It’s a roller coaster

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As I left for a cell phone dead zone in Canada for work, we started to second guess our future decisions. Grover was back to Grover after radiation. Was 3-6 months of life like this better than potentially getting more time with 3 legs? Radiation impressed me … I didn’t expect to see such a positive response. Who was I doing the amputation for? Was it for me, or for him?

For better or for worse, Grover made the decision for us, and while I was out of the country (Canada … so close, but so far away) Grover suddenly became very lame again. Repeat radiographs revealed that he probably felt a little TOO good with radiation and unfortunately his ulna had fractured. Unable to take calls and only get texts while hooked up to internet connections we made the decision to stick to the original plan and send him to surgery, except NOW instead of after I got home. It wasn’t fair to him to wait in pain just so that I could be there.

All the people on our team told him how much I loved him and off he went into very capable hands. Only time would tell now … would he be able to walk after surgery? Could the rest of him hold up? Or, were we asking too much of his already old and worn down body.

It was wonderful news to hear that he made it out of surgery with no major complications but we all knew the biggest battle was yet to come. Could he walk? Could he do so comfortably? Would the rest of him hold up? Only time would tell…

At the advice of a hospice veterinarian we made a “quality of life check list”. A list of things that we felt “made Grover, Grover” and indicated to us that he was happy. We also looked up quality of life assessments from Ohio State University and the hmmmmm assessment. These decisions are never easy but we wanted to be prepared with realistic goals and assessments so that if things didn’t go well we didn’t “drag” them out by saying “just one more day” only to find “one more day” had turned into weeks and he was none better.

A picture of Grover right after surgery recovering — snug as a bug in a rug (remember those great veterinary students … they kindly sent this worried out of the country pet parent a photo of “proof of recovery” so that I could see for myself that he was awake and safe)

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Decision Time

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After a weekend of soul searching (and a lot of crying in the shower) we came back Monday and had the opportunity to talk to all of “the teams”. It takes a village to keep an old Great Dane going and we are lucky enough to have a teaching hospital close by that we also use as our “regular” veterinarian.

I think that this is a great time to pause and talk a little about the term “teaching hospital.” Many times this brings up the wrong impression — that this is a hospital where people experiment or let unqualified people practice on your pet. It’s really not true and just the opposite. You have a team of people on each service (usually a board certified senior clinician, a resident and a 4th year veterinary student) that works with your pet. The resident has already graduated veterinary school and undergone at least one year of VERY intense specialty training and was now selected to pursue an additional 3 years of specialty training. No on experiments on your animal — however, if you are lucky you may have the OPTION to enroll your pet in ground breaking clinical trial research but it is YOUR option and you are ALWAYS fully informed and ALWAYS have the option to say no. And really, no one (student or resident) is allowed to do anything that they are not fully prepared to do and without intense supervision. The AMAZING side of teaching hospitals is that while the senior clinician may have many patients, and the resident has less but still many patients the students usually just have a few … this means that your pet gets so much extra attention.

The other benefit of a teaching hospital is that you get many specialists under one roof. So, Monday we met with the team. We met with oncology, soft tissue surgery, rehab, neurology, anesthesia, cardiology and orthopedics. Everyone got a chance to evaluate Grover, express any concerns that they had about going forward with an amputation. No one felt that he should NOT have an amputation, but everyone had concerns that there was a possibility it could go poorly based on his pre-existing issues.

Our amazing oncologist sat down with us and presented our options and spent so much time answering our 1 million questions while we continued to process the news.

(1) we could do nothing and stop. euthanasia is never a “wrong” answer and always an option to end pain and suffering.

(2) we could try palliative radiation. It could provide him with better pain control and on average gives animals 3-6 months. With this we wouldn’t have to worry about him not managing on 3 legs.

(3) we could amputate and go for chemo. Together, on average, this gives dogs 9-12 months. However, first the oncologist recommended a CT to take a closer look for thoracic metastases of the cancer. In a large dog like Grover, radiographs can be harder to interpret and she suggested that if the CT showed mets we may not have enough time left to make recovering from surgery worth it for him (given that we are expecting a harder and more challenging recovery).

To make things harder, I had to leave in just a couple days to go out of town for work. It couldn’t be re-scheduled … should we try to fit surgery in before the trip knowing I couldn’t be there right after surgery? Should we make him wait?

At the end of the day his CT still didn’t show any mets and we decided to do (2) doses of palliative radiation 12 hours apart to see if it made him more comfortable so that I could come back for his surgery. The great news … within 12 hours of the last dose of radiation Grover was back to being grover! He was off opioid pain medication, playing and comfortable on his leg!

A video of Grover back to playing with his favorite lamb chop (ok, lamb chop the 12th) IMG_0407

Diagnosis Day

My hope with this blog is to provide information for other owners faced with decisions regarding amputation in their large breed geriatric dogs.

As a bit of background, Grover is a 10.5 year old male neutered Great Dane who was diagnosed with a mid-diaphysial ulnar osteosarcoma at the beginning of July. We had had osteosarcoma (OSA) scares in the past (acute lameness in a large breed dog) and they were always injuries due to his fairly active life style. Unfortunately, this time we weren’t so lucky. 5 days prior we had been hiking the mountain and I had no inkling of what was to come. One day he came up lame on a simple walk around the block. We figured it was “just” another soft tissue injury … unfortunately radiographs revealed a lytic lesion in the middle of his left ulna. A sample (Fine needle aspirate) was taken and cytology (evaluation of the cells) confirmed an osteosarcoma. Thoracic (chest/lung) radiographs were taken to look for metastases and luckily none were seen. However, unfortunately, we know that 90% of dogs with OSA already have metastases to their lungs … it’s just whether or not they are big enough to see on radiographs that gives us more information about how much time we might expect.

Unfortunately, Grover is not what anyone would describe as a “good” amputation candidate. He is large (50 kg/110 lbs), has angular limb deformities and osteoarthritis due to having hypertrophic osteodystrophy/HOD as a puppy (before he came into my life at 9 months of age) and has cervical stenosis/wobblers disease resulting in some hindlimb weakness, mild neck pain and mild ataxia. All of these things are “do able” when you have four legs … but how much will loosing one leg affect him? Can he still compensate? Will it push his neck over the edge? Can his other leg hold up? What would HE want? ¬†We went home for the weekend (bad things always happen on a Friday …) with a ¬†combination of pain medication hoping to gain clarity on how to go forward and let this devastating news sink in.

The photo is from our last hike, 5 days before our diagnosis. Time to prepare for “new normals”.