Osteo Thread Part 9

[LBass]

Thank you all for the kind thoughts and commiserations.

 

The surgeon who first saw Mo and did the biopsy confirming the OSA diagnosis was suggesting that he could take the affected outer toe and the toe next to it. That surgery would have been followed by chemo. As soon as the mets in the lumph node were confirmed, however, the oncologist shifted from talking about removing the toe and doing chemo, to looking at palliative care--radiation, bisphosphates, and pain meds. I've got a call in to her now asking about the possibility of having the surgery to remove the toe as a pain control measure.

[tbhounds]

And sadly, MoMo's lymph node does have metastasis. Now the possibilities of Tramadol, Caprofen (?), Gabapentin, bisphosphonates, palliative radiation, etc. are dancing through my head.

Reach out to Suzie Collins-her Maggie had osteo in the toe and following a complete leg amp she had many wonderful years of remission.

[greysmom]

And sadly, MoMo's lymph node does have metastasis. Now the possibilities of Tramadol, Caprofen (?), Gabapentin, bisphosphonates, palliative radiation, etc. are dancing through my head.

 

Crap. Lucy I'm so sorry. Suckitude is now complete. I hate this stupid disease. {{{sigh}}}

[MaryJane]

FYI --

 

I forgot to mention that when I had the consult with the surgeon at Tufts, one of the options was a limb-sparing procedure. It might be an option in dogs where the affected bone is near the wrist - they cut the bone and fit a metal piece to take it's place. It seems to be an option that is used in large dogs that cannot do the "hop". Survival statistics are not well known. Adam's surgeon did not recommend it for greyhounds as their skin is so delicate and it looks like they are prove to more infections from this procedure than other dogs (however, no stats on that). The odds look better with amputation and chemo however, for people looking for an another option, this supposedly removes the pain as the infected bone is gone and I think (not 100% sure) it can be followed up with chemo.

 

I remember back around 2004, the only place that was providing this was Colorado State University as part of their research.

[MP_the4pack]

I had asked about limb sparing surgery for Tanzi last November and neither Dr Couto nor Mark said there were any good options, even though Tanzi's was in the wrist. We discussed several. However I'm not sure metal replacement was one of them.

[LBass]

I spoke with the oncologist last night, asking specifically if it might work for pain control to go ahead with the amputation of the toes. She said that the fact that there is already lymph node/system metastasis significantly reduces the average survival time we can hope for, no matter what we do. Her guesstimate is 2-4 months. She said that healing from the toe amputation surgery would likely be significantly more difficult that from a full amputation, because of the physical stress put on the foot through walking, even with restricted activity. Mo had a toe amputated on the non-osteo rear leg several years ago, trying to treat a large, stubborn corn, and I remember that healing that was a lengthy, difficult process. I think that the upshot of all this info is that, if I ask them to amputate her toes, she'll spend the remainder of her time with me trying to recover from that surgery. I don't want that for her.

 

I talked to my own vet's office--they'd asked for an update on Mo--and learned that the vet's own pitty girl, Charlotte, has osteo. I've made an appointment to talk with him next week. I figure his informed, educated veterinarian's brain has been sorting through all the options and he'll be able to share his thoughts, information, and instincts with me. I'm so sorry his family is facing osteo with their girl too. I remember her hanging around the clinic when she was younger--a really sweet girl.

 

At this point, with what I know of Mo and what I've learned over that last couple of week, this is the plan:

--pain control with meds, adding more as needed

--IV bisphosphonates from the oncologist. This can reduce the bone loss/deterioration that seems to be the source of pain and can help avoid fractures.

--all the fun I can give her for as long as she's comfortable

--careful leash walking

--I'll take a look at acupuncture, Artemisinin, immune boosters, etc. and if anything seems likely to increase her comfort and is available then I'll provide that.

 

An then there is going to be the making if that decision we all dread.

[NeylasMom]

I'm so sorry you're facing this. The toe is a more unusual location. It's such a shame that there is already lymph node involvement.

FWIW, we used the Zoledronate for Zuri and it really seemed to help him. It can cause kidney issues so between that and the pain meds, you may want to think about a supplement or two to support organ function. We went with milk thistle (I used the Gaia low alcohol liquid) and the renal support supplement from Vetri-Science. Standard Process also has a really good whole foods supplement for renal support, but you need to purchase it through a vet I think.

 

I would also do a hefty dose of Artemisinin. You never know if it will help slow things down. I believe it may have with Neyla. Zuri never really got it because you can't combine it with radiation.

 

I still have some left. At some point I had offered to send some supplements to folks, but I am TERRIBLE about mailing things. I think Connie has dibs on it if she wants it for Bowie, but otherwise, I could send it to you. I just won't be in my office for another week probably.

[4My2Greys]

Lucy, I am so sorry about MoMo. It's bad enough getting the diagnosis, but worse when what little hope you have is taken away. It's been almost a year since I had to let Chase go. Along with the osteo an enormous clot was found. It would have been too risky for surgery and the bone was so moth eaten that he risked fracture. I brought him home and spent the next day with him. The following day I said goodbye.

[LBass]

I'm so sorry that Chase was gone so quickly.

[MaryJane]

Adam had the leg removed last Thursday and while I might have taken him home Saturday, it ended up being Sunday as there is a national shortage of oral Amicar and even the equivalent Tranexamic was not in stock in most places - I only found it at Costco after checking many other pharmacies in my area.

 

Sunday night, as expected, difficult as he had a hard time finding a comfortable position & place and would come over to where I was sleeping and we would move to another room and bed for him to see if it worked better - this was happening through the night. Monday night was more manageable and I found if I slept right next to him so he could see me, he didn't need to get up. He also started sleeping on the incision side yesterday ... I didn't expect that .. maybe it is different with front amps.

 

Bruising, so far, is much less than expected. He was on Amicar the morning of surgery and he has his last tranexamic today.

 

He is managing to get around, I still help with a sling going up and down the ramp to the outside yard. He did come home with the other front leg swollen and bruised however, it gets better overnight and then as he uses it during the day, it starts to accumulate fluids. As expected, he is very tired having to support weight of front part on one leg.

 

He does not have a fentanyl patch, instead they put in pain control at the site (relatively new) which lasts for a few days.

 

The first night was the worst for the pain and I have dropped the dosage since then from 2 Tramadol & 1 Gabapentin every 6 hours to 1 tramadol & 1 Gapabentin every 8 hours. I do not want to drop the pan meds too quickly however, it looks like he doesn't need as much or as often.

 

Would appreciate if anyone can remember how long before their dog was weaned off pain meds.

[greysmom]

It wasn't long til our boy was off pain meds after coming home - maybe 3-4 days - but then had to go back on after another surgery due to infection. We didn't do tramadol or a fentanyl patch. We came home with codiene sulfate 30mg as our surgeon liked it better for sighthounds. Apparently, even though it's an opioid, there's less chance of having the typical opioid reaction, and we have found that to be the case. Dude also stayed in the hospital for four days after surgery so he was really quite mobile and able to get up and down by himself.

 

Sleeping and laying on the amp site, is *very* common. You'd think it would hurt or something, though just about everyone I've followed here has had their dog do it. Front leg, back leg, makes no difference.

[MP_the4pack]

For both my OS girls it seemed like 2 weeks was the magic number. Tanzi was sleeping on her amp site very soon after surgery.

[seeh2o]

Bowie was in the hospital for 5 days post amp, hopped out on her own, never needed a sling. Vet insisted she be on pain meds for 2 weeks. She couldn't lay on the amp side the whole time, she cried every time she tried.

 

I took her in 2 weeks later to get stitches out, still couldn't lay on the amp. Took her in a couple of days later for follow up and clearance to start chemo. All good. The very next day she was off her food in the morning, I came home from work that night and she had drained every bowl of water, peed everywhere, was panting and had a fever of 103+. I rushed her to the hospital and she was admitted for 3 days. She came home and was able to sleep on the amputation and roach from that point on.

 

She was never on Fentanyl, just Tramadol, Gabapentin and Rimadyl only.

 

Sending good thoughts for your boy.

Edited June 22, 2017 by seeh2o

[Beachbum1]

Taylor (right front amp) was weaned off of pain meds starting 2 weeks after surgery. Took a few days.

He was laying on his incision side when he came home, after being in the hospital for 6 nights due to excessive edema, and that was even with Amicar.

 

[MaryJane]

Thanks for the information ...

 

Based on what you have all said, I will still be continuing the pain meds at least into the weekend which would be about 9 days.

 

He had some edema in the good front leg but that has come down significantly yesterday and no longer builds up again during the day.

 

He sleeps fitfully and if I am not right next to him during the night, he will get up and want to move. If he sees me, he re-positions and goes back to sleep. During the day, if he wakes and can't see me, he will go looking for me, so he is able to get up and down and get around.

 

Very little edema or bruising at incision site and I have to thank the amicar and the med student (she was icing his chest every few hours).

 

He gets around both inside and outside but, still very tired supporting all the weight on one front leg.

[MaryJane]

The 2 weeks from hell is over... and Adam is getting used to the adjustments that tri-pods need to make, laying down and getting up much easier, and back to eating but, still fussy - he turned the corner on Tuesday. He's scheduled for Chemo on Monday.

[LBass]

I'm glad to read that your boy is settling into his "new normal".

[greysmom]

Great update for Adam! Now you start hoping for good bloodwork results!

[seeh2o]

Good boy!

[MaryJane]

Adam had his first chemo this past Monday and all went well. He got Cerenia to control any upset tummy and that helped keep his appetite steady.

 

He's due for bloodwork next week to access the impact on his WBC.

[MP_the4pack]

Yay for Adam!

[EllenEveBaz]

Good boy, Adam!

[greysmom]

[MaryJane]

Adam was due for his 2nd chemo today but, his white count was too low -- 1.8. We have another scheduled for next Monday. Discouraging however, his new harness (Julius k9) has been pretty good minus some small issues.

[greysmom]

It happens. And it might happen again. Try to not let it get you down. Good job Adam!