Storm came home yesterday. She had been away exactly a week , Iwas so excited about bringing her home, until the moment I started the car engine to go home. Then it hit me, it was just us, no Vets , no nurses just me and Storm. What if her staples ripped? Would I know if how she was feeling was normal or if she needed the vet? What if she could not manage the stairs to our flat? Mild panic set it.
As I drove away I went at a snails pace, what if she could not balance in the car? Then when she laid down in the back of my estate car i started to worry if she was OK because i could not see her. After a couple of miles i settled down.
Thursday, 10 January 2008
Monday, 7 January 2008
Amputation
Storm had her front left leg amputated on Friday 4th Jan 08. I felt sick all morning waiting for the phone call from the vets. 12.03pm i got the call all had gone well and she was fine.
I was told i could visit the following day.
I was so scared of going to see her. I knew i would love her no matter what she looked like, but i just could not imagine my Storm with only 3 legs. I found myself looking at photos of her but covering her leg with my thumb to see what she would look like.
After a very long night and even longer morning i set off to see her.
When i saw the nurse walk her around the corner, i was just so very very proud of her. Plodding towards me wagging her tail. I hugged.
I thought it was going to be such a shock seeing her, but it was not. She did not look horrific. She just looked like storm. She looked strange from certain angles, but from others you would not think she was any different.
From the second i looked at her i knew i had made the right decision for her.
Today was my 3rd visit to her since her operation. Her recovery is amazing, she is full of life. Walks as though she has always had just 3 legs. Her nature is just as loving.
For all the years i have moaned at her for pulling on the lead. Today i nearly cried with joy as i walked her and my arm was almost pulled off.
We still have the chemo to cope with so we are not clear of the woods yet, but i have not had a second of regert and i honestly say neither has storm. For anyone in the dreadful situation that i was in. Do not be frightened of what your dog will look like, or how your dog will adapt.
This course of action is not the right one for everyone, but i am so glad it was for us.
If i only get another 6 months with storm as a happy and mobile dog then it would have been worth every penny.
I was told i could visit the following day.
I was so scared of going to see her. I knew i would love her no matter what she looked like, but i just could not imagine my Storm with only 3 legs. I found myself looking at photos of her but covering her leg with my thumb to see what she would look like.
After a very long night and even longer morning i set off to see her.
When i saw the nurse walk her around the corner, i was just so very very proud of her. Plodding towards me wagging her tail. I hugged.
I thought it was going to be such a shock seeing her, but it was not. She did not look horrific. She just looked like storm. She looked strange from certain angles, but from others you would not think she was any different.
From the second i looked at her i knew i had made the right decision for her.
Today was my 3rd visit to her since her operation. Her recovery is amazing, she is full of life. Walks as though she has always had just 3 legs. Her nature is just as loving.
For all the years i have moaned at her for pulling on the lead. Today i nearly cried with joy as i walked her and my arm was almost pulled off.
We still have the chemo to cope with so we are not clear of the woods yet, but i have not had a second of regert and i honestly say neither has storm. For anyone in the dreadful situation that i was in. Do not be frightened of what your dog will look like, or how your dog will adapt.
This course of action is not the right one for everyone, but i am so glad it was for us.
If i only get another 6 months with storm as a happy and mobile dog then it would have been worth every penny.
Sunday, 6 January 2008
Making the decision
In the past i have had to make the heart breaking decision to have pets put to sleep. I some how manage to find the strength to make the best decision for my dog, not a selfish decision for myself.
This time though it was so difficult, my Mum died recently of cancer so it is fresh in my mind the pain cancer can cause. I did not want storm to suffer. I did not want to lose her, but then i did not want to put her through a treatment that would only cause her more pain and distress.
I spent hours weighing up the options, and i had decided that i would choose palative care and when that was not working, i would have my beautiful Storm peacefully put to sleep. With a heavy heart i went back to the Vets.
When i went back into the consulting room, i had another long talk with the vet who told me they found no trace of secondary cancer ( this did not mean there was not any). I asked a lot more questions about amputation, chemo, outcome etc. I was offered the opotunity to speak to the Oncologist. We spent much time talking.
I thought about Storm, her love for life, her love for people...... in fact her love for everything.
I did consider the cost £5000 approx, i considered her chances of survival and the truma of the treatment for her. The cost although i can not really afford it did not matter, all the other things i took an honest look at.
There was only one decision as far as i was concerned... Amputation.
This time though it was so difficult, my Mum died recently of cancer so it is fresh in my mind the pain cancer can cause. I did not want storm to suffer. I did not want to lose her, but then i did not want to put her through a treatment that would only cause her more pain and distress.
I spent hours weighing up the options, and i had decided that i would choose palative care and when that was not working, i would have my beautiful Storm peacefully put to sleep. With a heavy heart i went back to the Vets.
When i went back into the consulting room, i had another long talk with the vet who told me they found no trace of secondary cancer ( this did not mean there was not any). I asked a lot more questions about amputation, chemo, outcome etc. I was offered the opotunity to speak to the Oncologist. We spent much time talking.
I thought about Storm, her love for life, her love for people...... in fact her love for everything.
I did consider the cost £5000 approx, i considered her chances of survival and the truma of the treatment for her. The cost although i can not really afford it did not matter, all the other things i took an honest look at.
There was only one decision as far as i was concerned... Amputation.
Options / Treatments
TREATMENT OF OSTEOSARCOMA INVOLVES TWO ASPECTS:TREATING THE PAIN CAUSED BY THE BONE TUMORAND FIGHTING THE SPREAD OF THE CANCER.
HOW DO WE TREAT THE PAIN?
Keep in mind that dogs are usually euthanized due the pain in the affected bone. Treating the pain successfully will allow a dog to live comfortably.
AMPUTATION OF THE LIMB: Removal of the affected limb resolves the pain in 100% of cases. Unfortunately, many people are reluctant to have this procedure performed due to misconceptions.
While losing a leg is very handicapping to a human (who only has two legs total), losing one leg out of four does not restrict a dog’s activity level. Running and playing are not inhibited by amputation (after the surgical recovery period is over).
While losing a limb is disfiguring to a human and has social ramifications, dogs really are not so self-conscious about their image. The dog will not feel disfigured by the surgery; it is his or her owner that will need to adjust to the new appearance of the dog.
Median survival time for dogs who do not receive chemotherapy for osteosarcoma is 4-5 months from the time of diagnosis regardless of whether or not they have amputation. Do you want your dog’s last 4-5 months to be painful or comfortable?
LIMB SPARING SURGERY: Limb-sparing techniques developed for humans have been adapted for dogs. To spare the limb (and thus avoid amputation), the tumorous bone is removed and either replaced by a bone graft from a bone bank or the remaining bone can be re-grown via a new technique called “bone transport osteogenesis.” The joint nearest the tumor is fused (ie fixed in one position and cannot be flexed or extended.)
Limb sparing cannot be done if more than 50% of the bone is involved by tumor or if neighboring muscle is involved.
Limb sparing does not work well for hind legs or tumors of the humerus (“arm” bone.)
Limb sparing works best for tumors of the distal radius (“forearm” bone).
Complications of limb sparing can include: Bone infection, implant failure, tumor recurrence, and fracture.
RADIOTHERAPY FOR PAIN CONTROL : Radiation doses can be applied to the tumor in 3 doses (the first two doses 1 week apart, the second two doses 2 weeks apart.) Improved limb function is usually evident within the first 3 weeks and typically lasts 4 months. (Our local oncologists report a range of 0-19 months.) When pain returns, radiation can be re-administered for further pain relief if deemed appropriate based on the stage of the cancer at that time. In the Los Angeles area, a course of 3 doses of radiotherapy typically costs $700-$800.)
When pain is relieved in the tumorous limb, there is an increase in activity which can in turn lead to a pathologic fracture of the bone.
Radiotherapy does not produce a helpful response in about 1/3 of patients. (Remember, amputation controls pain in 100% of cases but if amputation is simply not an option, there is a 2 out of 3 chance that radiotherapy will control the pain.)
DRUGS: Analgesic medications such as carprofen, etodolac, aspirin, butorphanol, and fentanyl patches are all available but, unfortunately, they are no match for the pain involved in what amounts to a slowly exploding bone. These medications may be palliative at some stage but generally do not provide meaningful pain relief long term.
HOW DO WE TREAT THE CANCER?
Osteosarcoma is unfortunately a fast spreading tumor. By the time the tumor is found in the limb, it is considered to have already spread. (Osteosarcoma spreads to the lung in a malignant process called “metastasis.” Prognosis is substantially worse if the tumor spread is actually visible on radiographs in the chest so if chemotherapy is being contemplated, it is important to have chest radiographs taken.
Chemotherapy is the only meaningful way to alter the course of this cancer.
Young dogs with osteosarcoma tend to have shorter survival times and more aggressive disease than older dogs with osteosarcoma.
Elevations of "Alkaline phosphatase," one of the enzymes screened on a basic blood panel, bode poorly. These dogs have approximately 50% of the survival times quoteed below for each protocol.
CISPLATIN (given IV every 3-4 weeks for 3 treatments)
The median survival time with this therapy is 400 days.
Survival at one year: 30-60% (depending on what??)
Survival at two years: 7-21%
Giving less than 3 doses does not increase survival time (ie if one can only afford one or two treatments, it is not worth the expense of therapy)
Cisplatin can be toxic to the kidneys and should not be used in animals with pre-existing kidney disease.
CARBOPLATIN (given IV every 3-4 weeks for 4 treatments)
Similar statistics to cisplatin but carboplatin is not toxic to the kidneys and can be used if the patient has pre-existing kidney disease.
Carboplatin is substantially more expensive than cisplatin.
DOXORUBICIN (given IV every 2 weeks for 5 treatments)
The median survival time is 365 days.
10% still alive at two years.
Toxic to the heart. An ultrasound examination is needed prior to using this drug as it should not be given to patients with reduced heart contracting ability.)
DOXORUBICIN AND CISPLATIN IN COMBINATION (both given IV together every 3 weeks for 4 treatments)
48% survival at one year
30% survival at two years
16% survival at three years.
WHAT EXACTLY IS “MEDIAN” SURVIVAL TIME
When a population is evaluated statistically, there are a number of ways the central tendency of the group can be evaluated. The “median” is the value at which 50% of the group falls above and 50% of the group falls below. This is a little different from the “average” of the group, though more people are familiar with this term. When one evaluates “median survival times” one is looking at a 50% chance of surviving longer than the median (and a 50% chance of surviving less than the median).
WHAT EXACTLY DOES CHEMOTHERAPY PUT MY DOG THROUGH?
Most people have an image of “the chemotherapy patient” either through experience or the media and this image typically includes lots of weakness, nausea, and hair loss. In fact, the animal experience in chemotherapy is not nearly as dramatic. After the pet has a treatment, one should expect 1-2 days of lethargy and nausea. This is often substantially palliated with medications like Zofran® (a strong antinauseal commonly used in chemotherapy patients). These side effects are worse if a combination of drugs is used but the pet is typically back to normal by the third day after treatment. Effectively, you are trading 8 days of sickness for 6-12 months of quality life. Hair loss is not a feature of animal chemotherapy.
HOW DO WE TREAT THE PAIN?
Keep in mind that dogs are usually euthanized due the pain in the affected bone. Treating the pain successfully will allow a dog to live comfortably.
AMPUTATION OF THE LIMB: Removal of the affected limb resolves the pain in 100% of cases. Unfortunately, many people are reluctant to have this procedure performed due to misconceptions.
While losing a leg is very handicapping to a human (who only has two legs total), losing one leg out of four does not restrict a dog’s activity level. Running and playing are not inhibited by amputation (after the surgical recovery period is over).
While losing a limb is disfiguring to a human and has social ramifications, dogs really are not so self-conscious about their image. The dog will not feel disfigured by the surgery; it is his or her owner that will need to adjust to the new appearance of the dog.
Median survival time for dogs who do not receive chemotherapy for osteosarcoma is 4-5 months from the time of diagnosis regardless of whether or not they have amputation. Do you want your dog’s last 4-5 months to be painful or comfortable?
LIMB SPARING SURGERY: Limb-sparing techniques developed for humans have been adapted for dogs. To spare the limb (and thus avoid amputation), the tumorous bone is removed and either replaced by a bone graft from a bone bank or the remaining bone can be re-grown via a new technique called “bone transport osteogenesis.” The joint nearest the tumor is fused (ie fixed in one position and cannot be flexed or extended.)
Limb sparing cannot be done if more than 50% of the bone is involved by tumor or if neighboring muscle is involved.
Limb sparing does not work well for hind legs or tumors of the humerus (“arm” bone.)
Limb sparing works best for tumors of the distal radius (“forearm” bone).
Complications of limb sparing can include: Bone infection, implant failure, tumor recurrence, and fracture.
RADIOTHERAPY FOR PAIN CONTROL : Radiation doses can be applied to the tumor in 3 doses (the first two doses 1 week apart, the second two doses 2 weeks apart.) Improved limb function is usually evident within the first 3 weeks and typically lasts 4 months. (Our local oncologists report a range of 0-19 months.) When pain returns, radiation can be re-administered for further pain relief if deemed appropriate based on the stage of the cancer at that time. In the Los Angeles area, a course of 3 doses of radiotherapy typically costs $700-$800.)
When pain is relieved in the tumorous limb, there is an increase in activity which can in turn lead to a pathologic fracture of the bone.
Radiotherapy does not produce a helpful response in about 1/3 of patients. (Remember, amputation controls pain in 100% of cases but if amputation is simply not an option, there is a 2 out of 3 chance that radiotherapy will control the pain.)
DRUGS: Analgesic medications such as carprofen, etodolac, aspirin, butorphanol, and fentanyl patches are all available but, unfortunately, they are no match for the pain involved in what amounts to a slowly exploding bone. These medications may be palliative at some stage but generally do not provide meaningful pain relief long term.
HOW DO WE TREAT THE CANCER?
Osteosarcoma is unfortunately a fast spreading tumor. By the time the tumor is found in the limb, it is considered to have already spread. (Osteosarcoma spreads to the lung in a malignant process called “metastasis.” Prognosis is substantially worse if the tumor spread is actually visible on radiographs in the chest so if chemotherapy is being contemplated, it is important to have chest radiographs taken.
Chemotherapy is the only meaningful way to alter the course of this cancer.
Young dogs with osteosarcoma tend to have shorter survival times and more aggressive disease than older dogs with osteosarcoma.
Elevations of "Alkaline phosphatase," one of the enzymes screened on a basic blood panel, bode poorly. These dogs have approximately 50% of the survival times quoteed below for each protocol.
CISPLATIN (given IV every 3-4 weeks for 3 treatments)
The median survival time with this therapy is 400 days.
Survival at one year: 30-60% (depending on what??)
Survival at two years: 7-21%
Giving less than 3 doses does not increase survival time (ie if one can only afford one or two treatments, it is not worth the expense of therapy)
Cisplatin can be toxic to the kidneys and should not be used in animals with pre-existing kidney disease.
CARBOPLATIN (given IV every 3-4 weeks for 4 treatments)
Similar statistics to cisplatin but carboplatin is not toxic to the kidneys and can be used if the patient has pre-existing kidney disease.
Carboplatin is substantially more expensive than cisplatin.
DOXORUBICIN (given IV every 2 weeks for 5 treatments)
The median survival time is 365 days.
10% still alive at two years.
Toxic to the heart. An ultrasound examination is needed prior to using this drug as it should not be given to patients with reduced heart contracting ability.)
DOXORUBICIN AND CISPLATIN IN COMBINATION (both given IV together every 3 weeks for 4 treatments)
48% survival at one year
30% survival at two years
16% survival at three years.
WHAT EXACTLY IS “MEDIAN” SURVIVAL TIME
When a population is evaluated statistically, there are a number of ways the central tendency of the group can be evaluated. The “median” is the value at which 50% of the group falls above and 50% of the group falls below. This is a little different from the “average” of the group, though more people are familiar with this term. When one evaluates “median survival times” one is looking at a 50% chance of surviving longer than the median (and a 50% chance of surviving less than the median).
WHAT EXACTLY DOES CHEMOTHERAPY PUT MY DOG THROUGH?
Most people have an image of “the chemotherapy patient” either through experience or the media and this image typically includes lots of weakness, nausea, and hair loss. In fact, the animal experience in chemotherapy is not nearly as dramatic. After the pet has a treatment, one should expect 1-2 days of lethargy and nausea. This is often substantially palliated with medications like Zofran® (a strong antinauseal commonly used in chemotherapy patients). These side effects are worse if a combination of drugs is used but the pet is typically back to normal by the third day after treatment. Effectively, you are trading 8 days of sickness for 6-12 months of quality life. Hair loss is not a feature of animal chemotherapy.
Osteosarcoma
WHAT IS OSTEOSARCOMA?
Osteosarcoma is by far the most common bone tumor of the dog, usually striking the leg bones of larger breeds. Osteosarcoma usually arises in middle aged or elderly dogs but can arise in a dog of any age with larger breeds tending to develop tumors at younger ages.
Osteosarcoma can develop in any bone but the limbs account for 75-85% of affected bones. Osteosarcoma of the limbs is called "appendicular osteosarcoma."
Osteosarcoma develops deep within the bone and becomes progressively more painful as it grows outward and the bone is destroyed from the inside out. The lameness goes from intermittent to constant over 1-3 months. Obvious swelling becomes evident as the tumor grows and normal bone is replaced by tumorous bone.
Tumorous bone is not as strong as normal bone and can break with minor injury. This type of broken bone is called a “pathologic fracture” and may be the finding that confirms the diagnosis of bone tumor. Pathologic fractures will not heal and there is no point in putting on casts or attempting surgical stabilization.
HOW DO WE KNOW MY DOG REALLY HAS AN OSTEOSARCOMA?
RADIOGRAPHS: One of the first steps in evaluating a persistent lameness is radiography (x-rays). Bone tumors are tender so it is usually clear what part of the limb should be radiographed. The osteosarcoma is creates some characteristic findings:
The “lytic lesion” – looks like an area of bone has been eaten away.
The “sunburst” pattern – shows as a corona effect as the tumor grows outward and pushes the more normal outer bone up and away.
A pathologic fracture may be seen through the abnormal bone.
Osteosarcoma does not cross the joint space to affect other bones comprising the joint.
In most cases, radiography is all that is needed to make the diagnosis but sometimes there are ambiguities.
BIOPSY: A tiny section of bone can be removed for laboratory analysis. This type of analysis is considered to be absolute proof of diagnosis. The procedure is associated with some pain and our local oncologists have suggested that biopsy is not needed if the radiographs show an obvious bone tumor. If there is any question about the lesion on the radiographs, a bone biopsy should provide clear results.
Sometimes a bone tumor is surrounded by an area of bone inflammation and it may be difficult to get a diagnostic sample and several samples must be taken. These samples are too small to cause a pathologic fracture.
Amputation of the affected bone is recommended for any tumor involving bone. When the malignant structure has been removed, it is submitted for biopsy and the diagnosis confirmed at that time. Biopsy before amputation is felt to simply add a painful procedure to the patient and, if possible, is reserved for tissue already amputated.
Osteosarcoma is by far the most common bone tumor of the dog, usually striking the leg bones of larger breeds. Osteosarcoma usually arises in middle aged or elderly dogs but can arise in a dog of any age with larger breeds tending to develop tumors at younger ages.
Osteosarcoma can develop in any bone but the limbs account for 75-85% of affected bones. Osteosarcoma of the limbs is called "appendicular osteosarcoma."
Osteosarcoma develops deep within the bone and becomes progressively more painful as it grows outward and the bone is destroyed from the inside out. The lameness goes from intermittent to constant over 1-3 months. Obvious swelling becomes evident as the tumor grows and normal bone is replaced by tumorous bone.
Tumorous bone is not as strong as normal bone and can break with minor injury. This type of broken bone is called a “pathologic fracture” and may be the finding that confirms the diagnosis of bone tumor. Pathologic fractures will not heal and there is no point in putting on casts or attempting surgical stabilization.
HOW DO WE KNOW MY DOG REALLY HAS AN OSTEOSARCOMA?
RADIOGRAPHS: One of the first steps in evaluating a persistent lameness is radiography (x-rays). Bone tumors are tender so it is usually clear what part of the limb should be radiographed. The osteosarcoma is creates some characteristic findings:
The “lytic lesion” – looks like an area of bone has been eaten away.
The “sunburst” pattern – shows as a corona effect as the tumor grows outward and pushes the more normal outer bone up and away.
A pathologic fracture may be seen through the abnormal bone.
Osteosarcoma does not cross the joint space to affect other bones comprising the joint.
In most cases, radiography is all that is needed to make the diagnosis but sometimes there are ambiguities.
BIOPSY: A tiny section of bone can be removed for laboratory analysis. This type of analysis is considered to be absolute proof of diagnosis. The procedure is associated with some pain and our local oncologists have suggested that biopsy is not needed if the radiographs show an obvious bone tumor. If there is any question about the lesion on the radiographs, a bone biopsy should provide clear results.
Sometimes a bone tumor is surrounded by an area of bone inflammation and it may be difficult to get a diagnostic sample and several samples must be taken. These samples are too small to cause a pathologic fracture.
Amputation of the affected bone is recommended for any tumor involving bone. When the malignant structure has been removed, it is submitted for biopsy and the diagnosis confirmed at that time. Biopsy before amputation is felt to simply add a painful procedure to the patient and, if possible, is reserved for tissue already amputated.
The Big Decision
Storm has pretty much told of the run up to the diagnosis so I wont go over old ground.
Its strange because somehow i knew Storm had a tumor, so when I was told i felt sick in my stomach but was not surprised.
The specialist we were sent to was;
Davies Veterinary Specialists
Manor Farm Business Park
Higham Gobion
Hertfordshire
England
SG5 3HR
Telephone: +44(0)1582 883950
This place is amazing, you are not rushed or made to feel stupid. The care they give pet and owner is second to none. Fee's are expensive (but then take a look at our private health care).
I spent a long time talking to a Orthopedic consultant about Storm, he was kind but honest and answered all questions that i had, which were many.
I was told Storm had Osteosarcoma a cancer that eat at the bone in her front leg. It was an agressive cancer that almost always had a secondary cancer.
I left storm there for a couple of hours to have more tests and went away to consider the options
Its strange because somehow i knew Storm had a tumor, so when I was told i felt sick in my stomach but was not surprised.
The specialist we were sent to was;
Davies Veterinary Specialists
Manor Farm Business Park
Higham Gobion
Hertfordshire
England
SG5 3HR
Telephone: +44(0)1582 883950
This place is amazing, you are not rushed or made to feel stupid. The care they give pet and owner is second to none. Fee's are expensive (but then take a look at our private health care).
I spent a long time talking to a Orthopedic consultant about Storm, he was kind but honest and answered all questions that i had, which were many.
I was told Storm had Osteosarcoma a cancer that eat at the bone in her front leg. It was an agressive cancer that almost always had a secondary cancer.
I left storm there for a couple of hours to have more tests and went away to consider the options
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