Diagnosis to Amputation

Sawyer, 11-12 year old, Scottish Deerhound rescue started limping in October. He lives to run and chase. A limp after a long hike isn’t too unusual. I checked him over and did not find any obvious injury. After 3 days with a continued catch in his step, we made an appointment with the vet. He was diagnosed with a likely Osteosarcoma of his front right foreleg in his ulna.  I was devastated. My husband had not accompanied us to the vet and I had to call him to pick us up because I couldn’t stop crying. I’m not even exactly sure what the vet said after the diagnosis. My husband was shocked at the diagnosis and because I rarely cry. I’m an Emergency Medicine Physician. I give bad news everyday and even keeled in crisis. You have to be. No one wants a blubbering EM doctor. But apparently none of that counted when it came to my dog. Just goes to remind me that it is always different when you are the patient or the patient’s. Family member. Also, I was 5 months pregnant and my hormones were raging.

Basically, the Dr. Wolfe said that we had a couple of options:

1. Nothing – euthanasia when he got really sick

2. Amputation

3. Chemo

4. Specialist vet (1.5 hours away in Pittsburgh)

We went home without any decision made because I did not want to make any rash choices. I fretted for 3 days, watching my otherwise happy and wonderful dawg. My husband and I agreed that #1 was not an option. We love our 3 dogs. They are our family. Although, Sawyer is “old”, you’d never know it. He still loves to chase as is his nature. Still trying to my dismay to wat the mailperson. And still king of the house and often putting the other 2 in their place.

Initially, I scheduled amputation at our vet. The night before, I got cold feet and self-referred myself to the specialist because the referral form was on-line and I  speak medical language. I canceled the amputation. The next week we went to see a specialty surgeon at PVSEC. He looked Sawyer over and discussed the various surgical options:

1. Localized bone sparing surgery to resect the tumor: he did not think that this was a good idea given the location of the tumor. He was afraid that it would effect Sawyer’s ankle and hinder him more than help

2. Amputation: Sawyer is a tall long-legged old man and the tumor was in the ulna. The ulna is the non-weight bearing bone so he thought that Sawyer could keep his leg and still be able to get around okay

3. Radiation: He suggested that we try radiation when Sawyer’s pain got worse

Basically, he did not think that surgery was a good options. I liked him. He was kind and spent a lot of time with us and discussed all the options. Then they admitted Sawyer overnight for some staging (abdominal ultrasound, CXR, lab work) and to see the dog Oncologist. Murphy, my husband, drove home and discussed all the things that we had heard. We went home and scoured the internet, reading up on the different options.

The next morning, I drove back to Pittsburgh to pick up Sawyer and meet the Oncologist, Dr. Newman. She had a differing opinion. She really thought we should amputate to take away the primary source of cancer along with chemo. The thing about Osteosracoma – 90+% metastasis at time of diagnosis with survival usually in months. So none of the options are “cureative”. Only palliative to increase his quality of life for as long as possible.  I decided that we would not amputate because his limp was barely noticeable and intermittent at the time. She explained that Chemo was well tolerated in dogs and usually no side effects. So I went with Chemo + IV Bisphosphonates (medication for Osteoperosis in humans, speculated to strength his bone) and then we’d talk about radiation down the line. She thought it was too early for radiation. Sawyer received his first dose of Chemo and Bisphosphonates then we drove the 1.5 hours home.

Sawyer was a champ. No issues with the medications. Ate fine. Played fine. The only issue was that he had a few pee accidents in the house. Or at least I think that it was him. Hard to say with 3 large dogs. Could have been Rosie the Mastiff as she is very sensitive to any changes in her environment. But who really cares about dog pee. Easily cleaned up.

For 3 months, we did Carboplatin (chemo) and Bisphosphonates. But Sawyer’s leg looked worse every month. His limp went from intermittent to constant and finally, he stood on 3-legs at all times. The tumor had grown from a barely noticeable bump to looking like someone had shoved to golf balls under his skin. The skin itself was tight and red. We were afraid that he would suffer a traumatic break when we were on a walk or the tumor would erode through the skin. So at the beginning of January, we discussed options again with Dr. Newman about his leg.

1. Radiation: Stereotactic is extremely expensive around $10k. Palliative radiation still expensive but about half the price. Would likely shrink the tumor and give him symptom relief for 3-5 months.

2. Amputation

I had dropped Sawyer off for his Chemo that morning and I was standing in Target when she called me to discuss the options. Now about 7 months pregnant and an emotional nightmare. I asked to call her back. I called Murphy and I read a bunch of things on-line again. Thank you, iPhone. And we decided that amputation would give him the longest potentially highest quality of life left. I called Dr. Newman back and told her of my decision then I bought every piece of neutral gender baby clothing on the clearance rack at Target. The surgery couldn’t happen until the next day, so I picked him up and we went home to spend his last night as a quad-legged dog with his 2 siblings and his Dad. The next morning, the 3 of us drove back to Pittsburgh and dropped him off. I was a blubbering mess and Murphy was pretty strong until they took him back and then he had a few tears.

The next day, the vet called to say that Sawyer was doing well. He had eaten and gone outside for a potty break. He would be weaned from his IV pain medication and I could pick him up in the evening. My Dad and I drove back to Pittsburgh.

I really was not prepared. The vet tech explained how well he was doing and gave me a slew of post-op instructions. So when he was brought out by another tech, I was shocked. He looked haggard and barely getting around. Again, I couldn’t contain my tears and dissolved into a weepy mess. My work colleagues probably wouldn’t recognize me if they saw me. Usually a stoic champion of flat affect and calm demeanor, I was a mess. The nice vet tech helped us to the car and helped me get him into the car since I cant lift him on my own. He’s 90lbs and I’m a petite pregnant lady. My Dad has metastatic cancer to his bones so he definitely could not lift him. It was dark and freezing rain. My Dad drove home and I sat in the back comforting and petting Sawyer. It was a long trip. Murphy had to work late so my friend Andy came over and carried him from the house to the area I had set-up for him. Andy and my Dad were a little taken aback too. The incision was much larger than I anticipated. And Sawyer seemed so frightened which is not his nature.

Murphy came home and Sawyer did pretty well getting outside to the pee. I “slept” with him downstairs. Me on the couch and Sawyer in his dog bed. Every time, he moved I woke up to make sure he wasn’t eating his stitches or having a lot of pain. So now begins our journey and his life as a tripaw….