On our way to Brandon Fl (about 2 hrs away) for consult. Unfortunately, luck ran out for how well he had been moving after the bone strengthener last week.  He was holding his paw up this morning.  The thing that concerns me is he won’t hold it up and hop.  If he can’t put that leg down, he just lays down and won’t move.   I had to give him a little extra gabapentin and once that kicked in he started walking but uses the leg even though it’s clearly causing him pain.  I keep reading dogs have shown they can manage on 3 legs for by hopping on the 3 legs before the surgery.  Is he then showing me he can’t? 

Thanks to all of you for the incredible support and insight as I deal with what really feels like one of the most stressful, difficult decisions I’ve ever had to make. 

I had hoped yesterday’s consult would provide me with the “magic” solution for what I should do.  If anything, it made me more confused and, as emphasized in all of your posts, I need to do something sooner rather than later.  It’s not fair to Honor to keep him hanging on in this situation because his mom is horrible at making decisions.  

Radiation oncologist at yesterday morning in person appt. said she could get stereotactic started next week if I set it up today.  It’s a CT scan on Monday followed by 3 consecutive days of radiation.  Brief and painless procedure with short acting anesthetic to keep dog still.  Significant Pain relief starts within 24-48 hours and improves from there.  If pain not resolved by 2nd week and tumor not shrunk down, then it didn’t help (very rare but can happen) and I’d be back to amputation. She threw me for a loop when she said, If it was her dog, she would probably do amputation/chemo just due to statistically longer survival times and avoiding fracture risk (and would probably try to add the UF vaccine using tumor cells just to throw everything at it she could).  She said she only wished stereotactic radiation had something more close to the survival times with amp/chemo.  She said I’ll get different opinions based on each vet’s personal experience and neither are right or wrong.   Surgeon did a quick exam of him in back though I didn’t get to speak with her.  She conveyed that she wouldn’t rule him out as a candidate for amputation.  He does have right shoulder stiffness (arthritis) and possibly some arthritis in rear legs but pretty much expected for a dog his age and size. Honestly, I had forgotten about his right shoulder calcification/arthritis  issue diagnosed @2021 as it’s never been a big deal…until now when I’m considering only leaving him with that leg to provide most of his support.  🙁

2nd radiation oncologist virtual consult….a little more positive about doing the stereotactic and considering amputation later.  She said 10-12 months would be realistic good quality of life to hope for with the stereotactic (she had one dog who is at 3 years but it’s in his shoulder and they didn’t biopsy. She doesn’t require a pre-radiation biopsy but the other place does.  The other place has radiation oncologist on site.  The place closer to me has this Dr. working remotely and instructing technicians and supervising orthodpedic Dr.   She advises clients doing this that they must have a contingency plan in case of fracture.  Ideally one could monitor the dog and catch a fracture in advance but it rarely works out that way.  End of life usually happens due to fracture or spread.  She doesn’t see that stereotactic reduces life span if I was planning to follow it up with amputation.  She said amputation does not prevent or treat spread of cancer to other places (that’s the chemo).  So in either case of radiation or amputation, I am not treating/preventing/slowing down spread.  The chemo is for that.  She said the MST for amputation with chemo is 10-12 months (so oddly the same as what she told me for stereotactic yet the other oncologist said stereotactic doesn’t come close to survival times of amp/chemo).  I think that one told me 9-12 mos stereotactic and 12 to 14 mos chemo and if I moved from radiation to amputation to MST would be based on time of diagnosis. So, if we amputated at 6 months after stereotactic we might realistically expect another 6 months after amputation.  Meanwhile, there aren’t really stats doing stereotactic/chemo first then moving to amputation since few people do it that way due to cost, limited availability of stereotactic and most who go that route are doing it because their dog has issues that have made them decide not to do amputation.   She couldn’t really tell me what she would do in my case.  She has a small dog and isn’t a big dog person.  She said, for her, with a tiny dog amputation is a much easier choice.  She said she’s even had some success with pallative improving pain control in in 90 percent of dogs for 4-6 months and there is early research that adding zolendrate/chemo can extend that out to 9 months.  If we were doing radiation, I think I’d just go with stereotactic though.  

On top of that, UF clinical team responded to some questions I had about their vaccines.  One of them sounds particularly intriguing and they’ve seen some positive response.   The question is does it tip the scale in favor of doing amputation.  Obviously they can’t share clinical data with me right now.  It’s  6 vials (a couple thousand dollars) and can be used with or without chemo.  To get this one amputation must be done and it has to be done there.  Everything has to be done there for treatment so the chemo too.  They use cells from the tumor to create the vaccine.  She said they used to allow dogs doing radiation to enroll but lost too many of them due to fractures.  The other RNA vaccine is a completely new thing so not really any positive data or track record yet.  That one can be done while doing radiation but they require a bone core biopsy (which, of course has some risk of weakening the bone). Ugh.   My appt. for the consult is not until June 27.  She said they do typically move things along quickly one one’s dog is a patient and especially in a case like osteosarcoma which is urgent.  While they can try to get him in sooner (believe me, I have begged them due to his deteriorating condition), I certainly can’t bank on it. 

I’m going to list pros, cons and unknowns of each option.   Please let me know if those of you with clearer heads see anything I’m missing.  Maybe this will also help someone else along the way who is reading and facing these decisions.  

Option 1.  Stereotactic radiation/chemo/bone strengthener 

Pros:  We (hopefully) preserve a functional leg for longer without pain.  Utilize time to set things up in case amputation happens.  Order Eddie’s wheels asap to take stress of leg longer walks and so he’s used to using it already if amp happens.  Work on slimming him down some and doing PT to strengthen his other 3 legs.  Have more time to evaluate the arthritis in his other limbs.  Figure out logistics of plan of if he fractures.    Could start next week (only if I decide today) or the following week if I decide next week.   Initial pain relief within 24-48 hours which should keep improving.  Potential for up to 12 months.  Quality of life during that time could be very high and allow him to do normal walking, going places etc.  (if he lasts a long time without fracturing).  If he does get metasasis to lungs before he fractures, he probably would have gotten it around the same period of time after amputation.  So, he got to spend those months with a good quality of life and not recovering from surgery (this should probably be in unknowns)

Cons:  Unknown time period he would do okay for ranging from 6 months to a year depending on who I’ve talked with.  Substantial risk of fracture probably increasing as time goes on which can be difficult to monitor to catch it in advance.  Looked into cementoplasty but can’t find anyone offering it.  Potential difficulty of moving a very large dog in substantial pain to where he needs to go for help.  Potential risk of ending up in situation where he fractures, we decide to amputate but would run chest xrays first and if we found he had metasasis to lungs that would result in our having to say goodbye to him in a hospital while he is in pain vs in our home as it wouldn’t be right to put him through recovery of surgery or bring him home in extreme pain if that was the case. 

Unknowns:  Whether or not doing it this way reduces or increases or has no effect on overall survival time.  There is one theory that, if there is micrometastasis, it will sometimes undergo a growth spurt immediately after surgery (Dr. Dressler “The Dog Cancer Survival Guide p. 128).  Thus the chemo afterwards.  Chemo is also done after radiation though.  Would it be as effective after surgery if we’ve already used it after radiation (haven’t asked that question).   Little statistical data on doing things this way.  Most are choosing this instead of amputation for aforementioned reasons and not considering amputation afterwards. 

I asked what if I did radiation/chemo and found it had spread to his lungs within 6 months.  How would I not think it was because I didn’t amputate?  Both radiation oncologists had the opinion that, if that happened, it was a faster growing cancer, not responsive to the chemo and I probably would have been looking at the same scenario 6 months out from amputation as well.

How bad is a fracture situation?  It may depend on type of fracture as I’ve read everything from horrifying to witness their dog in such pain to people not even realizing their dog had fractured until they took him in for xray due to limping/favoring one leg starting up again.  

Option 2.  Amputation/Chemo - with or without vaccine

Pros:  It’s said the pain is easier to manage from the surgery with medications than the bone cancer pain.  Evidence of similarly sized and aged dogs doing well after amputation and not being my worst fear type scenario (ie Orphelia and Nicholas both Honor sized and doing remarkably well after front leg amp).   No worrying about when and if a fracture will occur.   I’d put less appointments here but the radiation appts. aren’t a big deal and he would be doing chemo in either case.  If we add the UF vaccine which requires amputations it’s 6 vials so that would also be a lot of additional visits and traveling.   

Cons:   My dog no longer has a front leg and he has arthritis in the shoulder of his remaining leg and uknown levels of arthritis in rear legs.  He was able to run to patrol the yard before the bone cancer set in (not particularly quickly but he could run) yet he did have a couple episodes of freezing up, standing very stiff and refusing to move starting around a year prior to when he started limping and vets say that was not due to bone cancer as it wouldn’t have progressed so slowly.  That was attributed to some calcification they found in his right shoulder.  When it happened, pain meds typically resolved and it didn’t slow him down or seem like a big deal…. until now.   Owner fears and struggles surrounding amputation (ie seeing how his favorite position is laying with his left paw crossed over his right and how he uses both paws to hold any chew toys, kongs etc.  and feeling like it would be highly disturbing to him not to be able to do that but not knowing if I am projecting), house with 2 young (and not particularly helpful) teens, 2 other dogs, 2 cats and various small pets yet stay at home mom and husband that works from home so probably balances out.    I guess Most of the cons are really in unknowns to be honest.     Other people’s judgemental , uninformed attitudes about how I was selfish and cruel to put my dog through that.  I have never seen a tripawd in our neighborhood for example. 

Unknowns:  Will he be able to function on 3 legs.  Will the cancer spread faster or slower if we amputate.  Will I regret not seeing if he would have been one of the dogs that did well keeping his leg for a long period of time by using radiation instead if he struggles and is miserable? 

Option 3.   Amputation/Chemo/ Waiting for UF appt. on 27th to add what looks like promising vaccine and maybe feeling more confident in whatever UF specialists recommend for him. 

Pros:  Everything he needs for care is in one building.   Vaccine could potentially add something to extend his life that we won’t get with amputation/chemo alone and it’s frustrating to lose out on it if we would do amputation anyway.  Other vaccines (Elias) and Yale are extremely more difficult for us to get (ie 26 hour round trip twice with a dog that doesn’t love the car for Yale vaccine) whereas this is doable and it can be done with the standard 6 rounds of chemo.   If we’re going to amputate anyway, it may make sense to wait to take advantage of the vaccine. 

Cons:  He is not doing very well right now and I’m worried about 2 weeks from now.  That zolendrate had a marked amazing effect but it wore off quickly and it can only be given once a month so I can’t ask for more.  While both radiation oncologists I talked with yesterday felt like 2 weeks wasn’t going to make a substantial difference as his tumor isn’t that large, there has to be some amount of time that lapses where it makes a difference and he has already had symptoms since beginning of April and might well have been diagnosed back then if an xray was done of that area.   

Uknowns:  Will UF get me in earlier.  I would hate myself if I proceeded with something (especially if amputation) and they called the day after to say they can get him in.  Am I negating any potential benefit of the vaccine by waiting another 2 weeks (plus at least a couple days) to get some kind of treatment started.  Will he get so bad between now and then that we can’t get him up the ramp and into the car to take him to UF.

Option 4.  Stereotactic Radiation/Chemo/Waiting for UF to take advantage of the RNA vaccine study which allows radiation but doesn’t have data behind it yet and is very new. 

Pros:  Adding something additional to the stereotactic radiation and chemo 

Cons:  Adding something with unknown effects to the stereotactic radiation and chemo, waiting for radiation and chemo that I could be starting right now, core bone biopsy being required before radiation because they use tumor cells to make the RNA vaccine. 

Unknowns:  Efficacy.  What if it turns out to be some amazing breakthrough and I missed out on it by 2 weeks? Or, if could turn out to have bad side effects and Honor could be hospitalized due to that whereas I could have done the radiation elsewhere and by the time of the UF appt., he’d be at home, feeling better and having quality of life.  

Thoughts:  When it comes to UF I feel more comfortable with the vaccine that requires amputation because hundreds of dogs have already taken it.  Unfortunately, the other is the only one that can be done with radiation or amputation and I’m more hesitant on that one pending talking with them.  IF I was doing stereotactic radiation, I don’t think I would wait on UF.  If I was doing amputation (pending their assessment of him) then it seems to make more sense to wait for UF because I could at least add in the vaccine.  

My husband’s take on it is he really thinks we should wait on the  UF consult or we could regret whatever decision we make…especially in light of the oncologists saying they didn’t think 2 weeks was going to change much.  He thinks we can’t make a fully informed decision until we hear what UF has to say.   He has hope they might get us in sooner but I’m worried they won’t.   This would have been an easier call if Honor was like he was the day before yesterday.  The way he is right now it makes it feel like 2 weeks is going to seem like a lifetime.  

For pain control, I have gabapentin (700 mg now 3 times per day).  The Dr. gave me tramadol when I asked for something stronger to add in  but the dose is 2-4 50 mg tablets.  Trying to research how close I can give that to the gabapentin.  In addition, he has galliprant (and all of the NSAID’s seem to upset his stomach so it’s a balancing act with that and his vet had given me 60 mg instead of the 100 mg.  

jerry said

Eustacia said

On our way to Brandon Fl (about 2 hrs away) for consult. Unfortunately, luck ran out for how well he had been moving after the bone strengthener last week.  He was holding his paw up this morning.  The thing that concerns me is he won’t hold it up and hop.  If he can’t put that leg down, he just lays down and won’t move.   I had to give him a little extra gabapentin and once that kicked in he started walking but uses the leg even though it’s clearly causing him pain.  I keep reading dogs have shown they can manage on 3 legs for by hopping on the 3 legs before the surgery.  Is he then showing me he can’t? 

  

Ohh I missed this earlier post, sorry.

No he is NOT showing you he can't do life on three, he is telling you the pain is unbearable.

Yes, I agree with Sally, it's very much time to make a decision.

By the time a dog shows pain like this (for sure a paw held up is one of many pain signals ), the pain is horrible. Gabapentin won't do anything to touch it over the long term, even a few days. Bone pain is not nerve pain, they are two different things. If the Gabapentin did anything it probably sedated him a bit but did not control the pain as much as one might think.

And there is a huge risk of fracture, too. You don't want to make a decision in the heat of the moment after his leg breaks.

Please see:

The Osteosarcoma Bone Cancer Fracture Risk is Real

Please get more pain control for him OK? But just keep in mind that even the strongest meds won't touch that pain for very long. 

  

Well, he rallied some after dinner and got more active and even tried to initiate play with one of our other dogs.  Sadly, I had to shut that down quickly because they were on the hard, slippery floors and I knew it wasn’t going to go well for him.  He also acted like he wanted me or my husband to take him on his evening walk but there is just no way he can do it. 🙁  I put on his leash and just walked him around the outside of our house and let him sniff.