More Ideas For Bone Cancer Pain: Pamidronate
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
Updated: October 5th, 2018
I have been getting questions about control of pain for bone cancer in dogs, so I thought this might be a useful post. Life quality is central in any type of cancer treatment plan, and therefore pain control is critical.
Osteosarcoma is the number one cancer affecting bone in dogs. It usually affects large or giant breed dogs.
Rottweilers, Irish Wolfhounds, Greyhounds, Golden Retrievers, Mastiffs and more are examples of some breeds with genetic tendencies making them at higher risk for osteosarcoma.
There is an association between spaying and neutering dogs early in life and osteosarcoma development, in particular in Rotts. Other breeds have shown this correlation as well.
One of the difficulties with this type of tumor is the pain it produces. It often first shows up as limping, since the most common site for osteosarcoma occurring is the long bones of the limbs.
Many times dog lovers will see a limp, only to be shocked later upon receiving the diagnosis following X-rays or bone biopsy.
This pain can be difficult to control. Common drugs used would be metacam, previcox or deramaxx. These are all anti-inflammatory drugs than control moderate pain and inflammation.
Usually these are combined with narcotic-type drugs like Tramadol, codeine or long-acting morphine.
Other choices used in combination with these drugs are gabapentin, amitriptyline, or amantadine. These drugs are newer neurotransmitter modifiers.
A patch containing the narcotic Fentanyl can be applied every couple of days to the skin. It is delivered to the blood through the skin (transdermally).
If your vet is not talking to you about options like these, please be bold and start asking about them. Be your dog’s primary health advocate!
Another option which is not given much attention at many veterinary clinics is called pamidronate (Aredia). This usually is a second or third line drug but I think you should know about it.
Pamindronate was looked into in some detail by Dr. Tim Fan, who I remember back at Cornell when he was an intern years ago.
This drug is used to slow bone breakdown, which is another advantage with bone cancer. It was shown to help roughly one in four dogs with bone pain due to osteosarcoma.
Down sides include the proportion of dogs that do not respond (about three out of four), and the fact that it needs to be given as an IV injection in the vet’s office. The oral form (pills) are not well absorbed in dogs.
Kidney markers should be checked with the use of pamidronate. One in 33 dogs had kidney marker increase with its use.
The dogs that do better on it get repeat injections every 28 days.
In spite of the drawbacks of pamidronate, this is another option for dogs experiencing bone pain that should be considered, especially those dogs whose pain is not being relieved with other therapies.
Keep pamidronate in mind and remind your vet if your options are shrinking. For more details about osteosarcoma, see The Dog Cancer Survival Guide.
All my best,
Dr D
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
Should my german shepherd who was diagnosised with bone cancer and is taking Apocaps continue to take his once a month heartworm (Interceptor) medication?
Do you have current information on the Metronomic Protocol? What about the “Navy Protocol”?
I have a 10 year old golden retriever (Tag) who has Osteosarcoma; doing well (stable) 6 months post diagnosis. He is just taking medication.
Thanks, Tag 🙂
Dear Tag,
here is a blog post on the topic, hope it helps!
D
My nine year old German Shepherd, Trooper, was diagnosed with bone cancer on July 5, 2010. My vet put him on 10 mg/day of Piroxicam for pain and 20 mg/day of Famotidine to prevent stomach upset. We were told he only has approximately 3-6 mos. of life left. I was devastated and felt like I couldn’t just sit back and watch the cancer slowly take him without giving it a fight. That is when I came across Acocaps. I immediately ordered a bottle and started him on them, giving three capsules, three times a day according to the directions. I have switched his diet to a high animal protein diet with 75% of his food being the high animal protein, the other 25% is Science Diet’s Nature’s Best dry food. I have also added sardines and wild Alaskan salmon oil to his diet. I have continued to give the pain med and stomach med..not really sure if I should be doing that, but he seems to be tolerating it well with the Apocaps. My question is…He was due for his monthly heartworm medication (Interceptor) yesterday. Should I give that to him? Our vet did not give his annual parvo/dhlp vaccine when we were told he had the bone cancer and I understand if she thought it would be pointless if he only has 3-6 mos., but if with the help of Apocaps, he is given more time…should he take the Interceptor monthly and should I ask the vet to give him his vaccines? Our vet has not heard of Apocaps so was unable to advise me. Also, thank you, thank you, thank you for giving me some hope in knowing that Trooper (and I) will not go down without giving this cancer thing a real fight!
URGENT HELP NEEDED. My dog Autumn on Feb 20 diagonsed with Osteosarcoma on her rib. Did not do surgery due to diagonosis of only 4-6 monthes with surgery & chemo. She is on Proxicam and doing great. Carafate, probiotics, arthemisisin, krill fish oil and
k-9 immunity. Tried Tramadol again, she is limping bad again. She gets diaharhia, low body temperature and panting. Please any suggestions on a pain medicine that works with the Proxicam well. Gaberpentin does not work for her either. When first diagonosed they gave her a steriod and an Roboxin and they do not work. Thank you, Melissa
My 9 year old Red Bone Coon Hound has osteosarcoma in his jaw and my vet has told me that there is no treatment for him. I want to keep him pain-free for as long as I can. Right now he is on Tramadol. How will I be able to tell when he need something stronger. What are the signs that a dog is having a lot of Pain. Casey is loved like a son and I want him to have tthe best quality of life that I can give him. I love him as much as if I had given birth to him. Thanking yo in advance for your help. Jill
Dear Jill,
This is a great question and I will write a blog post just for you. Have you read the guide and looked into Apocaps?
Typically jaw pain can be seen with difficulty eating or mouthing toys. Overall life quality should be assessed too:
https://www.dogcancerblog.com/blog/pain-in-dog-cancer-and-life-quality-part-2/
Other drugs for pain include the anti inflammatories, gabapentin, amantadine, and more. Acupuncture can help. Touch base with your vet on these.
Best,
Dr D
My dog was diagnosed in early January with osteosarcoma in her front limb. Currently she is on Metacam and Gabapentin an assortment of supplements and a strict diet.
Her leg has begun to swell to a heart breaking size. Soaking helps a bit…. Do you have any suggestions to help reduce swelling? Tracey
Dear Tracey,
have you looked into Apocaps? I cannot make a medical claim here, but I can suggest you inform yourself and your vet.
I assume surgery to help your dog’s life quality is not an option? The problem is not swelling, but is the cancer itself. What about Samarium (quadramet)? Palliative radiation?
These would be my first thoughts.
All my best,
Dr D
What are your thoughts on the use of Zoledronate for bone cancer pain management? We tried Pamidronate but it did not seem to have any effect. As of right now, my dog is getting by on Tramadol, Metacam, and Gabapentin. However, our oncologist suggested he might respond better to Zoledronate.
Though my dog limps and tries to avoid putting his full weight on his hind leg, he still enjoys a good quality of life (though we have limited his exercise to short walks only). I am debating whether or not to go through with the Zoledronate treatment for the following reason… Though most of the literature I have read on it suggests the drug can decrease bone invasion (in effect controlling the tumor), I came across one study (performed on mice) that found that even though the drug managed to strengthen bone, it actually increased metastases to the lungs in certain models.
We tried a course of palliative radiation therapy which seemed to do more harm than good. Despite the high success rate associated with this type of therapy for pain relief, my dog could barely stand and was tripping all over the place after the treatment. Seeing as how he is managing fairly well at the moment, I fear giving him a treatment that does not have a lot of research to back up its efficacy (like Zoledronate) might make matters worse- particularly if it speeds up metastases. On the other hand, I don’t want to withhold something that might help him and it seems like it would be good to target the bone invasion earlier rather than later.
Any advice would be much appreciated. Thank you so much.
Dear Denise,
The realm of what an oncologist deals with daily includes Zoledronate. The best choice for you, quite honestly, is to have a frank discussion about this treatment, including your fears, with your oncologist, who is familiar with your dog and is managing the case. You could also bring up Amantadine as another possibility.
Best,
Dr D
Thanks so much Dr. Dressler. I will look forward to the Apocaps becoming available. You have been very instrumental in our treatment of Oly, and he’s doing remarkably well. We love him so much, we really cannot thank you enough.
Hi Dr. Dressler,
Our sweet young Mastiff mix, Oly, was diagnosed with osteosarcoma of the ribs last September. We had surgery and just finished our 6th Carboplatin treatment. I have been giving Oly Lutimax for a couple of months now with our oncologist’s permission, 10 days on and 10 days off as advised in the Dog Cancer Survival Guide (and alternating with Artemisinin). This morning I noticed that Lutimax contains Xylitol, which I have read is poisonous to dogs. I am somewhat panicked. Did you know that Lutimax contained Xylitol? Have I been poisoning Oly?
Dear Lynne
This question comes up from time to time. Many things are toxic to dogs in large amounts but not in small amounts. An common example is sodium chloride (table salt). Xylitol is another one of them. If you would like a Xylitol-free preparation, the folks at SynoRx can help. Apocaps is another source of Xylitol-free luteolin that will be arriving soon…
Best,
Dr D
The subject of the email that led me to this article was “Do preservatives in dog food cause cancer?”.
I currently have my Welsh Pembrooke Corgi on Tramadol after being on Deramax but was told not to give them together. How do I know when the pain in not being controlled? Is panting (But not constant)and restlessness a sign of pain? I have a strap that I use to get him around with but other than that he stays on his memory foam mattress but rolls from side to side frequently. His appetite is still good and he has lost some weight (but he needed to anyway) but not a lot. He is 11 yrs old and very much loved and I want him to be comfortable but dread the thought of putting him to sleep permanently. He was diagnosed on April 23 of this year. Thanks so very much for your help through all of this. Sue