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Pallitive care, is it worth it?

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  • #21
    Originally posted by Houndhill View Post
    Just re read what you said, this was indeed done without amputation. I will be eager to hear in which cases this may be helpful, sounds like many restrictions may apply.
    Houndhill, yes - its a limb-sparing procedure so its ONLY useful if that limb isnt fully affected by the cancer. It truly is ideal for giant breeds if they are candidates as many giant breed owners do not opt for front limb amputation.

    Here is an excerpt, but if you call Yonkers they should be able to provide you with real stats.:

    Alternative Treatment Approaches Alternative approaches to treating osteosarcoma are being investigated. Charney is part of a team that has pioneered a limb-sparing CyberKnife® radiosurgery technique for dogs where amputation is not possible or desired. Combined with chemotherapy, this radiosurgery, also known as stereotactic surgery, has a survival time that is similar to the standard of care with amputation and chemotherapy for good candidates. Unfortunately, not all dogs are good candidates. The viability of radiosurgery is best assessed by a CT (computed tomography) scan. The benefit of radiosurgery is that it saves the limb.

    "With this procedure, a radiation oncologist uses a high-tech, image-guided and computerized robotic control system to deliver radiation with submillimeter accuracy," Charney explains. "The CyberKnife radiation beams are sculpted to conform tightly to complex masses and deliver multiple radiation beams from many points outside the dog's body to the targeted tumor. The beams kill tumor cells yet spare healthy tissue. When the beams converge on the tumor mass, they deliver high-energy, pinpointed radiation with astounding power."

    Compared to conventional radiation therapy, the precision of CyberKnife radiosurgery allows higher doses of radiation to be delivered to the tumor while minimizing damage to healthy tissue. One to three treatments are the same as 15 to 20 treatments of conventional radiation. The benefits include fewer hospital visits, fewer anesthetic episodes and reduced stress. Treatment is based on how much bone destruction has occurred

    The procedure currently is available on a limited basis. Besides the Animal Specialty Clinic in New York, radiosurgery is performed at clinics in California, Colorado and Florida.


    • Original Poster

      Squish, and Houndhill, is the cyber-knife y'all are talking about sutable for an older dog or is it for younger? The limb-spare tech. I am familiar with is surgical where the affected bone is removed andreplaced with cadaver bone. My vet feels this would be as difficult a recovery as the amputation for an old dog.


      • #23
        Thanks, Squish, I did google the cyber knife treatment, unfortunately looks like it is not offered anywhere near me. However, if the need arises I will certainly look into whether clinical trials using this technique might be going on at NC State. It is offered to humans at UNC and some of those faculty have joint appointments at the vet school so perhaps there will be some collaboration. I also contacted the IW Foundation with this info, they fund research on osteosarcoma in IWs and I think this would be a promising area of treatment research.

        OP, since the U Florida vet school offers this treatment, perhaps they could evaluate your girl to see whether she was a candidate if it is possible for you to get her there. From what I read, it looks like the type of tumor, location, and whether it had spread was more a consideration than the age of the animal.

        As mentioned, treatment with something like Fosamax (available generically) can also help with pain and can slow tumor growth. Results from a study funded by the IW Foundation suggested that a higher oral dose than originally used might be helpful to some dogs: http://www.iwfoundation.org/articles...tml?item_id=39


        • #24
          Originally posted by csaper58 View Post
          Squish, and Houndhill, is the cyber-knife y'all are talking about sutable for an older dog or is it for younger? The limb-spare tech. I am familiar with is surgical where the affected bone is removed andreplaced with cadaver bone. My vet feels this would be as difficult a recovery as the amputation for an old dog.
          Houndhill is correct , it has more to do with location, size and lytic status than age. If you vet/radiologist felt that limb sparing surgery would have been an option (due to the tumor, not his age) than he may be a candidate. You would need a quick run through the CT(a 64 slice should only take 3-4 seconds) to confirm the size/lytic status of the tumor.

          Higher dose of pinpoint radiation means (I think) often only 1 - 3 treatments are needed where conventional radiation is often far more. Less sedation/anesthesia for your dog to deal with. I dont see any reason why if your dog is suitable for conventional that he wouldnt be for CK. There is no surgery involved.

          Both of the dogs I know had the procedure at Florida, but I know Yonkers does it (any may have been the leader in it). Im not sure if there is anywhere else that does it. Both owners did one treatment (theyare from Canada, so driving back and forth isnt so easy), followed up with 6 chemo sessions here and are doing great. No signs of tumor lysis and no signs of mets. I am in NO way saying this is the route you should go, or that its a cure - its just an option that you may want to look into.

          I am also one of those people that would want to do everything and anything for my pets. But after working wtih cancer patients and critical ones for years now I have come to decide that what is the right decision for one may not be for another. I am ALL for giving something a try, but keep in mind your pets reaction. Happy go lucky dogs that think going for a ride to the vets to grab a treat with the techs is the "greatest thing in the world" are generally excellent candidates for things like chemo. We had one pittie that loved coming so much she would even visit us on a weekly basis after her chemo protocols were complete! Others however do not enjoy leaving home for vet visits. All the cancer patients here are treated like gold, most of the pets do enjoy the actual procedure - but some just cant handle the travel, anxiety etc. Chemo can make some dogs sick too, although the goal is to use a dose that does not. Keep in mind your dogs reaction to everything. I hope that if you decide to go forward with treatment that he will be one of those "oh boy, this is great" kind of dogs


          • #25
            I have posted before about my friend's dog with osteosarcoma. At first, all she was going to do were the painkillers as she thought the disease would progress quickly. Dog was initially diagnosed in May of last year. By fall the leg had become grotesque but dog looked good otherwise (shiny coat, interest in life) and had a good appetite. My friend then opted for amputation (rear leg) after having lung rads done. Now it has been over a year and the dog is still doing good. He adjusted very well to the amputation. He is an older dog (12 years?) I think every case is unique.


            • #26
              My 7 year old greyhound has osteosarcoma. There were no signs at all until he came up limping one day. He is one that always played hard, so we figured soft tissue injury. When it wasn't better in a few days, we made a vet appointment. The radiograph showed that his shoulder and leg were no longer attached. The cancer had eaten through it completely. We biopsied it and it came back highly agressive type which had likely already spread to his lungs, so amputation wasn't an option. We kept him alive on painkillers for about 6 months I think it was until it was obvious that he just wasn't happy anymore. This was 13 years ago so not as many treat were available back then.

              I am glad we gave him more time, but in hindsight the more time was really for us and not him which is usually the case. I can't say what I would do now.
              I love cats, I love every single cat....
              So anyway I am a cat lover
              And I love to run.


              • Original Poster

                Hi Everyone, Thanks for all the well wishes and support. Baby Girl is a little more comfortable today. Her scan had to be pushed back to Wednesday. I've been trying to make a list of all her favorite things to do, to see how many of them she can still do. It's a pretty short list. She mainly just sleeps and eats. She really wants to go for a walk, but can only walk about 20-30 ft befor she has to lay down and rest. Her spirit is willing, but her body just can't do it.
                From reading the posts of others who's dogs had osteocarcoma it sounds like
                my girl has something else going on. She is in to much pain for it to be just her leg. The scan will tell us, untill then what Baby wants Baby gets.


                • #28
                  I am so very sorry for Baby Girl!

                  As I have said, osteosarcoma is extremely painful, one of the most painful thingssever,not to say there could be something else painful going on.

                  Jingles former and for you, know it is awful to have an animal in pain!!

                  Sometimes, you have to listen to the animal, though tests can give us much information.


                  • #29
                    csaper58 I'm so sorry you are going through this. I lost my Rottie to osteosarc 4 years ago.

                    I did palliative care for her. It was worth it. We had a pretty good last month together. We didn't make it to palliative radiation (PTS before the first appt) but these were the meds (that I can remember) she was getting:
                    Misoprostal (for her stomach)
                    Fentanyl Patches

                    The pain management specialist said that the pain they are in from the bone cancer changes the way the body compensates for other pain. My dog went dead lame on one of her hind legs in which she had a lot of arthritis in here hip. In retrospect, it was a red herring to some extent because we just kept xraying the leg, looking for cancer. Her cancer was in her rib. We didn't find it until we went fishing.

                    She did pretty good. She was crazy lame, I had to wrap her hind feet because she was dragging them so bad, and she could only walk about 20 feet before needing a break, but she was happy, eating and trying.

                    Here is a pic of her, about a week before it was time for her to go:
                    Unrepentant carb eater


                    • #30
                      I personally would not subject a 12 yo dog to chemo or radiation or any radical treatments, especially for a disease as nasty as bone cancer. We lost our Golden to the disease 2 months shy of her 15th birthday. Up until she got sick 3 months earlier, she was SO healthy. Still running like a racehorse and the vet said she had the heart of a 5yo dog. A few years earlier she had had a shoulder injury, so when the limping began we "assumed" it was the same thing. We took her in for laser treatments and only when that didn't work, we found out what it was. We were told she had a few weeks, so we brought her home and promised her she'd never have a see a vet's office again. We made arrangements ( along with 2nd and 3rd backups) for a vet to make a house call when it was time. We changed her diet drastically, to make ourselves feel like we were doing something for her, and I believe that did help her outlive her prognosis and have some quality of life. She lived a full 3 months past diagnosis. Our huge fear was that she'd have a catastrophic break. We hovered over her, rednecked our kitchen with carpet remnants to help her with footing and cushion any slips and worried every moment we had to leave her. The last couple of weeks it became very apparent that it was time and we were blessed that it was so peaceful.

                      12 is younger, but we knew with our dog that if the cancer didn't take her, something would at her age. We didn't want her last days filled with vet visits and traumatic treats. One good week was better than stressful months of life. If she'd been a younger dog, we might have considered amputation and treatment IF there stood a good chance that she get a meaningful length of time to have good quality of life. IMHO, keeping them alive just to put them through hell isn't a choice I'd make. We managed our dog's pain well, and we were able to take her on several "field trips" in the car (she loved riding) and for awhile, she'd hobble around the yard to do her daily inspections. She was still wagging her tail until her last breath, but that's a Golden's nature. She was going to hang in there with us as long as possible, but the thought of her having a catastrophic break and having so much stress and pain at the end was just not something we were willing to risk.

                      Good luck. It's heartbreaking...you will make the right decision.


                      • #31
                        Belladonna Lilly, how do you know chemo and radiation is hell on pets? The goal of chemo is NOT to cure cancer, like in humans. We never continue chemo on the pets that get ill from it, however the majority do NOT get sick from chemo.

                        Since you didnt do chemo on your dog, its a little unjustified to say that its hell for them.

                        Our patients come in with their "parents", receive their chemo and go home. Most are so excited to be here and get snacks, belly rubs etc. Whole procedure is anywhere from 5 seconds to 30 minutes.

                        You are right that it ISNT a good option for all pets, but it certainly isnt that "hellish" chemo some people think of!

                        And its also not like you are signed up for x amount of time - you do one treatment, and if they dog tolerates it well you go to #2. If the dog doesnt enjoy the treatment, it makes the dog ill or too stressful for the owners then you stop. Too many people get freaked out by the word and dont understand the process.

                        Not saying to the OP this is the right decision (it's probably not as its usually not recommended unless there is an amputation), but just wanted to share some facts about dog vs, human chemo


                        • #32
                          I lost my 12 year old GSP to osteosarcoma last August. There is a thread on it here covering the course of his disease and the decisions I made, many with the help of the same people who are making suggestions to you now. When diagnosed, my vets recommended amputation followed by chemo while saying that the combination was likely to buy him 6 months to 1 year compared to a matter of weeks to 2 months if I did not amputate. They also said that one of the reasons they recommended amputation was that the leg would quickly become so painful that he would not use it and it would only be a burden to him. For a variety of reasons you can read on the thread, I decided against amputation and in favor of doing everything possible to combat the cancer as long as the treatment would not cause my dog additional pain. This included everything from homeopathy (in which I'm not really a believer) to turmeric to meals of raw chicken liver + conventional pain killers, a variety of herbs .... The cancer grew surprisingly slowly for over 4 months, during which he which he continued to swim, play, and generally enjoy life. For the last 2 weeks, I watched helplessly as the tumor grew, and finally had him euthanized in the bed we'd shared for over a decade when the enormous tumor reddened, split, oozed, and was obviously causing him so much pain that this previously bounding dervish was reluctant to rise in the morning. Nonetheless, he marched on that leg like a soldier when I took him out for his last walk an hour before the vet arrived to put him down. I like to think that he was showing me that he was glad I had decided not to take that leg away.

                          I am, of course, crying as I write this, hoping, like everyone else, to let you know that you are far from alone, and that after you receive the benefit of everyone else's knowledge and experience, you and you alone are in the best position to make the right decision for your beloved dog. It is clear from every one of your posts that you are trying everything you can to do what your dog wants. What more could anyone in her position want? My heart goes out to you.
                          Last edited by fish; Jun. 2, 2013, 06:28 AM.


                          • Original Poster

                            Thank you all for sharing your thoughts and the stories of your beloved pets. We have had quite a week. Baby Girl's tests came back as follows-
                            Blood work was normal as were the ultra sound and the chest x-ray. The bone scan did not show any other osteocarcoma lesions, so I was hopeful. Then we got the prices.
                            I have been in touch with the folks at Yonkers. The price for Cyber Knife is
                            $8000.00-$8500.00 And they can't tell if she is a candidate unless she goes there for an exam. So that isn't looking possible.
                            I have not heard from U. Fl.
                            LSU can offer pallitive radiation @ $1200.00, a drug (bisphosphonate?) @$400
                            every 4 weeks, and chemo @ $500.00 every 3 weeks. And the prognosis if we do all this is still not good, maybe 3-5 months. They think she might have 1-2 months without treatment.
                            There are some dogs that don't respond to the radiation, and it will make a big weeping burn on her leg.
                            So I guess we will be weighing our options and soul searching this weekend.


                            • #34
                              Wow!! Those prices are incredible!

                              Do be aware that the biophosphate can also be given orally at home (the generic Fosamax), it is inexpensive and I have known dogs to do very well on it. I posted a link to an article about it previously on this thread.

                              That is good news about where Baby Girl is at present! So sorry you are going through this.


                              • #35
                                Thanks for the update. You're hearing more in the way of conventional options than I did last year (e.g., I don't remember hearing anything about either Cyber Knife or Fosamax), but it doesn't sound as though the science has advanced enough to make the decisions any easier Baby Girl is a lucky dog to have the family she does, and I'm sure you will do all you can to make the time you have left together as positive as it can be.


                                • #36
                                  Originally posted by csaper58 View Post
                                  My 12yr old dog has incurable bone cancer. and is in alot of pain dispite all the pain meds she's getting. Her appetite is great and she still seems intrested in life.
                                  I am trying to decide if radiation and chemo are appropriate for her, I want to keep her alive no matter what, but putting her thru all these proceedures for a few months seems so selfish.
                                  Then, just when I've convinced myself letting go is best, she looks up at me and wags her tail.
                                  So, Anyone have experience with pallative care? How much better did your pet feel for how long? I know they are all different, but I need some guidence. Thank you.
                                  I am sorry if I cause you any more pain. I am coming with experience - and I absolutely wish I had had the guts to let my last long-term faithful companion go a lot earlier! I hung on because I couldnt "see" that he was deteriorating and was in constant pain and short of breath -all I could see was the faithful dog with a wag in his tail and a grin on his face who had got me through losing my sister (his original owner) in a car accident. I felt I had to hang onto him to keep her memory alive (a really dumb idea, i know!). I am tearing up again and it has been > 6 years now - probably because I am facing the same decision with my absolutely last one of her animals - her final horse.

                                  No, this type of pallative care is not worth it. Your dog sees you looking at her, she wags her tail in appreciation. It doesnt stop the pain or anything. I have been there and, finally, with some help from a nephew, i called time. He went out with the same smile - now filled with DARK RICH CHOCOLATE (he loved every mouthful of that family size bar as well ).

                                  I have promised my current two dogs that I will simply not put them through that - EVER.
                                  Still Working_on_it - one day I will get it!


                                  • Original Poster

                                    Thanks RaeHughes honesty always helps, Fish.. I looked up your post about your dog, and was very inspired by your fight to save him. And yes, if you have 'Oprah Money' there are new options. I am going to try the Artemisinin. Thanks for the link on where to get it.
                                    Houndhill thanks for the info on fosamax I will see if my vet can perscribe it.
                                    I'll post again soon.


                                    • #38
                                      Originally posted by csaper58 View Post
                                      Thanks RaeHughes honesty always helps, Fish.. I looked up your post about your dog, and was very inspired by your fight to save him. And yes, if you have 'Oprah Money' there are new options. I am going to try the Artemisinin. Thanks for the link on where to get it.
                                      Houndhill thanks for the info on fosamax I will see if my vet can perscribe it.
                                      I'll post again soon.
                                      Yes fosamax can be given at home, there are also lots of herbs and "natural" treatments that can "potentially" extend quality of life.

                                      Chemo IMHO is a waste unless amputation is done, and if you dont want to go that route (not always the best decision for an older dog) then its really throwing away money.

                                      I am surprised of the 3-5 month median survival time with radiation and clean chest rads - our stats are quite a bit longer than that (6-12). Each dog is different though, and I have known many who go far to quick, and others who do no treatment do well for months and months.

                                      Quality is important. Do some home research, and any natural treatments that YOU feel comfortable with (and run it by yourvet) I suggest you do. They arent likely to harm, the worst they will do is not work. But, you never know - one of our most powerful chemotherapies today is from a natural flower..

                                      Good luck, whatever you choose I bet quality of life couldnt get any better with you as his owner.

                                      I love how you commented on Oprah money Dont we all wish. Check with your pet insurance company though, the ones here do cover all radiation and chemo treatments - but dont think they cover cyberknife.


                                      • #39
                                        I am very sorry to hear about your dog. I have a female rott with bone cancer. I had the leg removed and she has finished her chemo. It was a tough decision, but she was young and vets felt she could handle it. She broke her leg badly so it was that or euthanize her. It looked so strange at first but I took it worse than she did! Its been months now and she is great. I know any day could be her last, but we go infor monthly checkups and everything is still clear. She never was sick with the chemotherapy and was awesome at the vets, she even stayed with her sister at the hospital when she was sick as moral support.

                                        I dont know what I would do in your situation with an older dog. If he wasnt arthritis I would 100% recommend amputation and chemo. I dont regret the decision at all. However, if it made all her other legs really sore, that wouldne be fair, and she is younger and otherwise healthy, so that makes a difference.
                                        give your doggie lots of kisses, treats and enjoy the time you have with him. I will pray for him that he will defy the odds!! Im sorry you have to go through this, but you will know what is the right choice for your dog.


                                        • #40
                                          I lost my wonderful Great Pyrenees last year to an osteosarcoma in her jaw. Because of her age (she was a rescue so we estimated her age to be 10-12), I decided not to put her through the surgery (removal of the jaw). Our oncologist suggested the oral chemo as palliative care only, and that's what we went with. I'm incredibly thankful I made that decision, as I got six more pain-free months in which to say goodbye. Sophie was a complete wimp, not your typical stoic dog, so she let me know any time she was in pain or otherwise uncomfortable. The chemo was a godsend for us. And when it ultimately was her time to go, it was incredibly beautiful. A group of the people who loved her (she was a therapy dog, so there were a lot of those, :-)) gathered around her at the vet's office on blankets and we were all there holding her as she passed. In those last months, I was able to take her swimming every day, walking on trails as long as she wanted, and give her all the treats she usually couldn't have (she had severe food allergies). And the chemo was relatively inexpensive.