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Osteosarcoma in Greyhounds: Early Diagnosis and Options
by Judy Kody Paulsen
(Excerpt from Spring 2005 issue of GCNM News)

Doc” had been limping around the house for about a week before he was taken to see Dr. Sandra Whaley at Manzano Animal Clinic in Albuquerque. Adopters, Shannon Gilbert and Beth Murray thought he had strained a “wrist” while playing with their German Shepherd in the back yard. An appointment was scheduled for him when the limping did not subside within the week. An x-ray was done which showed a very suspicious bone lesion – a biopsy of the area was performed the same day. One week later, the pathology report confirmed what Dr. Whaley had suspected: Doc had osteosarcoma.

Chest x-rays were done to rule out the possibility that the cancer had already metastasized to a critical point which narrows the options for treatment. It is important to note that by the time osteosarcoma is diagnosed, there are already “micro lesions” elsewhere, most commonly in the lung, although these tiny invaders are often not visible on x-ray in their initial stages. Dr. Whaley told Shannon and Beth of the most common options, those being; 1) amputation followed by chemotherapy, 2) no amputation and treat with pain meds, and 3) pain meds coupled with a bone hardening drug. The benefit of the bone hardening drug would be to reduce the likelihood of a pathologic fracture if they chose not to have the limb amputated. Dr. Whaley had given them statistics of survival both with and without amputation – all of which can vary for each patient..

Shannon and Beth were split on whether or not to amputate – one wanted to, the other did not. They struggled with their options and contemplated life without Doc. One comment Dr. Whaley had made resonated deep within Shannon and Beth’s minds during their discussions: Once the leg is removed, the pain subsides quickly. Dr. Whaley explained that because hip dysplasia is not common to Greyhounds, they function quite well on three legs. Often, the assumption is made that because the front legs support the greatest portion of a dog’s body mass, they will be more incapacitated by losing a front leg than a back leg. However, Dr. Whaley states that eliminating the pain of the cancerous limb by amputation brings on a surprisingly rapid recovery and soon the dog is unaware of its tripod status even when a forelimb is removed..

While waiting for the results on the biopsy, Shannon and Beth spoke with several people who‘d been faced with the same dilemma – some had chosen amputation, some had not. Although nine years-old, Doc was still very active and loved his romps with their German Shepherd and his walks with Shannon and Beth. His zest for life and the early diagnosis provided some encouragement when making their decision. Because Shannon and Beth were so observant and noticed the limp when it began, they were hopeful that their quick response in taking Doc to the veterinarian would have a positive impact on his longevity..

After receiving the definitive diagnosis of osteosarcoma from the biopsy, a decision was made to go ahead with amputating the limb. Dr. Raymond Bouloy of Manzano Animal Clinic did the surgery and the procedure went smoothly..

Three-legged Doc, Lounging

Shannon and Beth were amazed at the speed with which Doc recovered. Dr. Whaley was right: the pain seemed to vanish rapidly. Although amputating a limb is a major surgery, the severe pain generated by a cancerous bone lesion is evidently worse than that of the recuperative phase of an amputee, especially when taking into consideration the pain from the cancer was likely present for some time prior to the dog becoming visibly symptomatic..

Doc received four chemotherapy treatments after his amputation. A common misperception is that chemotherapy eradicates the cancer, however, Dr. Whaley emphasizes that administering chemotherapy after amputation slows the metastasis of the already present lesions and should not be mistaken as a cure for the disease. There are many chemotherapy protocols and pros and cons to consider with each. Some may increase longevity, but on the other hand will induce more nausea. Others create less sickness yet are considerably more expensive. All can be administered with anti-emetics and this will increase the dog’s comfort while undergoing chemotherapy..

According to Shannon and Beth, Doc’s quality of life is very good; he doesn’t seem to notice that he only has 3 legs! “He hasn’t slowed down at all and still runs around the back yard with Greta, the German Shepherd.” He’s sure to make himself very visible around treat time and one of his favorite tricks is to try and steal Greta’s cookies! They’re all looking forward to celebrating his one year surgery anniversary on April 23rd! Thanks to Shannon and Beth’s watchful eyes and the expertise of Dr. Sandra Whaley and Dr. Ray Bouloy, Doc is enjoying an apparently pain-free life. Who knows, maybe he’ll set a survival record just for the sheer joy of stealing Greta’s cookies!.

Points to consider:.

1) Osteosarcoma is twice as likely to occur in a front limb (always seek veterinary care for a dog who develops a limp whether it‘s the front or the back leg, especially if the limp persists more than a few days)..

2) Amputation without subsequent chemo treatments is usually not considered a viable option: The purpose of the amputation is to remove the source of pain and the purpose of the chemotherapy is to reduce the rate at which the disease metastasizes, thereby increasing longevity..

3) Is a biopsy necessary if the x-ray already reveals the typical appearance of osteosarcoma? Dr. Whaley says, yes, for the following reasons: If another type of cancer is present and has subsequently metastasized to the bone, there is no justification for amputation. In addition, if the amputation is done purely on the radiographic evidence and it later turns out not to have been osteosarcoma but rather a similar appearing non-cancerous lesion such as fungal infection, then the amputation was avoidable..

Biopsies of areas where there is less muscle are less traumatic. The wrist biopsy is probably the least invasive since there is little tissue to penetrate for the procedure. The deeper the surgeon must go to obtain a specimen, through muscle and other tissue, the more painful the recovery will be as this tissue is inflamed to begin with..

4) This bit of information is purely observational and anecdotal, but when asked, Dr. Whaley concurred: Arthritis vs. osteosarcoma – can you see a difference in the type of lameness exhibited? As in humans, when an arthritis sufferer first rises from being sedentary, the discomfort is more pronounced upon initial movement, but as the muscles loosen and blood circulates among the tissues most affected by arthritic changes, the movement seems to improve. Conversely, in 13 years of observing Greyhounds, it has been my observation that the ones with osteosarcoma seem to get increasingly more uncomfortable as they ambulate..

5) Expense is a significant consideration for most people faced with the costs involved in surgery and chemotherapy. Several thousand dollars will be the likely financial burden. If cost is a big factor, opt for pain management; and when you perceive that the pain is no longer tolerable, then consider euthanasia. Many people question their ability to make the determination of when their animal is suffering; however, keep in mind that you know your animal better than anyone. Behavioral changes such as disinterest in interacting with family; heavy, persistent panting; avoidance of using the limb – are some indicators your animal companion may be suffering excessively. Discussion among family members and consultation with your vet is paramount at this time..

6) The pathologic fracture is an unpleasant experience for the victim and the witness. Do take this into consideration as you ponder the pros and cons of pain management vs. amputation. Bone hardening drugs (similar to those used in humans to control osteoporosis) can lessen the risk of fractures at the site of the cancerous lesion – be sure to inquire about this option when discussing management with your vet if you choose not to have the amputation..

Author’s note: The early detection of any cancer and determining if it has metastasized is vital in the deliberation and consultation involved in making a decision on whether to pursue surgery or other options. You know your animal companions best and are most capable of deciding which approach is appropriate. It is never easy to make a call on what to do in a case where your animal’s life is on the line. Don’t fall prey to guilt feelings or pressure to pursue extreme measures if you feel your animal cannot withstand the trauma nor if your finances will not allow it. But by all means, discuss your options with your vet or seek a second (or third) opinion if you are not comfortable with the information you’ve been given.

 


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