Osteosarcoma----How Do You Know When It's "time"?

[Guest Mr_Owski]

A week before Christmas I found out my first dog ever, Nattie, has osteosarcoma. He's only 7, and I'm livid that he has to succumb to this disease so early in life and so seemingly quick into our relationship with him. Over the past 8 weeks I've seen him go from mild limping to now being completely non-weight-bearing and essentially a tripod dog. I'm astonished at just how quickly this disease has taken hold.

 

Unfortunately, we don't have the funds to afford any type of amputation or cancer procedures. Plus, the marginal extension of life isn't worth the exorbitant price tag as well as the pain and discomfort I know we'd be putting him through just to keep him alive for weeks/months longer. We're simply opting to do pain management and give him the best remaining life that we can.

 

He still has his personality and gets excited, but he knows he cannot run anymore. I have to carry him up and down the stairs, and he will continually turn in circles in an attempt to get comfortable when laying down, repeating the process numerous times each hour.

 

Given how things have progressed, I can only imagine how the next 8 weeks will go. For those of you who have dealt with this or who have ever had to put down your dog, how do you know when it's time?

 

 

 

[macoduck]

I understand your concerns regarding amputation or chemo. Usually, at our house, we consider how happy the dog is when seriously ill with a terminal diagnosis. Still eating, still wanting to play, still enjoying car rides. We've been fortunate that we read the look that says, "mom, it's time", or at least I hope so.

 

That said, we've never had an osteosarcoma dog here. Nattie's leg may break with a simple movement that he had no trouble doing before. He may alone when it happens. How would you feel if you came how to find him that way? Please know that I don't mean for that to sound harsh. I think you have already given yourself the reality check.

[greysmom]

It's all about his quality of life.

 

Pain management is the key. And your ability to deal with the possibility of a catastrophic leg break every hour of every day. You have to asses and reasses his pain levels all the time, including his level of comfort and his ability to live a somewhat normal life. Is he still eating with gusto or do you have to coax him? Can he go potty with dignity and manage all his needs that way? Can he get adequate rest? Can he enjoy life on his own terms?

 

You didn't say what mes you have him on, but most of us use a combination fo gabapentin (specifically for nerve pain), tramadol (as he can tolerate opioid pain relievers), and an nsaid (piroxicam has show some anticancer properties but again, anything he can take without too much stomach upset). Many regular vets are too conservative in prescribing dosing levels for dogs with osteo - it is hideously painful - we know this from humans with the disease - and there's no need to be conservative. But you also need to consider that when you are giving high dosages his pain level must be extremely high as well.

 

Most of us subscribe to some version of "better a day too soon than a day too late," especially with osteo. There are many ways to think about end of life care. Some people say to pick their three favorite things, and that it's time when they can't enjoy those things anymore. Some people say you'll know by the look in their eyes. I always go with putting myself in their position - what would *I* want if I was in the exact same medical condition? Fortunately, with our companion pets, we can make humane choices and not let their lives degenerate into laying around in a drugged stupor. Whatever yardstick you choose it's all about their quality of life.

 

It just sucks. And I'm so sorry that you've joined this sad club with your handsome boy.

[KF_in_Georgia]

I lost my Tigger to osteo last March. He fell in the house and couldn't get to his feet without help. When I got him up, he was still in pain and limping. We went to the ER, x-rays showed osteo, and we put him to sleep that night.

 

He was in pain. I could have tried drugging him more (he was on meds for what the vet had diagnosed as a soft-tissue injury). But Tigger had already had one fall when he wasn't woozy on pain meds, and I wasn't willing to risk another one. I didn't want to worry that he'd fall sometime when I wasn't home, break his leg and be in agony, potentially for hours, until I returned. I'd had one earlier experience driving a screaming, broken-legged dog to the ER, and I never wanted to put another dog through that if I could help it.

 

If Nattie is limping, he's in pain and his current meds are insufficient to counter the pain. This isn't like limping through a broken leg that's going to heal. This is limping that will never get better and may get catastrophically worse at any moment. Dogs with osteo have been known to break a bone just putting weight on the leg to stand up after a nap. Look at him and decide if he's going to have better days than he's having now. If his days won't be better than they are, I'd spare him the days that will be worse.

[Guest Mr_Owski]

I understand your concerns regarding amputation or chemo. Usually, at our house, we consider how happy the dog is when seriously ill with a terminal diagnosis. Still eating, still wanting to play, still enjoying car rides. We've been fortunate that we read the look that says, "mom, it's time", or at least I hope so.

 

That said, we've never had an osteosarcoma dog here. Nattie's leg may break with a simple movement that he had no trouble doing before. He may alone when it happens. How would you feel if you came how to find him that way? Please know that I don't mean for that to sound harsh. I think you have already given yourself the reality check.

 

Fortunately or unfortunately, I'm unemployed at the moment, so I'm with him every hour of every day to help him out and make him comfortable. He's still enjoying the doggy things in life, but there are instances where I can tell he's confused or unsteady about his rapidly changing condition.

 

Don't worry about sounding harsh. I'm thankful that at least the timing of his diagnosis is giving me some time to prepare for the inevitable, but I've come to terms with what's going on. I'm just pissed because my preconception is that dogs, like people, should get sick in old age, not mid-life. I'm more so just angry that I'm being robbed of time.

 

 

 

It's all about his quality of life.

 

Pain management is the key. And your ability to deal with the possibility of a catastrophic leg break every hour of every day. You have to asses and reasses his pain levels all the time, including his level of comfort and his ability to live a somewhat normal life. Is he still eating with gusto or do you have to coax him? Can he go potty with dignity and manage all his needs that way? Can he get adequate rest? Can he enjoy life on his own terms?

 

You didn't say what mes you have him on, but most of us use a combination fo gabapentin (specifically for nerve pain), tramadol (as he can tolerate opioid pain relievers), and an nsaid (piroxicam has show some anticancer properties but again, anything he can take without too much stomach upset). Many regular vets are too conservative in prescribing dosing levels for dogs with osteo - it is hideously painful - we know this from humans with the disease - and there's no need to be conservative. But you also need to consider that when you are giving high dosages his pain level must be extremely high as well.

 

Most of us subscribe to some version of "better a day too soon than a day too late," especially with osteo. There are many ways to think about end of life care. Some people say to pick their three favorite things, and that it's time when they can't enjoy those things anymore. Some people say you'll know by the look in their eyes. I always go with putting myself in their position - what would *I* want if I was in the exact same medical condition? Fortunately, with our companion pets, we can make humane choices and not let their lives degenerate into laying around in a drugged stupor. Whatever yardstick you choose it's all about their quality of life.

 

It just sucks. And I'm so sorry that you've joined this sad club with your handsome boy.

Thankfully, he's eating perfectly fine.

 

I make sure that on our walks I take him to places to pee so that the bad leg is on the "leg lifting side" so that he doesn't get the risky idea to balance on his bad leg. He's been having some trouble recently with pooping in that he used to be semi weight-bearing on the bad leg, but now he's been trying to get accustomed to squatting only on 3. His balance is still there, but I'm definitely keeping an eye on it.

 

We're giving him Metacam daily to help with any inflammation, and he's currently taking 6 tramadol per day (3 morning, 3 night). This was the initial dosage prescribed by our vet. He doesn't show any ill-effects caused by the meds. We have not increased or talked with our vet about any alternate/stronger medications yet.

 

In regards to "better a day too soon than a day too late" it's tough because the selfishness in me wants to milk every day that I can and don't want to jump the gun if he's still "alive", but objectively I understand that's not reasonable to the dog and have to use my better judgment. It's just a hard call to make because the proverbial yardstick seems so arbitrary and nebulous.

Edited February 9, 2017 by Mr_Owski

[Neighsayer]

If he is limping, he is in pain. If he has trouble settling, he is probably in pain. I lost two in one year from osteo, and one a few years ago. The first one was a surprise. He was eight, with a limp that would come and go. We treated him for a sprain, but he got better for a few weeks. By the time we got confirmation, he had cancer throughout, and I let him go at that visit. Other than the limp, he appeared fine.

The next was a nine year old who developed that same limp. The bone didn't look too bad, so I took her home on lots of meds.that lasted three days, because I couldn't stay ahead of the pain. She was still eating, and got excited when I came home. She was just in so much pain.

The next one was a twelve year old who developed that same limp. I took her home, but she lasted just over a week. She was eating, but panting, pacing, standing because it hurt to settle down, and just miserable. Some of it was a reaction to the tramadol, but she went downhill in a matter of a few days.

I live in a small house, have several large, active dogs, and a doggie door. I would come home at lunch to check that all was well, but had such a fear of finding a dog in agony from a broken leg. A dog lives in the moment, not knowing that it has a terminal illness. He only knows that he is in pain, but wants to continue to please you, no matter how hard that becomes. I would never want another dog to have such a terrible last few days as my last two. With both, the end just came so fast. I just kept trying one more day with stronger pills, hoping for the best that didn't happen. With both, they had a horrible last night. I was up all night holding them and crying until the vet came in the morning. I hope that you don't get to experience that. I will never do that again!

I would never have kept trying with the last dog if I had not seen my friend manage her dog's pain for months. I kept hoping that I could get to that level of comfort with my dog, but it didn't happen. I wish that I had just let her go with dignity a few days earlier. In hindsight, I know that I wouldn't have been jumping the gun!

I don't know your situation, and I'm not trying to give you advice. I'm just sharing my experiences to give you food for thought. Please make your decision based on your dog, family, finances, and situation, and don't look back! I hope you can make a decision that won't leave you awash in guilt. I felt guilt after the first one because I didn't take him home and try, but now realize that I did the right thing. I still feel guilt over my decision with the other two., and it has been over six months. Enjoy the time you have left. I wish you peace as you struggle with your decision. Hugs!

Edited February 9, 2017 by Neighsayer

[Houndtime]

Reading your assessment of his pain, I think you are pretty close to making your final decision. I think you know that, and, are really looking for affirmation. I am so sorry. I do hate cancer.

 

My vet used to say, better a day too early that a day too late. Let him go with his dignity. He is more than just a dog; he is your best friend. He looks to you to give him peace and freedom from pain.

 

G-d bless.

[carronstar]

Reading your assessment of his pain, I think you are pretty close to making your final decision. I think you know that, and, are really looking for affirmation. I am so sorry. I do hate cancer.

 

My vet used to say, better a day too early that a day too late. Let him go with his dignity. He is more than just a dog; he is your best friend. He looks to you to give him peace and freedom from pain.

 

G-d bless.

I couldn't have said it better. When I lost my last girl, I asked about the possibility of palliative care, even though I was packing my NYC apartment and moving home to LA and the drive would have been a challenge. Once the vet made it very clear to me that even with the strongest of meds, there would always be breakthrough pain, my decision was made. We all live by a pretty simple rule -- NO pain for them. If you can tell he is in pain, then you already know. I am so very sorry, this totally sucks.

[Guest Mr_Owski]

Thank you, Neighsayer. I appreciate the anecdotes and insight.

 

Houndtime, you are right in that I am looking for some sort of affirmation. Prior to this I've only ever had fish and hamsters die in the past, so I feel a bit inundated trying to cope with being the decision-maker.

 

For now we're just gonna continue with daily peanut butter filled kongs and enjoy the warm weather coming up.

[KF_in_Georgia]

You might try asking the trick question pet owners often ask their vet: What would you do if this were your dog?

 

When it's osteo, I don't know of any vet who suggests delaying.

[lukasmom]

I was told when my girl had osteo that no amount of pain meds can take away the pain. I let my girl go 4 days after diagnosis.

It is an awful disease that steals our sweet hounds. I am sorry you are going thru this.

[Annette]

So sorry you are a part of the awful "osteo club". We lost Pogo on July 7, 2016 to this horrible disease.

 

Pogo was 8 years old. He was part of our family for less than 2 years. We did have his leg amputated and he underwent chemo treatments. Pogo made it 7 1/2 months post amputation. The hardest part of making "the decision" was that I had to do it without Roy being physically present. Pogo's name was perfect for him because if he wasn't sleeping, he was pogoing. Losing a leg did not slow him down. The vets and vet techs were amazed by his exuberance (considering he was supposed to be a laid back, calm greyhound) and Pogo was always happy to see them. Eventually mets were found on his lungs and he developed medical issues (for a lack of a better term) due to his exuberance. We didn't expect to lose Pogo so suddenly, but he developed breathing problems and he wasn't his happy self. We already had an appointment with our local vet for a checkup and bloodwork. Pogo did not want to get out of the car, he didn't want to see the people he was always so happy to visit. A vet tech had to carry him into the clinic. We never did bloodwork because xrays showed more mets and a fluid filled chest. It was obvious we had to let him go.

 

It never gets any easier to make that final decision. Roy and I have had 12 fur kids in over 28 years of marriage (7 greyhounds and 5 kitties). We have lost 10 of our 12 "kids".

 

You and Nattie will be in our thoughts.

[robinw]

I've lost three greyhounds to osteo. I was told that they are so stoic and that they tend to hide pain. The vet went on to say that osteo is extremely painful, even if they don't show it.

 

I let my guys go soon after diagnosis. Pain is inevitable, and all I really cared about was sparing my doggies from having to live the bad stuff.

[cleptogrey]

I personally can not see having a dog in serious pain. I have used the barometer of its time when a dog stops eating. My first greyhound had osteo and I found that the pain meds did very little and I heard emily crying at night. She was on a cocktail of 4 meds. She still had a good appetite but it was time. I'm so sorry,osteo sucks and I too do not amputate. I initially asked to have emily euthanized if her xrays showed cancer. My vet's xray Mas down and the referral refused to. To this day I'm sad that she had to suffer at all.

Edited February 10, 2017 by cleptogrey

[NeylasMom]

He is in too much pain if he is non-weight bearing and struggling to get settled comfortably. I don't understand the 8 week timeline. Is that the prognosis your vet gave you? If so, that's arbitrary. You need to make the decision based on how your dog is feeling at the moment. I would not use whether the dog is eating to guage whether it's time. Per the vet who euthanized my last greyhound because of osteo (my second dog to lose, unfortunately in both cases it was osteo) many dogs will continue eating despite significant pain with this type of cancer. Certainly if he weren't eating I would say that's indicative, but the point is don't assume he's not in pain because he's eating.

 

You may want to read through the current and prior osteo threads. There is a lot of pain management information, but as a general rule you want the dog on an NSAID (Metacam in your case) daily, Tramadol every 6-8 hours, and Gabapentin every 6-8 hours. You want all 3 because they all treat different kinds of pain and the safety ranges are quite high on the latter two, while the side effects are quite limited (usually just sedation). You are dealing with a terminal and potentially very painful disease so this is not the time to be conservative. Gabapentin was a life saver for us, literally, and is quite inexpensive. Asking for 100 mg pills will give you the most flexibility on dosing.

 

I'm sorry you're dealing with this. It's a horrible diagnosis and very hard to process when it's sometimes only discovered in the later/more painful stages. Also, as someone mentioned above, he could break his leg at any moment. Even though you are there, he will be in horrific pain if it happens. So consider asking your vet for a strong pain med that doesn't require the dog to swallow it (something that be absorbed through the skin in the mouth would be good) that you can give just so you can get him in your car and to the vet for euthanasia. I'm sorry to have to even say that, but it's the unfortunate reality. Once the leg is broken, amp or euthanasia are your only options.

[Scoutsmom]

You are angry and I am angry. He is still young and should not have this horrible disease. The universe can be so harsh.

 

If you haven't started to make arrangements for him to leave, you need to do it now so you are ready. I am a big believer in having the dog put to sleep at home on his bed where he is comfortable--it will just be a very deep sleep for him. My town has a couple of vets (recommended by my vet) who will come to your home with only a few hours notice. A previous vet would come to my home if I was able to give her 2 days notice. Then spoil your dog rotten.

[Guest Mr_Owski]

Thank you everyone for your kind words and support. It means a lot.

I don't understand the 8 week timeline. Is that the prognosis your vet gave you? If so, that's arbitrary. You need to make the decision based on how your dog is feeling at the moment.

 

You may want to read through the current and prior osteo threads. There is a lot of pain management information, but as a general rule you want the dog on an NSAID (Metacam in your case) daily, Tramadol every 6-8 hours, and Gabapentin every 6-8 hours. You want all 3 because they all treat different kinds of pain and the safety ranges are quite high on the latter two, while the side effects are quite limited (usually just sedation). You are dealing with a terminal and potentially very painful disease so this is not the time to be conservative. Gabapentin was a life saver for us, literally, and is quite inexpensive. Asking for 100 mg pills will give you the most flexibility on dosing.

 

Indeed, the 8 weeks was just an arbitrary timeframe. I was simply stating that since right now it's been only 6 weeks since diagnosis, I can only imagine how much more atrophy will occur over the coming weeks in a similar timespan.

 

I've seen Gabapentin mentioned in other threads. I wanted to avoid over-medicating and having Nattie be in a drug-induced stupor, but I'll absolutely give my vet a call just to see how feasible it is to get those pills as we are in the home stretch to provide as much pain relief as possible.

 

 

You are angry and I am angry. He is still young and should not have this horrible disease. The universe can be so harsh.

 

If you haven't started to make arrangements for him to leave, you need to do it now so you are ready. I am a big believer in having the dog put to sleep at home on his bed where he is comfortable--it will just be a very deep sleep for him. My town has a couple of vets (recommended by my vet) who will come to your home with only a few hours notice. A previous vet would come to my home if I was able to give her 2 days notice. Then spoil your dog rotten.

 

I've already contacted people from Laps Of Love to have a home euthanasia because I can't bear the thought of his final moments being not at home.

[NeylasMom]

Thank you everyone for your kind words and support. It means a lot.

 

Indeed, the 8 weeks was just an arbitrary timeframe. I was simply stating that since right now it's been only 6 weeks since diagnosis, I can only imagine how much more atrophy will occur over the coming weeks in a similar timespan.

 

I've seen Gabapentin mentioned in other threads. I wanted to avoid over-medicating and having Nattie be in a drug-induced stupor, but I'll absolutely give my vet a call just to see how feasible it is to get those pills as we are in the home stretch to provide as much pain relief as possible.

 

If he needs enough medication to put him in a drug-induced stupor in order to be pain free it's time to let him go. That's the harsh reality.

 

But these medications shouldn't do that unless you are using really high doses. Zuri was up to 500 mg of Gabapentin per dose and his personality was the same. The only effect you're likely to see is the dog sleeping more, but consider that you may also see that simply because the dog is now comfortable. I would also change the dosing on his Tramadol. It would likely be more effective to give 2 every 8 hours if your schedule allows it. With Gabapentin you really need to dose every 6-8 hours because of its short half life in greyhounds.

[juliemac]

So many of us share the pain you're experiencing, and the decision is so hard. Saying goodbye will not lessen the pain in your heart, but it WILL take away Nattie's pain.

 

Since osteo damages the bones, please know that the slightest thing can take the decision out of your hands. I've unfortunately been in the room when a sick hound broke a leg by taking a step backwards, and when another hound injured herself by slipping when she was climbing up a stair.

 

Our prayers and heartfelt sympathy is with you and Nattie.

[Charlies_Dad]

I am so very sorry to read of your boys diagnosis. We have also been down this road and while we opted for amputation and were lucky to get a lot of time with our angel Charlie, when cancer returned I made the brutal decision to let him go. As many have already responded, we have the responsibility to help our pups and care for them like you are doing. Unfortunately the ultimate burden is having to make the decision to set them free when there are no alternatives. Your boy is in a lot of pain based on your description and you have two choices, immediately up his meds and/or add meds such as gabapentin, tramadol, etc or make the decision to set him free from the pain. My heart breaks for you as it's not easy but I know you love your boy and it's time not to be selfish but generous and think of him.

[MP_the4pack]

I too have an OS dog. But I went the amp route. She's 9 and doing great. Now I read that you can't afford to do that. How about a crowd funding option? People would donate to save the life of a dog.

 

Just thinking outside the box here.

 

I'm sorry to hear the news.

[Hubcitypam]

:grouphug I am of the "one day too early camp" When my sweet Buddy was diagnosed with lymphoma they gave him two weeks to two months. He went to the bridge 16 days later.

 

Honestly the most horrifying thing I've seen is my human neighbor with cancer that went through so many rounds of chemo I couldn't count them. They weren't working so they amped him up which made him so sick. He was nauseous, unable to eat and having a terrible quality of life. It was so had to watch him turn into a shell and be so sick from the drugs. Personally I'll just wander off to the elephant graveyard.

[Walliered]

I am giving my hound 3 tram and 2 gab every 8 hours. This has been going on for several years.

[BootsyCollins]

I have a hound with osteo and he takes a combo of pain meds (gabapentin + carprofen + tramadol). No drug stupor at all. I strongly recommend you change his meds and add in the stronger stuff. That will help you truly understand how he is doing. Good luck

[winnie]

I'm so sorry you're facing this. I lost my heart hound, Faye Oops, to osteo in 2011. We got the diagnosis in mid-October and let her go on December 1. We we're having family visit for Thanksgiving. We had the appointment set to say goodbye before they arrived thinking a house full of people would be too stressful for her. Darn if that dog didn't rally and have some her best days yet. She really seemed to enjoy the full house and attention, but went downhill fast as soon as they left. Faye Oops was still using all four legs though and able to navigate stairs with only minor assistance (osteo was in her shoulder). I'd be concerned that your pup isn't doing either. It sucks, it really does, but I'd tend to want to err on a day too early than too late.