Thanks for checking in Sally and Rene, very much looking forward to listening to the talk with Dr. Grubb - thank you for thinking of us! 

As for the incision infection, no concerns there - when we went in to have Dr. C take a look at his back leg limp he mentioned the incision is healing very well. He has barely even had any bruising. 

Yesterday was another day of ups and downs... he is sleeping a ton right now, I'm not sure I'd call it "lethargic" as when he wakes up he is alert and doesn't seem as heavily medicated as he was on the 600mg gaba dosage, so I think we've made the right call to reduce the gaba during the day. However, his is still barely wanting to get up and move around. I'm having to bring his food and water directly to him and he won't stand up to eat, will just eat lying down. I'm adding lots of liquid to his meals because he's not too keen on plain water right now.

Before bed we felt like he was possibly showing some more pain signals after a full 24hrs of only 300mg every 8 hours, so we decided to give him another 300mg for his evening dose in hopes he'd be comfortable throughout the night. He made his way into our bedroom to sleep which he hasn't done since coming home from surgery and wasn't super typical before surgery either. He was breathing pretty loudly and though not outright crying, there was an underlying drone of a slight whimper and this went on for nearly an hour before we decided to try and give him the metacam again since that was the only thing he'd been getting every night previously but hadn't had that evening. He quieted down pretty well after we did that. 

This morning he was pretty tired, didn't show any signs of wanting to get up to go outside/eat/get water. I added chicken, rice, greek yogurt, bone broth and water to his breakfast to entice him to eat (which he seemed quite eager to eat.) When I gave Dr. C an update this morning he said that Forrest seems a bit more down than typical for this stage... he's a bit concerned with his appetite - he felt that even when the dog isn't getting around so well, their appetite is usually still decent without needing enticing. He has asked us to stop the metacam until his appetite improves and wants us to try the methocarbamol, so I'm going to pick that up today. He is still drooling a bit more than usual/licking his lips, and I've noticed there will be larger wet patches on his bed under his nose (which has been dripping a bit)/jowls after he has been sleeping in one position for a period of time. 

After his breakfast, we brought Forrest outside (with some prompting) and he had a big pee. We then sat outside for about 20 mins and he seemed to like the fresh air. He was starting to shake a bit (even though it's like 10 degrees celsius outside) but when we tried to take him inside from the backyard, he showed hesitation and wanted to go around the front of the house - to our surprise, his gait seemed a LOT better once he started moving (not as strong as the first few days and still favouring that back left leg, but his tail was wagging again and he was moving on his own reasonably well). Once he got to the front yard he had a big poop - seemed a little wobbly after that, laid down outside for a few minutes and we then got him inside where he is now resting in a patch of sun on the floor. 

I've read the articles about depression, but I'm starting to wonder if that is playing a big role here. He just seems so sad - no interest in his toys, doesn't want his bully chews, hit or miss if he'll seem excited/greet us when we get home, and often just looks really down. It's heartbreaking. I just want my best friend back.

Hello and Happy New Year from Forrest and family! 

A few updates to share - first and foremost, Forrest is still doing well overall. His back leg with the suspected partial cruciate injury is getting on same as before, doesn't seem to be getting any worse, so we're hopeful that with continued rest and gradual increases to exercise we can keep any further degeneration at bay. We also have his first rehab appointment (Rene, we decided to go with Boundary Bay for this as well) next Tuesday, Jan 9th. He'll go 2x/week for the first couple weeks, and after that I'm not sure the exact frequency but would imagine maybe weekly/bi-weekly. They have hydrotherapy, cold laser, therapeutic exercises, electrotherapeutic treatments, etc all available. We've also been able to reduce his gabapentin to 300mg 2x/day in addition to the methocarbamol 750mg 2x/day, so happy about that. We'll keep it consistent for another week or two and then try drawing down further.

The second big update is that Forrest had his first chemotherapy appointment yesterday! We're working with Dr. Herrera at Boundary Bay and she seems fantastic. She has recommended 4 rounds of Carboplatin with CBC recheck between the 10-14 day intervals after minimum his first 2 doses, but can discontinue those rechecks if he's not showing any concerning WBC/platelet drops. We'll also do a recheck lung xray ~3 months after his initial diagnosis, which would bring us to early-mid March. She also has sent a referral to BARC in Seattle for us and I'll be calling them today to inquire about getting Forrest into the Yale vaccine. It's low cost and she said she has a few dogs that have done it, and no side effects to note, so may as well give it a go, right? 

Little less than 24hrs post treatment and Forrest doesn't seem to have any major side effects yet - he's had 3 meals and not shown any aversion to eating. He's a bit more tired today, but he was restless throughout the night so I'm not surprised. Wondering if he was maybe a tad nauseous overnight and unable to settle as a result, but hard to say for sure since no signs of it this morning. We'll cross our fingers this continues and his CBC stays strong. 

The last update I'll share is one that is very close to my heart... prior to Forrest's initial diagnosis, his bloodwork showed moderately elevated ALP (alkphos/alkaline phosphatase) which, for anyone who has done as much research, reading, obsessing as I have, you'd likely have come across the literature that high ALP can be a poor prognostic factor for dogs with osteosarcoma. Initially I spent many hours mentally spiraling over this, searching the forums for stories of dogs that had high ALP and went on to beat the odds (didn't find much). So when speaking with Dr. Herrera yesterday, we asked about it and she explained that the thinking here is that if the ALP is high, it could mean that the bone breakdown associated with OSA is causing elevation in B-ALP (bone alkphos, different than the liver ALP). If the ALP stays high following the amputation, it could mean that there is evidence in the body of additional bone breakdown that is perpetuating the increase, i.e. bone metastasis that they cannot find because it hasn't fully come home to roost yet. This is why dogs that continue to have high ALP following amp tend to fare worse because it likely means there is more cancer in the bone that they didn't remove and disease progression would be faster. Of course, ALP is also associated with any number of liver enzyme changes and elevation can happen in aging dogs regardless of an OSA diagnosis, so it's not been confirmed as a guaranteed negative prognostic indicator. 

All that to say, we had them retest his ALP during his bloodwork pre-chemo yesterday... and Forrest's ALP has returned to completely normal levels!!!! I know we can't know for sure that this means he won't fall into the subset of dogs who fare worse because of this indicator, but in some ways (and in combination with clean lung scans, clean lymph nodes from the histology), it feels like a step in the right direction. It's a glimmer of hope, and I'm holding onto that for dear life. 

That's all for now, still just living day by day. Forrest has been more hyper the past few days and wanting to play with his toys with us which puts a big smile on my face. I can tell he is itching to get in the car and "go somewhere" (he has always associated the car with his favourite walks on the beach, hikes, etc.) Maybe we'll drive him to the beach this weekend, even just to smell the ocean air if we can't walk too far just yet. 

Hope 2024 is kind to you all, thanks as always for being on this journey with us

Kati, Jamie & Forrest 

Thanks for all the responses, lovely to hear from you three! 🙂 Forrest and I are so appreciative to have your ongoing support. 

@sally - the comment about not rotating the knee too much makes total sense to me! I had actually been doing a bit of that myself the first few days in trying to identify where the pain was coming from, and I've since stopped doing that and instead focus more on just gentle massage from whatever position he's holding his leg in comfortably. Seems to at very least relax him, if not directly help! 

@karen - We're also very excited about Forrest starting with rehab! Really the only remaining concerns I have right now for him are his back leg, as well as some possible phantom limb pain he's been showcasing since we decreased his gaba dose 4 days ago (I've reached out to our surgeon, Dr Crawford, for insight about this and whether we should return to the higher dose until it subsides). Funny you should mention Myos, we actually have had him on this for about two weeks now! Not only do I think it's helping his back leg, but he also LOVES the taste!! When he was having a poor appetite for a few days previously, it was one of the first things that really started getting back to eating and drinking normally from his bowls vs. me hand feeding him. We'll absolutely be keeping this in his daily regiment! 

@rene - thanks for the kind words!! I don't take any notes when we're with the vets, but I spend an inordinate amount of time doing my own pre-research so I think the terms and specifics stick in my head a bit better as a result. Not sure I'm fully qualified to write a blog about the ALP stuff or what is required for those, but you never know, could give a crack at it! I know it was a big mental burden for me during this process, so if it could help anyone else feel more reassured or educated then I would be happy to consolidate whatever layman's knowledge I've acquired thus far. 

Re: the phantom limb pain - we changed Forrest to 300mg gaba 2x/day vs. previously 3x/day back on Jan 1st. Since then, we've observed a few times per day he will let out a little yelp and get up from resting quite quickly, or absent the yelp but still jump up quickly with ears pushed back. The last two nights since his first chemo dose he also has been quite restless, wandering from room to room and seemingly unable to sleep comfortably for long periods. It's quite disruptive to both me and him, clearly! Outside of these episodes though he seems quite comfortable and doesn't show any signs of localized pain when palpating over his body, incision, back legs, spine, etc. As mentioned, I sent an email to Dr. C this morning to get his advice, but do you think it would be prudent to return him to 300mg 3x/day since he wasn't showing the phantom pain at all on that dose? 

Pics from the beach to come this weekend for sure!

Hello Tripawds Family! Hope everyone is doing well. Wanted to let you all know that Forrest is doing great, detailed updates below.

Rehab: He started rehab on Jan 9th and is going in for his third session later today (was supposed to have two this week, but we got a big snow storm this past Wednesday and had to cancel as the roads were treacherous). In the sessions they are using therapeutic ultrasound, cold laser therapy, and the water treadmill. I asked about exercises for us to do at home but they didn't give us a whole lot... basically just getting him to go from sit to stand repeatedly?? To be honest, I'm not sure how much benefit we're going to get out of this, but we'll keep at it as we bought a 10 pack. Not cheap!! Vancouver/BC is just such a dead zone for good rehab facilities, seems almost no vets are CCRP/CCRT accredited which is a real shame. That said, the Myos supplement I think is helping a LOT - he really isn't showing much sign of pain in that back leg at all now, and one of the surgeons took another look during his first rehab appt and felt the cruciate was quite stable. 

Chemo: Forrest has done remarkably well with chemo - no nausea, GI upset and his WBC stayed within range on his first CBC. His platelets dropped to about 94,000 u/L (normal is 150,000 - <60,000 is cause for concern with increased risk of hemorrhage). He did have a small mysterious bruise appear on his abdomen shortly after the bloodwork which panicked me a bit given the low platelets, but it was really just the one and seemed to be somewhat trauma induced (had a small scabby area). We discussed with his oncologist and decided to employ a 'wait and see' approach, which proved fruitful and it healed up within 48 hours and no further bruising. Seems to be coincidental. We did opt to get his CBC bloodwork rechecked with his primary vet because it's way closer for us, but I sincerely regret that decision. I was VERY firm with them when I booked the appointment that our oncologist said we could only get the bloodwork completed by our vet if they were highly confident they could a) get us the results within 24 hours, and b) properly interpret the results and advise action as needed. They said they could do that no problem, and then when we got to the appt they said they wanted to send the bloodwork out to the pathologist to review instead of doing it on site and we likely wouldn't get it back for 48 hours as a result?! I was FURIOUS because it's extremely time sensitive if the WBC count showed signs of blood sepsis/infection. I pushed them to review onsite same day but I ended up having to send the result to Boundary Bay for an urgent review since they couldn't tell us much about the low platelets and what to watch for!! Will NOT be doing anything else with them related to his cancer care, and quite frankly might be looking for a new primary vet (this isn't the only time they've caused issues for us in his healthcare). 

Phantom Pain : We got confirmation from his surgical team that, though it is very rare, they believe Forrest is indeed suffering from phantom pain complex. They discussed a recent retrospective that suggested 20-25% of dogs experience some level of phantom pain post amp, and the more extensive cases of this (such as Forrest's) are best treated by slightly higher and consistent gabapentin dosages for 2-3 months, followed by a weaning period. We had some tough days figuring out the best cadence/dosage, but we've landed on 300mg 5x/day (5:30am, 10:30 am, 1:30pm, 7pm, and 9pm) - a bit random, but it seems to be minimizing it to maybe 3 episodes per day and FAR less anxiety in the evenings which is helping all of us sleep better!

What's Next: Forrest is headed across the border to BARC Seattle to receive the Yale vaccine on Jan 23rd! He will be getting thoracic xrays before treatment to ensure he is still not showing any signs of mets, so crossing our fingers for good results from that. Will keep you all in the loop. 

Other than that, he has been wanting to be a LOT more active lately so we've been taking him to our local dog park to play with his buddies in the evenings which he loves. He is running and playing with the best of them! He lies down for a break as needed, but it's truly astounding how mobile he is. No one can believe he is only 5 weeks post-op and he is so much happier getting the stimulation and socialization, which has been really great for our mental health as well. 

Here's some videos of his first time on the water treadmill - I'll post some pics/videos of him running through the snow later this weekend. 

https://imgur.c...../a/Q8v9Oid