Osteo Thread Part 8

[NeylasMom]

Oh Jen, I'll be thinking of you and Zuri both tonight. I'm not sure how many more nights I'll have with Cecil, so he's in my bed again tonight. Hopefully we'll get some sleep and tomorrow will be a better day for every one of us.

I wish Z would sleep in bed with me. I got rid of my frame and box spring and put the mattress on the floor so he could, but it's not our routine and he is SO routine oriented. Its only in the winter when he's cold that he would jump into bed with me in the morning and snuggle.

 

I am bummed he hasn't gotten on the couch for weeks. His LS prevents him from jumping up now and I was never able to get him using the step willingly. He usually curled up in his corner (we have a sectional that's a couch attached to a chaise so he likes being in the corner where they meet), but I would often scoot over there or sometimes he would curl up alongside me for a nap. I hate that we can't do that anymore.

 

Morning update - he's moving around a lot better. Limp is much improved. But he still does not want to do the stairs until he's busting at the seams. Last night that was at 2:30 am when I got up to give him his Tramadol and then we didn't make it all the way outside because I didn't realize how badly he was bursting and took the time to give him his meds first. Can't say I really mind - he went down our inside set of stairs and then peed outside our front door, on the carpeting in our lobby area. I grabbed a towel and caught most of it in that and we went back inside (I did go back to clean up the rest). In the end, it meant less stairs for him. But he hasn't asked to go out since.

 

So basically I think with the help of the Tramadol we've bought ourself a little time. I think I should have the vet come tomorrow evening, but I haven't been able to bring myself to call her yet. I think I am secretly holding out hope the hemp will do something magical.

 

In good news, Zuri's toe is almost healed.

Edited August 16, 2016 by NeylasMom

[greysmom]

I've been lurking and I just wanted to point something out--it's not Valium you want to ask for (that needs to be given IV) but, buprenex. Buprenex can be given as a SubQ injection or even just squirt under the tongue.

Sorry for everyone going through this battle--oh how a loathe Osteo.

 

Thanks!

[llm51807]

Jen, I understand you're hoping for a miracle with the hemp oil; it did seem to help us. I'm waiting for yesterday's zoledronate to kick in; it's been 24 hours and I've seen no improvement. Last night was a tough night and this morning has been very bad. The Tylenol 3 is making him wobbly and a little loopy and slightly anxious (or is that pain??). The harness came, but our issue is getting him off his side while lying down and up into a stand or sphinx. He can't push off his bad shoulder if he's lying on it. We try to keep him propped up against a wall by creating a bolster with his bed, pillows, blankets, etc. Lots of crying out this morning getting him out of my bed and not much sleep for me last night, but he slept well.

 

I got a call back from the mobile vet. She was so compassionate and after explaining the situation she said, it's so sad you went to such lengths to treat his osteo and this is from a fall. It's true. As far as we know, his cancer is still at bay, but the old dead tumor and the radiation plus the fall is too much for my sweet boy. Not sure we'll make it through the week. Our last chance with the mobile vet this week will be Thursday and she won't be available for emergencies again until next week. Hoping and praying for our miracle today or tonight.

 

And I would like to acknowledge the small victory that is Zuri's bum toe. Hey, we'll take ANY good thing we can get at this point!

 

Sending Zuri and Crouton love and healing with all I've got left to give

[Guest Roux]

So basically I think with the help of the Tramadol we've bought ourself a little time. I think I should have the vet come tomorrow evening, but I haven't been able to bring myself to call her yet. I think I am secretly holding out hope the hemp will do something magical.

 

In good news, Zuri's toe is almost healed.

 

Oh Jen, the irony of an almost healed toe! How bittersweet is that?!

 

Crouton has never been one to get up on any furniture, bed included. So, snuggling is a floor affair for us. Naturally, Niels the Giant is the one who likes to share the bed. Actually, he is very considerate about going to his own bed, if asked, and he is a supremely talented cuddler.

 

My newest concern about Crouton has been developing very slowly. almost imperceptibly, over the last couple of days. One outward sign is that she is declining to go out the usual times, and is waiting until I just insist. She still voluntarily gets up to greet us at the door at the end of the day, and for her two meals, but other than that I really have to encourage her to get her to move. She is holding her urine much longer than I am used to, which has me concerned. But the harder to describe change is in her "energy". She seems depressed, is probably painful, and seems to be here only because she has no choice. She is not holding her bad leg up quite as much as she was, and is starting to allow the top of her foot to touch the ground. I am very afraid we did not catch this early enough for the Zoledronate treatment to give her a few more good months. I am looking through her eyes right now, and think it might be a pretty awful thing to be inside her.

 

Will talk to my DH tonight, then perhaps to our vet. Barring a major change, I think we are getting also close to saying goodbye. So incredibly sad.

[NeylasMom]

Aww, I'm sorry it was such a rough night and morning with Cecil. I imagine all the activity yesterday may have made him sore. Hoping that Zoledronate kicks in soon for you!

 

Mini update - Zuri asked to go out about an hr ago. He was looking MUCH better, but got excited and starting running around! I put a stop to that quickly and he went down the stairs well and peed and pooped (another small victory - I ended up putting him on the VS Probiotic BD because the ABs make his stool a little soft and he has amazing poo again ) but he was clearly limping a bit more by the time we were done. Still, I am in a much better mood because he seems pretty comfortable today. The problem is we are pretty much maxed out on meds. I don't want to get stuck with another day like yesterday and not being able to get the vet to come or give more meds. Though I think from what I've found online I could technically give more Tramadol and just expect sedation. He actually doesn't seem any more sedate from this latest increase, which is really good.

 

Anywah, a friend mentioned another in home euthanasia service that is local to me. I called and spoke with them at length and she said they can typically accommodate same day requests, especially if you call earlier in the day, otherwise they can come the following day and they are open on weekends and do evening appts. So I think between the 2 I have some flexibility and feel more comfortable playing it by ear. I don't expect a miraculous turnaround, but a couple more days to spend with him and process this if I can keep him comfortable and a chance to try the hemp would be nice. Aside from the morning/afternoon yesterday until the extra Tramadol kicked in, he really is his usual self. Barking when he wants something, trying to run around, demanding pets, trying to lick his foot , eating with gusto so as long as we can keep his pain at bay and he is doing okay on the stairs we're okay.

 

Oh Jen, the irony of an almost healed toe! How bittersweet is that?!

 

 

Will talk to my DH tonight, then perhaps to our vet. Barring a major change, I think we are getting also close to saying goodbye. So incredibly sad.

I'm so sorry. Wow, what a ** week in here for all of us. I hate this disease so much. FWIW, if it helps you and your husband either way, the oncologist yesterday said if we didn't see improvement from the Zoledronate within about a week we probably shouldn't expect to. I don't know if she was basing that on our history or not, and bisphosphonates and how they work are still in some ways a mystery so possibly take it with a grain of salt, but thought I'd pass it along.

 

And thank you for appreciating the irony of the toe situation.

 

Can you increase meds more while you contemplate a decision? I can't remember what you bumped up to the last time you saw the vet.

[llm51807]

Bad news about Crouton, sorry, Roux. Aside from Zuri's toe, this has been a supremely crappy week for us. I agree with Jen, seems like Crouton has some room to move on the meds maybe?

[Guest Roux]

Can you increase meds more while you contemplate a decision? I can't remember what you bumped up to the last time you saw the vet.

 

I guess I can increase the meds a bit, but her demeanor is already so uncharacteristically flat, and I just don't want to do anything that borders on being unfair to her. She is currently at 100 mg tramadol 3x/day, and 300 mg gabapentin 3x/day, 500 mg Tylenol 3x/day and 75 mg carprophen 2x/day. Maybe I will just call the vet about a 4x/day schedule. Thoughts?

[NeylasMom]

I would. Since the change in her affect seems to not coincide with the change in meds, my guess would be it's because of her pain. Osteo can be so painful I just think it's best to do what we can to mitigate that. But you know her best.

 

 

Well, the hemp just came. He just had a snack of a chicken foot and an egg because I don't want to give it on an empty stomach, but don't want to wait until dinner. Really hope at the very least it doesn't cause any weird side effects.

[Guest Roux]

Thanks, Jen. I am just waiting from a callback from my vet about meds. Will really be interested to see what you think the hemp does for Zuri. Always good to have more options!

[NeylasMom]

Fwiw on the meds, I think I alluded to this earlier but my experience - and this is only with Z - is that the increase in dosage has been more likely to cause temporary side effects than the increase in frequency. I've really seen little or no change when going from 8 to 6 hrs but when bumping up the dose every 8 hrs I have. And the more frequent dosing has definitely improved our pain management. Again, Fwiw.

[Guest Roux]

Fwiw on the meds, I think I alluded to this earlier but my experience - and this is only with Z - is that the increase in dosage has been more likely to cause temporary side effects than the increase in frequency. I've really seen little or no change when going from 8 to 6 hrs but when bumping up the dose every 8 hrs I have. And the more frequent dosing has definitely improved our pain management. Again, Fwiw.

 

I do remember your mentioning this in our orignial "Zoledronic acid" discussion. Our wonderful vet called me back very promptly this afternoon. For this afternoon and tonight, I am adding another gabapentin and one more tramadol. If she seems really out of it tomorrow morning, I do think I will fashion some kind of 4x/day dosing and see if that works better for her. She was already feeling a bit better this afternoon, about 3 hours after the additional pain meds. If we still see breakthrough pain with regularity, that will be a different discussion.

 

Hope the hemp has a good effect on Zuri, and sending my thoughts to Zuri, Cecil, and humans for a better night.

[NeylasMom]

Glad you got some input and seem to be seeing improvement!

 

Lori, any improvement with Cecil today?

[llm51807]

Agree with Jen on the dosing frequency. Glad to hear the med adjustment seems to be helping Crouton. Jen, how did Zuri end up tonight? Seems like he was having a little better day today.

 

Cecil started out rough this morning, but by this evening seemed better. He's still not in a maintainable place in terms of pain management, but he's definitely better. I haven't heard a yelp all night with lots of ups/downs from his beds. He's stoned for sure from the extra meds, especially the newly added Tylenol 3, and he's still limping a lot. I'm happy with his improvement compared to last night and this morning, but this needs to be on the way to something better; we can't stay here. Still hoping this is the zoledronate kicking in and that we'll get to the other side of whatever this injury this is.

 

Today I decided if he wasn't better by tomorrow afternoon I would call the mobile vet to make an appointment for her to come on Thursday so we could say goodbye, but now I have a glimmer of hope again. Up and down up and down. And I see the same in Zuri and Crouton.

 

Wishing Zuri and Crouton and Cecil a good, pain-free night and some peace for their humans.

[greysmom]

Dr Couto is very clear that greyhounds metabolize pain meds and gabapentin much faster than other breeds. I would opt for more often before upping the amount.

 

Remember also, there's not a need to think about an "end point" for pain meds. Not to be indelicate, but osteo is a terminal disease, so your goal is pain management - period. There is no maxing out unless the dog doesn't tolerate it. When you reach that point, again, in my opinion, you may have waited too long.

 

Good nights for everyone tonight

Edited August 17, 2016 by greysmom

[Guest Roux]

Lori & Jen, so glad to have heard from both of you yesterday. I am sure you know this, but you will be in my thoughts all day. Hugs to Cecil & Zuri.

 

Agree with Jen on the dosing frequency. Glad to hear the med adjustment seems to be helping Crouton. Jen, how did Zuri end up tonight? Seems like he was having a little better day today.

 

Dr Couto is very clear that greyhounds metabolize pain meds and gabapentin much faster than other breeds. I would opt for more often before upping the amount.

Remember also, there's not a need to think about an "end point" for pain meds. Not to be indelicate, but osteo is a terminal disease, so your goal is pain management - period. There is no maxing out unless the dog doesn't tolerate it. When you reach that point, again, in my opinion, you may have waited too long.

 

Thanks, Chris (that is correct, Greysmom?). Today I am going to get a little creative on the meds schedule and see if it helps. The vet suggested I just add the new 50 mg tramadol and 100 mg gabapentin to each of the three daily doses. But, yesterday I gave the "additional" meds about 3 hours after I had given the others, and it made a difference. Since Crouton is obviously dealing with breakthrough pain, this is what I am going to try:

 

5:30 am - Carporfen 75 mg, Tramadol 100 mg, Gabapentin, 300 mg, Tylenol 500 mg

9:30 am - Tramadol 50 mg, Gabapentin, 100 mg

1:30 pm - Tramadol 100 mg, Gabapentin, 300 mg, Tylenol 500 mg

5:30 pm - Tramadol 50 mg, Gabapentin, 100 mg

9:30 pm - Carporfen 75 mg, Tramadol 150 mg, Gabapentin, 400 mg, Tylenol 500 mg

 

Crouton still does well during the night. She has not whined or cried out since the first scary days when none of us, including her, knew how to handle meds/repositioning. In the morning, since that is the longest stretch between meds, I give her the pills in cream cheese or boiled chicken, then wait at least a full hour before going out. This gives her time to get ready, and also gives us a little morning light. I know we will lose the early daylight soon, but it is nice for now.

 

If anyone sees a better way to tweak the above dosing schedule, please do let me know what you think. Thanks!

 

And, Chris, I do understand fully your last sentence, above. Looking back, I think that Crouton had been dealing with this problem for some time before she started limping and it became visible to us. I say that because before she ever started limping, she would occasionally have a little trouble rising from her bed in the mornings, which we attributed to, perhaps, a little "arthritis", or just growing older. She had a racing career, and had been a brood mom after that. I know she was raised in the Pacific NW, and was transported across the US numerous times to race, I am sure. It would stand to reason that she might be getting a little creaky as she grew older. Hindsight...

 

I do know that if I ever see any of these symptoms in Niels or Pi, or in any future greyhound we may bring into our family, I will be very quick to rule-out osteo.

Edited August 17, 2016 by Roux

[Guest Roux]

Oh, I forgot to mention for any of you dealing with tramadol-induced constipation, my vet suggested adding 1 tablespoon of vegetable oil to Crouton's food. She is not too crazy about pumpkin, but I will also add that if needed. Yesterday I was starting to see a little problem, and with only one good hind leg, I knew I needed to help her out a little.

[NeylasMom]

Lori, did you notice any side effects from the hemp oil? I actually have no idea how Zuri is doing painwise because he didn't want to get put of bed this morning. So I took the girls out and when we got back he was in his usual spot in the living room. Doesn't seem painful from what little I can tell, eating his morning snack and meds, just seems reeeaallllyyy chill. Maybe a tiny bit spacey.

 

He actually did really well yesterday. After our early afternoon potty trip where he managed to sneak in some trotting around with a toy before I leashed him up I figured he wouldn't want to do the normal 5ish pm walk, but he was up and running around again! I tried to quiet him as quickly as possible, but he got quite a bit of bouncing in. I had to go teach one class so I figured how he was when I got back would be telling. He was definitely a bit more sore, but nothing like Monday.

 

And yes Chris, I don't know if your comments about meds were in part because of my saying we're "maxed out" on Tramadol, but I mean basically what you say. From what I've read online, I could technically double Zuri's Tramadol dosage, but I'm not interested in prolonging his life just to have a sedated dog. We've had virtually no side effects from meds other than the day or two I mentioned with the last Tramadol and Gabapentin increases, which resolved quickly and I don't want to start having them. There's no point. For us, this increase was to give the Zoledronate a chance to work since it has in the past and I screwed up the timing. Which is why it would be nice if Zuri would get up so I could see how he's doing.

Edited August 17, 2016 by NeylasMom

[llm51807]

Roux, that sounds like a good med schedule. I may start playing with our timing a bit as well here. He's still limping too much, but less painful. Cried out getting up to reposition in my bed this morning, but was OK getting up from his bed (that's propped up against the wall allowing him to lie on a tilt which helps him over and up when he's ready). I can see something working, either the Tylenol 3 or the zoledronate. He's still woozy from the codeine and if we do get to the other side of this injury/pain, it will be the first to get tapered off.

 

I've increased his CBD oil/hemp dose as well Jen. It is supposed to have an anti-anxiety effect on them, so maybe that's why Zuri is so chill. Without the THC it's not supposed to cause any high or some of the other side effects of MJ. But I swear Cecil has the munchies. He's alway hungry and super food motivated and he has never refused food once since I've known him, but he's acting even more hungry lately. Could be because I've been spoiling him with people food which is new to him. Our other boy Jet can get anxious (in a "I'm so happy I could jump into your arms and lick your face off" kind of a way), so I'll be trying it on him when I know we're expecting guests or getting ready to go for a long ride (both MAJOR over the top excitement generators).

 

Well, sounds like things are a little more under control for the moment. Let's hope this continues heading in the right direction. Hugs to Zuri and Crouton and wishing all a good day.

[greysmom]

Jen, I wasn't speaking specifically to anyone, because I'm not there where you are and dealing with what you're dealing with, I just thought I should remind everyone since you are all kind of having the same issues. "Regular" vets often are *way* too conservative when talking about pain medication for dogs with osteo. They're doctors, and they feel tthey need to keep limitations in mind, like for a dog who is going to get better. My point was, that pain control is more important than concerns about side effects or long-term effects. If your dog can be comfortable and not a zombie on any dose of pain medication, then that's the dose you should use.

Edited August 17, 2016 by greysmom

[NeylasMom]

Jen, I wasn't speaking specifically to anyone, because I'm not there where you are and dealing with what you're dealing with, I just thought I should remind everyone since you are all kind of having the same issues. "Regular" vets often are *way* too conservative when talking about pain medication for dogs with osteo. They're doctors, and they feel tthey need to keep limitations in mind, like for a dog who is going to get better. My point was, that pain control is more important than concerns about side effects or long-term effects. If your dog can be comfortable and not a zombie on any dose of pain medication, then that's the dose you should use.

Yeah, totally agree. I always recommend people see an oncologist, or at least have their vet consult with one for that reason.

 

Zuri's a happy boy. Loves having the massage therapist come here. Between that, the hemp and all the treaties he got while she was here he's one happy camper at the moment.

 

I decided to try half the hemp just for today because I squished doses together a bit yesterday and then will probably go to normal dose tomorrow. It was nice to have the therapist here to give an unbiased opinion. She thought he looked alert and didn't notice anything unusual. He did get up for his walk right after I posted and looks pretty good. He actually got back up to greet the massage therapist and was walking around pretty comfortably.

 

Having said that, we have a new thing. He started licking his anus and it's bleeding a little from the skin around it. Its weird, not a sore, but like little pin pricks of blood. Don't know if he's been kicking when I'm not home, which is almost never, or something else is going on. He's not constipated. Stool has been a bit softer them usual at times, but no diarrhea. Could it be an anal gland issue? Anyone have any idea?

 

Regardless, I'm about to do his toe soak so I'm going to hit that with a salty washcloth. Epsom salts for the win!

Edited August 17, 2016 by NeylasMom

[FiveRoooooers]

Having said that, we have a new thing. He started licking his anus and it's bleeding a little from the skin around it. Its weird, not a sore, but like little pin pricks of blood. Don't know if he's been kicking when I'm not home, which is almost never, or something else is going on. He's not constipated. Stool has been a bit softer them usual at times, but no diarrhea. Could it be an anal gland issue? Anyone have any idea?

 

That sounds like Pagliaccio when he was 14 and fighting all sorts of issues - and then developed an anal gland infection. We treated with Baytril, three rounds IIRC.

 

Good thoughts for all of you.

[NeylasMom]

That makes sense. The bleeding is where the anal glands are, I think. But gah! The ABs he was on for his toe are why he had soft stool to begin with.

ETA: Hmm, just came across this as a reason for anal gland issues:

"Lumbosacral spine and muscle injury that leads to decreased energy flow to the anal glands and lack of tone."

 

 

Wait, further updating - the pin pricks are above the anus, not where the anal glands are. Was confused because he is laying down. But I can clearly see where the anal sacs are. Considering I don't know what that area looks like normally take this with a grain of salt, but I did look at Violet's for comparison, but the anal sacs are clearly delineated/visible and the whole area is a bit red and possibly inflamed. ????

 

I think I will do Epsom salts twice a day and try to keep him from licking and give it a day or two. I don't want to take him to the vet if we don't have much time left anyway.

Edited August 17, 2016 by NeylasMom

[Guest MnMDogs]

I've been reading back several pages and want to wish Cecil, Crouton and Zuri more pain-free days. It's definitely been a roller-coaster for all of you . I've been hesitant to jump in because we really don't know if Macy May does have bone cancer. Dr. Couto thought he saw some bone changes in her proximal right femur and recommended repeat xrays. My vet and the radiologist see nothing that would indicate cancer.

 

I honestly can't tell if the changes we're seeing in her are related to back end/LS type disease or if she's actually limping, she certainly doesn't seem painful most of the time. She seems to be having most trouble lifting that back right leg, and struggles a bit on our 2 steps to the house, and no longer will get on the couch (new over the past 3 weeks). That said, she's a wreck at the vet and if we do confirm cancer, we're not going to change anything we're doing (medications). I think she's getting what Crouton, Zuri, and Cecil are getting (minus tylenol). It's the same combo we were using for Mork for the last year or 2 of his life to manage his old dog woes (likely LS, arthritis)

 

Anyway, that's my long winded short story, to ask a question about Artemesinin. I figure it can't hurt to add it, but want to know what brand I should look for? I bought some many years ago when my Matty girl was first diagnosed, but hers was so advanced, I never got to use is, and I can't remember the brand.

 

Thanks for maintaining this thread, it's invaluable.

[llm51807]

Poor Zuri! I'm happy to hear he's feeling better but sheesh! Can't a boy get a break? I don't really have anything to add to his current issue, but the epsom salt washcloth sounds like a good idea. Hate to think you'll have to add AB's into his current med mix. Such a necessary evil they are. I always try to treat conservatively and topically when it comes to skin issues (which Cecil has had many over the years and never once had to take oral ABs).

[Guest Roux]

Jen, so wish I knew anything at all that could help you with Zuri. I so hope that resolves itself soon.

 

It was with hope against hope that Crouton's meds just needed better tweaking. After my morning post, I let her meds take effect, then called her to breakfast. She was on a bed just in the next room. She did come to her bowl, but just stood there for a few minutes before deciding to eat. For her, this is completely unheard of. I know it was pain and not meds, because I was not going to give the booster dose for another couple of hours. Crouton did finally eat, but afterwards just stood there. I asked her to come to the door to go out (she did not urinate on our late evening walk last night – just went out and stood). I could tell she wanted to do what I asked, but just could not. She turned away and walked the few paces to the bed where she spends the day – had a difficult time lying down. I gave her the booster meds at 9:30am, but she has been on the bed in the same position ever since.

 

Crouton told me today that it is time. We have an appointment with the vet at 5:15 CDT to say goodbye.

 

One more request for opinions about pain medications to help her until we can get to her appointment today... Our med schedule is posted in a previous entry, yesterday around 7am central. In addition to that, should I be giving more tramadol or gabapentin (or both, plus others) today if she seems to need it? I don't want to simply knock her out today. Although she is resting on her bed right now, we may need more later, if I can get her up to go out.

 

As my DH has told me – since the diagnosis, every hour has been bonus time with Crouton.