Osteo any new treatment? Amputation is not an option.

[GreytMom]

Well, my sweet 10.5 year old girl Brin looks to have osteo. She is my second greyhound - and my first one had it also. 😢 He was younger and strong so we amputated, did chemo, all the things. And he got nearly 3 more years post diagnosis. So, sadly I’m not uninitiated in dealing with osteo. 
 

Different scenario this time, however. My girl is older, has some back problems which causes her other rear leg to be somewhat weak, so unless there is something new treatment-wise, we are going to just have to move to palliative care. But, I wanted to ask the collective wisdom if there was anything new I may not be aware of that could be useful. 
 

BTW - I said “looks to have osteo” because we don’t have a certain diagnosis. As background, she has lived most of her life in southern Arizona where Valley Fever exists and can cause bone damage. We have done the blood test for Valley Fever, the test was negative, so unless by some chance it is a false negative, it is likely osteo. Chest X-rays haven’t been done yet, next week, and those may help determine a definitive diagnosis. I can’t take the chance to do a bone biopsy because the bone is already damaged and it could cause a fracture, and that would be the end. I have also not consulted with Dr Couto yet, nor seen the oncologist I saw before with my other hound. I just got the bad news last night so am scrambling a bit here to see if there is anything to do ASAP, or if the only goal is to keep her as comfortable as possible for the next month or two. 
 

Thanks in advance for any suggestions. 

Edited May 30, 2020 by GreytMom

[greysmom]

Best resource to find current and new medical knowledge is going to be your oncologist.  I will say I haven't heard of anything recently coming up or in the works.  There are several trials going on of new vaccines, in various stages, but most of them require amputation first.  

I'm so sorry you are having to deal with this again.  {{{hugs}}}

[GreytMom]

18 minutes ago, greysmom said:

Best resource to find current and new medical knowledge is going to be your oncologist.  I will say I haven't heard of anything recently coming up or in the works.  There are several trials going on of new vaccines, in various stages, but most of them require amputation first.  

I'm so sorry you are having to deal with this again.  {{{hugs}}}

Thanks greysmom. My research suggested the new vaccines were for post amp also. I’ll try to get into the onco, but I know she is busy. Hopefully since I’m a repeat customer... 🙄. Sadly given her other health issues I think I can’t push too hard and just have to go the palliative care route. But damn, cancer sucks. 

[MerseyGrey]

😢 oh god sorry. This sounds crappy all round so I hope you have some better news when you consult with Dr Coulto. Otherwise best wishes and lots of love to you and your hounds. 

[Houndtime]

No advice; just sorry that your girl had this sad diagnosis.  G-d bless.

[Time4ANap]

So sorry to hear this.  Spoiling her rotten is also a good treatment but also goes without saying. 

[cleptogrey]

osteosarcoma stinks, so sorry to hear this. i can't find the page but there is a national directory of vet. clinics who are involved w/ cancer treatment studies. up free treatment since they are studies. i did inquire about one locally, fit the criteria but the lymphoma that my pup had was too fast and furious. so, do a google search- "clinical trials for animal cancer" "clinical trials for canine cancer", avma (american vet medical association) clinical cancer trials, etc. best of luck, at least you will know you tried even if your dog doesn't fit the criteria. 

large vet schools- are doing research, anything out your way? i contacted cornell vet. but due to jamie's treatment w/ doxy when we first thought it was lyme he did not qualify. i looked under every stone.

[tbhounds]

Stereotactic radiation may be an option for you.

[EllenEveBaz]

No knowledge here, but sending our best and brightest wishes for Brin and hugs for you.  

[MaryJane]

Check with oncologist - if not going down the path of amputation,  there is radiation and also infusion to make the bone stronger. You might also want to check what trials are going on - that is what link is for. It looks like there is a study in Colorado for an alternate option from amputation/radiation.

https://ebusiness.avma.org/aahsd/study_search_results.aspx

[GreytMom]

Thanks for the thoughts and suggestions. Here is an update... 

I am mid-consult with Dr Couto. I say mid because he wants the X-rays in another format so he can see things more clearly. But, based on the files I did send... although it could be osteo he did suggest three other possible types of bone cancers it could be. Because... not only is there destruction of the bone (like osteo) there is also some proliferation of the bone (unlike osteo). I am scheduled with the closest oncologist who I saw with my other osteo guy, but she has nothing until late July. I don’t think Brin will be alive by then, honestly. I could possibly get her in to an oncologist 3 hours away in Phoenix, but I’m concerned about the possibility of a break as she rides that far in the car. Unless necessary for some type of cutting edge treatment, I don’t see the sense in a fine needle aspiration to determine the type of cancer at this point because amputation is the solution regardless, and that’s not possible. So, I guess I have mostly accepted defeat. 😢 Oh, and her chest X-rays are clear. 
 

Yet, I will continue to hope for a solution and am off to look into the Colorado study now. If it is a one shot treatment we could try and make the trip, but if it’s something you have to be local for it won’t work. 
 

Again, thanks for the thoughts and suggestions. It is heart-breaking. Two hounds, two bone cancers. And my third was just diagnosed with a (hopefully benign) tumor on her ear. I adore this breed but my heart may not be able to handle them. 💔

[tbhounds]

Please don’t rule out radiation as an option for treatment—at the very least it will help alleviate the pain.

[GreytMom]

28 minutes ago, tbhounds said:

Please don’t rule out radiation as an option for treatment—at the very least it will help alleviate the pain.

Thanks for the encouragement Tracy. I haven’t ruled it out... I just can’t get her in. So frustrating. I’ll call the oncologist again tomorrow. I’m on cancel list but... they said that was a 2 month wait also. Maybe I’ll get lucky. 

[MaryJane]

What are you using for pain control  - people here might be able to offer some suggestions.  If you would be willing to take a trip up to Colorado, you might want to see if you can get in there for an earlier appointment. They were on the forefront of osteo research back about 15 years ago and it seems like they are still noteworthy.  You might also see if anyone in the area will make a brace to protect the leg so less likely to fracture.

[NeylasMom]

So here the radiation oncologist is separate from the regular oncologist so you may want to ask if you can schedule directly with the radiation person. Both stereotactic and palliative radiation are options, and the latter has advanced. There's also IV Zoledronate (that would be your regular oncologist). 

[greysmom]

A two month wait to see an onco is not acceptable.  You might ask them if they can recommend another oncologist for you, since this is such a time sensitive disease.

[JenniferS]

Have you looked into Pamidronate or other similar infusions? We did this with my boy Wylie a few years ago and he had 6 good months post-diagnosis. It is essentially a bisphosphonate that may help strengthen the bone and reduce pain (along with pain meds). My vet was very happy with how it helped Wylie's bone around the tumor to calcify. 

[NeylasMom]

13 minutes ago, JenniferS said:

Have you looked into Pamidronate or other similar infusions? We did this with my boy Wylie a few years ago and he had 6 good months post-diagnosis. It is essentially a bisphosphonate that may help strengthen the bone and reduce pain (along with pain meds). My vet was very happy with how it helped Wylie's bone around the tumor to calcify. 

Just fyi, Zoledronate is the newer version. Pamidronate isn't used anymore because it had a higher risk of kidney damage.

[GreytMom]

It’s a shame that some of you are suggesting hopeful possibilities - but I can’t get her in to an oncologist to pursue any of them. So frustrating. I have an appointment here 7/28 and I am on the wait list. I called today to see if they had had any cancels. They hadn’t. But I’ll check in weekly and maybe that will help. I also called Phoenix (about 3 hours from me) and can’t get in there until 7/13. Clearly we need more pet oncologists. Or, better yet, less pet cancer. 

As for pain control - she is on 100 mg Gabapentin am and 300 mg pm - it makes her very tired so she only gets the larger dose at night. That is more for the back pain. We also added 75 mg Carprofen am and pm to address the cancer pain. I also have Tramadol left from another pet and have the ok to add that on if she seems to be in pain. She seems ok for now, but I have noticed she isn’t roaching anymore. Not sure what that means but it’s just something I’ve noticed. 

Hopefully in the next day or so I’ll have Dr Couto’s best guess as to the type of bone cancer. In the meantime, she is being spoiled rotten. 😊

[NeylasMom]

I'm sorry you haven't been able to get am earlier appt. That is beyond frustrating. Is that vet your only option without driving 3 hours? If so, my suggestion would be to really read up on the palliative options and consider whether you would really want to do them. None of these treatments are without risks. Zoledronate still has a risk of kidney issues, both palliative and stereotactic radiation can weaken the bone and increase the risk of a break. All of the radiation treatments require multiple sedations, though it's a very light, quick sedation for the palliative version. Stereotactic requires 2 longer periods of sedation, first or get the scans and then to do the treatment.

Also call the office in Phoenix and ask for estimates, or ballparks and decide if you would want to pay for them (none of them are cheap, I think Zuri's radiation was at around $2K and each Zoledronate treatment was $500-600 or more when you added in the vet recheck, blood work, etc. Stereotactic when I last checked a few years ago could easily cost you close to $10K when all is said and done. 

Then if you think you want to pursue any of them, consider driving to Phoenix. I would try to work out scheduling with them in a way that you can proceed to the treatment(s) in the same trip, at least the first time. Osteo really isn't something where you want to wait 2 months if you're going to do anything. 

Also, where we are everything is still contactless, which typically means handing your dog over to them, but our veterinary dentist agreed to look at photos I sent and then do the consult by phone because we knew she was going to need the dental regardless. So you might be able to convince someone to at least start with a phone consult. Hopefully Dr. Couto will serve that role and help you narrow down your options. 

I don't mean to sound pushy, it's just that time is of the essence. You might have to get a little creative to work out what's best. And if it turns out nothing but meds until they're not doing their job is it, there's nothing wrong with that either. 

[GreytMom]

Thanks for the info everyone. I do appreciate your concern.

NeylasMom - correct, there are no vets closer to me than the one in Tucson and then the group in Phoenix. Next would be the group I used in California with my other greyhound before moving to AZ. I know time is of the essence. (But, as a provider myself I also understand that when the schedule is full, it’s full. Although you can usually squeeze one more patient onto the schedule. 😊) I actually think if the local oncologist knew it was me, she might work us in as my last hound lived the 2nd longest of any hound she had seen with osteo. So, I think she’d remember my handsome Duke. I also had his amputation completed within 4 days.

With Brin I am very concerned about a fracture because of the weakness in her other back leg. I absolutely don’t want that to happen. I am definitely one to push when the situation calls for it, but I think I am seeing I am also willing to accept defeat when the situation calls for that.  We are still contactless also, but (and here come the tears) with the current rules at my vet I will be able to be with her for euthanasia. Even the mobile vets weren’t allowing that, but as of now my regular vet is. I’ll be with my girl one way or another when the time comes.

I actually am somewhat hopeful Dr Couto can make some treatment recommendations that my regular vet may be able to institute. So, I’ll push on my regular vet to get him the access he needs to the X-rays. That is taking too long and should have been done last week. Not Dr C’s fault, seems to be a hold up at my vet. Again, I haven’t done a fine needle aspiration so the exact type of cancer may not be able to be determined. If I thought it would impact treatment I would do it, but all the types of cancer he is suspecting are aggressive and best treated with amputation. 
 

Just an additional bit of info - I actually wonder if it is in her throat already. She is sort of half-yawning sometimes (sort of like when I try to pop my ears) and choking a bit on her food. She has had some swallowing issues for years but there has been a definite change recently. I guess when I add it all up... it explains why I'm starting to accept that the end is not too far in the distance for my precious Brin. 😢

[JenniferS]

I'm sorry you are going through this  One thing I will mention is my regular vet was able to do the Pamidronate infusions. Wylie never saw an oncologist. They were new to it and had only done it on one dog before, but they did it for me & Wylie and we had good results. Thank you Neyla's Mom for the Zoledronate name - I couldn't remember it. It was expensive about $600-$700 per treatment, but he had pet insurance which covered most of it. I didn't worry too much about the long term side effects since I knew his time would be limited. It would be worth asking your regular vet if they have ever done it.

 

[zimsmom]

On 6/9/2020 at 10:26 AM, GreytMom said:

(and here come the tears)

We have all been there.  Hoping you have some answers soon. 

[GreytMom]

Well, some good news. The oncologist had a cancellation so we got in yesterday rather than having to wait until 7/28. X-ray showed little progression from a month ago. Fine needle aspiration was unsuccessful. Times two. She only got blood and a few cells. Said bone was mushy. 😔 She still wanted to definitively rule out valley fever - and FNA did that although not enough cells to determine type of bone cancer. (I think I’ve got that right....)

Anyway, given amputation not an option treatment options discussed/offered were: 

1) stereotactic radiation - that is considered definitive in the same way amputation and chemo are... not a cure but better long-term prognosis, similar to amp and chemo extending good quality of life for ~10-14 months. (At a cost of $10-12,000.)
2) palliative radiation with zoledronate - hopefully getting her ~6-8 more months of good quality life. (At a cost of around $2500.) Possibly with the addition of some chemo at some point.   

Unfortunately she does not do stereotactic here, although she thought Brin might be a good candidate for it. We would have to make an 8-10 hour round trip daily for 3-4 weeks to get that. That is not feasible for Brin or I. So, I opted for palliative radiation and zoledronate. And, honestly, I’m thrilled to hope for another 6-8 good months with her. 

That’s the update from here! I’m pretty excited about it given otherwise we would not be looking at more than another month most likely.

PS - She had her first radiation and infusion yesterday and we will go in weekly for radiation for 4 weeks. Infusions will be monthly. She seemed to do fine. She gets whiny coming out of anesthesia.. but so do I. 😂 Other than that all went well.  

[Remolacha]

That is a relatively good update! If you can give her a good quality of life for 6-8 months for an adorable (again, relatively!) cost, good for you and her