Caring for a Three Legged Dog or Cat
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csmpez said:
Just wondering but has there been a median and average cost analysis done associated with amputation, chemo, etc? Also, any cost information on metronomics or anti-angiogenesis therapy?
Scott, Charlotte & Pez
Poor Pez. We remember those days of carrying 75 pounds up and down stairs . . . We hope you have an answer soon.
Meanwhile, as far as a cost analysis. Well, we did a very informal one of my own experience a while back:
These are just my figures, and they don't include IV chemotherapy, or the metronomic therapy I did later on.
Here is an updated report that shows the year 2008, which shows the increase in vet bills again. That's because I started metronomic therapy, once my lung mets started. I'm sorry that I don't have it all broken out by category, but hey, I am a dog after all!
Generally though, costs all depend on where you live and what kind of providers you see. If youre lucky enough to live near a teaching hospital, you'll see a significant savings. Where are you located?
In the coming weeks we will also be conducting another survey that will address the issue of what people paid. I know that doesn't help you now, but it might for later on. Stay tuned.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Well we're in the heart of Annapolis, the capital of Maryland so I'm sure it's going to be expensive. The place we're going is http://www.atla.....ntmed.com/ also know as http://www.cvss...../index.php.
Scott, Charlotte & Pez
We just got back from our appointment at the surgery center (long day) with the oncologist. The oncologist and three surgeons confirmed that PEZ has a fracture in the right leg, specifically in the head of the humerus where the bone cancer is located and the only course of action for us is to amputate the leg. They also took samples of PEZ's bone to determine if the cancer is Osteosarcoma (OSA) and not some other form of less aggressive sarcoma. However, pretty much all of the surgeons (including the oncologist) are certain it's OSA, which is the most aggressive form of bone cancer and unfortunately the most common, but they're not 100%. They also are doing a complete blood work up (CBC) and took digital x-rays of the chest and leg. The lungs are completely clear (no signs of mets). After having the leg removed, PEZ will require chemo therapy (but the oncologist said it's not always necessary). The oncologist was very objective and we liked her. I asked her about the other form of chemo - metronomics therapy (pill form/lower dose on a daily basis), she was not familiar with that particular chemo therapy (pill form). If anyone here has a reference for this, please post it so I can relay it to the oncologist. Also, she indicated anti-angiogenesis is somewhat in the future and is currently being tested, but not available to us. I will provide an update tomorrow as we have another appointment with a surgeon in reference to the amputation procedure. I'll tell ya, this is heavy on your heart.
Oh and I forgot to mention, amputation at this facility ranges from $2500 - $3500.
Scott, Charlotte & PEZ
Wow Pez. Overall that is all really promising, isn't it? Now you are just like most of us in the OSA boat - rather than the negative judgement bestowed by that other vet. I am relieved.
Often (probably most of the time from what I have heard and read) vets diagnose OSA from the x-ray and don't confirm with a biopsy until they send the offending leg to the pathology lab.
Most of us use the terms "metronomics " and "anti-angiogenesis" as equivalent, although the first refers to the timing and the second to what it tries to achieve. But maybe there is another distinction (Jake's mum can probably clarify since she works in this field). And some people opt to use that treatment early, usually if they decide to skip traditional high-dose chemo. There is lots of information on this website. I just saw a short and nice description of metronomics on a 'soft tissue sarcoma" website I posted in response to Breeze earlier today. Did you see Polo's post this weekend? He has been using a form of metronomics (low-dose chemo) instead of regular chemo and is doing well.
Your estimated costs are like mine. I am amazed to see how much less most of the tripawds paid - did you see Jerry's informative post today on this topic? (My specialist clinic was bought by an American company called Brightheart and apparently their costs went up steeply when it changed owners, which was before our OSA experience.)
So, it sounds as though they think that Pez would handle 3-legged life okay despite her arthritis. Is that right? (If so, YIPPEE!)
csmpez said ...
metronomics therapy ... If anyone here has a reference for this, please post it.
It's hard to believe the veterinary oncologist was not familiar with metronomics . Jerry consolidated links in one post to all his information about metronomic therapy for osteosarcoma metastasis. Some of the original posts may have links to more clinical information, I forget. Hope this helps.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Pez and Family
I looked into metronomics a lot around Aug to October so you will find a few good long threads from that era. Just type metronomics into the search and make sure to click "all forums".
I can probably dig up more references, and maybe some academic ones, but unfortunately not tonight. Because we had no oncologist in town, Maximutt helped get us in touch with an oncologist who specializes in this and prescribed Tazzie's pills. Toto sent me an abstract from a scientific paper showing better results for metronomics than for regular chemo for hemangiosarcoma dogs, but that is different, and more aggressive than OSA. But if your vet knew what anti-angiogenesis therapy was, she (or he) was talking about the same thing.
Maybe just focus on the amputation issue now. It is hard to deal with it all at once and you don't need to. I hope things go well this week, or as well as they can in the situation in which we find ourselves.
I'm sure you and Pez had a really long and stressful day. The news is encouraging, but pretty expensive - Yikes! Paws are crossed for you as you await the final test results and solidify a plan. Kick back and take a break and give the beautiful Pez a scratch behind the ears and a pittie hug.
Shanna & Spirit Trouble ~ Trouble gained her wings 3/16/2011, a 27 1/2 month cancer survivor, tail wagging. RIP sweetheart, you are my heart and soul. Run free at Rainbow Bridge.
The November Five - Spirits Max, Cherry, Tika, Trouble & Nova. 11/2008 - 3/2013 An era ends as Queen Nova crossed the Bridge.
Good luck with your hearts and heads over the next few days as you figure out what is best for Pez. I'm sure your love for Pez will guide you. These are tough decisions to make, and you know your dog better than anyone. I first learned about metronomics
from this site, and read all I could find about it. I'm not sure how much our vet knew about metronomic therapy, but the oncologist he consults with knew about it and said in Holly's case it would be good as an alternative to chemo if she doesn't tolerate chemo well (she just had her first chemo treatment today). She'd also like to pursue it as additional treatment after chemo if Holly does tolerate chemo well. I agree with the advice on your thread - keep asking questions until you're comfortable with the information you have. I found it helps to keep a notebook with my questions and the dr's answers - otherwise I found I was forgetting some when I was at the vet's and remembering them when I got home! We'll keep you in our hearts... big hugs to Pez!
Holly and Holly's mom
Holly joined the world of tripawds on 12/29/2009. She has a big little sister, Zuzu, who idolizes Holly and tries to make all of her toys into tripawds in Holly's honor. And she's enjoying life one hop at a time!
http://anyemery.....ipawds.com
Thanks for all the information. The oncologist was familiar with metronomics , but not the pill form of metronomics . I'll review the references and provide the oncologist with more information. This is a wonderful site and we greatly appreciate all your advise, assistance and kind words for Pez as we lay out her future treatment. Thanks again!
Scott, Charlotte & Pez
Pez and Family,
I've been reading your story—sounds like you’re finally getting good advice. I too have a soft spot for Pit’s. I had “Cassie the Staffie” years ago, who I loved very much—awesome dogs. Polo is a 10-year old Golden Retriever with osteosarcoma, Tripawd 29 Sep 2009. I shared all your concerns and I was scared as hell to amputate his leg (front left) because he’s over 100 lbs, active, etc… Then I found this site while researching and watched a video of Tazziedog, the 185 lbs Mastiff and knew that Polo could do it too (He’s the Big Dog). Many fine folks and dogs on this site!! Upon diagnoses, with biopsy confirmation, our doctor recommended amputation as soon as possible, gave us some time references and started immediately describing treatment options, one of which was Melphalan, brand name Alkeran, a low dose chemo, 2mg pills x 2, every other day (same dose but every day for the first week). It appealed to me because it has few to no side effects and the Doc had treated several other dogs for up to 18 months with excellent quality of life. Polo is almost 4-months post-op, doing great—no side effects.
Before Cancer, Polo was becoming stiff-legged and having trouble getting up after lying down for a while so we put him on a diet (was 123 lbs, lost 20 since last Jan), and started giving him a “veterinary strength” hip and joint supplement with Glucosamine and Chondroitin—you may already use that for Pez’s ACL and Arthritis. I noticed improvement after a few weeks, and he gets it every day, according to the package. Now-days he does everything he used to do like play tug of war with his little brothers (Rottie/G-Shepherd mix and Schnoodle), guard the house, protect his mom, take walks, everything he loves to do (except now he pees like a girl). I don’t hold him back—he can walk up to half a mile at a time, go up and down the stairs, play catch, etc. He gets pooped quicker, but otherwise normal stuff. The doc checks his blood cells monthly—so far so good.
Our surgery costs were lower than I’ve read—our economy is relative to our community I reckon (Fort Walton Beach/Shalimar Florida). Treatment adds up, but it’s amazing what we buy that we don’t need. Overall this situation sucks because we know what is to come, but we have found a lot of joy and a new appreciation for all our dogs. With treatment and luck, Polo will live his life pretty close to the natural order of things. It’s worth it. Good luck—best wishes. Polo and Mike.
Polo Jones, Golden Retriever, Shalimar FL
Sorry I haven't been around lately, but I'm even sorrier I've missed catching up on your story! Have you looked around at other locations to do the amputation? You don't have to have the surgery at the same place that you get further treatments. Our oncologist's office was going to charge $3000 (minimum) for the amputation, but our regular vet found a hospital that did it for $1300. Just make sure that the vet you choose has PLENTY of experience with amputations. Good luck!
<3 Laura and Jack
We spoke with Dr. Peterson (oncologist) yesterday, she did a complete blood work up, digital x-rays and cytology on Pez. The results on the blood work, everything looked good except the liver enzymes we a little elevated. She said it could be the Proxicam that is causing that. Results on the cytology - Pez has cancer of a sarcoma nature, but they could not define definitively as Osteosarcoma. The Digital X-rays confirmed a fracture but in a different location then what was previously shown to us on a lateral view of film from our family vet's office. The fracture location is in the head of the right humerus. The chest (lungs) look good, no signs of mets. We are going to talk again with the oncologist today to maybe set up an appointment with the orthopedic surgeon. The oncologist said it's a "no brainer" to her, PEZ needs the leg gone. I just wish they could set the bone, stabilize it and everything will be fine. We just hate the idea of taking the baby's leg. My wife feels horrible and if we take her leg, she'll feel like a bad mommy. 
Also, I find out that we could have been doing a metronomic protocol at timed intervals and/or bi-sphosphonates, which are used to treat osteoporosis to decrease the risk of fractures. None of this was ever brought up to us, which is a shame. Thank all of you for this very informative website, your support and your own personal experiences of what worked for your situation. Thank you.
Scott, Charlotte & PEZ
Pez and family
I think almost everyone here knows what you mean about you wish you could fix the leg and not amputate. But unfortunately we all know that is not an option, at least not once a fracture has happened. You have already had a few months since the first diagnosis. Maybe bisphosphonates would have delayed a fracture but they wouldn't work forever and you might not have gotten any more time from them.
Anyway, on to the present. It is natural to feel horrible about the idea of deliberately having your dog's leg taken off. It took a while but once Tazzie recovered from surgery and was his old (or rather youthful) happy self, life on three legs was Great!!
How is Pez doing? I assume she must be in a lot of pain right now and that amputation is the only way to stop that pain. Do you think you will go ahead with the amp and when?
What liver enzyme is high? Are they doing any other scans, e.g., ultrasound of the liver?
We're 99.99% sure we are going through with the amputation since that's what everyone is telling us. PEZ is doing great, no problems eating, sleeping, going to the bathroom, nothing. She's an extremely stoic dog and shows no signs of pain other then lifting the leg up when walking around. Right now PEZ and Mommy are sleeping:
click on thumbnail to enlarge image: [Image Can Not Be Found]
PEZ lets me pick her up, but she gets frustrated with me as she wants to do it herself (go up the steps on the front porch) or jump into the SUV. It's like holding a train back.
As for the enzymes, they didn't tell us which liver enzymes were high. Are there any particular ones we need to worry about? No other scans are currently scheduled at this time.
We will most likely go with the amputation next week and we will have a call this afternoon with the oncologist who has been really great to deal with.
Scott, Charlotte & PEZ
<PEZ's webshots gallery
Some of us just get copies of bloodwork when they are done. The receptionist is happy to copy them and the vets don't seem to mind. There might be things you want to follow closely from now throughout Pez's treatment. One of the important liver enzymes include Alk Phos, but I don't know enough to discuss these things. That would have to involve a vet.
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