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Caring for a Three Legged Dog or Cat

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Amputation or SRT (Stereotactic Radiotherapy)
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Forum Posts: 62
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17 February 2017
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17 February 2017 - 7:10 pm
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Our beloved black lab, Bree, was diagnosed with osteosarcoma in her front left leg near the shoulder a few weeks ago, which has clearly been heartbreaking.  She is an extremely active dog, even at 10.  She has some arthritis, but runs through pain.  She’ll even run full speed on the cancerous leg right now.

We went out to the University of Florida to explore the option of stereotactic radiotherapy (SRT, but sometimes called SRS or stereotactic radiosurgery).  It is used in human medicine for many cancers, and has been very successful in dogs for brain and other tumors that cannot be surgically removed.

It has also had good success with osteosarcoma in dogs at killing off the local tumor (90-100% tumor death).  Everything out there shows the same median survival as amputation (both of them require chemo after).  There is not much data on percent survival past the median, however (i.e., 2 year survival rates, which amputation and chemo shows at around 20%).  

The upside of the procedure is, of course, keeping the limb and accepting that similar median survival.  The downside is that there is a high risk of fracture (somewhere around 30%), a small risk (not sure the % but it’s small) of local tumor recurrence, a small risk of secondary cancer caused by the radiation (only a factor if she lives for years), and the fact that you are likely leaving some tumor cells in the body (though they can’t do much since most of the surrounding tissue is dead).

We hit a road bump as we started down the SRT road, and after having to reschedule, we decided amputation would be better since it may have a better shot at beating that year or so median survival.  Bree is a very happy dog with lots of heart, and whatever gives her the best odds at longevity is our goal.  It would be hers too.

We’ve been waiting to do the amputation since we started her on chemo at the recommendation of the oncologist as we awaited some tests.

But now we are torn.  I don’t want her to lose her leg, but the risk of fracture is a major concern for my wife.  We paid for a phone consult with a well known cancer vet (one of the authors of the Dog Cancer Survival Guide ), and he was leaning towards amputation.  Bree is very active and a pathological fracture while we are away from the house or I am out of town for work or even when I was with her (if it was a bad break) was concerning, in his mind.  By the way, the consult was well worth the expense, though he doesn’t often do phone consults.

So this is where we are at.  We had to wait to amputate due to chemo, and are at a point now where we can, but are torn.  Our local vet surgeon has expressed hesitation, since Bree is still putting weight on the leg and running and not exhibiting much pain (though we’re sure it hurts).  I think he is surprised we didn’t do SRT.

Help!  Anyone else go through this decision?  Would appreciate any advice.  SRT costs more, but we want to make this decision first irrespective of cost before we consider the financial side.  Our goal is long term survival, as I’m sure it is with most.

Blessings,

Hill family

The Rainbow Bridge



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17 February 2017 - 8:00 pm
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Hi Bree and family, welcome. You’ve clearly given this a lot of thought and consideration. I’m so glad. Bree is too!

Bree is like most animals. Incredibly stoic, they’ll avoid showing pain at all costs. It’s not until the pain is really bad that they allow themselves to show it. Most humans couldn’t cope with pain like that.

It’s great that you’re working with UF. By any chance did you talk to Dr. Boston? She has a clinical trial going on that involves limb sparing. Bree might be the perfect candidate.

SRT has worked for a number of people here. Some dogs survived close to what the typical odds are for amputation and chemo, some didn’t. Some ended up amputating anyways. These Forum Search Results mentioning Stereotactic Radiation Therapy may give you some insight. 

I’m curious what Dr. Dressler said. We love that guy. 

When it comes to longevity, try to keep in mind: dogs don’t know what days on a calendar are. They don’t track time and they aren’t obsessed with prognoses the way we are. To them, one day is one year is ten years, they simply don’t care. All they want is to feel good and for their favorite people to be happy.

I hope this helps.

It's better to hop on three legs than to limp on four.™
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Forum Posts: 62
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17 February 2017 - 8:56 pm
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I’ve searched the forums here already and read a bit on the experiences. No, we were working with Dr. Fox. They seem to have a good oncology department, but we were having some difficulty in getting info to make the best decision, I think mainly because data on SRT just isn’t widely published.

There is a trial at UPenn that has had great results, but it requires amputation followed by chemo. I’m not sure if we’ll be able to get in (I emailed a doc and they are closing it this month, they think, and finishing chemo is required along with some specific tests). I’ll look into Dr. Boston’s trial, but the only UF trial we were told about was a vaccine that we can do but have to pay for (Bree didn’t look like she would qualify, then when we started chemo it kind of took her out… it’s only $600 total, though, and if we pay we wouldn’t have to keep coming back for follow ups – we live 5 hrs away).

Yes, I’ll drive her to UPenn from Florida if needed. We love her so much.

Dr. Dressler was great! He stopped short of giving a solid definitive recommendation, but did say based on our family situation (5 young kids, wife at home with me gone, etc.) and Bree’s energy level that he would lean towards amputation. It gets rid of the “cancer burden” in the body, and we wouldn’t have to constantly worry about fracture. Worrying about a fracture is a little off my thought process personally, because you’re saying you’d amputate a limb to be sure you wouldn’t have to amputate it later. But my wife is worried a lot about having to deal with a fracture with me gone.

Again, our goal is long term survival. Bree has a lot of heart, and we belive she would do well with any option, including not removing the tumor (not an option for us, for the record), as she is still running full speed on the leg! She’ll limp later, but in the moment she pushes hard – it’s actually beautiful to watch. I do have some concern that some limited mobility on 3 legs will lesson that strong desire she has to thrive.

Any advice on our dilemma is appreciated!

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17 February 2017 - 9:13 pm
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I’m also concerned about what would limit her more:  SRT means limit activity to avoid a fracture.  Amputation means limit activity due to stress on other joints.  Which is more limiting?

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17 February 2017 - 9:21 pm
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Also, I looked up Dr. Boston online.  I don’t see any clinical trials.  The only one UF is advertising is the vaccine trial I mentioned.

Virginia




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17 February 2017 - 9:25 pm
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org9o said
I do have some concern that some limited mobility on 3 legs will lesson that strong desire she has to thrive.

  

I just wanted to quickly get you a couple of videos for you and yirur wife to watch. At least maybe after you see some of these maybe it will.lessen some of concerns you have. I know trying to make a decision is agonizing, emotionally draining and just plain rotten.

You are doing an excellent job researching all your options and trying to determine what is best for your sweet Bree! I don’t have specific insight into the STR path, as my Happy Hannah had an amputation due to osteo. I do know that we all think very highly of Dr. Dresller and his opinion would be very helpful.

I’m sorry you find yourself here vut, under the circumstances there is no better place ro be for support and understanding and lots of first hand experience should amputation be the route you need ro go!

Hugs to all!

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!

Virginia




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17 February 2017 - 9:32 pm
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Oops! I reproduced same video twice! I’ll try and be back with different ones!

Yes, as far as amputation you want to be proactive with joint supplements, fish oil, etc. The main activity you want to avoid has mostly to do with high impact jumping up and down…like catching high thrown frisbees, jumping in and out of trucks/vans, etc.

You will see lots of links on the site about building core strength, etc. Many here swear by Physical Therapy, especially in the beginning.

Okay…going to get some more videos!

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!

Virginia




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17 February 2017 - 9:53 pm
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Here’s one of my front leg tripawd Frankie (approximately 60 lbs) having no trouble playing full out with Merry Myrtle (125 lb)

Tripawd Frankie pinning quad paw Merry Myrtle:

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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17 February 2017 - 10:16 pm
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Ah, that’s great.  Thanks for the videos.  This was Bree yesterday… with bone cancer… charging up and down a hill, trying to get me to throw an 8 foot log for her to fetch.  Forgive my cheesy talking to her – she likes it.  Our other dog was with me too.  He had arthritis and is slow, but is otherwise healthy.

Anyway, I’m concerned about her being able to do this still with either SRT or amputation.  She loves hiking and chasing balls/sticks, and she really loves swimming in the ocean through the waves.

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17 February 2017 - 10:24 pm
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Here’s the follow up video:

Virginia




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17 February 2017 - 10:40 pm
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BREE IS BEAUTIFUL, ABSOLUTELY BEAUTIFUL!!! Quite majestic!!

Heck yeah, as far as amputation, Bree will be able to do everything she is doing now in that video!! She’s clearly fit and athletic!

Hopefully Jerry will.post videos of our Founder JERRY carrying big sticks and swimming in water at the beach or playing in the snow!

Such great videos! Thanks for sharing!!! 🙂

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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17 February 2017 - 10:51 pm
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Thank you.  She is an absolutely amazing creature.  She plays with my kids… so loving.  Just want to do what’s best for her now.  Thanks for the encouragement.

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18 February 2017 - 7:11 am
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When Nellie was first diagnosed, we were hopeful we could do SRS- there is a great cyberknife center in Malvern nearby. Unfortunately there was too much bone loss, and were told we’d almost certainly get a fracture- so it wasn’t an opton. The radiosurgery makes the bone more brittle. I’d talk to the radiologist or your primary onco vet to see how high they think the risk of subsequent fracture would be.

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18 February 2017 - 7:33 am
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The UF oncologist said she’d be lower risk cause of where the tumor had grown on the outside of the bone.  Dr. Dressler thought, however, that her being a very active dog would increase the risk.  The radiation damages even the good bone.

My wife is very concerned about a fracture if we do SRT, even at a low risk.  She is also concerned that we will have to alter her lifestyle to prevent fracture.  Bree has always been part of the family.  She sleeps in the kids room (we bought a 4 bedroom house and it turns out we only needed 2, as my oldest 4 kids want to sleep in the same room… the youngest is still in a crib) and sometimes even in their beds.  With SRT, my wife is concerned we would have to protect Bree from the kids and from activity to keep her from a fracture, which would significantly alter Bree’s lifestyle.  Dr. Dressler commented that with amputation, you don’t have this guillotine constantly hanging over your head.

But…

4 legs is nice.[Image Can Not Be Found]

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18 February 2017 - 8:22 am
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Can’t figure out how to attach pics right now, so here:

https://drive.g…..p=drivesdk

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