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Pallitive care, is it worth it?

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  • Pallitive care, is it worth it?

    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.

  • #2
    I can see foregoing chemo and radiation and opting for pain control as long as she looks up and wags, so to speak.
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    • #3
      My experience with chemo for my dog wound up being one of those instances where *I* was really not ready to let her go, and I needed to prove to myself that we did all we could. She did not respond, progressed very quickly downhill and we put her down nearly two years ago now--memorial day weekend, on Sunday. I don't think my choices made her life worse, but they also did not make her life better.

      I can say now that I would not do that again, and when I had a cat with mast cell, we did pretty minimal palliative care (steroids) and watched her very carefully for signs she was declining, and put her down at that time.

      If you can go into palliative care with open eyes and realistic expectations, it could be worth a go. But understand that it might not help, and may make things WORSE, and be prepared to make the call if you see anything that is not making the life of the animal BETTER.

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      • #4
        From what I understand, bone cancer is extremely, extremely painful. Dogs are pretty stoic in general, they often try to not show their pain, so if your dog is indicating pain even with all the pain meds she is on, it must be considerable.

        It is only going to get worse, not better, although she may have times when it is less severe than others. I know it can be very difficult to let them go, but she should not have to be in pain that is only going to get worse, would be the way I would look at it.

        As I understand it, unless you do amputation, chemo is unlikely to help. Radiation can help with pain, I have done that, but also makes fracture more likely. Have you consulted with an oncologist? If her pain can no longer be effectively managed, maybe it is time....I think in retrospect there have been times when I have waited too long. I have been told that for bone cancer "better a week too soon than an hour too late" due to the fracture risk for one thing.

        So sorry for you and your girl to be going through this, know it is a very hard thing. Bone cancer Sucks The Big One.

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        • #5
          Another thing to consider besides radiation is treatment with intravenous bisphosphonates (pamidronate). I've seen some dogs have a significant improvement in their comfort level with this.

          I'm so sorry you're going through this. It's so hard to see them in pain.

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          • #6
            You also might want to thing about having a plan in place if you have to euthanize her on a weekend or holiday. Do you have a vet who will come out to the house, and can you get in touch with them? Is your dog of a size where you could physically get her into your vehicle if she fractured? Keep enugh gas in the car to get to someone if that is your plan, and always know what you would do and where you would go. It seems things always happen on a night, weekend, or holiday!

            I know it is horrible to have to think of this, but we try to keep one grave ahead, dug, covered up, to be used when needed. Better to have it and not use it for awhile than be faced with digging a huge hole in ground that is frozen, baked rock hard, or in 100 degree heat. If you opt for cremation, know how to arrange for this, have a talk with your vet first. I find it is better to make these inevitable arrangements ahead of time rather than when you are under such stress at the time.

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            • #7
              Palliative care to me means pain control. It is extremely worthwhile if successful but when it no longer gets the job done it is time to throw in the towel. I don't know if I would consider radiation and chemo to be palliative although I guess it could be if it shrinks the tumor a little so it isn't causing as much pain.
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              • #8
                Originally posted by Laurierace View Post
                Palliative care to me means pain control. It is extremely worthwhile if successful but when it no longer gets the job done it is time to throw in the towel. I don't know if I would consider radiation and chemo to be palliative although I guess it could be if it shrinks the tumor a little so it isn't causing as much pain.
                Unlike the case of some other types of cancer, for bone cancer, radiation is done primarily for pain control, not to shrink the tumor or attempt to slow the course of the cancer. Radiation for bone cancer is done primarily for control of pain so it is actually considered palliative. I did a course of it once at the NC State Vet School, and while it did help with my dog's pain for a short time, I doubt I would do it again.

                OP, while I understand your desire to keep your girl going no matter what.....some battles you just cannot win. I know it is so hard when they look at you and wag their tail. One of my guys did that to me and the vet and techs, even with a fractured leg. We were all a mess!

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                • #9
                  Her appetite is great and she still seems interested in life.
                  that tells you a lot right there. I think you can easily tell when a dog is "done", and you're not there yet.
                  As mentioned above, the radiation/chemo they are offering aren't intended to prolong her life- they are intended to reduce her pain.

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                  • #10
                    Originally posted by wendy View Post
                    that tells you a lot right there. I think you can easily tell when a dog is "done", and you're not there yet.
                    As mentioned above, the radiation/chemo they are offering aren't intended to prolong her life- they are intended to reduce her pain.
                    And sometimes appetitie is not a reliable indication that it is not yet time, particularly if some of the other meds she is on tend to stimulate appetite. For example, prednisone can certainly increase appetite even in an animal in pain. You have to look at the whole picture. It is easier for some people than others. Some people are told "the dog will tell you when it is time, you will just know" but I think sometimes we are not observing and listening closely enough to what the dog is telling us.

                    It may also be helpful to think that there is not one "right" moment, but a range of time when the decision is in the best interest of the animal. Sometimes when we see a dog every day, we don't pick up on things that are going on.

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                    • Original Poster

                      #11
                      Thank you all for your thoughts and advice, you make some very valid points. I have not figured out how to quote a post yet so I'll try to answer this way...
                      Dancer.. Yes at this time she is just receiving pain meds-Tramadol and Gabapentin.
                      Simkie.. This is what I am struggling with, I am not ready to let go-but is she?
                      thanks for your help
                      Houndhill..Bone Cancer does Totally Suck! We have as much of a plan as possible, Thanks for helping us spot some loose ends we need to adress. Sounds like you've been here done this. Thanks for mentoring.
                      Laurierace ..Thanks for weighing in.
                      Wendy.. Thanks I'm hoping we aran't there yet too.

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                      • Original Poster

                        #12
                        We have decided to do a Nuclear Scan on Tuesday. If she just has the one tumor in her leg we will be more agressive with radiation and chemo, but if there are other tumors will will give pain meds only.

                        As Houndhill says we are trying to antisipate any problems, and I just found out our vet will be out of town for the long week end.

                        If the worst happens and her leg fractures, Can I put her down with an overdose of Tramadol or Gabapentin or both? Or will that make her vomit and have seizures? If we give extra pain meds befor transporting her to the Emergance Vet (he is 12 bumpy miles away) will that complicate it for him to euthanize her?

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                        • #13
                          OP - I work closely with the onco unit and frequently administer chemo to osteosarcoma patients.

                          My views are that some animals tolerate it like water, and others will not. Unless you try, you will not know. Yes there are risks, but there is also a potential benefit. There's no way in knowing what your pets response will be, and there is no wrong decision no matter what you choose. The role of chemotherapy is not to shrink the bone tumor, but to slow the progression of the lysis and progression of mets. Generally its recommended post amputation, but I have known many to not amputate and persue chemo in hopes that the progression will slow.

                          Although I do not have first hand experience with radiation therapy, I know many patients who have gone radiation and chemo route where amputation isnt possible. Most of the dogs have handled radiation well.

                          There IS, contrary to what Houndhill has said, a potentially "curative" radiation treatment commonly called cyberknife. It has limitations, and of course doesnt cure the disease - rather treats the tumor much like amputating it....but without the amputation. I have known two patients who have had this done, one is at year 3 with no metastasis and the other year 2. Stats Im sure however arent 100%, just my very limited experience. The procedure is very limited and I also have limited knowledge on it. I believe its only recommended on distal limbs with tumors under "x" cm with low chance of fracture. Its basically pinpoint radiation compared to conventional. Not many patients practically speaking are good candidates for this procedure from what I remember. Im pretty sure Yonkers does this treatment - not sure where you are located but if you google it, should give you some more detailed information incase you are interested.

                          I think your decision sounds more than reasonable. If there are mets (check the thorax too), then there is only very limited time left. If there is just one primary lesion, you will potentially have more time.

                          I would ask your vet for a prescription of both Tramadol and Gabapentin, but you are unlikely to enduce a "euthanasia" with them. Yes, seizures, dysphoria etc. could be the outcome. Pets fracture their legs all the time and yes its painful, but with tramadol and gabapentin on board they should be alright to transport to an emergency hospital. You could always ask for a prescription of Ace or buprenorphine as well. Hopefully this situation wont happen, many just have progressive lameness or hairline fracture without a sudden major fracture...but it can happen.

                          Jingles for your dog (and you!)

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                          • #14
                            Originally posted by SquishTheBunny View Post
                            There IS, contrary to what Houndhill has said, a potentially "curative" radiation treatment commonly called cyberknife. It has limitations, and of course doesnt cure the disease - rather treats the tumor much like amputating it....but without the amputation. I have known two patients who have had this done, one is at year 3 with no metastasis and the other year 2. Stats Im sure however arent 100%, just my very limited experience. The procedure is very limited and I also have limited knowledge on it. I believe its only recommended on distal limbs with tumors under "x" cm with low chance of fracture. Its basically pinpoint radiation compared to conventional. Not many patients practically speaking are good candidates for this procedure from what I remember. Im pretty sure Yonkers does this treatment - not sure where you are located but if you google it, should give you some more detailed information incase you are interested.
                            Thanks, Squish, did not know about this use of radiation. Just went to a presentation by the Broad Institute which is doing research on genetic markers of bone cancer. Will check this out. Sounds like it is pretty limited in usefulness though.

                            I assumed your vet was talking the more common use of radiation in bone cancer cases, which is only for pain control. That is what I had used it for at NC State vet School.

                            So sorry, and do get all the pain meds your vet will give you in case of a fracture! Mine also gave me injectable morphine, but that is pretty controlled. Also, if you can do IV injections, maybe they would give you such for euthanasia? Mine did, but not something most will do.

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                            • Original Poster

                              #15
                              Thank you Squish, Vet added Gabapentin to her Tramadol this AM. She seems more relaxed. sleeping better and actually dreaming again. Same dreams she use to have after chasing Nutria. Fingers crossed for a good report tuesday.

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                              • #16
                                Good news, OP! Sweet dreams for your girl.

                                Comment


                                • #17
                                  Originally posted by csaper58 View Post
                                  Thank you Squish, Vet added Gabapentin to her Tramadol this AM. She seems more relaxed. sleeping better and actually dreaming again. Same dreams she use to have after chasing Nutria. Fingers crossed for a good report tuesday.
                                  Fingers x'd!!!


                                  Houndhill - its pretty interesting, might be worth some research especially since you have IW's and they are unfortunately so prone to osteosarcs . One of the cases I know is an IW and is doing well, however he also followed up with chemo which wasnt cheap for the large beast! Still kicking though!

                                  Cyberknife is limited for sure, but excellent results in the limited amount of cases it's suitable for. Conventional radiation is still most commonly recommended after amputation/chemo.

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                                  • #18
                                    Interesting!

                                    Is the IW case you mentioned one who has also chosen amputation?

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                                    • #19
                                      Originally posted by SquishTheBunny View Post


                                      There IS, contrary to what Houndhill has said, a potentially "curative" radiation treatment commonly called cyberknife. It has limitations, and of course doesnt cure the disease - rather treats the tumor much like amputating it....but without the amputation. I have known two patients who have had this done, one is at year 3 with no metastasis and the other year 2. Stats Im sure however arent 100%, just my very limited experience. The procedure is very limited and I also have limited knowledge on it. I believe its only recommended on distal limbs with tumors under "x" cm with low chance of fracture. Its basically pinpoint radiation compared to conventional. Not many patients practically speaking are good candidates for this procedure from what I remember. Im pretty sure Yonkers does this treatment - not sure where you are located but if you google it, should give you some more detailed information)

                                      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.

                                      Comment


                                      • #20
                                        OP - no helpful ideas here, but MANY JINGLES. I just lost a 7 yr old dog to IMHA (nasty disease) a few months ago and these decisions are never easy. Go with your gut and you will make the right choices.
                                        We don't get less brave; we get a bigger sense of self-preservation........

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