Anyone Tried Zoledronic Acid For Osteosarcoma (Palliative Care)?

[Guest Roux]

I am new participant in the forum, but not to greyhounds. Our most recent adoptee, Crouton, is a sweet-to-the-core ex-racer and brood mom who turned seven in January. Sadly, we got a diagnosis of Osteosarcoma, distal femur, a little over two weeks ago. It started with a limp in her left hind leg, and we are already on four meds to control pain. Due to a number of reasons, she is not a candidate for amputation or chemo, nor do we have easy access to radiation due to distance from a major metropolitan center. Thus, we have opted for palliative care.

 

In doing research, we found that there has been some success using 4 mg zoledronic acid in an IV drip delivered every 28 days. I have read that it lessens the threat of spontaneous fracture, and that it helps with gait. It is not expected that it would stop the growth of the cancer, but it increases quality of life in the time that is left. Some dogs lived 14 to 16 months past their original diagnosis before needing to be euthanized, vs. the expected 3 months with pain/inflammation medications alone.

 

Crouton had her first treatment yesterday, so it is very early and we do not know what to expect. Also, we do not know if we are already starting too late. It will be a full month tomorrow since we were first aware of a limp.

 

I would really appreciate being able to ask questions of anyone who might have personal knowledge of this treatment.

 

Thanks very much,

Miriam

[4My2Greys]

I'm so sorry about the diagnosis. I lost my boy last month to osteo. GT'er Neylasmom is currently using it for her Zuri. I'm sure she'll respond soon. I've bumped up the Osteo thread in which you can find a lot of good information and support.

[buddibear]

We just got comformation of Osteosar in our 12+ male greyhound. Limping 6 weeks ago showed nothing on xray.At 6 weeks a hard lump is noticeable in the shoulder and new xrays shows the growth. He is on tramadol and rymidal. Not a candidate for amp. He could not handle radiation and chemo. I searched this Zoledronic Acid and found it extended the life 16 months of a large breed with tumor in the leg. It's a once a month iv . He has a most severe UTI and it is taking him down fast.

[llm51807]

Neylasmom's Zuri and my Cecil are both doing zoledronate right now. I'll let Jen tell you about Zuri, but Cecil has had 3 treatments and until this last one on July 15th it hadn't seemed to help with pain much. Cecil had Cyberknife radiation in December and then 5 rounds of chemo afterward and was pain-free until the end of April. Based on X-rays it appears his tumor is not active, but he still he was in pain and is still limping. The month of June wasn't good and I feared we were nearing the end of our options. We stared acupuncture and Cannabis Oil (Rx Vitamins for Pets - Hemp Rx) and got a 3rd zoledronate infusion all within 2 days in mid-July and he improved significantly. Not sure what did it, but those are two other things you might want to try. BTW, he's on 2 Rimadyl, 3/3x Gabapentin, a few Tramadol a day, and various supplements and homeopathic treatments.

 

Sending Crouton good healing thoughts. Poor baby, a brood Mom and only 7. I really hate this disease.

[Beachbum1]

When Taylor was diagnosed with Osteo in his right front "wrist" on 1/10/15, we did, I believe, 4 every 3 week treatments with Zoledronate.

 

Unfortunatelyafter around 8 weeks, the bone broke a little, it healed up, and then another area of the bone broke a month later.

His oncologist and I decided that the risk of a very painful break was going to happen, so the amputation was done 4/10/15.

 

(still running and leaping and spinning).

[NeylasMom]

Zoledronate has been a lifesaver for us. Amputation wasn't an option, palliative radiation doesn't seem to have worked for him, but the Zoledronate gives him amazing pain relief. He's scheduled for his 3rd treatment next week. Last time I saw improvement within 2 days. The previous treatment it took about a week, but he had had a CT and had a hard time handling the stairs because he was so doped up from the anesthesia so I think he was very sore from all of that for that week.

 

Hope you see good relief soon. And very sorry for the diagnosis. Please feel free to join us in the osteo thread.

[JenniferS]

My Wylie had osteo and Pamindronate infusions (similar to Zoledronate). I believe he had four or five treatments, approximately 3 - 4 weeks apart. It helped with his pain (also on rimadyl, tramadol & and eventually gabapentin), and on x-rays, the vet saw the bone actually calcifying. Wylie was only the second dog they had treated this way in their practice and the vet was very happy with the results. He was 11 yrs old and had 6 really good months with us post-diagnosis. After a while the pain/limping came back and I decided not to put him through more treatments (he got stressed going to the vet).

You are right it does not cure the cancer or shrink the tumor, but it can help with pain (I have read studies that 1 in 4 show pain relief) and it can strengthen the bone around the tumor, minimizing risk of a break which was my biggest fear during that time.

[Guest Roux]

There are so many ups and downs with this cruel disease, but they all seem to be on steroids! The way Crouton feels changes so quickly that I am almost at a loss to know the right thing to do. I am constantly going back and forth about whether I am being irresponsible to try to increase Crouton's comfort with the zoledronate treatments. The first treatment was just Friday and I know I cannot expect any results, and certainly not for some time if there will be any at all.

 

Two and a half weeks ago we started with 75 mg Carprofen plus 100 mg Tramadol twice a day. Our girl started to feel much better almost immediately. Then in just a week, we were back where we started with pain, and added 200 mg Gabapentin to her morning dose. There just didn't seem to be much change, so that evening our vet had us add 500 mg Tylenol, both twice a day with the Carprofen and Tramadol. Again, wonderful response from Crouton. Still happy, hungry, and alert, in spite of holding up her left hind leg.

 

Then, the last three nights, she has been so restless, wandering and crying. We made a ramp for her out the front door (two steps in front, six steps from the deck to the fenced yard out back). The first night, I thought she needed to go out, so I dressed and we went. No response from our girl, so I decided it must be pain. The next day was the first zoledronate treatment. That night, more restlessness and high, reedy, quiet little whines. Yesterday, she did a little better, still eating with gusto as she always has, and pottying normally. So, I called the vet about her night problems. He said we could add a third dose of Tylenol, and suggested Acepromazine. I asked if Dramamine might help her sleep. He looked at drug interactions and gave me a dosage of up to 160 mg for the Dramamine. She is a big, tall girl (75 lbs and as tall as our male greyhound/deerhound mix). I hoped we could just give the Dramamine, so we gave her 150 mg of the Dramamine at bedtime and she did rest much better, until 2:30am when she woke me up whining again. I helped her to a different bed, which seemed to help, and gave her the third dose of Tylenol and one Acepromazine.

 

Today I am feeling sad and guilty. The only thing I have been able to get her to do is eat two spoonfuls of wet food with her pain meds and Tylenol (NO Acepromazine ever again). She is drunk and not interested in eating or drinking. I found a place on one of her beds where she urinated overnight, probably right before the Ace knocked her out. I have not been able to get her outside at all today. She tried to stand for breakfast, but was shaking all over and too weak to eat. In fact, after the short walk from a bed to her food bowl, she slowly collapsed to the ground against the wall, panting, with her "good" hind leg under her. Then the second/third eyelids came up. We let her recover, then my husband and I carried back to her bed and laid her on her side – she gave us no resistance.

 

Does anyone have any wisdom for me? I have emotionally thrashed myself already.

[NeylasMom]

Yikes. I have to say I don't get your vets med recommendations at all. Contrary to popular belief Tylenol is safe for dogs, but it's really more of a last resort med imo. For starters, Gabapentin has a very short half life so dosing it just in the AM makes no sense and would explain why she was so painful overnight. I would be dosing that every 6 or 8 hours. Tramadol also every 8 hours. Doses for a dog her size are quite high. Zuri is 70 lbs and can have up to 150 mg Tramadol every 8 hrs and 900 mg Gabapentin every 8 hrs. The latter would be insane as he probably wouldn't be able to walk, but he currently takes between 100-125 mg Tramadol and 300-400 mg Gabapentin every 8 hrs and does fine (plus his nsaid and a muscle relaxer for his LS).

 

If I were you, I would first find an oncologist who can better help you with pain management. Barring that, I would get her off the Dramamine and Acepromazine ASAP (any vet who prescribes a sedative for a dog who is struggling with pain is out in my book!) and get her on more regular doses of the appropriate meds - 100 mg Tramadol 3x/day and maybe start with 200 mg Gabapentin 3x/day and see what you get. If that isn't sufficient You might switch to 200 every 6 hrs or 300 every 8 hrs. You don't want to increase the Gabapentin drastically at once as it can cause dizziness, unsteadiness, etc but the important thing is getting her pain managed and getting her feeling better.

 

I may be biased since Zoledronate has worked so well for us, but I think it's worth trying to get her on a proper med schedule and give it a chance to work. If she were on a normal routine of meds and you were close to maxed out then I would probably feel very differently but it sounds to me like there's a good chance she just got totally screwed up from drugs she really shouldn't have been on. Then again bone cancer is very painful so it's a lot to weigh.

 

I hope you are able to sort out a decision that's best for you. Dealing with osteo is indeed a rollercoaster with many highs and lows. All I can say is that I believe very strongly in not prolonging life when a terminal disease involved if I don't have a dog who is not in pain or not enjoying life, but I have also learned that there is a learning curve to figure out what is going to work for your dog and it can take a little time to figure out what works best. With Zuri we ended up having a few bad days here and there before we finally settling in a good place and I feel it was worth it, but he was never in severe pain either and has always acted like himself, eaten, etc throughout.

 

So sorry you're going through this.

Edited August 7, 2016 by NeylasMom

[kamsmom]

I wish there was a like/love button for Jens post.

 

Please, recheck with your vet on the pain meds or better yet find a new one. Ace and Dramamine are not sufficient pain meds at all.

[Guest Roux]

First, I want to thank everyone who has responded to my concerns and questions. To NeylasMom, my apologies for not being clear on the meds we are giving. Right now we are giving the following, all 2x/day:

 

Gabapentin 200 mg

Tramadol 100 mg

Carprofen 75 mg

Tylenol 500 mg

 

We went from nothing to this in just 10 days after our Osteo diagnosis. I have great respect for our vet, and do trust his judgement. But, it sounds like I need to have a new conversation about going to 3x/day and maybe upping the pain meds. This has been incredibly fast for him, too. Crouton's decline has been stunningly fast, and maybe our vet wasn't prepared for its speed, either. He has been incredibly responsive, and has called us almost daily to check on progress. I will talk with him tomorrow and see how we can adjust meds.

 

I do want to give the Zoledronate treatment time to work. I am the one who found the research, sourced the meds, and delivered them to the vet. To his great credit, he also did his research, and agreed to the treatment although he had not used it before. The closest canine oncologist is 5 hours away in any direction. We will work through this to find the best balance.

 

Thanks so much for the detail on meds, as it will really help with my conversation with our vet. Like all of you, I just want to do what is best for our girl.

[tbhounds]

Roux-I would be tweaking those drug dosage and frequencies.

Gabapentin 300mg (can go even much higher) up to 3 times daily, tramadol 100mg 3-4 times daily (huge dosing range) and if she's still painful you can add codeine to the Tylenol.

[NeylasMom]

Perhaps your vet could consult with an oncologist while working with you on this? My experience having gone through this with 2 dogs and being very active on this list while many others have is that many "regular" vets are often far too conservative with pain meds. Although I understand what you're saying about how fast the progression has been so it's worth seeing what your vet has to say first. But the important thing is that her pain is managed, the risk of long term side effects shouldn't even be on the radar.

 

Also, what did her x-rays look like? How much cortical involvement? Is there visible swelling of her leg? That's a pretty critical factor imo. If there's a lot of moth eaten area or other evidence that the cancer is progressed and she's at serious risk of fracture or you're less likely to get her pain under control that's a very different scenario than the tumor appearing to be in earlier stages and you just need to find the right palliative options.

 

I caught it early with both Neyla and Zuri. With Neyla we saw no progression on x-rays and very little pain (not much medication needed) for 5 months, but when it for bad it got bad. We bought ourselves some time with one Pamdrinate treatment (the older version of Zoledronate) but it affected her kidneys so we couldn't repeat it. After that, it for exponentially worse to the point that we couldn't get ajead of it, even maxing her out on her nsaid and adding in Tylenol with codeine.

 

Zuri on the other hand was tougher because his weak hind end from his LS is a complicating factor, plus the manipulation from the CT scan and him being stumbly after the sedation made him sore for about a week, but once we got past that and for the Zoledronate on board (and massages for his tight muscles from conpensating) he's been good. But neither had a lot of cortical involvement or much damage period.

 

Anyway, every dog is different. Just sharing my experiences, but knowing what the x-rays looked like would be helpful. Did your vet have a radiologist review them?

 

The alternative is to send everything to Dr. Couto and have him take a look.

Edited August 7, 2016 by NeylasMom

[Guest Roux]

More important information to have going in to my next conversation with our vet from both of you, NeylasMom and tbhounds. I will let everyone know what we decided. As for the x-ray, the osteo was clearly evident from the center of the bone to the edge a couple of inches or so above the knee - that lightly "motheaten" look – but we have had very little swelling to date. We did not have a radiologist look at the x-rays. With good pain control the first week, and then for a couple of days earlier last week, Crouton was still putting a little weight on her leg, but not now.

 

I'm hoping most of this is pointing to better pain control. Fingers crossed for a better week than this weekend has been.

[NeylasMom]

Good luck and please do keep us posted. I would be weighing the risk of fracture as well based on your limited description of the x-ray. Hope you can find a good option that gives you a lot more time together.

[Guest Roux]

So relieved tonight! Crouton was finally able to get up and eat her "breakfast" at 4:30pm. Then, she ate a late dinner about 3 1/2 hours later. She also drank plenty of water tonight. It looks like her frightening encounter with Acepromazine is finally over. That was truly a 12 hour nightmare I will never repeat. To the vet tomorrow...

[NeylasMom]

Great news! for a positive update tomorrow.

[GeorgeofNE]

I'm glad she had a better night--but please, be realistic.

 

Osteo is an incredibly painful disease. I know you love your dog--that's obvious. So please keep in mind that having her put to sleep BEFORE she is suffering from unbearable pain or her leg breaks is possibly the kindest thing to do.

 

I don't say that to be nasty or critical--but if she is suffering you need to be very, very brave for her.

 

Best wishes, truly, whatever you end up doing.

[Guest Roux]

I'm glad she had a better night--but please, be realistic.

 

Osteo is an incredibly painful disease. I know you love your dog--that's obvious. So please keep in mind that having her put to sleep BEFORE she is suffering from unbearable pain or her leg breaks is possibly the kindest thing to do.

 

You are absolutely right, and I agree with everything you said. As of today, we received Crouton's diagnosis only 2 weeks and three days ago. During these too few days, we have climbed way up the learning curve about the disease, and feel we owe at least our best try, within her physical limitations and our geographic ones, to control her pain and give her a chance to feel better during whatever time she has. But, we are also strong believers in the truth of science, and the inevitability of her condition.

 

This afternoon we plan to meet with her vet to look again at the x-rays and discuss them, armed with new understanding, and a bit of distance since the first shock of learning her diagnosis. We will discuss rebalancing her pain medications, and try to find the wisdom to do the right thing for her. We do love her very much.

 

I want to always be open to yours and others' perspectives. I'm new at this, and hope not to have to get used to it. We will always welcome another greyhound into our home and hearts, as long as we can.

[Guest budsmom]

I agree with Jen, also. Gabapentin can be very effective and it is very difficult to overmedicate with. Please talk to your vet, and if possible have them consult with an oncologist, Dr. Cuoto is the best in the world for greyhounds http://www.coutovetconsultants.com/.

[carronstar]

You've received great information and suggestions from many, and like many, I completely agree with Jen's suggestions.

 

I lost my last girl to osteo. The vets were very clear that even at the highest dosage, there would still be breakthrough pain. I chose to let her go that day. If I were home on a daily basis, I probably would not have done it quite that fast but I was in the midst of packing the apartment to move across country and there was going to be too much change to her world, her pain, where she would sleep and how to get her across country for me to prolong her pain so that I would have more time with her. If you are home with Crouton, and can monitor her, then I would say give the higher levels of pain relief that have been suggested. If you see no improvement in her pain, then you will have to do what seems unthinkable.

 

Hugs. My heart hurts for you.

[Guest Roux]

I'm so sorry about the diagnosis. I lost my boy last month to osteo. GT'er Neylasmom is currently using it for her Zuri. I'm sure she'll respond soon. I've bumped up the Osteo thread in which you can find a lot of good information and support.

 

 

Just wanted to thank you for directing me to the Osteo thread. I have been reading "back" several pages, but still have a long way to go. You must be missing Chase dreadfully, and I am so sorry you lost him. As my husband continues to tell me, no matter what happens, every day we did what was best at the time.

 

Since this thread has become a topic about all aspects of osteo and not just the zoledronate treatment I initially asked about, I will close out with this post, and move to the current Osteo thread. Later tonight, I will post there about our visit with our vet this evening, once all three of our hounds are settled.

 

Again, my heartfelt thanks to everyone who posted. You have given me exactly what I needed to try to navigate this maze. My sincerest appreciation to each and every one of you!

[NeylasMom]

 

You are absolutely right, and I agree with everything you said. As of today, we received Crouton's diagnosis only 2 weeks and three days ago. During these too few days, we have climbed way up the learning curve about the disease, and feel we owe at least our best try, within her physical limitations and our geographic ones, to control her pain and give her a chance to feel better during whatever time she has. But, we are also strong believers in the truth of science, and the inevitability of her condition.

 

This afternoon we plan to meet with her vet to look again at the x-rays and discuss them, armed with new understanding, and a bit of distance since the first shock of learning her diagnosis. We will discuss rebalancing her pain medications, and try to find the wisdom to do the right thing for her. We do love her very much.

 

I want to always be open to yours and others' perspectives. I'm new at this, and hope not to have to get used to it. We will always welcome another greyhound into our home and hearts, as long as we can.

Before you end this thread, I just want to say that I think Crouton is very lucky to have you. Hope your vet visit produces some good news.

[4My2Greys]

Before you end this thread, I just want to say that I think Crouton is very lucky to have you. Hope your vet visit produces some good news.

I would like to echo that sentiment. I will follow your journey with Roux in the Osteo thread along with Neylasmom with Zuri and Cecil and his mom.

[JenniferS]

Also, as you can see from everyone's experiences, they are all different. Some dogs don't live a day past diagnosis, some live years. It is an awful disease that plagues our beautiful greyhounds, and we can only learn from each other and support each other. Ultimately it is your decision, and I really do believe that the dogs let you know when they are okay to let go - love her every minute.