Oncology Consultation

My happy Christmas Dog!

What's the next step after receiving the bad news that your best friend has cancer? Well after crying your eyes out, you gather your wits and schedule an appointment with an oncologist. I recommend this even if you don't think you will pursue any further treatment. Even if your general practitioner is the greatest on the planet I still think the additional information you will gain from a visit to the oncologist is invaluable. They went through 4 more years of special training to become experts in this field and are the most up to date on the latest treatments. They may also know of a study going on that your pet may be eligible for. They will also give you a prognosis in months. Which you may want to hear and it may help guide your decision making process. Personally I am not a huge fan of the "months to live" statement because all dogs are different and that can give one a false sense of hope or despair. But it does give one an idea of the effectiveness of the various treatments.

In the case of osteosarcoma the most aggressive approach to treatment is amputation of the effected limb and injectable chemotherapy. This will buy your dog 10-12 months.

If your dog is not a good candidate for amputation, you can consider a limb spare procedure depending on where the tumor is. There is a surgical procedure where they remove the tumor and replace it with a plate and/or bone graft. There is also a special type of radiation called stereotactic radiosurgery that will kill the tumor. This type of radiation is only done in a few places. Colorado State and University of Florida are two, there may be more in the USA that I am not aware of. A limb spare procedure plus injectable chemotherapy will buy your dog 10-12 months.

Just amputation without chemotherapy gains an average of 3 months.

Palliative radiation is a type of radiation that just relieves the pain, but doesn't kill the tumor. Palliative radiation plus injectable chemotherapy plus a bisphosphonate (a drug that helps build bone strength) may give your dog about 9 months.

All these projections are based on a dog WITHOUT evidence of metastases in the lungs. Unfortunately when there is gross evidence on x-rays that there are nodules in the lungs you can subtract about 3-4 months from all these estimates.

So what to do? With Christmas coming there is going to be a delay no matter what procedure we choose.  I need some time to digest the information and make a decision. Until we decide on the next step I am controlling Cody's pain with the following drugs: Tramadol (a pain killer related to morphine), Previcox (a non-steroidal anti-inflammatory), and Gabapentin (a seizure medication that is thought to help with neurologic pain). Cody has also been wearing a pain patch of Fentanyl since his biopsy procedure. Fentanyl is 100 times stronger than morphine. He seems pretty comfortable with the patch on, but I hope I can do something more to treat the pain.

Cancer Returns

It has been a while since I updated Cody's blog because, well... you know the saying "no news is good news!" He had been cruising along without problems until September, 2012. In September he started having intermittent non-weight bearing lameness of his left hind leg. It would get better with chiropractic adjustments and laser therapy and then he would stop using the leg again. I took radiographs (x-rays) of his left stifle (knee) and chest in September and didn't see anything of note on the x-rays. I even had the chest films looked at by a radiologist. I did not have the stifle film looked at, which I regret now because it turns out there was a suspicious area present, even in September. Note - if your veterinarian recommends having the radiographs reviewed by a radiologist say yes! They might catch something your general practitioner missed.
In early December I took more x-rays because the problem was becoming more frequent and not resolving with any treatment or after adding on more pain medications.
Well, bummer of all bummers, this set of radiographs showed a suspicious area on his femur AND if that weren't bad enough, his chest x-rays showed nodules that were not there in September. Knowing that those sort of patterns on radiographs usually mean osteosarcoma I dissolved into a sobbing puddle of mush and just hugged my dog like the world was ending. Of course I held out some hope that the problem would be a lesser evil like a fungal infection or less aggressive cancer.

The tumor is the area that looks "moth-eaten" at his distal femur.

Cody had a bone biopsy done on December 11, 2012. The results were chondroblastic osteosarcoma, low grade. It isn't much reassurance that the tumor is "low grade." An osteosarcoma is an aggressive bone cancer and usually by the time we (veterinarians) identify it on radiographs there already is microscopic spread to the lungs. Cody is already showing nodules (small masses) in his lungs. The thing is, in his case, we can't be sure just by the radiographs that the nodules are metastases from his osteosarcoma. They could be recurrence of his previous lung cancer or they could be metastases from his osteosarcoma. Could we biopsy them? Well, it would be difficult and require a CT scan and probably wouldn't really change anything we do at this point.

You can make out small round densities (lighter areas) that are the nodules.

One Year Post-Op

I have really good news to share. Cody is more than 1 year out from his diagnosis of lung cancer. Yay!

We have done radiographs and blood work at 4-6 months intervals and so far everything appears to be clear and cancer free. He still has trouble with his arthritis, but you wouldn't know it when you pull out the ball! He still chases it with gusto! The dog door gives him a little trouble these days too.

Diet and supplement update:
I started him on a commercial frozen raw diet mixed with a high quality dry food. The raw diet I am using is either Nature's Variety Instinct or Stella and Chewy's. I mix in just a bit of Wellness Core, Reduced Fat. I also steam veggies and add them when I have time. I found this diet to be easy for me to fit into our busy lifestyle and he seems to be thriving on it. His poops are very small - I'm taking that as a good sign that most of what is going in is being digested and utilized.

Current supplements & medications: Adequan injections, Royal Coat (fish oil & borage oil, by Ark Naturals), Lubrisyn (hyaluronic acid), Veterinary Immune Tabs (Ramaekers Nutrition), Vitalzym (enzymes), probiotics, Apocaps, Pain Plus (Resources), Dasuquin, Previcox, Heartgard Plus and Comfortis. Oh and occasionally Gas X!

6 Month Check Up

Wahoo! Last month we took chest x-rays and did blood work to see how Cody is doing. No obvious evidence of any cancer. Yay!
The anti-cancer regimen has morphed and changed over time. I am now cooking for Cody sporadically as time allows and I tend to keep it really simple. I'll boil chicken and steam veggies. Now and then I will throw a bunch of green stuff (parsley, kale, brussels sprouts, etc.) into the food processor and sprinkle it on the food. The consistent base of his diet is Wellness 95% canned meat, and Wellness Core, Reduced Fat kibble. I usually will mix some kibble in with the homemade diet, just to keep his tummy from getting upset. Because I travel a lot and sometimes he comes with me or sometimes I have someone else taking care of him I've opted to keep an easy feeding option like kibble and canned food on hand.

I've also recently changed his supplements. I've gone back to giving him the Veterinary Immune Tabs from Ramaekers Nutrition. In a previous post I mentioned that there was some concern over the anti-oxidant super oxide dismutase. I think that the amount is not very much, so I'm not going to worry about it. For the last few months I've been buying Transfer Factor and K9 Immunity separately. The Veterinary Immune Tabs contain both of these plus vitamins, minerals, amino acids, probiotics, some essential fatty acids, joint supplements, and tumeric. This supplement is costing me about $174 a bottle and it lasts Cody about 1 month (the recommended dose is 1 tablet per 20 lbs). That is my cost plus shipping. If you purchase this product through a veterinarian it will probably be about $200+ a bottle. You can also contact Ramaekers directly and order it directly from them which may save you a little money.
I am still adding in the Apocaps - Dr. Dressler's product. I've weaned Cody off of some of the other pain and joint supplements to see how he does. I've stopped the Dasuquin and Pain Plus, but have continued to give him Lubrisyn (an oral high molecular weight hyaluronic acid). He still gets Previcox, a NSAID, every other day. I make sure he is getting digestive enzymes and probiotics to help with digestion and keep his gut healthy. So far we haven't had any bad bouts of diarrhea in a while (probably because I haven't gone crazy with home cooking!).
Tonight he got a treat. I decided that buying a whole Rocky organic chicken would be the least expensive option for chicken. I roasted the chicken with broccoli and zucchini. The easy part is cooking it, now the fun will be deboning it all!!
Instructions: Pre-heat over to 400 degrees. Wash the chicken, pat dry. Put chicken in roasting pan, spread veggies (in this case broccoli and zucchini) around the edges and stuffed inside. I also kept the livers and neck and placed them in the roasting pan along with the vegetables. Add approximately 1/2 cup water. Cover and roast for approximately 1 & 1/2 hours or until the internal temperature of the chicken is 170 degrees. Remove skin and debone. Serve! Cody says thanks! Yummy!