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Urgent questions about treatment options for my 8yr old Great Pyrenees
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Member Since:
1 April 2024
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10 April 2024 - 4:34 pm
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A couple weeks ago we received the bad news about our 130lb 8yr old fur baby named Ella, and we're devastated. She is a huge dog with a huge personality, and despite any pain she is in, you would never know it by the way she acts in the company of loved ones or our other dogs.  Anyway, I digress, Osteosarcoma in her right hind leg. Our vet referred us to an Oncologist, but our vet had her doubts that she would be a good candidate due to her weight and age.

 

After initial x-rays, there was no cancer in her lungs, so that was promising. Long story short the Oncologist had reservations for the same reasons our vet did, so he wanted to take X-rays of all her joints to see if she could still be a potential amputee candidate. he said everything looked good. the right side hip wasn't so great, but that wouldn't matter since the cancer was on the same leg. the other hip was ok, or so we thought. We left with new hope after that visit. however,  today the surgeon contacted us, and though she will do the surgery, expressed the same reservations as our vet and added she didn't think the left hip was so great. She basically poured cold water on my hopes. In her defense she said she only saw the dog briefly and her observations at the time were "she was slow to get up and suspected arthritis in the hip". I'm still waiting for her consultation notes to be sent to us so I can get more details on the left hip. 

 

I've been playing this out in my head telling myself she doesn't know my dog like I do, and Ella could do it, but now I'm just wondering if maybe my judgement is clouded and I'm not thinking rational.

 

the surgeon's recommendation when asked was low dose radiation therapy every week for 40 weeks and potentially chemo mixed in if she handles the radiation well.   

All the life expectancies for all treatments seemed low to me, but maybe I have read too many outlier cases and watched too many youtube success stories. 

Radiation treatment with chemo around 10 months. so basically 40 treatments. Risk of fracturing leg.  They did say there was Zoledronate to improve bone density, so interested if anyone has experience with that.  

Amputation 4-6 months and with chemo 10-12 months assuming she could make the transition to life on 3 legs.

radiation therapy and pain control 3-6 months.

I guess my questions are what peoples takes on radiation therapy? 

Anyway, my heart says to roll the dice on amputation, but I want to do right by my dog, and not make a bad situation worse. On April 19th I thought there was only one path forward with amputation and chemo, and I was actively committed to it and now today I don't know what to do, and feel a bit lost looking for answers that might not exist. 

 

Thanks for reading this, and if anyone has any thoughts, I'd love to hear them. I feel like so much time has past now that I need to decide ASAP. Hope to have the surgeon's notes emailed tomorrow. I know a lot of details are lost due to shock and panic when getting bad news. 

 

Kevin

Virginia







Member Since:
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10 April 2024 - 7:13 pm
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Hello Kevin and your sweet Ella.  

While we are sorry you found yourself here, you are definitely in the right place for support, information and an understanding from others who have been where you are.

First of all, I assure you we have had dogs much larger than 130 lb and far older than 8 years old. Check out some threads in Size and Age Matters.   My Happy Hannah was 125 -130 lb Bull Mastiff...8 1/2 at the time.  A bit..er...."fluffy" too.  We had a glorious one uear and two months!  .

We've had Saint Bernards, Newfoundlands, Great Danes, English Mastiffs, Pyrenees handle life on three very well.  And yes, we've had the other alternatives tried....generally because  amputation  was off the tavle for a variety of reasons.  To me, it doesnt spund  like amputation  is truly off the table.  Is itossible to get another opinion?

Most Certified Orthopedic  Surgeons will tell you age and size do not matter.  What does matter  is fitness, enjoying life and, you are right 

  she doesn't know my dog like I do, and Ella could do it,

 Knowing your dog best definitely  is part of the decision making  equation.   Following your gut....listening to your inner voice.part of the equation too..

Yes, in more "mature" dogs arthritis is often present.  Rarely, very rarely is it a deal breaker.   You can immediately  get her on some joint supplements, maybe Adequan  injections and get her evaluated by a Certified Rehabilitation  Specialist. 

One thing with amputatiom....one surgery and  done!.  

Also, check out this post Jerry just made about arthritis 

  https://tripawd.....-is-uc-ii/

 

Also a link to a survey basically shows the vast majority of members have no regrets about proceeding with amputation

https://tripawd.....y-results/

     

One of the hardest things when we are trying to decide  a path forward is to TRY....TRY...and not put too much weight on "number of survival days".  We have seen dogs blow statistics  ou9t of the water and we have seen some fall short of the average survival  time.  The most important  thing is to make every day count!  Make every moment the best moment t ever!!  Dogs live I  the NOW and do not cou t days on a calendar.   Ella doesn't  have a timeframe  stamped  on her butt.

All she cares about is having a pain free quality  time for more spoiling  and loving and extra treats (low cal of course).

Stay connected  and let is know how we can help.  We are here for you and for Ella to support whatever path you take.

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!

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11 April 2024 - 3:40 am
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Thank you Benny. After talking with my wife I think we are going to stay the course with amputation. 

I just feel like with radiation treatment Ella will still have this leg she doesn’t really use and the risk for fracture just seems too high to me. 

regarding a second opinion, I just feel like we have let too much time elapse to explore any other options. I originally tried to take her to another Oncologist and we didn’t have the best experience and wasted another week before we got to where we are which has taken another 2 weeks. I’m just not sure how long she had this before we got into the vet. She had a slight limp for weeks and I just thought she sprained something but it never got better. So yeah I feel time is pretty critical here. The surgeon said she would want to get Ella scheduled over the next couple weeks if we went that route, so I feel we are locked in.

 

I do believe this surgeon is competent and just giving an honest assessment that varied somewhat from the oncologist. I understand her wanting to give a sobering assessment in case things don’t turn out well. Thanks again. I’ll keep posting updates.

 

Kevin

The Rainbow Bridge



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11 April 2024 - 10:36 am
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Hi Kevin, welcome. Sorry to hear about the diagnosis and dashed hopes that the surgery would be a sure thing. I know that time is important here, but it really pays to get another opinion when you have conflicting ones. Yes osteosarcoma is aggressive, but many dogs carry it around for much longer than we know because they are so good at hiding pain. If the surgeon who saw her does not specialize in orthopedic cases, I would want one who does to look at her. The best ortho surgeons have told us that neither size nor age should exclude a dog from being an amputation candidate as long as they are otherwise healthy. Even dogs with OA can go on to be happy as Tripawds, but I would want to be especially sure of the degree of her condition because of her size.

Also, rather than radiation did any mention cementoplasty? It's a newer procedure here in the states but not in Europe, and it's been used on people for many years. It is a great option for giant breed dogs. Depending on where the tumor is, and where the nearest surgeon is doing it, this technique may be an option to save her leg and potentially slow the cancer. 

Sally's insight is spot on. Don't focus on the stats, every dog is unique and you never know how things will play out. 

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11 April 2024 - 11:23 am
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Thanks Jerry. Here is what I received from the surgeon consultation to better put her perspective in full view.

 

“I briefly examined Ella that day (during her Oncology consultation) and expressed my concerns about her overall ambulation at

that time with obvious signs of canine hip dysplasia (later confirmed with history and radiographs), challenges rising in

the rear limbs (despite the tibial lesion), and ability to recover well with amputation with her giant breed/weight

disadvantage. However, in some cases we do not have other options and do have to proceed with amputation as this may

be the only option for our giant breed patients. We do often have to offer them the opportunity to recover

post-amputation for appendicular osteosarcoma.

 

As discussed

today, Radiation therapy and amputation could be reasonable options for your pet. Since Ella is a giant breed

dog, has significant arthritis in other joints and life on three limbs could be challenging, radiation could be

considered to avoid amputation (but still permit her to retain the limb as long as there are no fractures

currently present.). This would require a consultation with our radiation oncology service and they would

discuss the recommended course of treatment, costs, potential risks and outcome (which is reported to be

similar to that of amputation in our canine patients.) Amputation of the limb followed by full-course,

traditional chemotherapy is an effective way to alleviate pain associated with osteosarcoma (by removing the

source of pain). Most dogs tolerate amputation well. The median survival time for dogs with osteosarcoma

treated with amputation and followed immediately after by chemotherapy is 10-12 months with approximately”

20% of dogs alive at 2 years.”

Her credentials are DVM, MS , DACVS so I guess she is a board certified vet surgeon. My wife mentioned cementoplasty, and they said they either didn’t or couldn’t do it where the tumor was. It’s right in the hock where the joint bends and looks as if it fused the joint. I have the x-ray the vet took, but not sure how to post image. Thanks for your input.

 

kevin

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11 April 2024 - 11:30 am
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I would also add that the use of her limb is so limited at this point that I’m not sure keeping it would have much benefit, and still have all the risk for being fractured if we chose radiation. 

I’ve already witnessed her hopping in short distances so I feel like she is already making mild transition to 3 legs if this makes sense.

 

kevin

Virginia







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11 April 2024 - 12:45 pm
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FWIW, your assessment regarding risk of fracture, not much benefit of keeping  it, etall important  in your dec making.  Yes, it does make sense that you are already  witnessing  her  making the transition to three.

One member Karen always suggests writing down all the reasons you are taking a particular  path forward....why you are doing one path over the other.  Granted, these are sometimes   "forced choices".  This will remind you though that you are making the best choice for Ellawith the information you have , regardless of the outcome down the road.

You know Ella best and you and your wife are clearly making a decision out of love for her. That is always the right decision. 

Is this an overnight fully staffed clinic??  She should stay a minimum of one night.  It may take several days to start getting more stable with her mobility.   You can use a towel slo g to help support her.

Keep is posted, okay?

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!

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11 April 2024 - 1:04 pm
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Hey Benny, it is an overnight fully staffed facility and she would be scheduled to stay overnight.

 

very good advice on writing down all the reasons for moving forward.

also, thanks far the link above with Jope. I ordered 4 mth supply for Ella to assist with any arthritis. 

Also thanks to everyone for their contributions here this place is such an amazing resource for those of us that have never gone through this.

The Rainbow Bridge



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11 April 2024 - 7:27 pm
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Hey Kevin,

It does sound like you are working with credentialed surgeons who have examined her closely and done all the diagnostics. Glad you mentioned the cementoplasty, it's always worth discussing in a situation like this. Just sorry that she's not a candidate. Based on what they wrote I can see why there are nudging you toward radiation therapy. It's worth considering. 

Whatever you decide we are here to support you! 

I hope you find the Jope supplement works well for her.

Here's how adding images works, there's a video you can check out that explains. 

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12 April 2024 - 8:02 am
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Well, just got surgery appointment set for next Wed. Drop off first thing in the morning. I feel a wave of anxiety but ready to move forward.

I did write out list of pros and cons for radiation treatment and amputation as Benny suggested. 

in the end I know amputation present more near term risk, but removing the pain is at the top of my list for multiple reasons. Ella is currently on gabapentin. She was initially on 600mg 3x a day and that turned her into a zombie. We took her down to 300 2x and 600 at night when she sleeps with the surgeons consent. With radiation we’d still need to do pain management and she just isn’t the same dog on pain meds. Between that and risk of inevitable fracture in my mind, and that fact that the leg isn’t really being used now, we think amputation presents best path for quality of life if successful. 

Virginia







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22 February 2013
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12 April 2024 - 9:45 am
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Kevin, thank you for taking the time to share your thought processes as to how you arrived at this decision. It will definitely be helpful to newbies trying to decide on a path forward.  You have done an excellent job of detailing how you got to this result.

You are absolutely 100% right,... the main goal is to remove the pain and restore quality back into sweet Ella's day to day routine.

Recovery is no picnic for the first couple of weeks as I've mentioned before though, it doesn't last forever! It sounds like you have a good handle on the pain management that works best for her system. Sometimes that takes a little bit of trial and error and tweaking, but once you get it balanced it does its job.

Is this a fully staffed overnight 24/7 Clinic? They'll keep her the first night and maybe an additional night or two, depending on how she's doing. So no worries, that's when you can catch up on your sleep. It's exhausting mentally and physically getting to this point of making a decision; however there is a relief in knowing you have a path forward now.

If you haven't done so already, you'll want to make sure you have non-slip scatter rugs for traction if you have hardwoods. Also, raised food and water bowls to help reduce any strain.

Alrighty, we're going to be sending a whole lot of tripawd positive energy for a successful surgery, a smooth recovery and a pain-free quality life full of spoiling and tummy rubs!👍

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!

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12 April 2024 - 10:13 am
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It is a 24/7 clinic. They will keep first night and if all goes well they said the generally hold till the following afternoon. 

we have the raised bowls already, and I would say they are a must for all giant or large breeds.

she is currently wearing Tiger Paw non slip socks. They seem to work pretty well, but she doesn’t like us putting them on. One of us have to distract her while the other puts the sock on. Scatter rugs might be a good idea also as we have a lot of hardwood. 

 

Regarding recovery, I’ve tried to prepare as best I can, but I’m sure nothing can fully prepare you for it. The one thing I can be certain of is we will do everything in our power to give her an opportunity for a better life. 

thanks again to you and Jerry for your kind words and support. They do mean a lot.

 

kevin

The Rainbow Bridge



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12 April 2024 - 11:16 am
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You've given this so much thought, it really helps for others to see it too. Amputation isn't an easy decision especially in a case like this. I agree, taking care of that pain ASAP is the most important thing you can do.

Sounds like you are all set except perhaps more rubber-backed runners for the house? Traction is so important.

Any questions just holler!

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18 April 2024 - 6:43 pm
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Ella’s surgery went well yesterday. We brought her home tonight. She is heavily sedated and resting. Now we begin the healing phase. 

ill give progress reports as we hit milestones or questions as they arise. Right now not a lot to report but going as planned.

 

kevin

Virginia







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18 April 2024 - 7:43 pm
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YAY for Ella! She is home and is starting the recovery process! The first few days maybe a bit of a roller coaster of ups and downs eventually things will even out into a "normal" recovery and more and more Milestones to celebrate will be coming forward.

Thanks for the update. Try and get some rest yourselves while she's still a little bit doped up. From the hospital meds.

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!

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