The decision making process went something like this:
I should take the most aggressive approach and help Cody beat this! We can deal with an amputation! We'll get a harness and even a doggy cart if we have to. I know good rehabilitation centers where we can get physical therapy. Cody won't miss his leg! I checked out Tripawds.com, a great web site and blog site for canine amputees. We can do this! The chemotherapy will stop the cancer in it's tracks! I gathered surgical estimates and thought about scheduling surgery for early January. His surgeon was going to be on vacation, so we would have to wait; bummer because the sooner the better. Oh wait... he has chest mets, and he is orthopedically challenged in the other 3 legs... maybe an amputation isn't a good idea.
This might be a good place to show some pictures of the hardware my dear pup is carrying around. Ya see Cody drew the short straw, so to speak. He got cancer in his "good" back leg (the left). He has no hip joint on the right because of a failed total hip replacement when he was a young dog. Since that time he has never really used his right hind leg much except to help with balance. Now with the left leg being bad, he has been forced to use the right leg, but it's not very functional
Ok, so amputation is out. That means palliative radiation and injectable chemotherapy. There! A decision. A plan. We can move forward. I scheduled appointments for chemotherapy and radiation for early January.Throughout this process I had been talking to every veterinarian that I know about the options. Just to not leave any stones unturned I reached out to another expert. This veterinarian used to work at University of Florida doing stereotactic radiosurgery (SRS). He is now in my neighborhood and I have a good fortune of being able to refer cases to him. We discussed Cody's case and he felt that Cody might be a candidate for SRS. He would contact the head radiation oncologist at Colorado State and have her call me. Wow! I was thrilled. This procedure is as good as amputation, but it's radiation so Cody would get to keep his leg and we would kill the tumor!
At this point things got really complicated. I contacted Colorado State about a consultation. I probably used all available technologies that weekend to try to get Cody's records and radiographs to the proper people. Fax, e-mail, text messages and phone calls! Saturday and Sunday went by.... 2 days are agonizing when you're trying to plan something like this. Monday morning (Jan. 7th) I spoke to the chief radiation oncologist. She hadn't seen Cody's radiographs yet. She thought that SRS might give Cody about 6 months. Unfortunately they were overbooked and didn't have an opening until the 16th. Of course that is a really bad week for me to leave California because I have a work commitment that I cannot cancel. We discussed the option of driving him out and leaving him for treatment, then coming back to pick him up. Ok, I figured I could do that if this was really going to be the right thing for Cody. The price tag for SRS is approximately $5500. With that and the logistics I wanted to be super sure that this was a good treatment plan. The chief radiation oncologist called me back that evening with some bad news... she had the opportunity to look at Cody's radiographs and felt that with the metastases in the chest, Cody probably has about 2 months, and therefore didn't recommend I make the trip for SRS.
I was devastated. This meant returning to the palliative radiation + chemo plan. It felt like I was giving up. I cried for 3 days. It didn't help that Cody was sick from his first dose of chemotherapy. He stopped eating and started vomiting about 2-3 days after chemo. He bounced back and seemed really good after radiation. I decided not to continue with the injectable chemotherapy and try oral Palladia (an oral chemotherapy). However, now his neutrophil count is low, so we cannot start Palladia. When an animal is getting chemotherapy, the bone marrow is suppressed and doesn't make as many white blood cells as it normally would. The neutrophil is one of the several different types of white blood cells that fights infection. When the neutrophil count is low the animal is at risk for developing infections that can be life threatening. We have to wait until his neutrophil count comes back up before we can start Palladia.
Cody had more chest radiographs taken on Jan. 9th when he went for his first radiation treatment. Since we had been making big decisions based on his chest x-rays (not going to Colorado) we thought it might be worth checking to see what things looked like now since his last x-ray was early December. It had been a month and I again got my hopes up that if things didn't look worse that I might still consider going to Colorado. Well, unfortunately things looked worse. The nodules are bigger and easier to see and now Cody has some fluid accumulation around his lungs (pleural effusion).
Sometimes the decisions just get made for you in a sense. I'm resigned to the fact that my dog has osteosarcoma and it is a bad cancer and as far as I know there is nothing I can do at this point to cure my dog. Now I need to take some attitude lessons from my beloved dog. Live in the present and enjoy the little things! We are doing what we can to make Cody as pain-free as possible and doing all the fun things he loves to do!
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