Caring for a Three Legged Dog or Cat
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Our 4-year-old mixed breed dog was diagnosed via punch bone biopsy with osteosarcoma in her back leg after about a month and a half of limping and other tests/x-rays. It's incredibly sad but right now we're just trying to figure out how to treat it to give her the most quality time we can. The x-ray of her lungs came back clean, and she's doing well with basic gabapentin and carprofen (even trying to put weight on her injured leg).
She is scheduled for amputation surgery this Tuesday, Jan 28 which, to be honest, we asked for because our research online said that is the next treatment step with chemo after that (our vet has not been particularly communicative about whether there are other options and did not offer any).
But we did a phone consult with a veterinary oncologist in our area who said we should hold off on jumping to amputation if she's not in a lot of pain and doing ok with gabapentin, and start chemo, her2 vaccine , and immunotherapy instead, with amputation as a future escalation path if needed if the bone degrades and she is in pain. We're trying to get a second opinion somewhere to figure out what to do. I don't want to delay amputation (even if we start chemo immediately) if that means the cancer will spread more quickly. But if chemo will slow the spread and shes not in a lot of pain I'm not sure what to do.
Does anyone here have experience with this or can recommend any online oncology consults?
Hi Jon and pup, welcome. What is your girl's name? It sounds like she is otherwise healthy and a good candidate?
It's good you went for a consult with the oncologist. Sounds like your vet isn't up on cancer therapy, which is fine. Many aren't and that's why specialists exist. I do like that you are getting a second opinion from the other oncologist, and here's why:
The recommendations for the immunotherapy treatment is not surprising as these therapies have shown promise when it comes to osteosarcoma. You can read more about them here.
Some vaccines do require the patient to hold off on amputation so they can take a tumor sample. Some do not require waiting.
The problem I have with waiting, and one that I'm almost certain most veterinary professionals will mention (especially pain management experts), is that osteosarcoma is an extremely painful condition. The most painful there is in humans or dogs. So, waiting longer than necessary subjects the dog to more pain in the long run, since bone pain is difficult if not impossible to manage with any pain meds. There is also the risk of fracture in a dog's affected leg. A sudden fracture is horrific, and something nobody wants to go through.
If you decide to go that route, I would be certain that the oncologist is well-versed in the latest pain management protocols so that you have a plan ready for the inevitable escalation of tumor pain. Animals are masters at hiding pain and by the time it shows it's really horrific pain.
Now I'm wondering if this is the newest recommended osteosarcoma protocol by the Veterinary Cancer Society. It may very well be and I just don't know it yet, since the immunotherapy vaccines are relatively new. I would want to know from both oncologists:
- where are the studies and data that show this (i.e., holding off on amputation until pain breaks through) is an effective protocol to follow?
- what were the outcomes of patients this vet has treated with this protocol?
- where is the data showing the timeline for bone degradation when a dog is using the protocol?
- how many clients end up amputating within a few months of beginning the immunotherapy?
- how many clients have endured pathological fractures while a dog was on immunotherapy and how many amputations were made under duress?
- finally, what is the cost comparison between the recommended therapy versus amputation and chemo or amputation alone?
We were told once by a vet oncologist that treating pet cancer is like throwing spaghetti on the wall to see if it's cooked. If it sticks, you know you're on the right track. If not, you try something else. The same vet told us that osteosarcoma is still a very tough disease to treat and many vets rely on their own patient experiences to determine what is successful, treatments that don't necessarily go by the book. Some have seen success with clients using protocols that aren't well-documented, so you never know.
I hope this isn't too much info for you guys. I'm totally curious about this recommendation so please keep us posted.
Oh and as for consults, the creme de la creme is Colorado State University's Flint Animal Cancer Center Consulting Service. They are one of the best in the world and can help with clarification.
Our dog's name is Nori. She is otherwise healthy (though they said she had some early/mild hip dysplasia and arthritis in an x-ray but hasn't shown any signs yet). She's pretty lean and eating/drinking/doing everything else normally - she has a lot of energy despite it all.
I filled out the form for Colorado State - thank you for pointing us in that direction and for the detailed followup questions we can ask. We're trying to find someone who can give us a quick consult on this, since the surgery is scheduled for Tuesday and our only other option would be to delay it so we can get another consult. I think my biggest fear is if we decide to delay surgery (even if we start chemo/immunotherapy immediately) - will that delay allow the cancer to continue spreading and meaningfully affect her outcome...
Just as an update, my wife and I discussed it and we've decided to start electrochemotherapy (I think w/ cisplatin) and immunotherapy w/ HER2 with this oncologist on Tuesday, and to postpone amputation. Our dog is not in severe pain, and the oncologist made a strong and convincing case for doing it in this order. In the mean time, we're going to see if we can get a phone consult with another oncologist just to get a second opinion on this treatment plan.
We actually did pass along the questions you recommended, and the oncologist sent us a bunch of research studies to look through but also basically said that he's not saying not to amputate, he's just saying there's a lot of major benefits to starting this kind of treatment as soon as possible. Amputation is still his primary recommendation for controlling bone pain if it progresses and that we will need to be very careful about having too much activity for risk of fracturing, but that he is concerned about the pressure immediate amputation will put on her remaining legs given the hip dysplasia diagnosis. He also said her x-ray radiology report said that she has proliferative osteosarcoma but that it did not mention osteolytic lesions, and so he expects slower progression in terms of bone degradation with that diagnosis.
So he doesn't want us to jump to amputation first if she's not yet in a lot of pain at the moment, until we've begun oncology treatment.
Hi Jon and aNora. I've been following along on your posts and the replies, but didn't really have any constructive insight to offer beyond what Jerry has shared. Actually, her I sought was far and above what I could add.
I can say at this point however, you have done your research, you've gotten professional opinions, you understand the options as best any of us can on this journey and you are plotting a path forward. There has to be a sense of relief getting to this point. Your Onco seems well versed in why he's suggesting the approach you are taking knowing amputation can still be on the table, just not yet.
We all learn from each other and we shall be following Nora's journey and adding her experience into our " Tripawd tool box of knowledge".
Please stay connected and keep us posted. We will certainly be cheering for sweet Nora. She is clearly very loved and so lucky to have such caring humans committed to her well-being♥️
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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