activity and for how long immediately after treatment? And did they give you the same % for increase in risk of fracture? He told me for the SR here it's about a 35% increase with about half of those being in the first 6 months and the other half being later on (those ones presumably from radiation damage to bone). Julie said she thought we'd be advised to avoid jumping, stairs and running for 2-3 weeks post treatment to prevent fracture and while I can prevent running, I can't prevent the others.

 

To be honest, I thought the benefit of SR was not just increases survival time, but better/stronger palliative benefits, but what I'm hearing is that's really not true. Lots to think about, but I think I'm still going to land on the palliative option being better for us.

 

By the way, Julie knew exactly who you were when I mentioned being referred and also remembered Murray.

I can't remember what the exact instructions were after the treatment, but from what I've read and also what Dr. Haney told us, the fracture stat was 30% in the 1st 6 months. After that, the bone actually starts to strengthen supposedly. We traded our SUV for a minivan a week after Cecil was diagnosed so he didn't have to jump into the back. We have no steps in the house, so no going up/down offleash and for the most part, Cecil is a pretty chill guy. He's been pretty easy to control, but he will get a little randy every once in a while and sprint from the dining room to the back door; we work on keeping that to a minimum as well, but there's only so much we can do. I doubt he'll ever be offleash again, and that's very sad for us; he loved to run.

 

We're approaching the six month mark and Cecil had no pain up until about a month ago. He limps now but doesn't seem to have any pain when not weight-bearing. He's hungry and happy and even still wants to go on walks. That said, we hadn't X-rayed since December, so we got a look this week; I was afraid the tumor was growing and the bone was highly damaged. Our ortho vet saw some changes, but didn't really know if it was him laying down new bone and/or radiation result. She sent to Dr Haney and she thought the Xray looked good and didn't think it was active tumor and saw no fratures, but thought it was new bone growth and radiation remnants. She did say the 1st 6 months were the weakest time for the bone and Cecil may have a small injury. She advised to stay to course on the zoledronate treatments, Rimadyl and tramadol.

 

So, as far as we know, the SR treatment was curative for the tumor in the shoulder. That said, he still has some pain, we're hoping it's an injury that will heal and REALLY hoping the zoledronate will help. Dr. Haney did tell us that many dogs have no more pain after the treatment. Cecil didn't have pain going into it, so I can't really judge how effective it was on that front. At this point, this could be bone pain from the tumor or could be injury. Hard to say.

 

His pain is controlled and the fracture risk doesn't seem any greater than it was when he was diagnosed.

 

I'm still glad we made the choice we did for Cecil with his personality. Honestly though, if it was our other boy, Jet, I would be extremely nervous about the fracture risk. He's a maniac greyhound and almost impossible to settle down. He jumps and zooms and romps in the house and is quite anxious without sufficient exercise.

 

Hope this helps. Wish I could be more definitive for you.

[llm51807]

Murray

 

Those folks at Hope and Veterinary Cyberknife Center are amazing. We were lucky enough to meet Lori and Cecil (and Jet and Gino) when they were here for the treatments. Cecil is supremely handsome. Good luck with whatever your decide, Jen.

Thanks for photo post and the compliment! He's a pretty handsome dude and the best snuggler I know.

 

And BTW, I rationed my Sly Fox 360 and just drank the last one the other day. I've looked for it a few times while I was in PA, but haven't been able to find it. Heading to Harrisburg next week, so I'll try again!

[NeylasMom]

We decided on the palliative radiation. The increased risk of fracture was just too great for me, especially since Zuri is reckless on stairs, etc even when in pain. He just had his first treatment and is starting to wake up. He'll have the second/last tomorrow at 9 am. I'm really hoping this gives him goof pain relief. He's actually been doing slowly and steadily better pain-wise since Thursday so that gives us a little wiggle room until the radiation can hopefully take effect.

[llm51807]

I'd love to hear how Pogo and Zuri are doing.

 

The update on Cecil is not great. He continues to limp and it's gotten worse. There was a short time before we started the gabapentin that he was painful getting up and lying down and letting out quiet little yelps, but that resolved shortly after the new pain meds kicked in. Ortho vet said limping does not necessarily mean pain (I'm not sure I get that), but he is still the same boy and his zest for snuggling in bed, tricks and treats, rides, walks, and mealtime are the same. No panting and anxiety; just that limping.

 

He's had 2 zoledronate treatments and he's gotten worse since we started those - that could just be a coincidence, but I'm not sure. Probably won't do another.

 

Ortho vet and Cyberknife vet both think the X-rays show very little change since before Cyberknife in December, so they think small injury from radiation weakness. We just don't know for sure.

 

We'll stay the course on his current meds which are homeopathic remedies from Dr. Loops, curcumin, arteminisin, Rimadyl, tramadol, and gabapentin. We've got room to go on the pain meds so we an add to the doses if necessary, but it doesn't seem like adding pain meds will stop the limp. I'm going to take him to a vet who does acupuncture and chiro work. Cecil has a history of neck issues and his gait is so off right now it can't be helping.

[Annette]

I'd love to hear how Pogo and Zuri are doing.

 

The update on Cecil is not great. He continues to limp and it's gotten worse. There was a short time before we started the gabapentin that he was painful getting up and lying down and letting out quiet little yelps, but that resolved shortly after the new pain meds kicked in. Ortho vet said limping does not necessarily mean pain (I'm not sure I get that), but he is still the same boy and his zest for snuggling in bed, tricks and treats, rides, walks, and mealtime are the same. No panting and anxiety; just that limping.

 

He's had 2 zoledronate treatments and he's gotten worse since we started those - that could just be a coincidence, but I'm not sure. Probably won't do another.

 

Ortho vet and Cyberknife vet both think the X-rays show very little change since before Cyberknife in December, so they think small injury from radiation weakness. We just don't know for sure.

 

We'll stay the course on his current meds which are homeopathic remedies from Dr. Loops, curcumin, arteminisin, Rimadyl, tramadol, and gabapentin. We've got room to go on the pain meds so we an add to the doses if necessary, but it doesn't seem like adding pain meds will stop the limp. I'm going to take him to a vet who does acupuncture and chiro work. Cecil has a history of neck issues and his gait is so off right now it can't be helping.

 

Pogo is still a pogo stick. He is happy and eats like a pig. His energy can sometimes be a detriment since he hurt his neck shortly after we adopted him (less than 2 years ago) by leaping onto the door stoop and crashing into the door. Tuesday he was doing a lot of yelping and we hope that it is just his old injury coming back to haunt him. I do think it is a good possibility this is the reason because Miss Miriam had two lumps removed on Monday and now she is wearing the cone of shame. Miriam is miserable wearing it and when she gets up, all she does is hang her head when she walks. Pogo has had to leap out of the way several times because of this. I am guessing he strained his neck somehow when doing that. Luckily the biopsy reports came back as negative for cancer on Miriam's lumps.

 

We will be back in Madison on the 30th for his monthly check up. Keeping our fingers crossed. Pogo is strictly on Palladia now because the lung mets disqualified him for the rapamycin study. He made it 1/2 through the study before the mets showed up.

[45MPHK9]

Lori, sending you and Cecil a hug.

[NeylasMom]

I'd love to hear how Pogo and Zuri are doing.

 

Thanks for asking about us. We're hanging in there, but not where I'd hoped either. Yesterday was 2 weeks since Zuri finished his 2 palliative radiation treatments and so far I don't see any clear signs that it's helping. We had our oncology recheck yesterday and she reiterated that for a small number of dogs it can take longer so we won't call it for another week or two, but honestly I am not optimistic. Its frustrating since he came through the treatments with flying colors and was doing so well for almost a week afterward.

 

We planned to repeat Zoledronate yesterday, but his kidney values were *slightly* elevated. Not enough to preclude treatment - she seemed to feel proceeding would be unlikely to send him into kidney failure - but having had that happen with Neyla and Pamidronate I'm a bit freaked. I had planned to start him on a renal support supplement that was arriving yesterday so I decided to go ahead with that and we will recheck values Tuesday and have the Zoledronate treatment tentatively scheduled for Wednesday. Barring them having actually gotten worse I plan to do the treatment.

 

We also had our PT appt this past Saturday and he got a really nice long massage. The doctor was great and showed me exactly what to do so I could do it at home. He has spasmy muscles from his LS so we're working to fix that. I'm also going to take him in weekly so they can work on him as well.

 

So we're sort of holding steady. He has times when he's more tired or sore, but overall he's his normal self. We take slow meandering potty walks, he trots around and plays with his Cuz ball, and barks for his dinner and "treats" (ie. meds) when he feels I'm behind schedule. But I would like to see an improvement in the near future from either the radiation and/or the Zoledronate.

 

I also want to start Curcumin, but am worried about blood thinning since he got a hematoma from his blood draw yesterday so I'll follow up with the vet about that next week. Radiation doc said we can start Artemisinin 1 month after treatment so we'll be doing that as soon as we can.

 

 

Sorry to hear you are still seeing the limping with Cecil. The limping thing is interesting. I think there has to be some pain involved if the dog is limping, but perhaps in some cases not as much as we think as the limp is serving a protective purpose. I don't know though. Zuri definitely has a hiccup in his giddyup as I like to say, but that doesn't stop him from trotting around with toys.

 

 

Hope Pogo feels better soon!

Edited June 23, 2016 by NeylasMom

[NeylasMom]

Don't know how often people check this thread anymore, but needed to "vent" for a sec. We rechecked Zuri's kidney values today. Different machine, but BUN was up a few more points and creatinine is 2.2 (vs 2.1). Disheartening as it seems they are still creeping up. Had been hoping he just took a hit from all the sedation and would hold steady, but I have to suspect meds are contributing.

 

Anyway, we are going to proceed with the Zoledronate tomorrow and will do IV fluids to try to mitigate any kidney effects. If anyone could spare some good thoughts that the treatment gives him pain relief without kidney issues, I would be grateful. If it doesnt, I'm afraid we are out of options.

Edited June 27, 2016 by NeylasMom

[llm51807]

Sending good thoughts for Zuri's infusion tomorrow. I've read some really positive things about zoledronate, but it doesn't seem to be helping Cecil after two. I hope it helps Zuri and his kidneys hang tough. The fluids should help with that.

[NeylasMom]

Thank you. I think the first treatment we did did give him good relief, it just happened slower than we thought, but some of that was probably pain from the CT and the issues we had with him moving around after their heavier sedation. I'm just worried that now that we've put it off (it's been 5 weeks instead of 4) it will take longer again, rather than keeping up with regular treatments. And of course the kidneys are the big concern. The oncologist said it should be okay (his values are barely outside of normal), but really nothing has gone our way in this whole thing so I'm not particularly hopeful he won't be the anomaly who goes into kidney failure. I'm feeling particularly low today, I think because I am totally sleep deprived. He had an incident Friday where he slid off his bed, got startled and jumped up scrambling so he was sore afterward. So I increased meds so he is now getting Gabapentin every 6 hours, which means at 4 am my alarm goes off, I give him the pill and attempt to go back to sleep until 8 when I have to give other meds. I had to make myself coffee at 5 just to get myself to my massage appt and I still have to teach tonight.

[Rickiesmom]

I know someone whose dog had compromised kidneys and was given Pamidronate (the drug of choice then) at half the usual infusion rate, with fluids, and she did fine. Every dog is different, but just wanted to share that.

 

Will be thinking of you and Zuri tomorrow - this is a tough road to travel, especially when you aren't seeing the hoped for results yet.

[llm51807]

We were JUST talking about dosing Gabapentin at every six hours and were discussing the overnight implications! The Gabapentin has helped for sure, but I can see the difference between an hour after he gets it vs 8 hours later. We're at 200mg every 8 and we're debating on going 200mg every 6 vs 300mg every 8. I saw some of your posts on Gabapentin from a few years ago and that's helped guide us on our decision...thank you for that

 

I'm happy to hear the 1st treatment helped Zuri; we're debating on a 3rd but have a few weeks to go. We have an appointment tomorrow with our Chiro vet who also does PT and acupuncture. Hopefully that helps.

 

I hate to say this, because I'm a normally a glass half full kinda person, but lately most of our choices have been based on what's the least bad option. Sifting through the pros and cons of every decision is tough, especially knowing where we'll end up. Add in the 4AM medicine alarm, the slip here and the "sleeping on it wrong" there, and things just stink for you right now, and we're close behind you if that helps at all. Blah is right!

 

I guess we'll just keep on keeping on trying to make the decisions for our beloved hounds and hope for the best. Maybe tomorrow will be a better day for both of them.

[greysmom]

{{{HUGS}}} for you and Zuri, Jey...

 

...and everyone dealing with this monster.

[NeylasMom]

Thank you you guys.

 

I know someone whose dog had compromised kidneys and was given Pamidronate (the drug of choice then) at half the usual infusion rate, with fluids, and she did fine. Every dog is different, but just wanted to share that.

 

Will be thinking of you and Zuri tomorrow - this is a tough road to travel, especially when you aren't seeing the hoped for results yet.

Thank you. It does help to hear this. Honestly, my vet's words were that she'd treated dogs with values like Zuri's successfully and had never sent a dog into kidney failure, but then caveated that with Zuri hasn't read the book on how this stuff should go so she couldn't promise me anything. Based on how this week has gone, I think I should have just let them do it when we were there. But this is of course the way things go with osteo - it's completely unpredictable.

 

And Lori, thank you for the support. But no, it does not make me feel better that you guys are struggling. I hope you can sort things out. Fyi, we were at 300 mg every 8 hrs until the bed incident and that was working well. I'm hoping we can return to that when/if the Zoledronate works. But I also bumped up his Tramadol a bit so lowering that back down and possibly lowering the Deramaxx likely take priority because of the kidney issue. In any event, I recommend avoiding the middle of the night dosing if you can.

Edited June 28, 2016 by NeylasMom

[tbhounds]

As an FYI--many clinicians feel that previcox is a bit more renal friendly than other NSAIDs. Maybe it worth a phone call to your Vet to discuss.

[NeylasMom]

As an FYI--many clinicians feel that previcox is a bit more renal friendly than other NSAIDs. Maybe it worth a phone call to your Vet to discuss.

Unfortunately I don't think there's any way we could do a washout period, but I'll keep it in mind if we get to the point where we could.

 

 

Oncologist's office called at 8 am. We're on for today. My stomach is a mess already.

Edited June 28, 2016 by NeylasMom

[NeylasMom]

Well we're done and home. They decided on subQ fluids as well. Zuri handled the visit well and is getting around better today than he has been so now we just wait and hope.

[llm51807]

Well we're done and home. They decided on subQ fluids as well. Zuri handled the visit well and is getting around better today than he has been so now we just wait and hope.

 

That's great news...we'll keep the good thoughts coming for Zuri. Strong kidneys and no pain!

[Annette]

How common is it for bone cancer to spread to the ribs?

[NeylasMom]

 

That's great news...we'll keep the good thoughts coming for Zuri. Strong kidneys and no pain!

Thank you!

How common is it for bone cancer to spread to the ribs?

I don't think it's a common location for a metastasis, but you do sometimes find bone tumors there. If I remember correctly, rib tumors are often chondrosarcoma, which has a better prognosis, rather than osteosarcoma. There are other cancers like multiple myeloma that can also cause bone tumors, but they are fairly rare. Edited June 28, 2016 by NeylasMom