A week ago Hunter came in from the yard unable to bear weight on her right hind leg. She hopped around on her other three without much trouble and continued to eat and behave normally. Our regular vet was out of town so on 12/23/2010 she saw his associate/partner. They took an x-ray and diagnosed Hunter with a fractured femur in an osteosarcoma. After explaining the disease and the fact that the fracture would never heal, she told us that euthanasia was our only option. My husband couldn’t bear to make that decision right then and so he brought her home after they splinted her leg and Rx’d some pain meds and an NSAID (Tramadol and Metacam).
We cried and grappled with what to do next. Having worked as a vet tech in college I understood what we were facing but had a hard time accepting that euthanasia was our only option. Yes she is large. Yes she is old. But why wouldn’t she be a candidate for amputation? Thank goodness Hunter is either wired differently or has an extremely high threshold for pain because she was hopping around in her cast like all was normal. In fact the meds seems to make her feel yucky so we stopped the Metacam and reduced the Tramadol to 50mg at night only. That was all it took for her normal self to return. She was dragging us out the door for short walks, jumping up to visit with people, “running” to the window to bark at the mailman, etc. Christmas evening she woke us up with the thump, thump, thump of her tail wagging so that she could tear out the back door after some creature in the backyard. My husband grabbed her by the tail to stop her as she was peeling out so that she wouldn’t hurt herself. Tumor or not, I would bet that’s how she fractured her leg in the first place… peeling out after some creature in the yard.
I spoke with a close friend who is a vet and after receiving confirmation that I wasn’t crazy to want a second opinion we made an appointment to consult with an oncologist.
On 12/28/2010 we saw the oncologist. After reviewing her x-rays, taking a history and doing an exam he had two recommendations – amputation+chemo or euthanasia. He suggested doing chest rads and possibly an ultrasound (because she had a small mammary mass) not because it would change his recommendation but because it might give us more information to aide in our decision. No surprise there – pretty much what we expected him to say. He thought she was a good candidate for amputation and said that their board certified surgeon could meet with us that day to weigh in or we could take her elsewhere for the surgery. The tech brought in cost estimates for all of our options and we sat there for quite a while hemming and hawing, crying, etc. We decided that, largely due to finances and that the odds were that we wouldn’t be buying her much time; euthanasia was what we had to do. We decided to take her home, spend the day with her and euthanize her that evening or the next morning. We took Hunter back to my car and sat there bawling. I could see Hunter in my rearview mirror standing up in the back of the car excitedly looking out the window, tail wagging. I couldn’t take it. It didn’t feel right. But does losing a pet ever feel right? I said “I want to do the tests.” Tears streaming down our faces, we walked back into the office. The receptionist laughed but apologized “I’m sorry for laughing but every few months we have someone walk out and then come back.”
The chest x-rays were clear, they didn’t see anything abnormal during the ultrasound and bloodwork/urinalysis were fine. Additionally, ALP was normal.
The oncologist told us about an Ohio State study they are participating in “Palladia/Piroxicam/Cyclophosphamide Treatment for Dogs with Osteosarcoma”:
http://vet.osu.edu/research/palladiapiroxicamcyclophosphamide-treatment-dogs-osteosarcoma
We received info about the study, including the cost breakdown and signed the forms so that, if Hunter qualifies (basically the last step to qualify will be to ensure that her mammary mass is benign), we can participate. As of right now, I’m leaning towards not participating. I’m not even 100% sold on the Carboplatin protocol much less 8 additional months of maintenance therapy with possible side effects and more trips to the vet, x-rays, bloodwork, etc. And even though the trial pays for the Carboplatin (which we would pay for anyway if we did the standard chemo) and the Palladia, it doesn’t cover all the costs of the extra meds and tests. So, unless I am misunderstanding the paperwork, the end result is more $$$.
After the onco consult, we met with the surgeon. We really liked her as well. She did a very thorough physical exam, explained why she thought Hunter was a good candidate for the amputation and then explained the surgery and recovery. I asked her if she thought I was nuts for considering this with a 12 year old large breed dog and she said “Not at all.” She said that she didn’t know who had counseled us to put her to sleep but that there are other options and Hunter was an excellent candidate for them based on the additional tests, exams and how well she is already doing on three legs dragging around a splint that was likely doing more harm than good.
The stats that both vets quoted for median survival were 4-6 months with amputation alone and 12-14 with amputation+chemo. Both doctors were surprised that euthanasia was presented to us as our only option initially. I can see both sides – the onco and surgeon are in the business of treating cancer and cutting patients open. A general vet is looking at the bigger picture.
So we left with Hunter scheduled to return bright and early the next morning for Sx. It was a whirlwind six hours in the medical center between the cancer unit and the critical care surgical department. Lots of ups and downs.
