Pain related & palliative care for osteo

[kudzu]

We’re ending our third day post  osteosarcoma diagnosis. We have ruled out amputation. There are already spots in the lungs. It’s the upper, right humerus. She already has a weak, wobbly & arthritis in her hind end.

Su was already on Galliprant & gabapentin for her hind end trouble. Now we’ve increased the gabapentin & added tramadol. It took a day for visible pain reduction. Today she is finally wagging her tail, putting ears on full mast. She tried to have a spring in her step but quickly relapsed to limping. 

We are monitoring & looking for further short-term improvement. At this point it appears the outer portion of bone looks solid enough to give me hope a break won’t happen in the short term. (It’s all short-term now.) 

We already had a ramp fit the outside stairs. We’ve put the baby gate up to block the stairs inside. This did not please little miss picky butt! Doesn’t matter that were brought The best bed downstairs.

What else can we do? I know she won’t be with us long & I’ve no interest in dragging things out if she goes back to the pain she had Friday. But… but, well, I’m …  lost

[MerseyGrey]

I’m so sorry. I can’t offer any advice but we are thinking of you and sending our best wishes 

[Remolacha]

[cleptogrey]

sorry to read this. SPOIL HER ROTTEN!

just remember spontaneous breaks do happen and they are horrible. annie had NO signs of osteo. jumped off the bed and her rear leg snapped in 2. X-rays revealed a star burst configuration of the bone- osteo.  emily had osteo of the front leg and increased pain meds(tramadol, metacam, gabapenten and amandine) went from working to no help what so ever over night. of course this was a friday new year's eve and she had to hang in there until our vet reopened on the 4th. why didn't i use an e-vet- to avoid unnecessary x-rays. 

[FiveRoooooers]

You feel lost but please know that you are not alone  If she's already maxed out on the best meds and still shows signs of pain, you'll know what you need to do. You've been here long enough to know that there are many of us who believe that a day early is far better than a day late - avoiding the looming crisis. You'll make that last day one of the best days ever, and those will be the memories that fill your heart along with those created for all the years you've shared each others' lives.  

Our hearts are with you 

[EllenEveBaz]

Oh, no.   to you and Su.  

Is Miss Pickybutt eating?  

[MP_the4pack]

My vet says that the newest evidence shows tramadol doesn't work in dogs. But the good news is gabapentin can really be upped.

 I'm sorry for your news. I've lost 2 to OS. Sucks!

[Time4ANap]

So sorry you are dealing with this.  We've been through this a few times too, and Miss Jan from CG said it best above. It never gets easier.  Spoil her rotten! 

[LBass]

I'm so sorry you and Su are dealing with this.  I'm in the spoil her rotten until she let's you know she's had enough.  My MoMo has osteo and was not a candidate for amputation either.  Knowing your girl and her preferences is a huge part of the decision making.  It is a brutally hard decision.  For me with Mo, I looked for adequate pain relief and reasonable physical independence.  When either of those was gone it was time.  We had 6 good months.  Then we had an absolutely blissful November afternoon basking in the sunshine and cuddling on a blanket in the yard.  The memory of that still makes me smile.  Enjoy every day.  

[greysmom]

1 hour ago, MP_the4pack said:

My vet says that the newest evidence shows tramadol doesn't work in dogs. But the good news is gabapentin can really be upped.

 I'm sorry for your news. I've lost 2 to OS. Sucks!

This.  Tramadol doesn't even work that well in people.  And Fentanyl can really cause anxiety and other mental issues with dogs.  We've used Codeine Sulfate with very good results for the past 10 years instead.

And just keep in mind that what you're really doing is providing at-home hospice care.  There's no need to be (too) concerned about long term side effects or other effects that may come about from long term use.  Talk with your vet beforehand - now - about incremental increases you can make to her pain medications, and keep smaller or dividable tablets of each on hand so you can tweak her amounts as she needs more.  And talk with him about what to do in case she does suffer a break at home.

Monitor her daily for quality of life.  One thing our vet told us was to pick her favorite three things, and when she can't enjoy those things anymore it will be time to let her go.

Big hugs!!!  {{{hugs}}}

[tbhounds]

You might want to consider adding Tylenol 4.

[dante2zoe]

I am so very sorry.  When Sherman was diagnosed, the vet figured he would have a couple months.  The pain increased faster than thought (His tumor was in his knee).  I literally spoiled the cr@p out of our boy.  He got to eat everything that he wasn't not allowed to have.  He decided chocolate was wonderful, so he got some more.  He went to the bridge with a mouthful of peanut butter cookie.  Once the meds had to be upped and he was more drugged than not, we let him go.  I just only hope that the pain in our hearts was nowhere close to what he felt.

You and Su are in my thoughts.  

[ramonaghan]

I'm so sorry. You are definitely not alone.  

We found that Galliprant wasn't quite as effective for pain relief as Previcox. Given that you don't need to worry so much about kidney values now, could you try switching to a different NSAID? 

[kudzu]

Su heartily agrees with the recommendations for spoiling her. Right now she is demanding feta cheese omelettes. (And it makes me hungry!) She is still eating canned dog food but it doesn't hold a candle to omelettes. Am picking up more supplies tonight. I think tomorrow will be cheeseburger sliders day. She is also getting a lot more attention.

Thanks, all. Su is doing okay right now, but I would still like improved pain control. The pronounced limp shows we can do better. Thank you for the suggestions there. The vet did give us 100 mg gabapentin capsules so we can customize that dose more. Will definitely ask about a potential switch in NSAID. I'm hesitant about Tylenol 4 because it makes me feel ill. Then again, I am not Su so I'll have that discussion with the vet, also. We are doing new xrays Friday to see if there are changes. Am trying not to ponder in advance what I will need to do if it is worse.

Had made up my mind long ago what I would do if I had an osteo dog. The first one was Salsa, the humble little lurcher. Her shattered leg took us completely off guard & her lungs looked really bad. There was only one thing to do, really no decision to make. Still I knew if I was in a position like I am with Su it would either be immediate amputation, if a good candidate, or immediate euthanasia. So easy to think that until it happens. Clearly, I chose a third path.

Now I'm off to the store for Suni supplies. She's looking like she wants another omelette.

Edited February 28, 2022 by kudzu
poor speeling

[Time4ANap]

There was a time when I scrambled a dozen eggs at a time for a certain brindle boy.  I'm really glad that he didn't know about omelets.  I suck at omelets. 

Let the spoiling continue! 

[BatterseaBrindl]

We know you'll do everything you can to make her happy and comfortable.

[spottydog]

We were able to get a prescription for oxycodone for our non grey. For our big grey boy, I didn’t wait… I second a lot of spoiling…and a day too early…sending best wishes…

[kudzu]

Day 5 Post Diagnosis

 Someone is possibly too perky this morning. She was out in the yard for her morning doodies. She looked over, saw me in the porch & decided to trot across the yard & then broke into a run all the way up the ramp. She still has a limp but it is so much better. I do worry about a break but her energy & enthusiasm, for a lazy 13.5 yo, made me very happy.

So the change was made to up the gabapentin dose & we did switch NSAID. Crossing fingers & toes this improvement holds for… is hoping for a couple weeks too much?

 Also, I have in my possession alendronate. Not giving it to her yet as it is someone else’s leftovers. Will be speaking to vet about it. 
A few days like today would be gift enough. (Thinks my pessimistic self) A few more than that would feel like a miracle. Wish us luck.

[RaineysMom]

you can try adding Amantadine!  It ups the effectiveness of Gaba and the other meds such as Meloxicam.  It got us almost 6 more months with our 13 YO Larry (back end went out).  It might help.  Sending hugs.

[MarkRo]

I'm so sorry. We just went through all of this ourselves. There's nothing really to say here other than Tex went downhill very quickly after the diagnosis and even though I tried to prepare myself for inevitable, it was . . . you know. As a practical matter, if you're likely to have the vet euthanize your Su, it's worth a call to understand the protocol particularly as it relates to Covid. We had a few tense minutes when they said only my wife or I could be with Tex. This was resolved fairly quickly, fortunately. There were a couple decisions that I would have preferred not to have to think about. They offered three different ways of handling remains and also offered a mold of his paw. I just would have rather sorted this out beforehand. They did bring the credit card machine into the room which was good although I would have preferred to have had the payment out of the way if I could have. Our previous vet was a Vietnam War fighter pilot and had a very structured approach to such thing. When our greyhound Trey had a stroke, I was in and out in 15 minutes. With Tex, it was a solid hour. My wife appreciated the "spending the last few minutes." Me -- not so much.

[BatterseaBrindl]

I will just add to the above post ...

Yes... Plan what you want done now ....  prepay if they will allow.  

My Vets will come to our home... perhaps your will, too.

[kudzu]

Thank you for the reminder on planning. I've had to do this too many times already, but my brain gets fried everytime so advance planning is much better. And, sadly, the reminder was timely. 

Su's pain level is ramping back up. We've had a good two weeks since diagnosis. While there is more we could do for pain control, she is already on 4 different pain meds and at max dose for 3 of those. Her hind end is getting more wobbly, either from shifting more weight to hind legs or from the meds or likely a combo of those. She's landed on her bum a few times now. Balancing pain control while keeping her on her feet and managing risk of a pathological fracture is hard. And if she gets too stressed it can trigger her LP. Making sure things are good in Su's world is starting to feel impossible.

With the help GT and a very caring vet, we've had a good two weeks. I am very thankful for that. We have Su's last vet appointment tomorrow morning. She'll get trazadone before we leave. The vet will come out to the van. From now until then Su gets whatever littlemisspickybutt wants. That means lots of eggs, meat and cheese. She'll get at least a couple bacon cheeseburgers with an egg on top. She can also have junk food like Beggin' Strips and Pupperoni. Not sure how, but a couple bags of those just fell into my grocery cart (my hands were involved) so I had to buy them. I never get stuff like that, but I figured now was the perfect time. Su approved.

[MP_the4pack]

Let her try chocolate before she goes. 

[dante2zoe]

I am sorry to read this and will keep you in my thoughts.  As I mentioned before, Sherman spent his last day eating all kinds of things and would strongly second the suggestion for chocolate.  

Wishing you much peace as Su prepares for the next chapter.  

Lordy, I loathe osteo. 

[Remolacha]

I am glad you got the good two weeks, but it is never any easier