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Osteosarcoma - Treatment/Palliative Care Options

1K views 11 replies 5 participants last post by  big black dogs 
#1 · (Edited)
Hi Everyone! I am so grateful for this forum. I typically just lurk in the background and read posts, but I find myself looking for guidance now.

My partner and I adopted an 8 year old Rottweiler last November, named Honey Bee or "Bee" for short. She has absolutely stolen our hearts. In late August, Bee started limping on her hind leg and after a week of pain medicine with no improvement, we opted for x-rays. The x-rays showed structural changes to her femur, which her vet is almost certain is bone cancer/osteosarcoma. The vet also ran bloodwork, which showed mildly elevated ALP and eosinophilia. We started her on gabapentin and carprofen 2X daily to manage her pain, and we are keeping her quiet (no off-leash running, jumping) to reduce the risk of a break. Since the diagnosis, her limp has gotten worse and she often pauses during walks to rest the leg, but she is eating normally and still excited whenever she hears us pick her the leash for a walk or car ride. She isn't showing any signs of significant pain aside from the limp and needing to rest her leg... though I know that rotties can be very stoic.

Our primary vet has recommended palliative care for Bee, with medication for pain management. He gave us an expected survival period of around 3 months. He did not recommend more aggressive treatment (amputation, chemo or radiation) given her age, size and preexisting conditions. He felt that aggressive treatment would not add significant time to her expected survival period, and would likely harm Bee's quality of life more than help. Bee will be 9 years old next month and is just under 100 lbs. She has some mild arthritis and her x-rays also show minor hip dysplasia.

We met with an veterinary oncologist today, for a second opinion. The oncologist suggested we consider amputation and chemo, or radiation. She felt that amputation or radiation would help Bee with her pain, and might extend her life for "a few" more months. The oncologist also mentioned bisphosphonates but said she has only seen mild success with those drugs.

We also had a consult with an integrative/holistic vet, who advised against amputation but suggested some alternative treatments - high-dose vitamin C infusions and acupuncture.

My partner and I are completely heartbroken and struggling to process all of this conflicting guidance. Our primary goal is to ensure that Bee has a good quality of life - we do not want to put her through painful procedures or treatments unless she has a significant chance at improved quality of life and longer survival period. Our instincts are pointing us toward palliative care with medication and perhaps acupuncture, but we do not want to be left wondering if we could have done more for our girl. The oncologist did make a strong case for adding radiation, but Bee does not particaurly enjoy vet visits and the through of her being sedated/anesthetized multiple times gives us pause, particaurly if we will only be giving her another month or two.

I know from this forum that many others have been faced with these difficult choices, and I would be forever grateful for any experiences, perspectives or opinions that you all are willing to share. We have already discussed home euthanasia for our girl when the time comes, but we want to be sure that we are doing the "right" things until then.

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#2 ·
I'm so sorry to hear that you are going through this awful disease with Honey Bee.:cry:
This is my opinion, and I have been through it a few times with my own dogs, and seen it happen with rescue dogs that I fostered and later adopted out. I would just enjoy her, love her, and spoil the crap out of her and keep her comfortable. Don't put her through any treatments or amputation. Once cancer is in the bone and it's seen on x-ray...the cells have already spread to somewhere else and often shows up in the lungs and organs soon after.

I often would get phone calls from adopters to tell me that their beloved dog had developed bone cancer. They wanted to know what to do...just like you. Vets were pushing amputation ($2000. -3000. ) for the surgery...weeks of recovery and the dog dead 6-12 weeks later because the cancer had shown up somewhere else. Poor dog was recovering from a major surgery for the last days of it's life. It does not buy anymore time...sadly.

My own dog China has almost the same story as your Bee. About 8-9 years of age. Started limping, given pain meds and Metacam...hoping it was just a pulled muscle. Got worse instead of better. x-ray done...and that swiss cheese look on her femur that is common with bone cancer. Blood work done...blood is perfect. I opted to keep her happy and comfortable. One day woke up with her leg swollen...and she did not want to eat. That was the day we euthanized her. This dog had never missed a meal in her life.
Bone cancer is painful. Make sure you see the signs that she is in discomfort and take action. Better for her to go a day early, than a day too late.:( My biggest fear was that China's leg would snap at night...and then what would we do??

I will be thinking of your Honey Bee and you.
 
#4 ·
Sometimes there is no true right or wrong in these situations, but i agree with BBD.
Amputation or similar to give you another few months wouldn't sit right with me but i also wouldn't blame anyone for making that choice. Whatever you decide as long as it's the dog's best interest and not your own that take priority, you will be on the right track imho. Lots of love and know that you gave her a great home for whatever time you are lucky enough to have. x
 
#6 ·
Thank you, all. We have decided that amputation is not the right choice. While the oncologist was pushing amputation, our regular vet (who we love and trust) had reservations about it, and we feel the same way. Our sweet girl is not a spring chicken and she has a hard enough time recovering from short vet trips and procedures - putting her through a major surgery at this point doesn't seem right, especially when we know it will not give us significantly more time. We have agreed to a radiation phone consult but we are not leaning that direction either. The specialty vets make it very hard to choose palliative care. We got several guilt-laden comments from the oncologist's office about our choice not to amputate .. how it will cause Honey Bee more ongoing pain, amputation and chemo are the accepted standard of care, etc., etc. But at the end of the day, I feel that we (and our regular vet) know our dog best, and the advice on this forum has helped to reaffirm our decision.

We are going to try a series of high-dose Vitamin C IV infusions. We consulted with a holistic vet who suggested it, and our traditional vet feels that the science behind it is strong and the risk is low. It seems like a non/minimally-invasive and almost risk-free way to potentially extend her quality of life. If we find that it makes any significant difference in her comfort or survival time, I will certainly report back to this forum.

Honey Bee is pretty comfortable at the moment with carprofen and gabapentin - and we are going to give CBD oil a try too. She's still excited for every meal and walk, and she still gets ecstatic about car trips, so we are trying to focus on treasuring every day that we have. Her limp is pretty significant, but fortunately she isn't showing any other signs of pain at this point (no panting, restlessness, yelping, etc.).

Thank you all, again, for your kind words and sage advice. And my heart goes out to you for your losses.
 
#8 ·
I agree!! I'm so sorry that you and your Honey Bee are going through this. For some reason specialty vets seem to really push throwing all sorts of treatments....just because they are available. It's not their bank accounts that are getting emptied ....nor do they have to live with the poor dog that has to go through the treatments. Survival rate is very low for this kind of cancer. :( If she was a 2-3 year old dog, and you had money to burn...it may be an option. You have to be an advocate for your dog...and I think you have made a very good choice. Let us know how the vitamin c infusions work. At least with them , they will do no harm...and fingers crossed may help to keep her around a bit longer and comfortable.
 
#9 ·
My first Rottie developed osteosarcoma when she was 10. I had the same reaction as you, seeking second (and third) opinions. I finally the decision to provide palliative care for her. She lived a few months more, and for the most part, the pain seemed manageable and she knew she was loved. I agree that at Bee's age, palliative care is best. It's a hard decision to make, especially with the medical providers throwing so many choices at you.
 
#11 ·
Thank you for thinking of us! I've been so preoccupied with caring for Honey Bee that I forgot to respond when I first saw your comment. Bee is doing well, considering her diagnosis. Her limp is still significant but has not gotten worse, and there is still no visible swelling on her leg. She's still on gabapentin and carprofen 2X daily, and we have also added Pepcid (the carprofen seemed to give her heartburn) and CBD oil. We went ahead with the series of high dose Vitamin C IV infusion as well.. our regular vet was kind enough to review the protocol from the holistic vet and give the infusions in our regular office so we did not have to travel far. The infusion did not improve her limp, but for whatever reason, we noticed a big improvement in Bee's energy level and spirits starting about 1 week after her last infusion. We are now 3 weeks out and the improved energy levels and mood seem to be sticking. Our best guess is that the infusion knocked back some micro-metastasis that were wearing her down.
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