Your experiences with nonsurgical Osteo treatments

[Mercsmom]

We got the bad news yesterday.  Amputation is not an option.  Mercury is 11 with spinal arthritis and a fair amount in his front right wrist (Osteo is in front left leg).  So, my goal is to keep him as comfortable and with me as long as possible.  Yes, we have an oncologist consult next week, but I'm doing my homework now.

I'm pretty sure I want the biophosphate treatment to retard progress but what about chemo or radiation?   What have been your experiences with  non-surgical Osteo treatments.

Thanks for your input and I'm sorry for your loss.

[ramonaghan]

I'm so sorry to hear about Merc's diagnosis. We did an amp with Sweep but she also went through chemo. Before we knew it was osteo for sure, she had three rounds of doxorubicin, which is more of a broad spectrum chemo drug. That was hard on her GI wise and she needed a day or two to recover. Once we had confirmation of osteo, she was switched to carboplatin (more targeted for osteo) for the last three rounds and she never missed a beat with that. Once she had finished the IV chemo, she was put on two different oral chemo drugs, first cyclophosphamide and then later Palladia, and she tolerated both without side effects. We would have done radiation but our nearest option was Atlanta (4 hrs away) and she wouldn't have done well with all that travel. We got almost 15 months with her after the initial leg break. No signs at all before that.

For pain, gabapentin plus an NSAID plus or minus Tramadol is common. Don't let your vet be conservative. Gaba can make Merc woozy until he adjusts, so watch for that and help keep him steady if he needs support. 

I can't recommend a consult with Dr. Couto highly enough. He's fantastic and will know if there's anything new in the works.

 

Edited December 27, 2022 by ramonaghan

[BatterseaBrindl]

Nixon was 12.5 when he was diagnosed. That was exactly 5 years ago, with the lesion in the same location as Merc.

Amp was not an option due to his age..he was already borderline frail.  
We opted for palliative care …GABA and Metacam… and he was well medicated and seemingly pain free for several weeks. As winter raged on and the risk from a fall on snow covered / slippery footing and having the leg break increased, we decided to euthanize in mid February.
I am a very firm follower of ‘’Better a day too early than a minute to late‘

I’m sure there are more here who will chime in with much more modern treatments that we had here in Ontario 5 years ago.

[zimsmom]

2 hours ago, BatterseaBrindl said:

We opted for palliative care …GABA and Metacam… and he was well medicated and seemingly pain free for several weeks. As winter raged on and the risk from a fall on snow covered / slippery footing and having the leg break increased, we decided to euthanize in mid February.

Exact same experience here.  winter in NE was too much for Lexi.  Lots of wendy hamburgers for sure.  

[Time4ANap]

 

None of ours who had osteo had anything more than pain control as they were all seniors at an age where we felt that putting them through treatment would have been harder on them than any benefit we would have gotten from treatment. I'm also a strong believer that a day too early is better than a minute too late when it comes time to make that decision. We've had to make it too many times but have never taken it lightly. 

I hope you get lots of time to keep spoiling that boy and we are so sorry that you have to deal with this. Lots of ear rubs from Camp Broodie to the MercMan. 

[FiveRoooooers]

8 minutes ago, Time4ANap said:

 

None of ours who had osteo had anything more than pain control as they were all seniors at an age where we felt that putting them through treatment would have been harder on them than any benefit we would have gotten from treatment. I'm also a strong believer that a day too early is better than a minute too late when it comes time to make that decision. We've had to make it too many times but have never taken it lightly. 

I hope you get lots of time to keep spoiling that boy and we are so sorry that you have to deal with this. Lots of ear rubs from Camp Broodie to the MercMan. 

 Same here. Pain meds until the meds were no longer effective at managing the pain. I believe in my heart that with the osteo kids we were able to give them their wings a day early. My most recent was in 2018, when Trevor Double-Heart was diagnosed with osteo at 13.5, including a large abdominal mass. We didn't have time for a consult with Dr. Couto but he was incredible with two of my others so as Rachel said, I also strongly suggest reaching out to him. 

I'm so sorry about Merc. You know what to do, continue to pile on the spoiling. 

[Beachbum1]

 Good that you are seeing an oncologist next week.

Nonsurgical Osteo treatments leave you with the risk of a catastrophic, extremely painful break that could happen at any time. 

Per Dr. Couto 5 months ago, he has experienced catastrophic break in bones that "did not look bad at all in imaging", and has seen dogs go a LONG time with bones that look eaten away like Swiss cheese.  Thus, very hard to predict. 

 

[greysmom]

Echoing what everyone else has said.  Our experience with amp and chemo was ages ago, and many things have changed and improved.  Also recommending contacting Dr Couto for the most up-to-date info on palliative care.

Retrospective Evaluation of Outcome in Dogs With Appendicular Osteosarcoma Following Hypofractionated Palliative Radiation Therapy With or Without Bisphosphonates: 165 Cases (2010–2019)

Conclusions

This study suggests no difference in outcome for dogs treated with and without BPs in addition to hypofractionated RT. Prospective studies are needed to determine if the addition of BPs to hypofractionated RT leads to an improved quality of life in dogs undergoing palliative-intent treatment for OSA.

I'd say better than half the dogs we've seen here on GT have added Zolendronate to their palliative treatment regimen.  Most see immediate relief from pain, but the effect does seem to lessen over time.  Studies have also shown that Tramadol is not an effective pain reliever for dogs (or people).  We have found it to be very ineffective for our dogs that need an actual pain reliever.  We prefer codiene sulfate if an opiate is needed.  It's also a little cheaper.  If you are going to use an nsaid, the one called piroxicam was once touted as being particularly effective on osteo.  I think this has since been disproven, but if you're going to use one it might as well be one that might offer some added benefit.  I think Laila is taking it for her bladder tumors.

Even if you don't want to think about it, you have to think about it.  We all want as much time as we can with our dogs, but osteo doesn't care what we want.  Have a plan in place for the most horrible outcome - a catastophic break at home.  Because you can't be calling around and figuring out your options when you have a screaming dog in your yard.  How will you carry him?  Where will you go?  How will you get there?  Because you just never know from now on.

There are tons and tons of supplements being suggested out there.  Most of them don't work.  One called "turkey tail mushroom powder" has shown some benefit though.  You also might explore the number of federal drug trials out there to see if Merc qualifies.  Ask your oncologist and Dr Couto for suggestions.

AVMA Study Search

Pull up the latest osteo thread.  Browse through the links in the first post.  It's years out of date, but will give you a jumpstart on your research.

[Houndtime]

I am sorry to read the sad diagnosis.

[Mercsmom]

Chris, Thank you for the academic articles.  I shall read the biophosphate one carefully.

"Plan for a catastrophic break at home" - What would anyone suggest?  That is my biggest nightmare and I will do a lot to minimize that scenario (yes, a day early).

[Jerilyn]

26 minutes ago, Mercsmom said:

"Plan for a catastrophic break at home" - What would anyone suggest?  That is my biggest nightmare and I will do a lot to minimize that scenario (yes, a day early).

It's kind of a long shot, but I had a end of life/palliative care vet when Lila was reaching the end of her life. She gave me a comfort/emergency kit to have at home with some pre-loaded syringes of a sedative. Just knowing I had it in the house was a comfort. Maybe see if your vet would be willing to give you something similar. 

[Time4ANap]

I have a couple of folding stretchers in various sizes in case we need to transport a dog in an emergency. They are basically a piece of canvas / nylon with handles for easier carrying. ou would still need 2 people to carry a larger dog with one, and I look at them more as insurance and hope that I will never need them. If you search your usual suppliers or Amazon for Veterinary Stretcher you will find various options.  We also have a belly sling that just wraps around the core of the dog and can be used for lift assistance or walking assistance. https://flyingpaws.biz/product/medium-lift-extended-handles/  I like this one because the handles have dowels in them which helps lift solidly instead of flopping around like a nylon strap would. 

As Jerilyn said, a vet who specializes in pallative care can be a huge help. We have one locally who also provides in-home euthanasia, and as long as the situation allows, we will always do that at home. Ask other dog owners locally for recommendations if you don't already have contact info for an in-home vet who does this. 

Don't be afraid to ask the hard questions if you need to. We are all here for you and most of us have been through some aspect of this at some point. 

[EllenEveBaz]

((((((((((((((((((((((((((((((Merc and The Many Who Love Him))))))))))))))))))))))))))))))

 

Just brainstorming on the planning -- There was  a thread here a year or so ago on stretchers for carrying a dog.  Some of GT folks have them ready.  Lots of different kinds and sizes.  I remember thinking I would want one that would be soft and encase the dog like a burrito so that 2 people could put the dog in just about any size car without having to transfer him off the stretcher.  

Since I can't carry even one end of a stretcher (balance issues), I have a helpful neighbor on speed dial.  He has agreed ahead of time to come help in just about any kind of emergency -- I wouldn't have to explain and request.  

[EllenEveBaz]

Don has chipped in on stretchers just as I was posting.    

[Time4ANap]

2 hours ago, EllenEveBaz said:

Don has chipped in on stretchers just as I was posting.    

I looked before posting and the place where I bought mine doesn't have them on the web page any longer so they are probably using a different supplier. Ellen's description of how those work is perfect. I have previously helped to carry dogs wrapped in comforters or blankets and the one thing that would have made it easier was having handles. That's why I like the simplicity of the vet stretchers generally found online. They may also be referred to as a litter. 

[Potomacpupsmom]

Elizabeth, I cannot begin to tell you how devastated I was to hear this news.   Having experienced it firsthand, I know the whirlwind of feelings and fears you are going through.  Although we chose a surgical option for Beka, she also had chemo post op and I can tell you that she had no side effects at all from her chemo treatments.   I'm glad you are consulting Dr Couto as he can tell you the most recent non-surgical treatment and studies that are going on.  The stretcher is also a good idea and please research vets for at home euthanasia if possible when the time arrives.    We will be with you every step of the way.     

[dante2zoe]

I have had three dogs with this diagnosis and with two of them, the diagnosis was made when the bone broke.  (There were zero indications of anything amiss prior to the break.)  I don't wish that scenario on any one.  With Dante, I was much younger and able to carry him to the car myself.  With Maverick, his break was in the middle of the leg, which is way more painful.  We muzzled him to avoid fear/pain biting.  With Sherman, we elected for pain management for many reasons.  He was already uncomfortable at the time of diagnosis and deteriorated rapidly as the medications did not reduce his pain adequately.  If I recall, he was taking gabapentin, a pain reliever, and an NSAID.  There is no worry about liver or kidney issues at that point.  We spoiled the literal poop out of him and pre-scheduled his passing within the anticipated time frame.  We still ended up taking him in earlier as it became too much.  If you have a Lap of Love vet near you, make sure you ask about emergency visits.  There are no at home services in our area.  Our vet was not able/willing to provide us with any strong emergency pain medication in case of a break, despite all the letters after David's name.     

Sherman got to have chocolate and every single thing he may have ever wanted.  He crossed this world with a mouth full of the famous GT PB cookies and left us with heartbreak and the worst gas EVER, lol.  

I am so devastated by your news.  Please give our bestest polka-dot bowtie boy gentle scritches from us.     

Cindy

[macoduck]

I have a stretcher very similar to this:  https://www.google.com/shopping/product/6195335358261196946?q=newfoundland+dog+rescue+stretcher&biw=1536&bih=711&dpr=1.25&prds=eto:5445738626742254265_1,pid:852403949803795828,rsk:PC_4798558287108571552&sa=X&ved=0ahUKEwiK3Ynkm538AhW8lGoFHVwfBf0Q8gIIkQsoAA

[Mercsmom]

22 hours ago, Jerilyn said:

It's kind of a long shot, but I had a end of life/palliative care vet when Lila was reaching the end of her life. She gave me a comfort/emergency kit to have at home with some pre-loaded syringes of a sedative. Just knowing I had it in the house was a comfort. Maybe see if your vet would be willing to give you something similar. 

I wondered about exactly that option.  My next door neighbor is an RN, if a civilian is not to be trusted with the drugs. 

[Jerilyn]

I had a similar kit for my mom when she was on hospice. I think it's a pretty common practice for hospices. If you're not going to pursue any treatment, I'd check to see if there is a palliative care or home euthanasia vet in your area. They seem to be pretty rare but maybe there are more around now. They seem to be more willing to offer this type of thing than a regular vet.