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Unsure we're making the right choice with Amputation
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Forum Posts: 11
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9 February 2017 - 2:10 pm
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Hi Tripawds!

Firstly, we can't thank you all enough for this incredible resource. I'd love to fill you in a little on our pup and would greatly appreciate any feedback. I apologize for the length of this post, I just felt the actual remarks would be helpful. We're hoping someone has been through this as well and had insight. We also know there's a wealth of knowledge on this site. We're scared for our pup and the super challenging road ahead.

Our little man, Holden, a 2.5 year-old Aussie Mix rescue, collided with a dog at the dog park at the beginning of December. He immediately sat, looking a little dazed, and did not want to put his left paw down. We kept an eye on him, and it resolved itself over the course of two weeks. He had a minor limp, but was otherwise his normal, bubbly self. Mel and I both travelled home for Christmas and boarded Holden at his favorite play place. When I picked him up, I noticed the limp was back, and there was swelling. We gave him three days, and then when I took him to the vet for some vaccines, the vet offered to X-ray. The X-ray showed some cloudiness in his leg at the bone and she referred us to a surgeon in the area for a closer look.

Our surgeon's initial thought was that we were dealing with osteosarcoma. It's in the number one place this presents, and since Holden is still young, he felt he was in the young age range for when this disease presents.

That's when we started on a very long journey for answers. Chest X-ray (early January) was negative for masses. We also did an aspirate. This came back inconclusive, but was positive for "active cells" and negative for infection. So, we went back again and did a bone biopsy. This biopsy was very, very confusing. Here's the summary from the pathologist:

The intimate intermingling of the spindle cells and collagenous stroma with irregular lakes of osteoid is suggestive of a

fibroblastic variant of osteosarcoma and given the location and the radiographic findings this is the favored differential diagnosis.

However, these kinds of changes can also occur at fracture sites and secondary to inflammation and trauma. Other differential

diagnoses such as fibrous dysplasia and ossifying fibroma cannot be entirely ruled-out but are less likely.

Immunohistochemistry for an osteoblasts marker (osteocalcin) may be useful although this marker is associated with relatively

low sensitivity (70%) and therefore false negative results are common. If a cellular aspirate is available, ALP staining could also

be considered. This test can be useful for identifying osteoblasts if atypical cells are present on cytology.

We've also done a stain that came back inconclusive, and we also had the bone sample sent to the leading pathologist on osteosarcoma in the country. Everyone seems to think this certainly LOOKS like osteosarcoma, but no one really wants to definitively say it.

We met with an oncologist yesterday to discuss our options. He was willing to offer palliative radiation to the area. He works very closely with our surgical vet at the same clinic, and they discussed. We originally were going to do a biopsy again on Friday, but now are thinking we should amputate and send the entire limb to the leading specialist so that she might take samples as she pleased to try and get a definitive answer. We also re-Xrayed yesterday and the degeneration has very mildly advanced, but stayed in the same place, which our vet believes is also indicative of osteosarcoma.

We are willing to amputate because he IS in pain and has a consistent limp. We also want to start getting some definitive answers. Our vet said young pups average 9 months to a year after diagnosis. We don't want to lose out on time.

However, we feel as if we might be taking a drastic measure with not enough information. Our write up from yesterday says:

Diagnostics & Treatments:

Two-view left carpal radiographs:

Image Findings:

Compared to rdvm films dated 1/7/2017:

There is moth eaten lysis and stippling of distal metaphysis of the radius with an ill-defined zone of transition. There is mild

cortical expansion and there is thinning of the cranial cortex at this level. Minimal ill-defined new bone formation is noted

along the cranial cortex. These findings are relative unchanged from the prior study. The remaining skeletal structures are

unremarkable.

Diagnostic Interpretation:

Left distal radius aggressive lesion. The primary differential is a primary bone tumor. Fungal osteomyelitis cannot be

completely excluded. A benign lesion (e.g. bone cyst or osteoblastoma) cannot be completely excluded given the slow rate of

change. Bone biopsy is recommended. Thoracic radiographs are recommended.

Visit Summary:

The lack of a definitive diagnosis coupled with the somewhat atypical presentation of the lytic bony lesion makes

Holden's case challenging. Radiation therapy typically plays a role in the palliation or alleviation of pain/discomfort in

bony neoplastic processes when aggressive surgical intervention is not possible or declined by the owners. While

Holden is uncomfortable from his mass at this time, his young age and possible detrimental short and long term side

effects from radiation therapy (particularly if the lesion turns out to not represent osteosarcoma), as well as the

possibility of Holden being a good, reasonable candidate for amputation (and chemotherapy if needed) leads us to

not recommend radiation therapy as the treatment of his condition at this time.

We discussed additional sampling of the mass with resubmission of biopsy to attempt to gain a diagnosis. While a

somewhat drastic procedure, a limb amputation would potentially gain the best chance of diagnosis (by submitting

the entirety of the lesion) as well as likely be well tolerated by Holden considering his lack of additional comorbidity.

The possibility of a non-diagnostic biopsy, even despite an amputation, was discussed. We would also recommend

obtaining an additional cytologic sample of the lesion even is amputation is pursued to hold for potential future ALKP

ICC in the future. If amputation is elected, we strongly recommend repeating thoracic radiographs for restaging to

ensure there is no evidence of pulmonary metastatic disease which would drastically alter Holden's prognosis.

If amputation is elected and the diagnosis confirms osteosarcoma, we recommend following surgery with adjuvant

chemotherapy to attempt to slow the metastatic progress of the tumor.

The thought of doing this and it isn't cancer is devastating. We are feeling very lost, and need to tell our vet tomorrow morning what to do.

Any and all advice is welcome. Thank you in advance!

Mel, Katie, & Holden

The Rainbow Bridge

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9 February 2017 - 3:46 pm
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Mel, Katie & Holden,

Welcome! I apologize for the brief welcome but I'm on my way out the door. I wanted to get your post approved so others can chime in. I'll be back later to share my thoughts OK? Meanwhile hang tight for feedback from this great community, and if you haven't already be sure to check out Jerry's Required Reading List, it will answer a lot of your questions.

It's better to hop on three legs than to limp on four.™
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9 February 2017 - 4:32 pm
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I am so sorry you and Holden are going through this.   I'm not a vet, but let me see if I understand - it might be osteo, in which case amputation is the best bet.   It might be some other form of cancer, in which case amputation is the best bet?   It might be fungal, in which case I think amputation is also the best bet?   It might be something benign, but if so, are there treatment options other than amputation?   To be honest with you, I don't read anything in the notes (again, not a vet) that suggests that this is nothing and that it will resolve on its own.   So, what are your choices?   Holden is in pain and is not using the leg.   There is something wrong with it.   It sounds like radiation has been ruled out, although perhaps you want to get a second opinion if that is something you think would be viable for Holden.   (Some members have declined radiation because of the number of vet visits involved and the fact that the dog is under GA for each visit).   Obviously, you know Holden best, and any decision made out of love is a right decision.   But, personally, I would get the follow-up chest x-ray and proceed with the amputation.   He is a young dog, and I would want to give him every chance I could, whether it is some form of cancer or fungal.  And please know that, while the recovery is intense for about 2 weeks, most dogs do just fine on 3 legs, and his age will be a positive for him in terms of mobility and recovery.  And most dogs go back to doing whatever they did before the amp, although perhaps walks are shorter.   My Otis was 106 pounds pre-amp and had mild arthritis.   Our walks were very short, but he could chase cats and squirrels, steal food off the counters, do the stairs, jump on the sofa - basically everything he did before.   Dogs do not sit around thinking about the missing leg, or considering themselves disabled.   They just figure out how to do whatever it is that they want to do.   Many people on this site, including me, will tell you that we do not regret the decision to amputation - it gave us additional quality time with our dog.   Once the leg is off, they hopefully will be able to come to a more definitive diagnosis, and you can make a decision about chemo.   You are in a really tough spot here, and the vet reports you have been given don't really give you much on which to make a decision.  Hopefully some others will post soon and share their perspectives.   Today is the one year anniversary of my Otis' amputation.   While he passed too soon, we had a wonderful almost 7 months together and I do not regret the amputation for even one second. 

Otis - 106 pound lab/Dane mix, lost his right front leg to osteosarcoma on Febuary 9, 2016.  Four rounds of carboplatin completed in April, 2016.  Lung mets August 25, 2016.  Said goodbye too soon on September 4, 2016.   Lost his adopted sister, Tess, suddenly on October 9, 2016. likely due to hemangiosarcoma.  

Wherever they are, they are together.

Minneapolis, MN
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9 February 2017 - 5:34 pm
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I'll be honest, I think Christine (otisandtess) was so succinct, I just don't know what to add.  This is a highly personal decision, but I think she decoded a lot of what I see in the reports the same way I do. And I am also someone who has no regrets about amputation - well, we lost our boy 3 months ago and the only regret I actually do have about amputation is that it wasn't done sooner when it likely would have improved his post amp survival timeline. 

Sending you very best wishes as you make this decision.  It is not easy and your circumstances are mysterious.  We also had red herrings - false negatives, confusion about where the pain was located (Pofi's cancer was a different one and in a tougher to diagnose location).  We amputated a toe first thinking it was where a cancer might be located and I thought we were so lucky - "at least it is not a leg".  My tune changed.  

Lisa, Minneapolis

On October 27, 2016, nearly 6 months after amputation, and 18 months since his cancer likely started, we lost Pofi to a recurrence of Soft Tissue Sarcoma in his spine quite suddenly.  His Daddy and I miss him terribly along with his canine sister, Mia, and two feline siblings, Lucia and Cliff.

Blog: Pofi, Peripheral Nerve Sheath Tumor Amputation

Norene, TN
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10 February 2017 - 10:58 am
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Howdy and welcome!

So very sorry you're dealing with this. I think the confusion of it all is so agonizing. For me, it's only after we lost our sweet Harmony that we wished we had been more diligent about her early limping. That brings me to my awe of your endless determination to not leave any stone unturned.

Sometimes our fur-babies are so stoic about pain and illness. They're not much help telling us what they want. And good-grief, trying to make sense out of lab results takes a degree of understanding in of itself.

If I had it all to do again, I'm not sure I would follow the same path we did, but the most important thing of it all is bringing quality back to your sweet Holden.

Keep us updated!

pam

Harmony became a Tripawd on 10/21/14 (MCT). She left us way too soon on 11/1/14.

"We miss you so much; our love, our heart, our Harmony."

- Pam, Ron and Melody, Meesha and DoubleStuff

Green Bay, WI
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10 February 2017 - 12:19 pm
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Ditto all the above....its a stressful time, the news is scary, you gasp at whatever straw is out there, hoping it's not cancer. My Dobe Nitro's initial x-Ray showed the bone to be lacy, like a honey-comb. 3 of 4 biopsies were inconclusive, one saying "sarcoma, fibrous variety". He has his right front leg amputated in June 2014, and continues to do well. If only I knew then what I know now, I would have saved myself so much stress and worry. Dogs really DO do well on 3 legs. And statistics ARE just numbers; we all want to know what the prognosis is, so our vets tell us ballpark numbers. The most important thing is to take away the pain, and go on from there.  Good luck moving forward, keep us posted.

Paula and Nitro

Nitro 10 yr old Doberman; right front amp June 2014. Had 6 doses carboplatin, followed by metronomic therapy. Rockin' it on 3 legs!  Follow his blog entitled "Doberman's journey"

http://nitro.tr.....27_2_1.jpg

The Rainbow Bridge

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10 February 2017 - 1:52 pm
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My first thought: have you asked the vet: can the leg be saved at this point in time? Or does it have to come off regardless of the diagnosis? If the leg appears salvageable, what are the odds that the salvage procedure will work? If the leg is beyond repair (based on orthopedic evaluations), then amputation makes the most sense to help your pup get out of pain. 

Occasionally we DO see fungal infections here, but it's rare. If there's one thing we've learned is that osteosarcoma shows no favorites. Small dog, big dog, old dog, young dog -- AND CATS! So even though your pup is a smaller breed, unfortunately it can happen. The most important thing is to help your pup with the pain relief so that he can go on to be a happy dog. Oftentimes we have to wait for the diagnosis until after amputation, but as long as that pain is gone, that's all our pets care about. 

I hope this helps.

It's better to hop on three legs than to limp on four.™
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11 February 2017 - 2:54 pm
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WOW.

We cannot even begin to explain how reassuring and helpful all of the responses have been from you. We appreciate your time and heartfelt words so much. At the same time, we're sure you felt the same when you found this community.

After reading these replies and thinking long and hard about how everything has presented itself, we went forward with the amputation, yesterday. As of 12:30 today, he was back in our apartment with us. His leg and a lymph node are on their way to Dr. Barb Powers at Colorado State and hopefully, news will come with a definitive diagnosis so we can really start attacking whatever it is. We're still hopeful it's somehow not cancer, but we know our boy can tackle anything at this point.

He is being a model patient - already bopping around, although he's still figuring out how to carry the new extra weight - there's some elbow buckling when he gets tired. All of this sounds like it to be expected for a while, though.   

We'll post updates as soon as we have them or maybe just a fun picture here and there. Thank you all again - your words were so kind, helpful, and genuine. It's what we all really need big-blink

Mel, Katie, and Holden  

Holden! Image Enlarger

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11 February 2017 - 3:23 pm
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What a gorgeous! Good job, Holden, you are a champ! And yes, this community is invaluable. I will be looking for updates on your sweet boy!

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11 February 2017 - 3:28 pm
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Oh my gosh, are you adorable or what!? Great coloured fur. You are so unique and even more so with that leg gone. Happy healing Holden. You look like a smartie and will figure it out without any problem.

Kerren and Tripawd Kitty Mona

Here and Now

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11 February 2017 - 3:31 pm
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Thanks for the kind comments!

Welcome home Holden, and best wishes for a speedy recovery. Take it easy for a while and please keep us posted.

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11 February 2017 - 4:03 pm
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Continued prayers for you all and Holden!!!  Keep us posted, from one herding dog home to another.   

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11 February 2017 - 5:23 pm
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Goodness, Holden is just so handsome!  Striking!

So glad he is off to a good start post amp.  Sending very best thoughts for his recovery to continue on a positive path!

Lisa, Minneapolis

On October 27, 2016, nearly 6 months after amputation, and 18 months since his cancer likely started, we lost Pofi to a recurrence of Soft Tissue Sarcoma in his spine quite suddenly.  His Daddy and I miss him terribly along with his canine sister, Mia, and two feline siblings, Lucia and Cliff.

Blog: Pofi, Peripheral Nerve Sheath Tumor Amputation

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11 February 2017 - 5:25 pm
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So glad he is home!  The next two weeks will be intense, particularly around day 3 - 5 when the hospital meds wear off, but then he will probably amaze you!

Otis - 106 pound lab/Dane mix, lost his right front leg to osteosarcoma on Febuary 9, 2016.  Four rounds of carboplatin completed in April, 2016.  Lung mets August 25, 2016.  Said goodbye too soon on September 4, 2016.   Lost his adopted sister, Tess, suddenly on October 9, 2016. likely due to hemangiosarcoma.  

Wherever they are, they are together.

Virginia
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11 February 2017 - 10:11 pm
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OMD!!! HOLDEN IS SO HA DSOME!!!

Holden even has the tripawd front leg centered perfectly already!

Just catching up on everything and wanted to add my good wishes for a smooth recovery. As already noted, the recovery phase is no picnic. Right now Holden still has some hospital meds in him, so he may have a bit of a crash in a day or two when they are out of his system. Tweaking his pill pain meds can be a bit daunting at first, but you'll get it all worked out.

Stay connected!! Let us know how we can help.

Hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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