Osteo Thread Part 9

[ramonaghan]

4 minutes ago, gracegirl said:

I’m here to very sadly join the worst club. Tessie was diagnosed with OS on Thursday. She has an appointment with an oncologist one week from today. 

I'm so sorry, Lauren. I read your posts on the ABT. Is the oncologist part of a larger specialist clinic? Ours was, and he was able to bring in a surgeon for a quick consult at the same time when we were deciding whether to debulk Sweep's soft tissue tumor (this was after she'd already had her amp for osteo). That might shorten the wait and lessen your anxiety a bit if they can coordinate that.

I'm glad you have Dr. C on board. He is such a kind man. He sent a condolence email for Sweep even though it had been months since we last corresponded.

Sending hugs to you and Tessie.

[gracegirl]

8 minutes ago, ramonaghan said:

I'm so sorry, Lauren. I read your posts on the ABT. Is the oncologist part of a larger specialist clinic? Ours was, and he was able to bring in a surgeon for a quick consult at the same time when we were deciding whether to debulk Sweep's soft tissue tumor (this was after she'd already had her amp for osteo). That might shorten the wait and lessen your anxiety a bit if they can coordinate that.

I'm glad you have Dr. C on board. He is such a kind man. He sent a condolence email for Sweep even though it had been months since we last corresponded.

Sending hugs to you and Tessie.

Thank you. Yes, we have a large specialty center near us that is wonderful, we’ve had to visit the e-vet there several times and that’s where we take T for her pannus checkup with the ophthalmologist as well. So they’ll swiftly coordinate with the surgical specialist, assuming that’s the treatment plan they recommend.  
 

And to think I hesitated to continue with Healthy Paws after the large price increase in April. Now I will happily pay that monthly amount because it means I can say yes to every treatment option because it’s best for T without having to think about the financial implications. Her plan is $100 annual deductible (we’ve already hit that) and 90% coverage so I’m very glad we got the very best plan for her. 

Edited June 18, 2022 by gracegirl

[ramonaghan]

15 minutes ago, gracegirl said:

And to think I hesitated to continue with Healthy Paws after the large price increase in April. Now I will happily pay that monthly amount because it means I can say yes to every treatment option because it’s best for T without having to think about the financial implications. Her plan is $100 annual deductible (we’ve already hit that) and 90% coverage so I’m very glad we got the very best plan for her. 

Same here. We almost canceled Sweep's policy and are so glad we didn't. It made every decision much easier. HP was great and timely with refunds. I think all told her treatment was about $23k.

[FiveRoooooers]

Lauren 

[greysmom]

I'm so sorry Lauren...........  {{{hugs}}}

[okslater]

I'm sorry Lauren. Such a dark day getting this news. 

I'm really glad you're insured. We let ours lapse and a couple of months later got the diagnosis. Lemming died in January and we're still paying our £25k (30k USD) bill. You kinda hope your dog lives longer than it takes you to pay for the medical care, but hey ho. I really hope you manage to get a good amount of quality time with her. Every extra day we had with Lemming when she was feeling herself were like a gift from the heavens, and she seemed to love life even more than before (maybe all the chicken helped). Good luck with the next steps.

[gracegirl]

My head is reeling and I need some advice please. Here is what I know so far. 
Tessie started limping last Monday. 
Got her to the vet on Thursday and had them do x-rays. 
OS seen on the x-ray. Started Carprofen and Gabapentin that night. Can add 

I emailed Dr C with the rads and initial diagnosis and this was his response:

the lesion in the left distal (lower) femur (thigh bone) is highly suggestive of a primary bone cancer (more likely, osteosarcoma - OSA). However, this lesion could also be a chondrosarcoma (CSA), a fibrosarcoma (FSA), a histiocytic sarcoma (HS), or a less common primary or metastatic bone tumor. Although similar changes can occur in dogs with fungal bone infections (osteomyelitis), they are extremely uncommon. A fine needle aspirate (FNA) of the area for cytology usually yields a definitive answer. Her thoracic radiographs do not show any evidence of metastases (tumor dissemination)

He also encouraged bloodwork so I have an appointment to get that next week. 
 

I made an appointment with an oncologist for June 25th. They’re part of a larger group who has surgical experts, so assuming amputation is recommended, her oncologist wilL coordinate with the surgeon. We’d still need a surgical consult before any amputation though, and depending on schedules and severity they sometimes take dogs into surgery same day. 
 

So I now for the questions. Will they use the same rads taken at her vet when I go to the oncologist? I sent those to Dr C and he’s requesting a different format. I’ve asked for that from my vet. I’ve got a tech appointment scheduled for bloodwork so we will know if her white cell count is elevated soon. I saw Dr C’s recommendation for an FNA but I seem to recall that it’s painful and unnecessary. I imaging they’ll biopsy after amp and determine radiation or chemo protocol from there, right?

Should I send the treatment protocol from the oncologist to Dr C for his confirmation once I have it? 
 

Is there anything else I should know about? What’s the medication that helps with bruising, is that Amacar? Does she need a clotting test before surgery? Anything else that stands out as different for greyhounds? The vet pointed out the enlarged heart and Dr C basically said “yep that’s because she’s a GH”. 

Edited June 19, 2022 by gracegirl

[tbhounds]

Sorry jumping in here late and I haven’t read the thread but noticed you are located in Colorado.  There is not another clinic in this country that I would recommend over this one for top notch, cutting edge osteo treatment.  Have you considered…….

https://www.csuanimalcancercenter.org

[gracegirl]

3 hours ago, tbhounds said:

Sorry jumping in here late and I haven’t read the thread but noticed you are located in Colorado.  There is not another clinic in this country that I would recommend over this one for top notch, cutting edge osteo treatment.  Have you considered…….

https://www.csuanimalcancercenter.org

I thought about taking her to CSU but it’s easily an hour and a half from home and I’ll be juggling her cancer treatments alongside my full time job. Luckily I work from home, but driving to and from appointments in Fort Collins just isn’t feasible. Many of the vets in the Denver area are CSU grads (the one who diagnosed her is). 

[ramonaghan]

I'll try to help with your questions since I've been through this so recently, but I'm sure each place has its own protocols so mileage may vary.

Sweep was diagnosed at the specialty clinic/e-vet (sounds like a similar setup to yours), so they always had their own x-rays. I suspect your clinic will want to take their own rads.

We did the FNA per Dr. C's recommendation but the oncologist was skeptical he'd find anything, and he was right. You have to hit the exact right spot. I probably wouldn't do it again. We didn't get 100% confirmation of osteo until after the amp.

It never hurts to run anything by Dr. C IMO, but there's not much debate: If it is osteo, carboplatin seems to be the chemo drug of choice. Because Sweep had already started chemo before her amp and confirmation, she'd had 3 rounds of doxorubicin (which targets multiple types of cancers) before switching to the carboplatin. The doxo was much harder on her than the carboplatin. Tessie should do fine with carboplatin, but they can give IV Cerenia at the same time and that will help mitigate any GI effects. They should also send you home with Cerenia in pill form and possibly metronidazole.

Yes to Amicar. Sweep did not have a clotting test before her surgeries—first the leg break repair and then the amp. She got Amicar with both surgeries (immediately before, during, and in post-op at the clinic), but we were only sent home with it for the amp. The difference in bruising between the two surgeries was significant: her bruising was much better with her amp, so I would strongly recommend that they send you home with a few days' worth of Amicar and ideally have you start it a day or two before the surgery. She did not have any complications or bleeding issues. 

Other thoughts: With Sweep's surgeries we saw a marked improvement once she was off the hard drugs. She was so loopy the first couple of nights and needed a ton of help getting around. Her mobility improved further still when she was off the Amicar and allowed to have an NSAID again. She had a rougher go I think because she'd never stopped using the leg, so tripodding was completely new to her.

Finally, Tessie's temperament might somewhat determine how long she stays in the clinic after surgery. Sweep was very anxious there and they thought she'd do better with us, so she came home the day after her amp. If Tessie is fine there, let them keep her for the roughest first days. Insurance is a wonderful thing that gives you that option. 

[ramonaghan]

I also wanted to add that I would be happy to mail you the harness Lucy (@LBass) sent us when Sweep had her amp. It was so helpful in those early days and is way more comfortable for the dog to wear 24/7 than the other harnesses out there. I also have a fleece-lined sling with handles I can send you. 

[greysmom]

Yes and seconding everything Rachel said.  In addition:

If it's anything other than OSA, amp and chemo *may* be curative, particularly since you've caught it so early.  I would also not waste time with a FNA.  The result of it doesn't really matter since you'll probably want/need to amp anyway (unless you choose palliative-only care).  The one caveat to that is if it's osteomyelitis, but as Dr Couto states, that's extremely rare.  The odds are overwhelming that it's osteo.

Have you said whether it's a back leg or front leg??  That may enter your calculations regarding her adaptability as front leg amps seem to have a little more difficult time getting going following surgery.  The adjustment time seems to be much quicker with rear leg amps.

I also agree with leaving them in the clinic for a few days following surgery and letting the professionals deal with the worst of the getting them up and moving around.  Unless the dog is just terrified and terribly anxious in that environment - remembering they will be mostly drugged up.

I would *never* do an amp without Amicar on board.  Never.  Even if they've never shown any bleeding issues.  Remember, it's not an inability to clot that's the problem.  It's the inability of the clot to hold long term.  So the dog could be fine following surgery and then the next morning, or whenever they begin to move around, the clots fail, and with the size of an amp incision, it can get very dangerous very quickly.  Look on Good RX for the best price on it in your area.  I just had to get 15 pills and the initial price was over $300.  

Good luck.  Keep us updated!

[gracegirl]

Thank you both. I’m making a notes file on my phone with all of this info to go over when I meet with the oncologist. 
 

It’s her back left with the OS. She has slight arthritis in her front left from all the turns on the track (she raced just over 100 times). It only really bothers her if she runs/plays hard in the yard, which she rarely does, or if we walk her for more than 1.5 miles, which we obviously don’t do any more. She’s happy with her .5 to 1.25 routes. Sometimes I’ll drop her off at home and then go on another loop with the other two. She also stays home when we take the other two hiking. 
 

She does okay at the vet. Not amazing but not terrible. My biggest concern would be if she can’t/won’t lay down to rest. She might be so loopy that she doesn’t care though. I think she’d do okay staying at the vet longer. She might just be really whiney. Her high pitched whine is ear piercing. Lol 

[gracegirl]

22 hours ago, ramonaghan said:

I also wanted to add that I would be happy to mail you the harness Lucy (@LBass) sent us when Sweep had her amp. It was so helpful in those early days and is way more comfortable for the dog to wear 24/7 than the other harnesses out there. I also have a fleece-lined sling with handles I can send you. 

This would be amazing, thank you. Once she has her appointment with the oncologist and we have the amp scheduled, I’ll let you know. I’ll pay you for shipping, of course. And I’ll send it along to the next GTer when the time comes as well. 

[Remolacha]

I was told that the back leg amps are a little easier for them because so much of their body weight is in the front. Made sense to me. 

[gracegirl]

Has anyone changed their dogs diet upon an OS diagnosis? I read one of the links from page 1 that suggested sugar and carbs feed cancer, so a low carb diet might be good. Would be willing to do pre-made raw or kibble for her. Or even those expensive diets that mimic home cooked. 

[ramonaghan]

I didn't make any changes to Sweep's core diet (Fromm adult classic kibble). Her appetite did change a bit with either her age or the cancer, so sometimes she refused treats she used to love or she ate breakfast a little later in the morning. Overall, though, she ate well and maintained her weight up to her last day. If you're not already giving it, fish oil is a good idea for its anti-inflammatory properties (just stop it before surgery and while she's on Amicar).

IIRC, a raw diet isn't recommended during chemo due to their compromised immune system.

[greysmom]

The whole carbs thing has never been proven, in dogs or people.  It's a cancer myth!  Feed her whatever she'll eat, whenever she'll eat it!!

[gracegirl]

She got pizza bones the other night. 😋

[okslater]

Yeah I wouldn't worry about diet. We just fed Lemming her usual food with extra treats. Food was such a pleasure for her, and she had good guts on her usual food, so I didn't want to mess around with faddy diets. I've been to quite a few (human) oncology appointments with friends and family and the advice is always to just eat as much as you can stomach, as cancer is so highly metabolic and it churns through calories. 

[gracegirl]

Just got home from our oncology appointment. Oncologist basically just confirmed an “aggressive, painful bone lesions that is osteosarcoma” in her back left femur. Amputation is the best “curative” course of action. Curative is in quotes because it’s typically buying time until the cancer metastasizes in the lungs, as you all know. We also did an ultrasound of her abdomen today just to make sure there were no tumors and we are in the clear. 

The only new information I got today was in regards to an experimental immunotherapy that sends her tumor off to a company in Kansas, they use the cancerous cells in the tumor to make a vaccine followed by t-cell therapy. This would be in place of chemo. The first thing I need to do is see if Healthy Paws will cover it (it’s approx $8k in addition to the cost of the amp) and then get more information from a vet in Boulder who has been doing this with her patients. 

https://eliasanimalhealth.com/treatment/

I asked about any trials at Comorado StTe University and she said there was nothing currently for osteosarcoma, the only reason to be treated there would be for a PET-scan of the lungs ($4k) or for limb sparing treatment (3D printing bone where the tumor is removed), but she’s not a candidate for limb sparing treatment because of the location of the tumor. 

I’ll be calling two clinics on Monday to see how quickly I can get surgery scheduled. Typically you need a surgical consultation followed by the surgery appointment. No one is open until Monday. So more waiting and poor quality sleep. Boo. Though this does make her med schedule easy since I’m pretty much awake all the time  

The oncologist and the tech both loved Tessie, they commented separately how outgoing she was. While she was awaiting the ultrasound, Tessie laid on the floor with the tech and the tech shared her burrito with her. 💞

[EllenEveBaz]

Just adding our best wishes.

Quote

No one is open until Monday.

Weekends are the pits with serious illness.

Quote

Tessie laid on the floor with the tech and the tech shared her burrito with her.

Score!  

[greysmom]

When Dude was going back to the oncology department weekly for check ups and bloodwork and chemo, the techs wouldn't put him in one of the holding kennels.  They just set up a bed in the middle of their offices and treated him there.  Even techs from other departments would come in and hang out with him for his chemo, giving him treats and attention the whole four hours he was there.  He LOVED going in for treatments!!!    And when it was his time to pass, just about every tech on duty came in to say goodbye and give him a kiss, and to tell us what a sweet and loving boy he was.  Even the doctor cried as she was giving him the IV.  The card we got with his ashes was 4 pages long.  I'm bawling just remembering it!

I'm saying this because it's important to take Tessie's personality into account.  We made the right decision with Dude - he was so outgoing and loved being around people who were paying attention to him.  And he was never nervous or afraid or anxious when we had to go in.  A dog with a quieter personality, or who was particularly nervous at the vet I would seriously consider what I was asking them to handle.

And definitely get it in writing from Healthy Paws if they'll cover this.  I would expect they consider it "experimental" and will not cover much, if anything.  It took me several years to pay off Dude's bill of @$20K, so that's unfortunately something to think about as well.

[gracegirl]

45 minutes ago, greysmom said:

When Dude was going back to the oncology department weekly for check ups and bloodwork and chemo, the techs wouldn't put him in one of the holding kennels.  They just set up a bed in the middle of their offices and treated him there.  Even techs from other departments would come in and hang out with him for his chemo, giving him treats and attention the whole four hours he was there.  He LOVED going in for treatments!!!    And when it was his time to pass, just about every tech on duty came in to say goodbye and give him a kiss, and to tell us what a sweet and loving boy he was.  Even the doctor cried as she was giving him the IV.  The card we got with his ashes was 4 pages long.  I'm bawling just remembering it!

I'm saying this because it's important to take Tessie's personality into account.  We made the right decision with Dude - he was so outgoing and loved being around people who were paying attention to him.  And he was never nervous or afraid or anxious when we had to go in.  A dog with a quieter personality, or who was particularly nervous at the vet I would seriously consider what I was asking them to handle.

And definitely get it in writing from Healthy Paws if they'll cover this.  I would expect they consider it "experimental" and will not cover much, if anything.  It took me several years to pay off Dude's bill of @$20K, so that's unfortunately something to think about as well.

Awe Dude. That’s wonderful he was so loved. My first hound would have hated going in for treatment, she was terrified at the vet. Not sweet T though. She does whine a bit because I think she’s trying to ask what the heck is going to happen next, but she doesn’t act fearful at all. Goes off with whoever takes the leash. Leans right up against everyone for pets. (This is reminding me of the time I was at the e-vet with Grace and they had to drag her in the back…next think I know she comes running back through the swinging doors after having chewed her nylon leash in half to escape 🤣🤣🤣 -RIP) 

[macoduck]

Lauren, just adding my experiences with Amicar.

The first time I needed it was the day after the manufacturing company was sold and the new owner made the price unbelievably high. Then, even with GoodRx, it was still over $600. It was also very hard to find. My local CVS pharmacy ordered it even though I knew the GoodRx coupon wouldn't work. I can't remember now why that was, but I was desperate. Turned out it did save Oliver's life.
During all that I reached out to Dr Couto and he said Tranexamic Acid is an acceptable substitute for Amicar. Vets don't carry it because it is considered an off-label use. Normally it's used for heavily menstruating women. My Walmart pharmacy had it at an extremely reasonable price.
With another greyhound I thought getting the Amicar compounded into a liquid would be a good idea. Local non-chain pharmacy did that for me, and the liquid was put in capsules. Although it was easier to give that way, it must be refrigerated and discarded after 14 days.
I was also able to talk my vet into having the injectable Amicar on hand for my senior greyhounds' dentals because I knew there would be extractions. Vet injected the Amicar into each socket. Unfortunately the price for the vet to have it in stock, and that very few of his clients needed it, the vial of Amicar would expire before he could use it all. He doesn't hesitate to write a prescription for Tranexamic Acid prior to dental or surgical procedures on my dogs.
None of mine had any pre-procedure bleeding tests. Allen came to me as a super senior, his owner did have the test done and it was negative. Oddly enough he started to bleed out during a microchip insertion.

None of mine have had osteo, *knock wood*.  Hoping for the best for your girl Tessie.