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.
|
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.
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.
I hope I never have to deal with cancer in my animals- I know it's a vain hope, but it's there.
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 ;)
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 :~(
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.
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...
Righteous has all our best wishes for a happy healthy life on three legs. My people chose not to do chemo after my amputation and I just celebrated my 14th month as a tripawd! All the stories we hear are different. Hopefully Righteous and his people will share theirs in our new <a href="http://www.tripawds.com/forums/" target="_blank">canine cancer discussion forums</a> and find those of others helpful.
Thanks again for your wonderful work and continued support of our efforts!
-Jerry (And Jim & Rene)
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?