Thanks for your question regarding your 12 year old Norwegian Elkhound boy Victor who has cancer in his right shoulder. These bone tumors can really be quite painful which likely explains Victor's limp, however as the tumor grows it can also become a functional issue in that the size of the tumor alters the gait of the dog as well. Both may be the case here for Victor, but the main concern at his age is to keep him as comfortable as possible.
Victor is currently on a good combination of Tramadol and an anti inflammatory. This is typically the combination that I would reach for and tends to be the most well tolerated for these dogs. The tramadol has a wide dose range, so if Victor is still limping quite badly despite his current drugs, your Vet may potentially be able to increase his dose a little more. The typical dose range for Tramadol is 2.5 - 5mg per kg. The anti inflammatory dose likely can't be adjusted any further, but your Vet could also check that. As for a cortisone shot - this is unlikely to help as it isn't really inflammation within the joint that is the issue, but rather bone pain due to the growth of the tumor. Your Vet could consider something like a fentanyl patch for your boy in the late stages of this problem.
As I am sure you are well aware, the main goal with Victor is to keep him as happy and comfortable as possible until a time where his quality of life is affected such that it is best to have him put down. Hopefully that is some time away, and you will likely know when this time is when you get there. You may also be aware that as the tumor grows within the bone, the strength of the bone weakens and sometimes we can see a 'pathological' fracture of these bones. If this were to happen to Victor, the fairest thing to do at that point is to put him down.
All the best with your boy and keep up the good work in keeping him as comfortable as possible. Do follow up on this with your Vet to see if an increase in tramadol, or a fentanyl patch could be an option in Victor's case.
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Dr M D Edwards
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