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Feb 28, 2012 08:52AM
Michelle, first of all, I am so very sorry to hear about your baby. As a veterinarian I can tell you that it is so hard to tell a client that their beloved pet has cancer, especially bone cancer (osteosarcoma), because of the fact that it is such a painful type of cancer and traditionally there hasn't been much one could do other than amputate the affected leg, which usually only buys them a little bit of time.
Right now it seems like from your post that your baby is comfortable with the morphine. If needed, there are additional medications that can help such as Fentanyl patches, oral tramadol, injectable hydromorphone and buprenorphine and even an NSAID such as Rimadyl or Previcox. Since she seems comfortable, don't feel pressured to make an immediate decision. I think you need to take some time to absorb the information, do some further research and even consider a 2nd or 3rd opinion. I know that traditionally the only treatment for bone cancer (osteosarcoma) in dogs has been amputation +/- radiation or chemotherapy. However, I do know that there has been a lot of work being done at several vet schools in the US with other treatments. I just don't know at this time if anything has changed, success rates, etc. So, I think basically your only decisions at this time would be 1) do nothing and concentrate on pain control, 2) amputate to buy some time or 3) euthanasia. I would probably lean towards 1 or 2 right now as I think a lot of these guys can be managed quite well with the proper pain control. If you would consider amputation, I can tell you that given the right candidate (a dog that is in otherwise good health with strong hindlimbs i.e. no evidence of severe hip dysplasia, knee problems, etc) these dogs do very very well with proper pain management post operatively. I usually keep these guys on constant rate IV infusions of Fentanyl, morphine or hydromorphone along with ketamine and lidocaine and then I transition them over to a Fentanyl patch and/or oral morphine or SQ injections of buprenorphine or hydromorphine and then to an NSAID and oral tramadol. If you do decide on amputation I would definitely recommend a workup prior to check for metastasis as it is very common that these tumors metastasize early. As to time, it is very difficult to say. It can range anywhere from months to a year perhaps or more possibly.
If you decide not to amputate and do nothing I think that is okay too. You are the best judge of your dog's health and ability to function with the amputation. Again, you want to make sure that your vet goes with very aggressive pain management such as Fentanyl patches, oral morphine or both along with possibly an NSAID as needed. Then you need to closely monitor for any changes in behavior, appetite, ability to ambulate, go to the bathroom, etc. as these are all indicators of progression and pain. If your vet isn't familiar with aggressive pain management or isn't willing to go there then I would definitely consider a 2nd opinion or 3rd opinion with someone who is. I'm not famliar with what is available in your neck of the woods but there should be something that can be done. There are even hospice vets now that travel to your home to help with pain control so that the pet remains comfortable and then can even provide euthanasia in the home environment which is often easier on the pet and the family. So, you may want to research this too.
If at any time you decide to euthanize that is okay too. Only you know what constitutes quality of life for your baby which is why it can be so hard for a vet to recommend it. Just don't feel pressured to do it right away. Take your time to think about it and to come to peace with it. It is never an easy decision but you will know when it is the right decision. For me as a veterinarian, sometimes the decision for euthanasia is clear cut (the patient is definitely suffering) but in most cases it is not so clear cut which is why I try to help "guide" my clients in making the right decision at the right time. I definitely think you have the time to make this decision. So, don't feel pressured in any way and if you vet is pressuring you or making you feel guilty then perhaps you again need to go elsewhere. I am saying this however with the assumption that your girl is somewhat comfortable and not suffering in anyway.
I will be keeping you in my thoughts and prayers. Again, I am so sorry you are having to deal with this. Even as a veterinarian I suffer terribly when I am having to face this decision with one of my pets as well as with my clients. Please let me know if there is anything I can do. You are welcome to PM me at anytime.
I hope you don't mind that I put this all out there publically. I was thinking that perhaps there may be someone else that may be helped or benefit from this discussion.
Hugs to you and your girl,
Original Diagnosis: 3/08/2005 Stage IIb IDC, ER+, PR-, HER2-, 3/11 nodes positive; Recurrence 10/22/2009 extensive bone mets; 11/20/2010 diffuse liver mets; 1/2013: grade 4 liver cirrhosis, portal hypertension and esophageal varicies
4/5/2005 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel)
10/4/2005 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left
10/22/2009, IDC, 3cm, Stage IV, Grade 2, 3/11 nodes, mets, ER+/PR-, HER2-
1/15/2010 Femara (letrozole)
3/1/2010 Aromasin (exemestane)
5/15/2010 Avastin (bevacizumab)
5/20/2010 Taxol (paclitaxel)
3/22/2011 Abraxane (albumin-bound or nab-paclitaxel)
7/1/2012 Xeloda (capecitabine)
2/13/2013 Halaven (eribulin)
12/6/2013 Gemzar (gemcitabine)