Caring for a Three Legged Dog or Cat
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I just found out that my dog might have osteosarcoma in his hind leg and have spent the weekend reading everything I can find about the disease. He will be 12 in June and is a mixed breed. He is about 50 pounds and is on the thinner side. He is healthy other than his leg. Our regular vet took chest xrays and said they were clear, but the specialist (internal medicine) was worried about a spot and is recommending a CT scan.
I plan on asking the specialist these same questions at our next visit, but was hoping to learn as much as I can before the visit so that I can ask the right questions.
From what I have read, I gather that if there is no metastasis to the lungs, amputation is recommended and there is a chance of several months (or more?) of good quality of life. I could not find as much information about recommendations if there is metastasis to the lungs, especially minimal (that would not show up on an xray but might on a CT scan). The specialist said that if the CT scan shows signs of metastasis, then amputation may not be recommended. I should have asked why but did not think to do that at the time. A friend who is a vet in another state also said that if is there is metastasis in the lungs, because my dog is 12, she would recommend making the dog as comfortable as possible until his quality of life is no longer good or his leg breaks.
What is the usual recommendation if there is metastasis to the lungs? The literature I've found does not seem to discuss this. Is treatment not recommended at that point? Above all, I want my dog to have good quality of life for his remaining time, so I don't want to subject him to treatment that would make him sick for the last few months of his life. But it feels like I gave up if I did not at least try to fight the disease. The CT scan is expensive and if there is any chance of fighting the disease when there is metastasis to the lungs, I would rather use that money towards treatments (if my dog could still have good quality of life with the treatments).
Our regular vet had said that amputation was more for relieving pain than curing the cancer — that even if xrays were clear, it's likely that the cancer has already spread. If that is the case then do we need the CT scan — is the CT scan only used to decide whether or not to amputate or does its results also determine whether or not we pursue chemo or other treatments?
Also, the vet is recommending a bone biopsy before amputation. I am both relieved and panicked by this recommendation. I would like to know for sure that it is bone cancer before amputating my dog's leg. But the vet said that the biopsy results (fungal cultures) could take some time (appointment in a week then another week to several weeks for results?) and everything I've read says that osteosarcoma is aggressive and should be treated immediately. My vet friend felt that two weeks could make a difference, but the vet that we saw did not seem as concerned. Will a couple of weeks make a big difference?
Other than his leg, my dog is healthy. I don't want to give up without a fight just because he is "older", but even more importantly, I want the rest of his life to be happy and as comfortable as possible. Any information that you could give me would be greatly appreciated.
AJ
You have asked some good questions! First of all, it is true that most dogs have at least microscopic mets to the lungs or other bones at the time of diagnosis. Dogs with lung mets at the time of amputation do tend to live a shorter time and injectable chemo may not help. Amputation would still be indicated to take away pain.
Where do you live? I tend to skip the biopsy and go straight to amputation.
Pam
Wow, thanks for your quick reply!
We are in Florida. The vet said that Florida is not typically a place where you would find fungal infections but she has seen a few cases here. She recommended the biopsy because she said the xray of the leg bone was not completely typical and we've done some travelling.
Welcome to the family. I will offer what our experience was and my feelings towards some of your questions. Gus was 7, a lab-rott mix, was limping, we thought muscle injury at first so we had him on rimidyl for 2 weeks, no change, did the x-ray, saw a suspicious spot in the upper part of his left front leg. Sent the x-rays to OSU and they were also read by another radiologist down there and both felt we were dealing with cancer. Did the bone biopsy, came back negative but still decided to amputate. At the time his chest was clear, and our vet felt we had caught the cancer early. about 6 weeks post I discovered a lump on his neck, took him in, did a chest x-ray and found 3 spots. I did start the metronomic therapy at that time, which includud cytoxin, doxycycline, prednisone and power mushrooms. the lump grew to about the size of a grapefruit and we lost him 3 1/2 months after surgery. Even the vet was surprised at how agressive the cancer was. So, I will tell you from my experience how I would handle some things. Personally, I would skip the biopsy, I think it added alot of pain to his leg, wasted at least a week in time, not to mention the $465. We opted to no chemo from the start, partly financial, but more for quality of life, and do I regret it, not a bit, since I am wondering if it would have been effective with how agressive his cancer must have been. The thing is, we really didn't know what kind of cancer we were dealing with, although the vet feels osteo. He was himself by week 4, and only his last few days was he not able to do his usual things. Would I do it the same way again, can't say, but make a decision you won't second guess yourself on, this ride has lots of ups and downs, you don't need to be second guessing anything you did, you make the choice and move forward. Personally, if his health is good, I might be inclined to amputate, I know the pain is terrible, and don't know how long it can be controlled with meds, and some meds will make them goofy, plus I couldn't stand to wonder if you didn't amputate, is today the day he might break his leg, then what, what happens if he does break it and its the weekend, or at night, myself I couldn't live with that thought on my mind all the time. There is a drug called Palladia that several here have had some extremely good results with, but it is also very expensive. You know your dog best, so between suggestions from people here that have been down the road, your vet and ultimitely yourself, you can make a decision that will best work for you both. Around here we say there are no wrong decisions, we make them with our buddies best interest in mind and hope we get the intended results.This is something that can become extremely expensive real fast, so if that is a concern, hopefully your vet can present the best options for you. Some have spent alot of money, and have seen there dogs live over a year, some even longer, some, like Gus aren't so lucky, but it's something you never know how the outcome will be, everyone is different. I am just trying to be honest, this crap can drive you bonkers trying to figure out what the best choice is, you put everything under the microscope, everytime your dog sneezes funny you'll wonder if something is wrong, try not to get to that point, it will eat you up. It's not an easy road but alot of dogs do really well and enjoy life quite after surgery. good luck and Paws up, Spirit Gus and Dan
My buddy Gus had a left front amputation on April 7, 2010 and lived a great life until July 26,2010
I, too, was told exactly what you were, except our diagnosing vet did not feel Trouble was a good candidate for surgery because she was overweight. We got a second opinion the following day, and this amazing man saved Trouble's life. He did recommend surgery even though he acknowledged the weight was an issue. He insisted the only way to stop the pain was to remove the limb.
We chose not to biopsy. I didn't see the need to put her through the procedure knowing the chances were great she would still require amputation. Trouble's tumor was localized (no spread) and her lungs were met free. She had 5 rounds of Carboplatin and was x-rayed again. Still met free. She survived the cancer, but not old age. She left us 27 months 20 days post amp and cancer free.
My point is each and every one is different. You make the best choice you can based on the info you have available and then you just dive in and give them all the love and support you can possibly muster.
Sending lots of good thoughts your way as you face the choices you must make, and healing thoughts for that wonderful companion.
Shanna & Spirit Trouble ~ Trouble gained her wings 3/16/2011, a 27 1/2 month cancer survivor, tail wagging. RIP sweetheart, you are my heart and soul. Run free at Rainbow Bridge.
The November Five - Spirits Max, Cherry, Tika, Trouble & Nova. 11/2008 - 3/2013 An era ends as Queen Nova crossed the Bridge.
Hi,
First off, I'm sorry you have to deal with this. It's confusing and frustrating I know.
Although Champ's journey was little different than most, initially we thought it was osteosarcoma. Like everyone else said, I was not going to go biopsy then amputation. I would have gone straight for the amputation. My feelings are — get the cancer out. When the mass on his spleen was found that is exactly what I did. Our oncologist wanted to do a biopsy and I scheduled with my regular vet the spleenectomy the following week. My oncologist was a little surprised and put off that I would do this without her guidance but in the end it was the right thing since it confirmed hemangiosarcoma.
You have to look in your heart and do what you feel is right. Do your research, listen to all the sage wisdom you will get here, and make your decision. As I've said before in other threads, YOU are your dog's advocate. You know your dog better than anyone else.
As far as lung mets…. Champ's last xray showed a small nodule. This is almost 6 months after his amputation and 10 months after his spleenectomy. We went the chemo route, and he's currently on metronomic chemo as well. We have a visit today with a holistic vet to see what we can add to his medicine to try and tame this a bit. We have no idea how long he has but I am determined to fight it with everything there is.
Best of luck.
Joy & Champ
Welcome to the club nopawdy wants to join, we're so sorry.
If you haven't already, be sure to check out our Required Reading List and for more in-depth information, our ebook, "Three Legs and a Spare ." You'll find that the information you've been given is pretty spot-on based on what we've seen here.
Be sure to watch these fantastic videos about bone cancer with Tazziedog, aka Dr. Pam Wiltzius, you'll also find answers there.
Yes, generally if mets are found before surgery, amputation not recommended. If there are no mets and it's osteosarcoma, chances are that they're microscopic and just too small to see. Amputation doesn't cure the cancer, it's a means to get rid of the horrible pain from disintegrating bone.
As far as bone biopsies go, unless the diagnosis is so uncertain that several opinions can't confirm it, it's generally not done (especially if you already know that you are going to remove the leg no matter what). See Dr. Pam's video for details.
Sounds like your pup is getting some great care. Always remember that no matter what, statistics dont' take into account your individual dog's health and background. For every Tripawd who doesn't make it to the six month mark, there are many who blow statistics out of the water and live far beyond anyone's expectations (see Reno's story). I lived two more years after amputation and nopawdy thought I would live six months, because I didn't have chemo. So always remember, nine out of ten statistics are wrong!
Good luck. Keep us posted (and thanks for using Tags in your post so well!).
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Hi AJ. I'm new to all of this too and I just wanted to say I am sorry this is happening to you and your baby. I had to make this decision last month, so maybe it will help you?
Ellie had a very fast growing tumor on her hock. We were given several possible diagnoses, and by the time a vet said "cancer" the tumor was 14". Amputation was vital and we scheduled it on the next business day. My thinking was that she was so uncomfortable with the tumor that I couldn't see how an amputation would be any worse. I was SO RIGHT. She might still have cancer (lung x-ray came back clear, but as you know that means nothing really) but she is SO HAPPY. The day after surgery she was smiling and playful, and was very proud of herself for figuring out her 3 legs.
Our diagnosis was slowed due to my regular vet leaving the practice and the backup vet not having an opening in her schedule for a week and the backup backup vet going on vacation for a week. It was awful trying to find someone to see us and give us some answers. To make a long and frustrating story short, the last vet called 5 other vets before she left to see who could do the surgery the soonest, and how much they would charge. I know it seems silly to shop around, but my first vet was gonna charge $4000 for the amputation, and another one the next town over did it for around $900. I know it seems like a crazy time to shop around, but we got in faster and the "country vet" was very good and his staff took great care of her. This left me with money to buy her a dog cart to help with recovery. Still can't afford the chemo/radiation, but we do what we can.
Also, we had a biopsy done during the amputation so she was not in pain at all. I'm glad we did it, because it helps inform treatment. I think Cornell Vet School charged us $85 for the biopsy (country vet sent it there).
Look around more on this site for info. it's been so helpful to us with trying to navigate all of these issues. good luck!
Ellie, 8 yo German Shepherd
Rear left leg amputation 3/21/11 (happy 1 month ampuversary!)
Osteosarcoma, so far no signs of metastasis to lungs (using Budwig Protocol, meloxicam, grain-free diet only; no chemo/radiation)
Just wanted to clarify - we did not biopsy prior to amputation. They did biopsy AFTER amputation. I think that is the only prudent way to get an accurate diagnosis and treatment plan.
Shanna & Spirit Trouble ~ Trouble gained her wings 3/16/2011, a 27 1/2 month cancer survivor, tail wagging. RIP sweetheart, you are my heart and soul. Run free at Rainbow Bridge.
The November Five - Spirits Max, Cherry, Tika, Trouble & Nova. 11/2008 - 3/2013 An era ends as Queen Nova crossed the Bridge.
You are getting such good advice here, the only thing I want to say is this: Please, please keep in mind Dan's point about there are no wrong decisions!
We are 2 months post-diagnosis and almost one month post-amp. Are there things I wish we'd done differently? You bet. But you know what? We did the best we could with the information we had at the time.
The main thing is that you are asking all the right questions, you'll get your answers, and you will do the best for your boy. Whatever the outcome, you love him, he loves you and what a blessing that is in and of itself. What's his name?
http://tate.tripawds.com/
August 16, 2006 to November 28, 2011
TATE ~ Forever in our hearts.
Thanks to everyone for your kind words and your advice, and thanks Dr. Pam for your quick reply. I would not wish this situation on anyone, but reading your stories makes me feel less alone in this. I am worried and am frustrated when I cannot get appointments fast enough and worried about bothering the specialist with too many calls/questions because I can't seem to get all my questions together at once, but still wanting as much info as I can get to make the "right" decision. I'm still not sure exactly what to do, but I will try to follow my heart and do the best I can for my Percy.
This site has been a wealth of information and I am working my way through the articles and videos.
Jerry mentioned above and the specialist also said that if lung mets are seen then amputation is not recommended. Why is that? Is the survival time that short? (What is the expected time?) Wouldn't amputation still relieve the pain? Are any kinds of treatments — chemo, metronomic, radiation — recommended if lung mets are seen? It feels like we're giving up without a fight if we don't try something.
Also, almost everything I've read states using xrays to check for lung mets. I've read that CT scans have significantly higher radiation levels which is part of why I'm worried about that. Is a CT scan typical to use in checking for mets?
AJ
mck025 said:
...if lung mets are seen then amputation is not recommended. Why is that?
That would totally depend upon the extent to which the lungs had metastasized. But then, most vets think differently than their clients do, and the truth is micromets are usually present at the time of diagnosis.
Be sure to review the canine lung mets treatment options document available in the Downloads blog if you haven't already, and don't miss Jerry's osteosarcoma lung metastasis information links.
When we discovered Jerry's mets, we started him on metronomics and K9 Immunity, which we believe contributed to his longevity.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Before you spend the money and have your dog under anesthesia for a CT, you might want to have the CXR transmitted to a radiologist to be read. An internist is no better skilled than most general vets at interpreting X-rays. Older dogs can have questionable markings in their lungs that may not be significant.
The radiation risk from a CT scan to your dog should not be a factor in your decision. Radiation effects are cumulative. The lifespan of dogs pretty much eliminates the issue.
A pre-op CT for all dogs would be ideal for documenting metastatic disease, but I'd bet the incidence of mets would be significant. Is it really necessary to find something that may not be symptomatic for a long time? It's expensive & requires anesthesia. OSA is not a disease most of our dogs will outlive and everyone's wish is to provide the best quality of life for them, but sometimes you have to be practical & choose where your funds are best utilized.
Try to get your questions together in advance of your appointments, but keep in mind, you are paying for the consultation and should get all of your inquiries addressed. I know how confusing this can be, but I think you might need to take a deep breath and step back for a moment. The speed at which you amputate, does not have a great impact on survival. it is a palliative therapy for pain control. I'm not clear on what specialists you are referring to, but you might consider narrowing that selection to a surgeon & radiologist. You can make decisions about an oncologist & further therapy later. Trying to determine an entire treatment plan at one time is overwhelming.
A note on your biopsy question related to a possible fungal infection….even if it was fungal, the treatment is difficult, prolonged and can ultimately require amputation anyway, especially in a senior dog. You are likely going to be paying for another pathology evaluation post-op whether or not you biopsy the site.. With the increased risk of fracture, pain, time, & expense involved....you have to ask yourself what the benefit and impact on the outcome is....
Cynthia
After some additional frustration in scheduling things locallly, I decided to just go to the veterinary school which is several hours away. They got us in right away. A needle aspirate showed sarcoma cells so I guess it's official.
I had not planned on doing the CT scan but was talked into it, to see if my dog would be a candidate for a new radiation treatment that would save his leg. (which he is not) The CT scan showed 5-6 small spots which were not on the xray and they could not tell me if the suspicious xray spot corresponded to one of the CT spots. I am confused now as to what to do. This was why I did not want to do the CT — I expected that it would show more information which means that smaller and more mets would be visible, making the decision harder. If this were a purely selfish decision, I'd do the chemo, but I don't want him to be sick his last few months. The tentative recommendation was amputation-or-radiation plus six rounds of chemo three weeks apart. That would run 4.5 months out of the 3-6 that they are estimating, so he could very well leave before the treatment is done. So my question is, if it's a good (humane?) gamble to go ahead with amputation and chemo with a clear xray, and our xray was clear except for one small spot, would it be reasonable to proceed that way and despite the CT results? Or does any sign of lung mets mean very little time?
tatespeeps said:
You are getting such good advice here, the only thing I want to say is this: Please, please keep in mind Dan's point about there are no wrong decisions!
We are 2 months post-diagnosis and almost one month post-amp. Are there things I wish we'd done differently? You bet. But you know what? We did the best we could with the information we had at the time.
The main thing is that you are asking all the right questions, you'll get your answers, and you will do the best for your boy. Whatever the outcome, you love him, he loves you and what a blessing that is in and of itself. What's his name
Thank you all so much for this comment. On the long drive home I started getting angry at myself for subjecting him to the stress of the CT scan since it did not result in anything positive and using up that money which could have gone toward treatments. I went to the vet school because I wanted to get answers more quickly so that treatment (if necessary) could be started sooner, not expecting that making decisions quickly would be so difficult. At the time I thought it was a good decision because it potentially gave me an additional treatment option; looking back, not so sure. I've been afraid to talk to anyone about it because I think they will just tell me, "Why didn't you think it through more carefully?" So it really helped when I remembered these comments.
Don't you just hate what this crap puts you through. In regards to your question does any sign of mets mean little time. Like I said before , each of these guys are different. In Gus' case, his chest was clear in the first x-ray, six weeks later mets were present. But there have been others here that have lived up to a year with mets, some did chemo, some didn't , so to answer your question, no, mets aren't a short time death sentence, depending on your interpretaion of short time, mine is a few months, for others a short is a year, the next person will say a year is great. I will say this, I know there are ones here who did radiation that will tell you to stay away from it, they had a bad experience, didn't get the results they hoped for, and felt they wasted time and money. I think bottom line is if your comfortable with your vets diagnosis and trust his opinion,have him tell you each option, possible side effects, cost of each,etc. Nobody can tell you just because you do one thing or another what the results and prognosis will be, our vet thought Gus should live at least a year. I will say this, once these guys heal from an amp surgery, depending if you chose a chemo or not,or maybe some other treatment, they live a very good life, and cancer pain can get extremely painful, which a surgery can take care of. Some have side effects from chemo or other treatments, some seem to handle chemo really well. I assume you have read about the metronomic therapy, and there are other drugs that have shown positive results, like Palladia, if your dogs cancer would respond, but that is extremely expensive. One thing to keep in mind, I found if you choose a treatment that uses cytoxin, you can get that ALOT cheaper from Canada, and maybe some other drugs, but it takes a few weeks to get it from there, just a thought. Just remember to make a decision you won't second guess yourself on, make it knowing you have the dogs best interest in mind. But, and not to put you under pressure, try to come to a decision in as short of time as possible, you want to start recovery and try to eliminate as much cancer as you can as soon as possible. Good luck, Paws up, Spirit Gus and Dan
My buddy Gus had a left front amputation on April 7, 2010 and lived a great life until July 26,2010
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