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Forrest's Story - Preparing For Life as a Tripawd (Need Help With PO Logistics)
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Member Since:
6 December 2023
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6 December 2023 - 7:48 pm
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Hello, 

First, I am so thankful that the surgeon we are consulting with recommended this website - 24 hours in and I already know this is going to be a place of true solace and support as my family and I navigate our dogs cancer diagnosis. Thank you so much for being here and all the incredible work that you do. 

I'll start by introducing myself (Kati) and the amazing dog (Forrest) that I share with my husband (Jamie.) Forrest is an ~8 year old mixed-breed rescue (we think Australian Shepherd/Great Pyrenees) that joined our family when he was ~2.5 years old. He is the absolute light of our lives, the centre of our universe and has just brought so much joy to our life every single day. He is the most affectionate dog I have ever known, always keen to jump up on the bed for a cuddle and gives endless kisses. He is also such an active dog - loves running and hiking, has been jumping up on stumps and logs all his life - my husband even had him jump up on a log with my engagement ring attached to his collar during our proposal! He is my soul dog - I know without a shadow of a doubt that I will never love another dog as deeply as I love Forrest. So with that, the news we've recently received has me feeling lows I have never known before and to be honest I'm really struggling to cope. 

Back in late September of this year, Forrest started showing signs of limping/lameness in his left forelimb. About a year prior, he had shown similar signs but with some recommendations we treated that with CBD oil and it completely disappeared until returning in September of this year. Unknown if the two are at all related, though hard not to speculate since it's the same leg… Regardless, since he was still on the CBD when the limp represented, we took him to the vet. 

The first vet we saw at our clinic (which has three vets total - important later) was very gruff, horrible bedside manner and jumped right to worst case scenarios (osteosarcoma) and immediately said we should do X-rays, but at the time it just felt so unlikely that we opted to get a second opinion from one of the other two vets at the clinic. We did opt for bloodwork and all came back normal, except slightly elevated ALP levels which we were told to just monitor. Upon speaking with the second vet at our clinic, he thought it was much more likely to be soft tissue related and started Forrest on librella and cartrophen injections, which had limited success. The limp would come and go, worsen and improve, but it still wasn't suggested again that we do X-rays... until about 3 weeks ago on November 19th he started showing signs of real pain (crying, unable to settle) and we took him to a nearby 24hr emergency vet to get him some pain meds. Surprisingly, the vet on call was actually the THIRD vet that works at our primary clinic, the only one we had NOT yet seen for opinion on his symptoms. At the time, she recommended we proceed with X-rays and we set up an appt for 4 days later with her back at our primary clinic. Well, in the span of just two days following the overnight emergency visit, Forrest developed a very large mass (think closed fist size) on the scapula of the affected limb.

Fast forward to the X-ray appt, the doctor is surprised at the sudden onset of the mass so decides to do a fine needle aspiration - the cells come back showing spindle cells with inflammation and necrosis. The radiologist who reviewed the X-ray at the time didn't THINK the tumour was on the bone (leaned towards it being soft tissue sarcoma), but couldn't say for sure. A CT scan was recommended and we were referred to a local specialist hospital here in Vancouver, BC, Canada - Boundary Bay Veterinary Specialists. 

We had our consult with Dr. Evan Crawford yesterday and did both a CT scan and biopsy of the tumour. Initially, he said he actually felt the original X-ray DID show signs of it involving the bone and he leaned more towards an osteosarcoma than soft tissue. After the CT and biopsy, his initial review of the CT scan all but confirmed the opinion that it is likely osteosarcoma affecting the scapula. On his review, he does not see any signs of metastasis in the lungs, but we are anxiously awaiting the radiologists report to confirm. We are also waiting on the cytology report for the biopsy. 

Regardless of what comes back, unless the radiologist thinks there is reason to believe metastasis is already present and surgery won’t do much, our next step will be full amputation of the limb and scapula with chemotherapy to follow. We can get him in for surgery as early as Monday, December 11th. My husband and I are OK with this prognosis (as much as one can be), we’re just hoping and praying that the radiologist agrees it has not spread and we can move forward with aggressive treatment to try and give Forrest the best possible chance. We should know soon, but the waiting is agonizing… 

In the mean time, I’ve just been reading as much as I can and for the most part I feel like I can mentally prepare for how to support Forrest through majority of his recovery. The one thing I am REALLY stuck on is that we have 10 somewhat steep stairs at both the front and back entrances of our home (no other access points without stairs unfortunately.) He is about 70 pounds and I just cannot picture how we’ll be able to get him in and out of the house safely to go to the bathroom while he is recovering. Given that the entire scapula is coming out, would we even be able to use the Ruffwear Flagline at first with how large the incision will be? He has never been comfortable being picked up so I just am really struggling to picture how this will work. We don’t really have anywhere else that we could go stay during his recovery. Any tips from the Tripawd community? 

Thank you to anyone who made it this far - I will be sure to share updates along Forrest’s journey. It means so much to know I have somewhere to turn for support. 

Member Since:
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7 December 2023 - 7:43 am
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UPDATE:

We heard back from Dr. Crawford about the radiologists review of Forrest's CT scan as well as pathologists initial review of the biopsy samples. Here is what they had to say:

 

"The CT report didn't show anything particularly more concerning than what I thought.  The radiologist agrees the mass is most likely coming from the scapula, and the appearance is consistent with either bleeding into, or necrosis of the centre, which would fit with the previous cytology (usually tumor necrosis is sterile).

There was not any clear evidence of metastasis.  Some of the lymph nodes in the region were very mildly enlarged, but this could also (and I would think is more likely) due to general reaction to the inflammation usually associated with tumors. They notes some nodules in the spleen, with the character consistent with any number of benign things.  There were a few other incidental changes noted.
 
The pathologist read the samples out as a sarcoma; and while they cannot be conclusive, there was evidence of bone remodelling, and they have a strong suspicion is is an osteosarcoma.  If you want confirmation, we can submit the biopsy sample, but I think with all the information it is extremely likely we are dealing with an osteosarcoma."
 
 
We've been presented with two main options that we are considering: 
 
1) Proceed with full amputation in Canada at Boundary Bay Veterinary Specialist clinic, followed by chemotherapy also in Canada at the same clinic
 
2) Our clinic has a sister location in Bellingham, Washington (about 1.5 hour drive door to door across the border for us) that offers the Elias vaccine treatment. It's more than double the cost of treatment here in Canada, but this isn't the main deciding factor for us.
 
We've reached out to our vet with some questions, but would love to hear from this community if the amputation with vaccine really is the preferred option and whether the efficacy of the immunotherapy truly greatly outweighs the amputation/chemo route? I know no two cases will be the same and no definitive statement could be made, more so looking anecdotally and i guess... with both options available, what would YOU do, fellow Tripawds? 
Virginia







Member Since:
22 February 2013
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7 December 2023 - 9:30 am
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Well Mr Forrest jas taken you on quite an adventure.   Ups and downs butnit looks like you are in really good hands with Er Crawford and can determine a path forward.

We have had members  here to forward with the vaccine.some the chemo...and some  just the amputation with supplements and.nutrition support..  in each case, some sis well and exceeded expectations  and some did not.  Somet thos whole journey  and decision  on follow up treatment  really does appear to be a crap shoot

Others with more first hand experience  with the vaccine can chime in.  Back when my Happy Hannah had her amputation these options weren't  ava.  I did proceed with four rounds of Carboplatin  with her her .  She had no side effects and was fine with carrides and visits back and forth to the Vet..  I had the pr of having my Happu Hannah with me another full year plus two months.  For me, I obviously  was pleased with that route.  However, back to the crap shoosome didnt  get as much time, some more.time.

 

As far as the stairs, sumit possible  to get a ramp built?  Soing the stairs with a harness would be "doable" if necessary.  I also have a dog who does not appreciate  my "help" either.

You are doing a great job of determining  the best path for Forrest.  

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!

The Rainbow Bridge



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7 December 2023 - 10:40 am
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Hi and welcome! I apologise for not responding to your post last night but we had company over and I couldn't get to my laptop without being totally rude lol! I'm so happy that the one and only Sally was able to give you some insight. Thank you as always Sally!

So Forrest's story sounds a lot like our Jerry's story (same tumor location too) and unfortunately many other Tripawds who have had that on-again-off-again limp. The good thing is that you're acting quickly now, and there's no mets. YAY!

As for the therapy type, well, more people are opting for the immunotherapy. It appears that dogs are going longer with immunotherapy than without. But like anything on this journey there are no guarantees. You can see some immunotherapy examples here.

https://tripawd.....unotherapy

Before I forget, the stairs are something many people, including me, had to deal with for our dog. We had a LOT of steep, narrow old steps to get Jerry in and out of 2-floor walkup. It's how we discovered and now recommend the Ruffwear Flagline harness . You'll see in this old video that he was wearing the Ruffwear Webmaster , which we used to recommend for all Tripawds. But now that the Flagline is out, we like it better for front-leggers.

We only recommend using the harness right after surgery in a situation like this, where the only access to a potty place is by using stairs. Put a t-shirt on Forrest first, then the Flagline so it doesn't rub his incision. Just use care and gently guide him so that you're not totally lifting him but just there with your hand on the harness and giving him a light bit of help. Also, be sure to put traction down on your steps and anywhere with slippery floors. 

P.S. Please thank the surgeon who recommended us, it's quite an honor when a vet sends a client here. 

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8 December 2023 - 8:45 am
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Thank you both so much for taking the time to reply, we appreciate it more than you could ever know. Jerry - the video is extremely helpful and puts our minds at ease that we'll be able to help Forrest up and down even in the early stages of recovery. 

Right now the biggest decision we're facing is around the treatment choice and location for treatment. We're receiving so much information but it's also very piecemeal and we're trying to put it all together and make sense of it. I am just terrified of making the wrong choice in some way. 

When we spoke with the Boundary Bay Clinic in Bellingham, WA (sister clinic of our vet specialist's office here in Canada,) they said they could do the Elias vaccine protocol but they do not have an apheresis machine on site so we'd have to involve a second clinic in Bellingham (Bellingham Veterinary led by Dr. Ed Sullivan, oncology and Dr. Theresa Westfall, surgery). They couldn't give us an estimate for the cost of the apheresis, so we proceeded with contacting Bellingham Veterinary directly to try and piece together the total quote. 

Dr. Sullivan called us back later in the evening after hours and was SO incredibly kind, he stressed how important it is to not waste a single day and he could have Forrest in as early as tomorrow (now today) depending on Elias's ability to receive the limb. Absolute latest (and again, only based on Elias's role in all this) would be Monday. He told us that his clinic was one of the first in the US to be involved in the trials of the Elias vaccine and he truly believes it is the single best option out there for the treatment of osteosarcoma. He mentioned that osteosarcoma in dogs is very personal for him because his own dog passed from it just prior to his involvement with Elias.

Googling him, he seems to be involved in many very advanced treatments of canine cancer. He's working on preparing a quote for us for both the option of the entire treatment (amputation, vaccine, infusion/apheresis) with them as well as if we wanted to do the amputation/vaccine with Boundary Bay and just the apheresis with them - we should have that early today. But it seems like our best action may be just to switch to doing everything in house with Dr. Sullivan/Dr. Westfall given his broader experience with Elias... We just feel a bit conflicted given how much we've already been discussing with Boundary Bay and this takes us out of contact with the only specialist we've actually met in person so far. 

Another wrench in this is that the clinical studies for chemo/carboplatin show similar DFI and MST with 6 doses as the clinical trials on Elias:

Carboplatin:

  1. 48 dogs, 4 doses carbo, DFI 257 days, MST 321
    2. 155 dogs, 3-4 doses, DFI 256 days, MST 307
    3. 25 dogs, 6 doses, DFI 425 days, MST 479 days.  6 dogs alive at 599,1119,1599,1699,1743 and 1766 days.
 
Elias:
- one study looked at 15 dogs that got the treatment.  Median disease free interval (DFI) was 213 days, median survival time (MST) was 415 days, and 5 dogs lived > 730 days
 
We are unclear what dictates a dogs eligibility for 6 doses vs. 3-4 -- is it just cost to the owner? or are some dogs not recommended 6 because they cannot handle it? 
 
I really don't know how people make these decisions 🙁 we just feel confused and like every answer brings more questions.
The Rainbow Bridge



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8 December 2023 - 11:51 am
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Hi Kati,

I don't blame you for feeling so bewildered, that's a lot of information to put together. Here are my thoughts FWIW:

For amputation surgery, you want a clinic with overnight staffed care, one that practices the latest pain management protocols, and that has advanced care available on site if something goes wrong. If your local vet clinic can offer that, I would work with them. It's perfectly OK to go elsewhere for the rest of how you want to treat the cancer.

Boundary Bay is a large, advanced clinic that appears to meet the criteria for what I would look for in a clinic. They have a lot of board certified specialists too, which is fantastic. It's hard to say if the other practice has more ELIAS experience than they do, have you asked how many dogs they've treated? 

We are unclear what dictates a dogs eligibility for 6 doses vs. 3-4 -- is it just cost to the owner? or are some dogs not recommended 6 because they cannot handle it? 

That's a question for the team. Not being able to handle it has not been an issue with dogs, at least that we have seen here. They may be experimenting with the amount of treatments in the same way that oncologists have done with chemotherapy treatments over the years. For a long time it was debated whether 4 or 6 rounds of carboplatin were better for osteosarcoma, and as of now, it appears that it's 4. Those kinds of questions are probably now being asked about the vaccine.

The Rainbow Bridge



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8 December 2023 - 11:52 am
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Kati if you're online I"m in the Tripawds Chat for a bit. 

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8 December 2023 - 8:20 pm
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First, a big thank you to Jerry for taking the time to talk this all through with us via chat - I appreciate you SO much! 

For numerous reasons including a high comfort level with our surgeon here in Canada (Dr Crawford, board certified surgeon practicing at Boundary Bay in Surrey, BC), as well as the tricky logistics with crossing the border multiple, multiple times for the Elias protocol, lack of 24hr care with the clinic offering the Elias vaccine, and a few others -- we have decided to move forward with amputation here in Canada and follow up with chemotherapy. 

It has been an agonizing decision and we've struggled with feelings of guilt and "what if we aren't doing the absolute most we can?" but ultimately we just feel in our guts that this is the best decision for our family, allows us to stay close to home, and we just really trust Dr. Crawford so much and feel safe putting Forrest in his care. That is the most important thing and I know we'll make peace with whatever the outcome is knowing we based our decision on those factors. 

So with the decision made, we've scheduled Forrest to go in at 8am PST on Monday, December 11th for his amputation. After a walk at our local dog park today with his friends, we stopped by a neighbourhood pet shop and picked up the Flagline harness so we're ready to help Forrest on his stairs in and out of the house next week! We explained his story to the friendly staff working there and they sent him home with a free bully stick and bag of treats, as well as great recos for local PT/aquatherapy/acupuncture/massage following his surgery - so wonderful to have so many people love Forrest and want to help!

We are also having a very close friend of ours help us take some family photos tomorrow morning ahead of Forrest's surgery which I know we will cherish forever. We'll spend the weekend getting the house ready (traction ! treats! tripawd friendly bed! high value food/fluids to encourage eating! etc) and just giving Forrest as much love and attention as we can. I'll be sure to update this post with the results of his surgery next week. Love to everyone here and all those going through this - it's heartbreaking and so difficult, but trust yourself with the knowledge that any decision you make is the right one because it was made with the MOST love for your furry family member and nothing but their best interests at heart sp_hearticon2

Livermore, CA




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8 December 2023 - 8:44 pm
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Hello and welcome.

You have put a ton of thought and research into your decisions....good job!

When faced with these types of decisions I remind myself that there is NO WAY I could ever know what would happen if I made a different decision or chose a different path.  We humans tend to second guess ourselves, and yeah, I do it anyway sometimessmiley4.

I'll be sending good thoughts on Monday for the best possible surgery and I will be looking for an update.

 

Karen and the Spirit Pug Girls and Boy

Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.

1999 to 2010

 

              Maggie's Story                  Amputation and Chemo

Virginia







Member Since:
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8 December 2023 - 11:11 pm
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Shhhh.....shhh....don't tell anyone, okay? Just our  secret.

I'm really glad you made that decision for all the reasons you laid out.  

We try hard not to impose our own opinions and are always supportive of any route anybody takes and in a non-judgmental way.  Quietly to myself, ...shhhh.....I was hoping this was the path that you would take.

Keep things chunked down and just deal with amputation and recovery for now and everything else will unfold as it should.

Hugs

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

Looking forward to seeing some of those pictures of this adorable boy. His Avatar picture is so cute.

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!

The Rainbow Bridge



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9 December 2023 - 8:41 pm
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I agree, you guys did a fantastic job coming to that decision. It's not easy with so many options that were laid out in front of you, but I agree that sticking closer to home is smart, and Dr. Crawford is a stellar vet, as well as the clinic team. 

We can't wait to see the photos from your session! What a neat idea. 

If you think of anything you need to ask, we are here for you! Monday will be here before you know it.

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11 December 2023 - 10:39 am
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Sally, Karen & Jerry - thank you as always for the words of encouragement! Of course everyone has to arrive at these decisions for themselves, but I'd be lying if I said it wasn't incredibly validating and reassuring to know that "the pros" agree with our thought process, reasons and ultimately our choice of treatment. 

We dropped Forrest off for surgery about 90 minutes ago... I tried so hard to keep it together, but I couldn't help but cry when hugging him before he went into the back. I feel guilty that maybe I made him more scared as a result, but I just needed him to know how much I love him, how strong he is and how proud we are of him for being so brave. I am hoping and praying every minute that the surgery goes well today. He is so, so strong and has honestly been doing incredibly well the past couple weeks with the pain meds he has been on, so I'm trying to remain hopeful that he is as ready as he could hope to be for this. I trust Dr. Crawford and the team to take the absolute best care of him, and the tech said she has our email and can send us photos of him to let us know how he's doing. I guess there's not much to do now but wait to hear. 

In other news, we spent yesterday trying to live in the now and "Be More Dog " - we took Forrest to one of his favourite places where he spent nearly two hours walking the trails in the rain forest, jumping through streams, chewing sticks, watching waterfalls, and begrudgingly being posed for a few pictures. I've attached a video here so you all can see Forrest in his element - this is what he loves most in the world, and I am so so hopeful that by moving forward with this treatment we can get back to doing this with him as soon as possible. 

 

Forrest in the stream

<-- video of Forrest playing in a stream! 

 

We also are feeling as ready as I think we could be for his return home tomorrow - we put traction down throughout the slippery kitchen floors, we're also going to try purchasing the indoor/outdoor traction socks from RC Pets (our house is all hard floors so it would've been impossible to put carpets everywhere). We also got him elevated food bowls and he's been using those the past two days - wish we had done that sooner as he's not slipping anywhere near as much!! We're stocked up on bully sticks, treats, bone broth, wet dog food in case he needs some encouragement to eat; we're going to use a firm mattress on the floor in our living room as his recovery area, so I've ordered a waterproof mattress protector for that in case he has any accidents. I hope I'm not forgetting anything - I'm a very Type A/plan ahead kind of person, so being prepared is therapeutic for me.  

I'll post some photos later from our photoshoot the other day, it was pretty wet and cold out but we made the most of it and I'm glad we did it. I'll keep you posted later when we hear how his surgery went. Thanks again for everything and sorry my posts are so long, it just helps a lot to write this all out. 

The Rainbow Bridge



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11 December 2023 - 10:47 am
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Hey I was thinking of you guys today. The waiting is so hard! And I cried when we dropped our Jerry off too, that's totally human.

Your posts could never be too long, especially when you post adorable videos like this! He is such a handsome boy. That TAIL! Really swooshy and cute! sf-kissI love the way he's wearing his Ruffwear Flagline like an expert. Good idea to get him used to it. Watching him it's so hard to believe that he's got such a painful cancer. Dogs are so stoic! I can tell he will acclimate to his new Tripawd life really well. And you will too! 

Being a Type A planner is good in a case like this! Sounds like you've gotten all the basics handled. My only observation is to not be disappointed if the traction socks aren't the end-all, be-all. They tend to rotate on some dogs' paws. If that happens, you don't need to cover your entire house in carpet, just place runners where the most common paths he likes to take, like to his bed, food, entrance/exit, etc. What you are doing now is what you would do for any senior dog, just doing it earlier for Forrest. 

Dr. Crawford's team will be awesome. We are all sending tons of pawsitivity your way! Please let us know how things are going when you get a chance, and if you'd like to start a new topic in Treatment and Recovery feel free!

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11 December 2023 - 10:50 am
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Here is one more video I took this morning - this is what we call Forrest's "Smile Spot" - we discovered it when we first adopted him when he was ~2.5 years old. We scratch a specific spot on the back of his neck and without fail, he smiles. It's one of my absolute favourite little Forrest quirks and I really hope he still does this post surgery. But even if he doesn't for whatever reason, I know to just be thankful that he's still here and we'll have a million other ways to make our boy smile, and him us sp_hearticon2

Forrest’s smile spot

The Rainbow Bridge



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11 December 2023 - 10:53 am
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ADORABLE! sf-kissOh my gosh. He really does smile, and he will again soon!

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