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6 Year Old American Bulldog Potential Osteosarcoma
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The Rainbow Bridge



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18 April 2024 - 10:43 am
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Hopefully I'll hear back from BioceraVet today and have some answers. I just noticed on the TheraVet website (Biocera's channel for the product), that the University of Florida is doing a clinical study. We did have one member go there to get the treatment, for their dog, Honor. She (Eustacia) may be able to tell you about her experience if you private message her.

As for cementoplasty with radiation, absolutely. In our Tripawd Talk cementoplasty show, they tell us "can be used alone, or in addition to any other treatments."

Hang in there. Clarity will come to you and you'll create a plan that feels right.

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18 April 2024 - 12:48 pm
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Thank you. 

We do want to get another opinion from a surgeon. Do you have some recommendations for surgeons in the LA area?

Livermore, CA




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18 April 2024 - 1:41 pm
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I'm sorry this decision got so complicated for you guys.

I don't have any insight on cementoplasty, it became available long after Maggie's cancer journey and wouldn't have been useful with her type of cancer anyway.

We were offered radiation treatments to try and shrink the tumor in her knee.  I did not consider that an option for her because she did not handle anesthesia well and she would have to go under weekly for many weeks.  She actually had trouble coming out after her amp surgery.

I hope you are able to get some answers and clarification so you can feel as good as possible with your decisions for Nova.

 

Karen and the Spirit Pug Girls and Boy

Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.

1999 to 2010

 

              Maggie's Story                  Amputation and Chemo

Virginia







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18 April 2024 - 3:21 pm
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Just catching up on everything.  Lot that you jave a Billdog and English Mastiff as your pacek.  What a pair. 

Just went to reiterate that arthritis and cruciate issues, hip dysplasia,  deep chested dogs  etc generally aren't a deal breaker

I do encourage you to check out the link that Jerry gave you to  Honor.  She joined is in July and transitioned  the end of October.  She did a LOT of research checking out a wide variety of "options" She never did do amputation and he did develop ling  mets.  Almost everything she tried had "consequencesz", so to speak,  including fracture.  The  cement thing did cause a lot of pain and seemingly "failed".

Anyway, read through it and draw your own conclusions regarding everything she tried to "save the leg" without amputation. 

Yes, always good to get a second and third opinion if there are any orthopedic concerns. You can maybe check with the certified rehabilitation specialist too to get their feedback.

One thing about amputation, it's one surgery, one recovery and. Done!  the pain is removed 

Instantly! Of course, not saying that recovery from a major surgery is easy, but generally it only takes about 2 weeks to recover from the surgery and the mobility is usually mastered and becomes more fluid and normal within about a month

Would love to see some pictures. Let us know if you have any trouble with the adding images link

Hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

The Rainbow Bridge



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18 April 2024 - 8:47 pm
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sam_and_nova said
Thank you. 

We do want to get another opinion from a surgeon. Do you have some recommendations for surgeons in the LA area?

  

Oh yeah. Without hesitation I would try to get her into ACCESS in Culver City. They have a really innovative Bone and Joint Center with two ortho vets who have excellent credentials, and are connected to one of our favorite top surgeons at UC Davis, Dr. Marcellin-Little. Speaking of, if it's within your ability to get up there for an evaluation, I would go to UC Davis first for a situation like this.

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21 April 2024 - 10:32 pm
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Thank you. Nova's initial diagnosis on April 10 was by ACCESS in Culver City and we may with their soft tissue surgeon on April 11. They felt better about her odds as a tripod than the team at the VCA West LA. 

Posting a few updates / questions in case others have input or guidance on any of the below:

1. As you know, our current debacle is to confirm whether Nova would be a successful tripod given her other orthopedic issues . Along those lines, I just wanted to understand one basic matter - is amputation purely a procedure to eliminate pain or does it also play a role in slowing down the cancer / extending life? If she turns out to be a good candidate, should we amputate before she shows signs of overbearing pain? She is currently putting weight on the affected limb. 

2. While we strive to resolve the question of whether she would succeed as a tripod should we commence her chemotherapy ASAP to slow down the cancer or can that only occur after amputation in order to be effective? 

3. Some information online suggests "stereostatic" radiation is an amputation alternative? What is the difference between stereostatic radiation and regular radiation offered by her vet (that barely extends life and is viewed somewhat as palliative)?

4. Do we know if Nova receiving the Yale vaccine prior to amputation impacts the potential effectiveness of the vaccine? Since there are no participating clinics near us and we'd have to get to Seattle or Salt Lake City, I would prefer to have Nova travel with us prior to the amputation - as we are trying to get her the vaccine as soon as possible. 

5. Has anyone heard of Gilvetmab, which is produced by pharma giant, Merck? We are considering this as a potential added component of Nova's future treatment. I will also inquire with Nova's oncologist but thought to ask the community here as well. 

6. @Jerry, did you ever hear back from the professor behind the histotripsy study/clinical trial? How about the team at BioceraVet? I would note that after reading more about cementoplasty I've come to be more weary as most surgeons' ability to pull off the surgery appropriately as there is just so little exposure of this in the US market. 

7. Has anyone had any success with the drug combo of losartan, propranolol, and palladia? has anyone done that prior to amputation, radiation or chemo?

8. We switched her to a keto diet consisting of turkey, broccoli, green beans, chia seeds and coconut oil. We've read that this can be accretive to the fight against her cancer and also help her lose some weight. Any things to consider here as we make this switch? 

9. We are going to begin providing her with the following: turkey tail powder, life gold immunity booster, Wei Qi, milk thistle and carbon60. Anyone have experience with these supplements?

The Rainbow Bridge



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22 April 2024 - 11:43 am
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sam_and_nova said   

Sam,

I'll try to answer as best as I can:

Along those lines, I just wanted to understand one basic matter - is amputation purely a procedure to eliminate pain or does it also play a role in slowing down the cancer / extending life? If she turns out to be a good candidate, should we amputate before she shows signs of overbearing pain?

It is palliative care only. It gets rid of the horrific pain of disintegrating bone. You do not want to wait until she shows signs. By the time an animal shows pain, it's really, really bad. They do whatever it takes to hide it.

should we commence her chemotherapy ASAP to slow down the cancer or can that only occur after amputation in order to be effective? 

That's a question for your oncologist. What I can tell you is that we have seen some cases where dogs are given chemo before amputation, but not many.

Some information online suggests "stereostatic" radiation is an amputation alternative? What is the difference between stereostatic radiation and regular radiation offered by her vet (that barely extends life and is viewed somewhat as palliative)?

It is not really an alternative, nor does it ensure longevity either. See Hazel's story. But, it's another non-surgical option to slow down bone disintegration and alleviate pain when given with an infusion of a bisphosphonate. SRT as it's known, is done in shorter, more powerful, and more targeted bursts of radiation than traditional radiation therapy.  It requires a lot less visits than traditional radiation, and is a newer therapy. Is it better? Yes in the sense that your dog won't need to be under anesthesia as often, and there are less visits (amount depends on the cancer and tumor). Some dogs do really well with SRT and live as long as a dog who has an amputation but no chemotherapy. 

4. Do we know if Nova receiving the Yale vaccine prior to amputation impacts the potential effectiveness of the vaccine?

That would be a question for the oncologist giving it. No idea and I'm going to guess they will say that studies are still being done on that aspect. But it would be good to ask them directly.

5. Has anyone heard of Gilvetmab,

It appears to be for mast cell cancer and melanoma tumors only.

6. @Jerry, did you ever hear back from the professor behind the histotripsy study/clinical trial? How about the team at BioceraVet? I would note that after reading more about cementoplasty I've come to be more weary as most surgeons' ability to pull off the surgery appropriately as there is just so little exposure of this in the US market. 

Yes, heard back from UVA, they are still doing histotripsy and enrolling dogs. There is one pre-amp study you will be particularly interested in. Sending you a PM shortly. Nothing from BioceraVet yet. 

Cementoplasty has been routine on the human medical side for many years here in the states. Vets are being trained on the procedure now, but I don't blame you for being leery at this point with it being so new. You could however talk to the ortho vets at the University of Florida who are doing this procedure now.

7. Has anyone had any success with the drug combo of losartan, propranolol, and palladia? has anyone done that prior to amputation, radiation or chemo?

Do you have links to studies done with this combo that you can share? It sounds a lot like some losartan studies done at Colorado State.

8. We switched her to a keto diet consisting of turkey, broccoli, green beans, chia seeds and coconut oil. We've read that this can be accretive to the fight against her cancer and also help her lose some weight. Any things to consider here as we make this switch? 

Unfortunately there are a lot of anecdotal stories about "cancer diets" but no hard studies done to prove that they actually work or are safe. Every dog is different. We recommend working with a board-certified vet nutritionist who can come up with a specific diet for her, especially when cancer and weight loss are concerned.

9. We are going to begin providing her with the following: turkey tail powder, life gold immunity booster, Wei Qi, milk thistle and carbon60. Anyone have experience with these supplements?

Check out our Tripawds Eating Healthy Forum. And please post any food and supplement related questions there so that they're easier for folks to see and answer.

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23 April 2024 - 1:48 am
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Thank you for the detailed responses.

We are getting the hopefully last / third surgeon's opinion this Thursday (earliest we could get with this particular surgeon). 

I just wish that Nova was a clear shot candidate for amputation but that's just not the case. The vets and surgeons have no way to guaranty that she'll do well as a tripod but they are also not eliminating it as a possibility so effectively leaving it to us to decide. 

The non-surgical options available today do not seem to enhance Nova's odds for a longer and high quality life and many of the newer techniques are in early stages. The success stories seem fairly limited without amputation.

We just want to give our girl the longest and most fulfilling life, whatever that may look like but have plenty of risks either way. I am just worried about her not doing well on 3 and the resultant regret of harming her remaining time with us. All the while the clock continues to tick and either actually or in my head that damn tumor on her ankle looks bigger every few days. 

The Rainbow Bridge



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23 April 2024 - 12:01 pm
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Hey Sam,

I can't blame you for feeling so uncertain, I would too.

The problem with this cancer is, no matter what you do, no surgery or treatment is curative. Scientists still haven't found a way to eliminate osteosarcoma metastasis entirely, sadly. Many humans can live a long time after being diagnosed with it, but they also get a LOT more chemotherapy than dogs could ever tolerate (nor would we want them to, since their lives are so much shorter than a humans').

What we focus on instead, is quality of life over quantity. Try to keep in mind that dogs don't keep calendars, and one day to them might as well be a month, or a half second. The concept of time is a human thing. Dogs mostly live in the moment, and all they want is to wring every drop out of it, without being in pain, and with the people they love. Unfortunately there's just no way to know how much time you can buy with treatment, so like life in general, every day is a roll of the dice and all we can do is remember to make the most of it. 

I hope the next consult bring some additional clarity and confidence in your next steps. Please keep us posted.

The Rainbow Bridge



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23 April 2024 - 12:04 pm
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Oh I want to point out the story of Atlas, a Great Dane who was not considered a good candidate for surgery. He ended up living two years, into old age. Not bad for a Dane with Wobblers and other issues. 

I'm not sharing this to convince you to proceed, just food for thought to show that you just never know what will happen with this poopiconcancer.

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23 April 2024 - 5:09 pm
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Really appreciate the responses!

We've decided to amputate and hope for the best. Hoping for surgery on Monday, April 29. We agonize over having waited almost 3 weeks post diagnosis by the time of the surgery but hindsight is 20/20 vision I suppose. 

We have read that beginning chemo as soon as possible is ideal (some dogs began 24 hours after) but her oncologist recommends that we wait 2 weeks following surgery to allow her to heal fully. We've read conflicts things on this point.

We will also strive to get a slot with the Yale vaccine and Torigen, but in due course. 

Here's to hoping the universe is on Nova's side.  

Virginia







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23 April 2024 - 7:15 pm
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Okay, you have a path forward and that in itself can be a bit of a relief.

  

We agonize over having waited almost 3 weeks post diagnosis by the time of the surgery 

I know these past three weeks feel like an eternity, but a lot of dogs sont get the diagnosis  that quickly.  My Happy Hannah. Like many dogs, was first "doatnos2d" with arthritis and treated  accordingly.   It seemed to get better off and on and then clearly dis r.  I think about two mp ths plus passed before the amputation.   Actually, I even delayed it a tiny bit more as I cancelled  her first surgery  appt bec I was soooo scared!  This was before I found Tripawds 

My Happy Hannah thrived on three for over one uear and two months She had four rounds of Carboplatin  and started the first round at three weeks.  It was originally  scheduled at the two week mark, but she needed a bit more recovery time.

  some dogs began 24 hours after) but her oncologist recommends that we wait 2 weeks following surgery to allow her to heal fully

Yes, weve seen some do it sooner, some at the two week mark.  I would just trust your Onco and go with her recommendation.  IMO at 24 hrs you really dont know if a dog is going to be one of those that has a rough recovery, maybe an infection, maybe off food, etc, etc,   On top of that,   you also do not know if a dog might have a rough time with chemo side effects, etc.  BTW, very few have  bad side effects.  Usually just a little lethargic for a few days and maybe not much of an appetite.   The majority do sail through though.  

To give you a pawsitive outlook, we had a dog here many years ago...A Great Dane named Queen NOVA!  If I recall, she did indeed beat this crap disease for five years and I believe passed at the  old age.of thirteen.

Sendng paswitve energy out to the aipUnoverse for your sweet Nova♥️

Hugs 

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

The Rainbow Bridge



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23 April 2024 - 8:30 pm
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Great! Making that decision was so hard and not done lightly. You guys have put so much love and thought into her next steps. At least now you have a plan in place, so that's got to be a little bit of relief, right? Time to prepare your home, Archie, and yourselves for the big day.

Yes some dogs do get chemo early on, but there are no hard and fast rules about when to do it. The more the body can heal, the better. I kind of feel like doing it really close to surgery packs such a whallop on the body, I can't imagine how crappy that must feel. So yeah, trust your onco vet with that timing, and move forward with the next steps. We are here to help answer any questions as best we can so ask away.

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25 April 2024 - 2:56 pm
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Hi all - we are back down the path of confusion today. 

Nova met with the surgeon today at the VCA West LA - Doctor Maureen Mueller. Doctor Mueller is a highly experienced surgeon and in fact has sadly lost 3 dogs to OSA herself. 

Doctor Mueller also did not think that Nova was a great candidate for amputation. She is concerned about existing orthopedic issues (the partial crucial tear and existing ACL surgery). She is also concerned about Nova's shape and size. She would nonetheless proceed and perform the surgery if we elected to do so but her recommendation was to perform stereotactic radiation and chemo, and if down the road the tumor began to bother Nova again and radiation was no longer possible (and there was no metastasis at the time), then to consider amputation. 

Doctor Mueller thought that Nova's bone was in OK condition and Nova did not show signs of discomfort during her exam. 

We are focused on balancing longevity with quality of life. We have since day 1 asked the vets whether stereotactic radiation and chemo can give a dog the same potential life span as amputation and chemo. Most vets told us that lifespan would be shorter but Doctor Mueller didn't think that was necessarily the case as she doesn't believe that tumor removal via amputation and the odds of metastasis are necessarily linked. We have no idea. Doctor Mueller didn't think Nova in the level of pain that required immediate amputation either. 

We just don't know what to do and would really welcome any and all feedback and guidance from the community. We now have one surgeon that thought she was an OK candidate and two that don't think she's ideal (her oncologist also told us that if it was her dog she would probably choose radiation over amputation). Thank you in advance. We are totally lost and are so afraid to make the wrong decision for our girl.

Virginia







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25 April 2024 - 8:30 pm
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Ugh!  I can understand your frustration and  uncertainty on a path forward.  

Honest to goodness, I would still get another  opinion from an Orthopedic Surgeon.

The main reason I say that is that weight/size  (at 85  lbs)  mentioned at least by two Surgeons/Onco  I dont know what  a "good" weight is  for an American Bulldog, but I do know it's very easy to get our dogs to lose weight safely and quickly..  So maybe we can take that off the table of concerns.

Weight reduction would help get his rear legs stable and even help the "possible" cruciate issue one leg. The TPLO leg is still holding  strong I assusme?

Arthritis waa mentioned.  Again, not not normally a deal breaker.  

I think I asked before if he was on any adequate, extra special joint supplements etc. How noticeable has his arthritis been? Is it really hard for him to walk, does he have a hard time getting up, is he very stiff, etc.?

Curious what path Dr Mueller took with her three dogs who had osteo?  

 .....whether stereotactic radiation and chemo can give a dog the same potential life span as amputation and chemo. Most vets told us that lifespan would be shorter but Doctor Mueller didn't think that was necessarily the case as she doesn't believe that tumor removal via amputation and the odds of metastasis are necessarily linked

 

All I can say is  the two different perspectives  are interesting.  Doubt that there are any hard case reliable studies  on either scenario.  

Sometimes  making decisions  like this with differing opinions just comes down to "gut instinct"...×what your inner voice tells you what Nova would want..If we only has a crystal ball. Right?

One thing to always hold onto.....whatever decision  you make is out of your derp love for Nova♥️♥️♥️♥️

Hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

PS. Here's a link abput another American  Bulldog  oddly enough named Nova also.  

  https://tripawd.....vas-story/

Just thought you might enjoy reading through it simply because she's another American bulldog.

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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