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Does anyone have any experience with lameness as a side-effect of palladia?

My dog Zeke (~13 years old, 70-pound, mixed-breed) was diagnosed with thyroid cancer back in December and had one thyroid gland removed in January. He's been on 80mg of palladia three times/week since then. I know that one of the possible side-effects of the drug is lameness, but I haven't found much info about it, as in how it manifests.

For roughly the past two months, Zeke has off-and-on favored his right rear leg. It started while we were out for a walk. Part way into the walk, I noticed he was slightly limping so we turned around and headed back to the house. In the 15 minutes it took to get back home, he went from 'slightly limping' to 'not using at all'; he held that leg/foot completely off the ground and wouldn't put any weight on it. The next day, he'd put it down and walk a couple steps on it before holding it up again. By the third day, he was mostly back to normal, though his gait looked a little different.

And that seems to be the cycle. He'll be fine for a few days and then, out of the blue, he'll refuse to put that foot on the ground to bear any weight. 2-3 days later, he's mostly normal again. I called the vet hospital that's treating him for the cancer and they didn't think it sounded like palladia lameness. I had Zeke to my regular vet for blood/urine work last month and told her about the problem. Zeke wasn't favoring the leg at that time but my vet poked, prodded, and manipulated the leg all over and got no reaction from Zeke. He's gone through the cycle twice since then and started it again yesterday evening. I've got another appointment with my regular vet next Monday to see if she can find something this time.

So, my main question in this long message is: Has anyone experienced lameness in a dog while on palladia? If so, how did it manifest? How quickly and how severe?

Thanks!

Dave & Zeke
 

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Hello Dave,
I'm a new member of dog forums. I saw your post regarding Zeke's lameness due to Palladia. I don't have an answer to your question, rather I was going to ask some of my own. My dog Raven was recently diagnosed with thyroid cancer. Our vet is recommending Palladia. I was wondering, aside from the lameness, how Zeke was responding to the drug. Has your vet said anything regarding how long they plan on keeping Zeke on the drug? My vet left me a little confused because she started by saying that Palladia would just stop the growth of the cancer, but I was left with the impression that the hopes are it will kill the cancer. It being such a new drug it's hard to find any real information on the internet. I'm having a hard time deciding between conventional chemo and the Palladia. If you wouldn't mind sharing some of your experiences with it, I would really like to hear from someone that has had experience with the drug.
Hope to hear from you,
Sheryl
 

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Hi Sheryl,

Sorry to hear about Raven's diagnosis! I never did find a definitive reason for Zeke's lameness. It finally stopped and hasn't come back and he's still on Palladia, so maybe it wasn't drug-related.

The oncologist told me that Zeke would be on the Palladia for the rest of his life provided he keeps tolerating it with no severe side-effects and it keeps working. It evidently doesn't work all the time. I was told that Palladia will not destroy the cancer. It works by *trying* to keep new blood vessels from forming. In order to grow, a tumor creates blood vessels to feed itself. So Palladia keeps the tumor from being able to grow.

The main side-effects Zeke has experienced are soft/runny stools (that issue comes and goes and has been minor) and 'inappetence' (ie, loss of appetite). He goes through periods where he just won't eat. He weighed almost 70 pounds when he was diagnosed and he stays between 55 and 60 now. He was a bit heavy at 70 but 55 is a bit light. They had me start him on over-the-counter omeprazole (generic Prevacid) to help with the appetite and when that doesn't help, we skip the Palladia for a week (he takes it every monday/wednesday/friday). I frequently change foods to keep him interested, too. All-in-all, I'm happy we went with the Palladia instead of the traditional chemo treatment.

Having said that, at his last check-up last month they said it looks like one of his lymph nodes might be enlarged. We go back for a re-check in a two weeks. *fingers crossed*

Good luck to you and Raven! If you have any other questions, feel free to ask!

Dave 'n Zeke
 

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This is heart-breaking. Dave's dog is 13 + years old...Sheryl didn't say how old her dog was. Thyroid cancer can be a broad term in humans...probably not so much in dogs. Same as lymphoma, same as mast cell....After almost 30 years in dogs...I had to deal with this. In my case it was a rare form of lymphoma. Once diagnosed...my vet immediately wanted to refer me to an oncologist....immediately wanted my best friend to get on cancer poison/meds. I asked the tough questions....meaning asking about a CURE. After a lot of hmming/hawing...the best they could come up with was "remission" but my vet was not forthcoming about THAT. So....I had to do my own research.

Obviously life expectancy in humans is very different than dogs. Humans live on average in the 70 year range, dogs in the 12-13 year range, ON AVERAGE. This tracks with my research on "remission" regarding cancers....in humans....5-10 year remission rate might be worth horrific treatments. In dogs....relatively....it is 3-9 months remission. So the important question to ask....for our beloved dogs...in order to eke out a few more months of life...what sort of pain/discomfort are we willing to make them endure when they already have a death sentence?

I feel greatly for Dave, because his 13 year old dog is obviously suffering...the dog is wasting due to cancer....he has lost appetite....he has lameness issues that the VETS won't attribute to the meds (most likely because they get some sort of subsidy from the drug company)...they are putting band-aids on sypmtoms such as prevacid in order to induce appetite....this wonderful dogs is THIRTEEN YEARS OLD. He won't be cured.

My dog had lymphoma...and she was MUCH younger. I cried rivers over the unfairness of it all...I cried rivers because I was NOT ready to let this wonderful dog go....but I also knew, in my pain, that this WASN'T about my wanting to avoid the pain of losing her, it was about giving this dog the respect of not allowing her to suffer. Even at the end stage of her cancer...when edema made her limbs swell up 3 times normal size....and I called the vet to let them know I was coming in to finally release her...they wanted to put her on YET ANOTHER DRUG that would reduce the edema...IT WASN'T A CURE. Crap was going on in this beautiful dog's body...I knew she felt awful....the vet wanted me to reduce the visible "offender" for WHAT? So I could feel better that I "tried" everything????

We owe it to our dogs to admit reality and not be selfish because we don't want to face our own pain. Let's be real....you WILL have to go through the grief...the big question is, how much pain are you willing to put upon your dog for the luxury of delaying that ultimate grief? The Palladia hype is a joke. Please, research it for yourselves...
 

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Whoa there, you read more into my reply than it actually says and threw in a whole lot of extra emotion. At no point did I say Zeke was "wasting" and he's not "suffering". Far from it! Yes, he's down to 55-60 pounds from a high around 70 (72 was his heaviest, I think). But I also said he was heavy at 70. A good weight for him is right around 60 so at 55, he's a little light but not by much. And his weight ranges from 55 *to* 60, so he's actually at a healthier weight than before his diagnosis. And he has plenty of energy for his age, too. He still gets excited to go for walks though they take longer now, but that's from age. He still tries to catch the rabbits that foolishly come through the fence (he's occasionally successful). In short, his quality of life is still extremely good.

Also as I said, I'm happy we went with the Palladia. It seems to have worked well so far. With ANY cancer treatment there is no guarantee of success. The way Palladia was explained to me at the time of Zeke's diagnosis, it was still fairly new but showed promise for certain types of tumors/cancers. I researched it online and if I remember correctly, it showed success in 30-40% of the cases. So no, it's not a cure-all or wonder drug by any means, and it was never billed that way to me. And it's also not "a joke"; it DOES work for some. It's merely another tool that's available. I don't believe there is a "cure" for cancer most of the time except for certain types that are caught very early. So remission is the best you can get. And you know, I'll take that! It sure beats the alternative. You have to be realistic in your expectations.

We go back in another week or so to check that lymph node to see if it is indeed growing. They wanted to remove that lymph node when they removed the thyroid gland that was affected because they said it was also likely affected even though it wasn't showing anything at the time. They said that they'd try to get to that lymph node through the same incision in his neck that they'd make to remove the thyroid but they might not be able to get to it without cracking is rib-cage open. He was leery about doing that though due to Zeke's age. So he explained the pro's and con's and left it up to me, which I think is how it should be. I decided that if they could get the lymph node without opening his rib-cage, to do it. But NOT to open his rib-cage. They couldn't get to it through his neck incision. So if that node is now enlarged and the only option is to open his rib-cage, I will likely not do it. I'll keep him comfy and spoil him rotten until the time comes when 'quality of life' just isn't there any more.

Each person has to make treatment decisions for themselves. What may sound "worth it" to one person in one situation may not sound the same to another. And I agree people should research diagnoses and treatments themselves.

Dave 'n Zeke
 

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Hi Dave,
Thank you for responding to my post. I'm sorry to hear about Zeke's lymphnode. I hope it's not the cancer raising it's ugly head again. If so, it doesn't seem like the Palladia bought him much time. I know you must care for him deeply to do this for him. I can definitely relate. Cancer is ugly, luckily they are making great progress and I'm sure in the future we will look back on these days, and wish we knew now what we will know then. In the mean time we just have to push on and try to do the best we can for them, right? Maintaining a good quality of life is definitely the goal. There are going to be good days as well as bad, I think few leave this world without some suffering. I think we are lucky that we can put an end to the pain when the time comes, though deciding when that time is can be tough. If you're lucky they let you know. But enough of that...

Raven is an 11 year old Basenji. Most of my Basenjis live to be around 15 or 16, so as far as I'm concerned it's far to soon to give Rave up without a fight. He looks and feels happy and healthy. Doesn't have a clue anything is wrong with him, and was quite unhappy when I took him to the vet and he came home looking like Frankenpup. I found the lump when I took off his collar to rub his neck. I knew what it was, got sick to my stomach. I had another really special dog that had cancer, it was 2 years in Hell. I know what I'm going up against and I'm trying not to feel defeated before I even really get started. I was feeling fairly lucky in that the surgeon said the tumor came out really cleanly. One lobe of his thyroid was removed and it wasn't attached to anything else, encapsulated. The biopsy to my regular vet and I seemed somewhat inconclusive as to whether all the cancer had been removed. I'm going to look into finding out if it is worth running a more thorough test on the tumor. The oncologist has a different view of the results and says that we didn't get it all. I'm not sure I know where that is coming from so I'm frustrated. Hopefully I can get a clearer picture tomorrow.

The oncologist gave me three different options. Chemo with adriamycin and cytoxan, Palladia, and a cytoxan and piroxicam combination. I'm kind of wondering why she didn't suggest radiation if she's just worried about it returning locally. She said metastasis wasn't likely. She is really trying to push the Palladia, only she is saying she would hope it would cause remission and that Raven would hopefully have to be on it for only 6 to 12 months. I'm not understanding that. I not seeing any evidence that Palladia does that, rather as you said, it stops the cancer from forming it's own blood supply. For a time anyway, and then often stops working. If we didn't get all the cancer out, isn't it likely that cancer that is left already has it's own blood supply?

I'm sorry, this is what my brain has been doing all weekend and I can't get any sleep. Hopefully I will have more answers tomorrow. This is a hard one, I've read that some dogs live 1 to 3 years longer just by having the tumor removed. Some die after several months, even with chemo. I'd hate to put Rave through chemo just to have that happen to him. It feels like it's all just a flip of a coin. No matter what you do, it could go either way. My regular vet says it wouldn't be unreasonable to just not treat him and do regular chest xrays and lymphnode aspirates, etc. to keep an eye out for the cancers return or spread. If it shows up again, then decide what to do. We'll see. I'll give an update. Please let me know how things are going with Zeke. My dogs (Raven, Remi and Scarab) and I are going to be sending him all of our positive vibes.

Sheryl

Sheryl
 

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Hi Dave,
I just thought I'd check back and see how it went with Zeke's lymphnode. I hope everything was OK. I went and saw an oncologist that has a special interest in thyroid cancers. He was really clear and informative and I liked the way he felt about approaching Raven's cancer. Summing it up, he said that chemo was at best going to have a 30% success rate. The risks involved weren't worth it. Most information on it is anecdotal. He said studies show that thyroid cancer is very responsive to radiation and with treatment the average life expectancy is 2 yrs. It all depends on the size and spread etc. of the tumor, plus the treatment plan. There is a lot more to it of course. But he said in Raven's case, since the tumor was relatively small and we are only worrying about microscopic cells, that we could stand a pretty good chance of extending his life at least 2 years if I do the one treatment a week for 4 weeks. He thinks, but makes no promises, that with the 16 treatments in 3 weeks we stand a good chance of killing off what remains of the tumor. Again, no promises, it's cancer. Anything could happen. There are no studies of surgically removing the tumor and then treating with radiation. He also said we could do it now, or if I want to wait and see what happens, we can treat later. He doesn't think that would be an unreasonable course of action. But later the tumor may be more involved and I think he said more aggressive.

He is putting Raven on Piroxicam. He said he would do this for any dog in this situation, regardless of which course of action we take. I understand this is an anti-inflammatory with anti-angiogenic properties.

My oncologist said there was no reason to believe that Palladia would have any effect on this cancer. Studies were done that showed that thyroid cancer had a reaction to Palladia but that is pretty much it. He felt that it was a bad idea to recommend someone put their dog on an expensive drug like this for an open ended period of time, with no way of telling if it was even doing anything at all. I'm not saying your doctor is wrong, I'm just giving you another opinion so you can figure out your options. From what I've read and what my other vets have told me, it was the feeling I was also left with.

Radiation is going to be the way I'm going to go. As he explained it to me, any problems that Rave has from radiation will fix itself in a couple of weeks, chemo could kill him. I'm not willing to risk the last healthy days he has left. I had another dog with bladder cancer. Putting him through chemo caused complications that led him to become a diabetic.

I hope this info helps someone now or in the future. It's frustrating trying to get answers. I will try to keep updating.

Sheryl
 
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