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.

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.

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.

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.

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.