Last week’s client came crying (justifiably) over her dog’s bone cancer (the too-common osteosarcoma, in this case). After the requisite diagnostic biopsy, her previous vet had told her there was nothing to do unless she elected in favor of amputation and chemotherapy. Unsatisfied with this ultimatum, she’d come looking for a second opinion.
This owner was miserable over the ordeal but loath to submit to amputation and chemo based on her personal biases and beliefs (more on this later this week). Nonetheless, she wanted her dog to feel better immediately. As frequently happens in these cases, she couldn’t stand to watch him suffer like this but couldn’t yet let him go.
“Righteous” was doing poorly with the pain medications (standard-dose Rimadyl) prescribed. No wonder: This was a 150-pound Rottweiler with too much fat on his frame and joint disease in full swing despite his mere six years of age. (Excess weight has a way of accelerating joint degeneration.) The painful tumor on his right hind leg (at the knee) had rendered this leg a cumbersome and excruciating burden. To make matters worse, the biopsy sites were not healing well.
In the end, this was the plan we agreed upon:
1-Emergency weight loss using Slentrol, an obesity drug indicated for rapid weight loss.
2-Booties for support and slip-protection on the three limbs he was able to use.
3-A sling for assistance and regular bouts of forced mobility (the owner was young and strong).
4-A stepped-up pain protocol to manage his evident discomfort (we added high doses of Tramadol for the present time and a Fentanyl patch every three days, to boot.
5-An immediate referral to a surgeon for amputation.
6-Culture and sensitivity of the non-healing sites for appropriate antibiotic therapy in the interim.
In short, I did nothing his own vet wouldn’t have done at this point. The only positive note I added to the pro-treatment speal was the acceptance of this client’s choice to decline chemo and still do right by Righteous. (Though I did try to convince her otherwise, as lengthier lifespans statistically result from the use of chemotherapy along with amputations.)
Now, you may think a three-legged 150 pound Rottweiler an abomination—not to mention a gravity-defying impossibility—but we had little choice. This guy was already three-legging it—with difficulty, but it nonetheless pointed to his capacity to withstand this surgical approach.
Predictably, his owner declined chemo and proceeded to opt for amputation, heartened by the fact that he’d be in much less pain, but aware that the spread of the cancer was inevitable. She’d ultimately been swayed not by me, not by the surgeon and not by Righteous’ pain, but by what she’d read on Tripawds.com. Three cheers for them!
Though Righteous suffered a day of rough recovery on an opiate drip, much as my Sophie did after her neck surgery, the following day he was far brighter than he’d been in weeks.
This is why we do amputations. Because though we know they’ll suffer for a short period of time, their improvement after surgery is dramatic—in almost all cases. If ever I had a case where amputation was a scary option, this large, overweight, osteoarthritic dog was it. And even he recovered with aplomb.
Success stories like this make me want to cry with relief and an abundance of sentimentality. Watching him walk out of the specialist’s place, the owner couldn’t stop hugging me. How sweet is that!—and how gratifying.
Though Righteous won’t likely be with us long (six months?), his owner knows that the next step is likely to be euthanasia. This tumor likes to go to the lungs, eventually. And at that time his owner understands that she’ll need to be prepared. In the meantime, though, he’s almost pain-free and well-loved. The only thing better would be no cancer at all.
Each owner must choose his own path on this question. Ten years ago I elected otherwise for my own Boxer dog with osteosarcoma. Given my financial circumstances, Agatha’s severe hind limb osteoarthritis and the dearth of drugs like Rimadyl, Metacam and Previcox on the market, I felt certain this was the right choice. But today? I’d like to think I would’ve gone with it. Who knows?
Regardless, it’s our job to present the evidence and hold the client’s hand, not so much to cajole and convince. Sometimes, however, I can’t resist. After all, I’m only human.
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Just wondering, Dr. Khuly , what your experience has been so far with Slentrol?
Our practice was chosen to take part in a Slentrol promotion and were given, I think, a three month supply for four medium size dogs with wieght problems. The rules were strict and we have to be sure that the patients we choose to use as guinea pigs have very complient owners who will follow directions to a T. That rules out a lot of clients, but we have at least found one of the four animals.
The information and statistics that the rep provided were very impressive, but that's his job, so I was curious to see if it is working as advertised for your patients.
Brian Hewitt February 29th, 2008 06:48:00 PM
I feel very sad when meeting folks that have lost a dog to bone cancer; 6 years ago had to say goodbye to one of my own Scotties for the same.
I received a dreaded call a year earlier, from a littermate owner that lived by the ocean. Walks were a daily ritual, and he called to ask me what I thought of his Scottie limping occasionally for several months previous. He was diagnosed via biopsy with osteosarcoma in the right front shoulder, stopped eating, and was euthanized at 12 1/2. Not long after, I noticed my (littermate) Scottie limping every once in awhile, slight swelling at the right front 'wrist joint' and I just knew. He never stopped walking or climbing stairs (3), never stopped eating, but became restless at night. His x-rays showed cancer (like a swiss cheese) from the paw into his shoulder blade. His breathing had audibly changed (though no tumors seen).
I would have elected surgery had he been a younger age, but at 13 years and almost 5 mos., I couldn't put him through it. He received humane and peaceful euthanasia. The last surviving littermate died 3 months later.
Barbara A. Albright February 29th, 2008 07:28:00 PM
My sis just went through this with her beloved 'Zoi. Went through an amputation and a few months later, went through his euthanasia. She loved that dog so much- and he was such a good loving soul throughout it all.
I hope I never have to deal with cancer in my animals- I know it's a vain hope, but it's there.
Trish February 29th, 2008 09:03:00 PM
From what I understand of Slentrol, it promotes rapid weight loss but, unless diet/exercise changes are made when the drug is discontinued, the dog will gain the weight back. I think it's disgusting to medicate a pet to lose weight simply because the owner doesn't have the willpower (yet) to alter said pet's lifestyle, so when we got the promotional materials in our clinic, I rolled my eyes (as did most of the doctors). Although most owners are looking for a quick fix when all they really need to do is feed less/exercise more, here's a legit use of the drug I hadn't though of - thanks!
anna February 29th, 2008 09:54:00 PM
Thanks Anna, but I was asking about personal experience and seeing if it works, in practice, as advertised.
The manufacturer is very clear about it being for extreme cases of obesity, where rapid loss is the best option, and then working with the owner, via education and support, to help them keep the weight off. It's not just a matter of willpower on the part of the owner. Many owners don't realize how fat their pets are until it is pointed out, in a polite way, to them. That is why they stress only using it with pets who have complient owners. Also, when an animal is that overweight, simply cutting back on food and exercising more isn't going to cut it. For slightly overweight dogs, yes, but for the extremely obese, no. To manage a near normal weight pet is within the realm of most people, but I can think of plenty of owners who would have trouble even trying to keep up with the exercise regimen required to take large amounts of weight off from a dog in a quick fashion, even with controlled feeding.
FWIW, I think that the general public views a dog that is at an ideal weight as too skinny. I've had so many people I need to feed my walker hound more to "put some meat on his bones." Baxter is the picture of health, yet lay people always say he is too thin. Funny, the Dr's at work said he is perfect. Not that Baxter wouldn't mind trying to reach the status of "a sausage on stilts," I'm sure ;)
Brian Hewitt February 29th, 2008 10:57:00 PM
Brian: Check back a week or so and you'll find a post referencing the "your dog is too skinny" mantra that drives us all crazy. As to the Slentrol: I have no other experience with it yet. i've been very reluctant to use it, in fact. Emergency weight loss in orthopedic cases seems like the best indication. I've been warned by some nutritionists that weight gain is common after discontinuing the drug, but others contend it's necessary to give clients a feeling of success so they'll continue to comply with other weight loss measures.
Dr. Patty Khuly March 1st, 2008 09:41:00 AM
Dr. Khuly, any chance of finding out whether "Righteous" had been neutered prior to one year of age? I did a double take when I saw this, since two members of the Border Collie Forums have posted recently about Rotts that died of bone cancer, and I'd been writing a post on the subject for my blog.
The study linking early spay/neuter to osteosarcoma in Rotties was published in 2002, and I've mentioned it before in posts related to CA's AB 1634. One of my fears regarding mandatory spay/neuter laws is that responsible owners of dogs at risk will opt for spay/neuter by four months [as the Los Angeles law requires], and unintentionally increase their dogs' chances of getting bone cancer. Do most vets you know discuss these studies with their clients?
I've lost just one dog to bone cancer, and that was one too many. He was neutered at about five months :~(
Luisa March 1st, 2008 05:31:00 PM
Dr. K., is there no hope of the dog receiving chemo? I know of so many dogs who do well with it, including one of mine. Once you're into your credit card balance for the cost of diagnosis ($2000), rad. Rx or amputation (another $1500 - $2000), my opinion is that one might as well give chemo a try.
I know more than one dog owner who was given a dire Dx and elected to try chemo as a last ditch effort.... and it worked!
Best wishes for this dog and her owner.
Deanna March 1st, 2008 06:42:00 PM
Brian - my comment was just a general one, not in response to yours (if it had been, it would have been kind of a snarky comment!). Of course there are indications where the drug is useful...in general, most of the questions I'm getting (as a tech) regarding it are being asked by clients whose pets really could lose some weight if the owner would just feed less/exercise more - that's where my frustration lies, since these owners admit to the pill "just being easier". I just thought Dr. K's use in an orthopedic case was nifty and was happy to learn a scenario where I could wholeheartedly recommend it to clients. :)
anna March 1st, 2008 10:58:00 PM
Thanks for clarifying, Anna.
I know what you mean about clients not being willing to put in the time. We thougt, "4 dogs, we should be able to find them quickly." Right, lol. This was close to a month ago and we just found our first likely candidate a couple of days ago because the other owners were ruled out due to complience issues or else they didn't think their dog was fat.
On that note, I made the mistake of saying "you look like a little tick," to a patient one time. The owner did not look pleased. Oops...
Brian Hewitt March 2nd, 2008 08:02:00 AM
Brian: I made the same mistake of calling a dog a tick just last month. In my defense, this once-twenty-pounder was now an eye-popping forty pounds. The epithet just slipped free! The owner, far from being upset, came in just last week with another dog and reported that "the tick" was losing weight well. ;)
Dr. Patty Khuly March 2nd, 2008 10:29:00 AM
On a slightly divergent note from the canine/weight/cancer issue, I've found that tripods of both the canine and feline varieties do very well, particularly those due to traumatic injuries. I have two kitty tripods of my own (both trauma-related), and they are at least as active (and perhaps more) than my four-leggers. In fact, everyone who has met these two has become a convert. A co-worker of mine has a cat who had a freaky non-union tibia/fibular fracture of a rear leg last winter. After two months of splinting and repeated x-rays, he considered having her euthanized, as he was afraid she would not do well as an amputee. I invited him to dinner at my house with the ulterior motive of meeting Lucy and Rocky and seeing how healthy and active a three-legger could be. He had decided that if there was no bone callus formation at the next splint change, he would proceed with amputation; but one week later, she finally had bone formation, and has avoided losing the leg, though she still has a slight limp and stiffness in the leg. On the other hand, a lot of my friends (and my own daughter-in-law) who have met the two resident tripods have now placed themselves on the waiting list at the shelter if we should have any new amputees to be placed.
Shellie March 3rd, 2008 12:27:00 AM
I have a friend who had a Labrador so obese she could hardly get to her feet. I suggested we use the dog for a weight-loss series. First, my friend insisted the dog wasn't fat. Then, that the dog "liked being that way because eating made her happy." Finally, she agreed to have the dog used in a story. First month: The dog GAINED weight. I kid you not.
So we dropped the project. A year later, the dog died, age 8. Littermate brother (with the ex-husband), a dog who stayed slim, ran daily, etc., died a month later.
Take home message for my friend: "See? It didn't make any difference. And she was happier because she wasn't starved like her brother was."
OK, but the dog couldn't walk across the room without panting and sitting down to rest on the other side. Quality of life, anyone?
Gina Spadafori March 3rd, 2008 10:51:00 PM
My used-to-be-80 lb four-year-old neutered black lab got to be 100 lbs thanks to my parents being treat givers to excess. Slentrol, along with cutting WAY down on treats and upping his exercise, helped my dog lose 15 lbs in 2-3 months. He's still 85 lbs but looks great, and keeps his energy up with our 9 month old spayed female lab. We also cut back his food, since he is neutered and did not need excess calories "coz it's the amount on the dog food bag". So Slentrol does work, if everyone complies. I work at the vets as a tech, so I made sure everyone stuck to the dog's diet plan.
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