Caring for a Three Legged Dog or Cat
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Hello! Thank you to everyone on this amazing site! It is so helpful to know that I have a place to go where people understand. Bailey is a 10 year old springer spaniel type dog (she was a shelter dog so we are unsure of her exact ancestry). She is super smart and active and loving - a great family dog!
In early September 2017, Bailey came back lame from chasing a rabbit. She was holding her left hind leg up and refused to put any weight on it. Of course it was 10:00 at night and my husband was out of town and our two boys were sleeping soundly. I was able to call a babysitter over and rush Bailey to the ER. She was examined by the ER vet and was sent home with pain meds and the order to rest (good luck with that!). The ER vet thought that Bailey had sprained something and would begin to improve in a few days. When Bailey did not improve after a couple of days, I checked in with our vet. After a physical exam, our vet came to the same conclusion as the ER vet - nothing in the leg seemed to be out of place or swollen - so rest and pain meds. When Bailey still didn't improve after a few more days, I consulted with our former vet who had recently moved to another practice across town. She did a physical exam and ordered an x-ray. Physical exam did not reveal anything remarkable but the x-ray showed fluid around the stifle joint. So, our former vet set us up with the orthopedic vet in her new practice. After the consultation with the ortho vet, it was determined that Bailey likely had a torn ACL and we decided to pursue surgery to repair it.
On the day of her ACL surgery, I received a call from the orthopedic surgeon saying that during surgery it was discovered that Bailey's ACL was absolutely fine - no tears or other signs of injury. However, there was a significant amount of "strange tissue" around the stifle joint. He asked if I would like him to send a sample of the tissue out for biopsy - of course! We were given many possibilities of what the tissue might be - infection, arthritis, cancer. A few days later, we got the devastating news that the tissue was histiocytic sarcoma, a really nasty, aggressive soft tissue cancer. We were referred to the oncology department at Purdue University, about a two hour drive from our house.
We made the trip to Purdue for staging of the cancer. Every conceivable scan and blood test was done on Bailey. The tissue from the original sample was also sent for further testing and grading. All of Bailey's tests came back great except for one lymph node deep in her abdomen, closest to the leg with the cancer. The lymph node was too vascular to safely biopsy but the oncologist was fairly certain that the cancer had spread there or the lymph node could be presenting that way due to the ACL surgery (Very worst case/best case scenario there!) The recommended course of treatment for Bailey was 5 targeted radiation treatments to the stifle joint and lymph node followed by chemotherapy (CCNU) every month for the rest of her life, or in the words of her oncologist, "Until it no longer makes sense." The hope was that after radiation, Bailey would be able to use her leg again.
So, by this time, it was October of 2017. We met with radiation oncology at Purdue and set up Bailey's treatments. It was so hard to leave her there overnight on the two occasions that we had to but it really was the best option. They took excellent care of her and sent frequent updates. By the end of her radiation treatments Bailey was still not using the leg, not even toe touching. Radiation oncology suggested we give it a little more time. We went back to oncology at Purdue where Bailey received her first dose of chemo on October 31, 2017 and was sent home.
On the 7th day after her first chemo treatment (nadir day for those of you who are familiar), Bailey became very lethargic and sick. We talked to her oncologist at Purdue and it was determined that she should go to the hospital immediately. We took her to our local ER where it was found that Bailey's white cells had completely tanked and she had a high fever - a very sick baby! She was admitted to the hospital where she received iv fluids and antibiotics. She spent two days and one night in the hospital followed by a two week course of antibiotics at home. It was determined that the chemo was at fault. Our local internist, who would be administering Bailey's chemo from this point on, consulted with the oncologist at Purdue. It was decided that Bailey's next dose of CCNU would be reduced by 10%. Long story short, Bailey continued to have bad reactions to chemo (not as bad as the first, thankfully) every month that she had it. Before each chemo, her CBC was taken along with a liver enzyme panel. Then, 7 days after chemo, the tests were repeated. The dose ended up being reduced by 30% to find a dose that Bailey could tolerate. She continues to receive chemo every 4 weeks a year later.
While Bailey was in the hospital after her first dose of chemo, the orthopedic vet from the hospital examined her and performed an x-ray on her leg. The x-ray revealed pathological fractures in her femur from the cancer. At that time, amputation was recommended. Bailey's left hind leg was amputated on December 21, 2017.
Through this entire saga, Bailey has continued to be her happy, loving, spirited self. We would not have continued to put her through all of this if, at any time, Bailey seemed to be suffering. She took to being a tripawd like a champ and continued to play ball (gently) and even swim! We fell into a rhythm of monthly chemo treatments and staging every 3-4 months to check for metastasis.
So, here we are a year later. A few weeks ago, Bailey stopped wanting to walk and it seemed that her remaining back leg was having some issues. So, a few trips to the ER and a couple of x-rays later (including a clear chest x-ray!), it is the thought of the radiologist that Bailey has torn her cruciate in her remaining back leg. I just spoke with her internist this morning to discuss our options. Bailey is currently on pain meds and rest and is doing well. My husband and I fear that the cancer has spread to her right stifle joint, although her internist thinks that is highly unlikely. We are trying to decide what our next steps should be. Some options are: meet with the orthopedic surgeon to discuss surgery on her remaining back leg, meet with rehabilitation to see what they can do for her, aspirate the stifle joint to check for cancer. My feeling is that we definitely should aspirate the stifle joint but, after that, I don't know. I would appreciate any thoughts you all might have on where we should go from here (if you've made it this far in this novel!). Thank you to those of you who have taken the time to read our story!
OK so you'll have to forgive me but my mind is a bit scattered right now. The vet's made a definite diagnosis of histiocytic sarcoma right? If so, that's super duper she's done so well.
Also, I was unaware that HS can spread to other limbs but apparently it can go anywhere.
it is the thought of the radiologist that Bailey has torn her cruciate in her remaining back leg. I just spoke with her internist this morning to discuss our options. Bailey is currently on pain meds and rest and is doing well. My husband and I fear that the cancer has spread to her right stifle joint, although her internist thinks that is highly unlikely. We are trying to decide what our next steps should be. ... I would appreciate any thoughts you all might have on where we should go from here
I would definitely meet with the ortho vet to confirm whether or not it's a cruciate tear. If so, the ortho will probably recommend surgery. After all, it's what they do. However, to get a balanced perspective and put your mind at ease so you can feel confident knowing you've done your homework, I would also talk to a canine rehab therapist to get their perspective. They can tell you whether it's a tear that can be managed with a brace and rehab therapy, or if surgery is mandatory.
If it is not a tear and is metastasis, that's a whole other type of situation. For now, find out what you're dealing with and take it from there.
Hope this helps! Keep us posted, we are here to support you no matter what you decide.
P.S. What's nadir day? I am clueless!
Thanks for your reply, Jerry. I really appreciate your perspective. This whole cruciate tear thing kind of took me by surprise today. When we left the ER a couple of weeks ago, we were told that the x-ray looked normal. However, Bailey's internist was going over her file today and saw an additional report from the radiologist that mentioned the tear. Apparently the report was not yet available when we were in the ER. Ugh!
I agree that we need to investigate all of our options. The orthopedic surgeon is a friend of a friend so we're hoping she will be able to look at Bailey's case "off the record" to advise us on next steps and to avoid unnecessary appointments. I need to have the needle aspirate done for my own peace of mind (although HS is sometimes hard to diagnose from an aspirate). It's kind of like I'm re-living the whole past year all over again.
Unfortunately over the past year, my vocabulary has expanded in some unexpected ways. Nadir refers to a low point. In chemotherapy, it is the day in which the blood cells are typically at their lowest. It is explained better here. We always rejoice when Bailey makes it past nadir day without getting sick!
Oh you are so lucky for your orthopedic contact! Good job.
I can't blame you for feeling deja vu all over again. I'm sorry. You are holding strong with a great attitude though, that makes such a difference.
Ahhhhh thank you for the explanation of nadir day. Geez I thought it was some new holiday I should know about. NOT! Appreciate the link.
Update on Bailey. Bailey has been doing great! She is on Rimadyl and one Gabapentin before bed along with Cosequin which she has taken for years. She has been hopping around normally and sleeping through the night (We also had to put her on Apoquel because she was very, very itchy. The vet thinks she has developed an environmental allergy. Apoquel worked like a charm. After a few hard freezes, we're hoping to discontinue the Apoquel.)
Bailey had a consult yesterday with her internist and orthopedic surgeon. We were prepared to do a needle aspirate of the effusion in her stifle joint but it was determined to be unnecessary given how well she has been doing. Both doctors physically examined her leg. The internist was unable to get any sort of pain response from Bailey when palpating her leg. However, the surgeon was able to get a slight response (she is a little rougher). They both agreed that Bailey is doing well and that we should continue doing what we're doing and take a conservative approach to her treatment. They mentioned that, in some cases especially in small dogs (though Bailey is 31 pounds), the cruciate can begin to stabilize itself. They think that is what is happening with Bailey. They said that her frequent, short walks have probably aided in the healing process. They did not pull rehab in on the consult. The internist said that rehab would not use a laser on Bailey because she has cancer (I'm not sure if anyone on here has had a different experience? I have not researched it yet.)
So, the plan is to slowly scale back her pain meds and see what happens. We will stop the Gabapentin right away and continue the Rimadyl until early January when Bailey has her next chemo appointment. And, of course, we will continue to keep her activity low and not allow her to jump or do stairs or get so excited about a critter that she hurts herself (which is what we think happened back in October). I'm still concerned that the effusion in the stifle joint is the histiocytic sarcoma returned but the doctors are fairly certain that that would be exceptionally rare. They compared the x-rays of her now amputated leg to the x-rays of her remaining leg and do not think that they look like the same issue. So, we wait and try to take it one day at a time.
22 February 2013
WOW!!! Just catching up on the beautiful Baileu! What an ordeal!
You are such a powerful advocate for your Bailey! Good job on leaving no stone unturned! So glad you are seeing improvement. Such a relief!
Keep us updated. Your doing such a good job!
Sally and Alumni Happy Hannah and Merry Myrtle and Frankie!
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!
Wow you've got some great vets on your team! That's such great news, we are over the moon that things are going so well. And it's because YOU are managing her activity soooo well, kudos to you!
They said that her frequent, short walks have probably aided in the healing process.
Yes! Yes! Yes! Good job, you rock star!
The internist said that rehab would not use a laser on Bailey because she has cancer (I’m not sure if anyone on here has had a different experience? I have not researched it yet.)
There is mixed information about whether or not to use laser therapy on pets with cancer out of concern that it can stimulate new cancer cells. Few studies have been done on the effects but most rehab therapists we've talked to take a cautionary approach depending on the type of cancer the animal was diagnosed with.
They compared the x-rays of her now amputated leg to the x-rays of her remaining leg and do not think that they look like the same issue. So, we wait and try to take it one day at a time.
Hang onto that x-ray of her amputated leg, it's gold! When Wyatt Ray was having issues with his remaining rear leg, his orthopedic vet commented on how she wished she could compare his leg with his missing back one. An x-ray is the next best thing.
Keep up the great work and give Bailey a big old smooch from us!