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Good Days and Bad Days

June 15, 2011 Fido 2 Comments

Like most cancer patients, Argus has good days and bad days. For a long time now, the good days have outnumbered the bad though we may be reaching the point of diminishing returns on that. Since he can’t talk, it’s hard to tell how he’s feeling. We hope to get a dog that talks next time…

External Changes
The lumps and bumps are hard to overlook. The one on his neck — the very one that came back as dead cells when the doctors tested it in Davis — is growing seemingly as we watch. Whether these cells are cancerous or not, they are alive and well!

He also has a large mass on his back. This one is different than the one on his neck. It’s harder than the one on his neck and much larger. The one on the neck seems to be a soft mass and this one is hard. Maybe it’s a bone tumor?

Finally, we can’t deny that there is another bone tumor on his remaining front paw. He licks this paw often (more than just grooming) and it’s very clear to us he is in more pain. Dogs carry 60-70% of their body weight in their front paws, and Argus now only has the one in front to carry his ~80-pound load. He is much more selective about which events are important enough to come down the deck stairs out back (neither Greg nor me coming home makes the list) and his walks are shorter. We’ve got him on 30 mg of prednisone at this point, given to him in one dose with his breakfast. Dr. Sutter has assured us we can’t OD him on the prednisone, so we feel like we can give him more if/when it appears he needs it. We started at 5 mg back in March and have ticked it up along the way.

Internal Changes
His breathing has been pretty steady up to this point. When we met with Dr. Martin in April, she recommended we take a baseline measurement of his breaths per minute when sleeping soundly. At that point, it was 9 breaths per minute. His sound sleeping is still consistent, but he is coughing more often and more things trigger coughing. This could be a result of the lump(s) they found on his lungs or perhaps the one on his neck is affecting his windpipe.

One example: he loves to bark at the mail person each morning until she gives him his well-earned three treats. The barking now results in a coughing fit every time. The same thing happens when he barks at the raccoons at night. Also, he will get into a play stance to instigate one of us to play with him, but as soon as he makes a sudden movement to be chased, he starts coughing. It sounds and looks like he’s trying to hack something up, but nothing (thankfully) ever comes.

His spirits still seem good and his appetite has certainly not waned (though we know this is also a side effect from the steroids). He is interested in going out each afternoon and enjoys being around us when we’re going about our day around the house. I took all the above photos Tuesday evening when we went over to the lagoon for a paddle and he was game to tag along.

Around The House
His favorite spot used to be on the couch, but he never gets up there anymore. Even when I lift him up there to snuggle with me, he quickly jumps back down. This is one of my all-time favorite pictures of him from a couple of years ago:

The next best spot was the overstuffed chair and he rarely gets up there anymore. It seems that he can’t get comfortable when he’s folded up, which used to be his normal sleeping position. I haven’t see him curled into a ball in at least a month. This picture was taken immediately after surgery; I couldn’t believe he got up there unassisted:

He has found a comfortable spot on the guest bed and he gets himself fully spread out when he lays there. My desk is in the guest bedroom, which means we spend a lot of time together during the day. While we miss him at the foot of our bed each night, we’re grateful he has found a place where he can get the rest he needs. Luckily, our overnight guests have been happy to share the bed with him!

The heartbreaking thing, of course, is that we don’t know how long we have with him or what will end up being the last straw. Will it be his own breathing? Or will we have to make that awful decision that the pain is too much? Of course, our hope is that he goes to sleep one night and just doesn’t wake up…but we are not fooling ourselves to believe it will be that easy — for him or for us. We continue to live in the moment with him and be thankful for each good day we have with him.

Argus Update: The New Normal

January 31, 2011 Fido 1 Comment

Argus received his third chemo treatment last Wednesday and bounced back quickly. They preempted his vomiting by giving him an injection of anti-nausea medicine when they administered the chemo. It was clear he was more tired than usual for a couple of days, but things were quickly back to normal. His hair is coming in nicely and the incision is fully covered. Isn’t he handsome?

I was nervous going into this treatment. January 15 marked three months from his diagnosis. Our vet told us that the average prognosis for metastasis if we were to do nothing is three months. We obviously opted to treat him fully (amputation + chemo), but there are no guarantees. Argus has his blood counts tested every week and he is consistently in the normal range, and this visit also included body scans to see if tumors have formed on his lungs and liver. No spreading! What a relief!

I’m also proud of my big dog that he will lay still for the technicians while they work on him. When we first started our treatment there, they told us it is a policy that they have to sedate any animal over 25 pounds, but they make an exception for Argus because he doesn’t give them any trouble. I am sure it’s because he’s lazy and he enjoys laying down while people fuss with him. I’m just glad they don’t have to pump him full of more drugs! Remember the last time he was fully sedated?

Look at his poor little tongue hanging out

He has adjusted very well to life on three legs; I wonder if he even remembers having four… We have really worked to increase his endurance and he can walk a couple of miles at a steady pace with minimal stopping. Around 3 PM every day, he finds me and engages in a “conversation” to remind me that he would like to go out for a walk. It’s kind of like a low growl, usually with an exasperated “ahem” at the end. He does this when it’s time to eat, too.

Greg and I took him over to the beach for happy hour on Friday and I got a good video of him running with Greg. Walking is still very “hop-along” and it seems labored, but he can run almost seamlessly. He even has good control in doing a tight turnaround.

Thanks to everyone who has called and emailed and texted to ask how we’re getting along. Your concern is much-appreciated!

Treatment Phase 2: Chemotherapy

December 1, 2010 Fido No Comments

After a long weekend with Greg home, Argus and I spent Tuesday in Davis. Our appointment was in the Oncology department and Argus also got his staples out. Our student surgeon from a couple of weeks ago, Ms. Bowles, came by to say hello when we checked in and Argus fully kissed-clean her face.

Reason with me: if a big guy like Argus doesn’t hold a grudge against the lady who cut his leg off, can’t we all strive for a little more understanding and peace?

I continue to be impressed with the care we are getting there. The oncology student, Ms. O’Hara, took us into a small room and explained that she would do a physical examination of Argus and then bring in her instructor (a professional veterinary oncologist) to discuss the treatment options. Ms. O’Hara was gentle with Argus and he was cooperative with her. He seems to endear himself to all of these people, which I somehow believe is a personal reflection on me and I am proud to take credit for his behavior. Of course, if he were a rotten dog and everyone groaned when we walked in, I would take none of the blame. Thank goodness I’m not having children, as I am pretty sure this behavior is frowned upon at parent-teacher conferences!

The situation is this:

  • Argus is a candidate for chemotherapy, as the cancer has not yet metastasized into his organs — yet. When it does, the lungs and liver will likely be the first to be hit.
  • I agreed to make Argus part of a study that might net us slightly more positive odds than the standard treatment option. The average prognosis for amputation + chemotherapy is 12 months. I will be as clear as the doctor was with me: 50% of dogs do not live for 12 months from the time of diagnosis and 50% live longer than 12 months. Not pursuing chemotherapy puts the hourglass at 4-6 months. We knew we would move forward with chemo if the price was reasonable.
  • The treatment we are pursuing as part of this study is alternating 3 doses of carboplatin and 3 doses of doxorubicin, 3 weeks apart, for a total of 6 doses. The cost per dose of each is $250. To treat Argus’ cancer with carboplatin from the specialist in San Mateo, it would cost $800 per dose. We are happy to be part of the study to get the same medication at such a reduced rate!

Caryn drove in from El Dorado Hills and met me at the clinic just as the consultation began. When the doctors took Argus for his tests and treatment, Caryn and I went on a brisk bike ride in the outskirts of Davis. We had a couple of hours to kill and I was thankful for the diversion to keep my mind off of all the decisions and worry. We were both bundled up in 3 layers of gear and the biting wind still chilled us to the core. Bright side: we can keep our training rides up through the winter since I’ll be in Davis every three weeks for the next four months!

When I retrieved Argus at 3 PM, he was a little groggy from the mild sedation. I am grateful it was nothing like it was when he was sedated for the cytology last month! He ran out to the car and hopped up by himself, alert most of the way home. Once we got home, he settled in the kitchen for his dinner and then retired to our bed — a first since the surgery! I had to leave right away to babysit for friends and he jumped at the chance to come with me. He spent several hours “protecting” a dear 18-month old girl by laying under her crib; I couldn’t get him to leave her. It was so sweet.

I am confident that the worst of the treatment is over (knowing, of course, that the worst is as little as 4-6 months and hopefully as long as 12+ months away). I feel so fortunate that UC Davis took our case and that the care we have gotten has been so professional and caring at the same time. Please, if you ever find yourself in a situation like this, I highly recommend checking out a veterinary teaching hospital. This was our “hail mary” attempt at being able to afford treatment for Argus and I’d make the same choice again hands-down (and would likely make the choice even if money were no object).

I also want to give a shout-out for our local vet, Dr. Sutter at Aragon Vet Clinic in San Mateo. He has called several times since we made the decision to take Argus to Davis for treatment to inquire about his progress. He continues to provide counseling and reassurance that what we are experiencing is “normal.” I appreciate how hands-on he has been through this process of diagnosis, referrals, and treatment.

Here is Argus’ incision with the 43 staples out:

Day 15 - Staples Removed

An Expensive Week

October 22, 2010 Fido 2 Comments

Last Friday, we were devastated when we learned why Argus was limping: there is a tumor on his left paw at the “wrist” joint. In 7 days, we have spent $1236 diagnosing the tumor and it has been confirmed as the worst kind of canine bone cancer – osteosarcoma.

We now know more about bone cancer than anyone outside of the veterinarian community should ever know. And we’re not alone. Osteosarcoma affects roughly 10,000 dogs each year and it occurs most prevalently in large breed dogs. It’s a terrible disease that quickly spreads and robs a dog of any chance for a long life. Here’s how our week unfolded:

We spent last Friday and Saturday in shock. We were so sad and weepy; it was all we could do to cling to each other and Argus. Greg researched a special cancer-fighting diet that he believes will help, so we ran errands together to pick up the necessary ingredients on Saturday afternoon. Dr. Sutter called to check in and answer any questions we may have since I was a disaster in his office on Friday. Greg appreciated being able to talk with him first-hand and have his questions answered directly rather than me trying to remember what I had been told. Sunday felt more like a normal weekend day with a road trip to Sacramento. Neither of us shed a single tear that day! My eyes finally de-puffed a little and I didn’t feel so desperate.

Monday, we were back at the vet’s office for more tests. Poor Argus gets nervous every time we pull into the parking lot. I wasn’t sure how long he’d have to be there, so I was “that doggy mama” who brought her own dog’s bed in with us so that he’d have something familiar with him all day. The nice people there smiled and politely obliged me; they deal with crazy pet people like me every day. He was a good boy and sat still for his full-body x-rays, ultrasound, and blood work without the need for sedation. I got the call from Dr. Sutter at noon. Good news! Nothing has spread (yet) and his blood work came back clean. I collected my dog and left the office $460 lighter.

The next step was to meet with the surgeon and oncologist on Wednesday morning. Greg attended this appointment with us. I was armed with pen and paper this time so that I could take notes and keep everything straight. This appointment lasted over 90 minutes and we were given several options (as we heard and understood them):

  1. Do nothing. Prognosis = a few months at best. Cost = pain medication
  2. Radiation. Prognosis =  several months probably. Cost = $8000
  3. Chemotherapy. Prognosis = average of 12 months. Cost $3000
  4. Amputation. Prognosis = average of 12 months. Cost $4000
  5. Limb Spare. Prognosis = average of 12 months. Cost $7000

I asked them both if there was any chance the tumor was perhaps a fungal infection instead. They agreed with Dr. Sutter that it was not likely, but could not entirely be ruled out. Unfortunately with a fungal infection, you can’t just treat it with antibiotics (but they appreciated my optimism).

I asked each of them separately what they would do if the decision was theirs to make. Both doctors said that Argus is a young and otherwise healthy dog. If we can save his leg, we should. Dr. Cadile, the oncologist, said that there are some studies indicating that leaving the primary tumor in place helps the body stave off metastases. Greg and I agreed: if all things are equal (cost and prognosis), let’s proceed with chemotherapy rather than amputation. It’s still a lot of money to spend in the hopes of getting one year with Argus, but one year is better than six months. The only thing left to do was to confirm that the mass is not a fungal infection, which could be done with a cytology. Dr. Banz estimated this at $60 + sedation. We agreed to move forward with this procedure. I hated the cloud of uncertainty hanging over us.

Greg left for work and I left Argus there for the procedure. When I picked him up a couple of hours later, he was a drunken sailor from the sedation medicine. He couldn’t walk a straight line and his back legs wanted to slide out from under him when we stopped for a few seconds. It would have been comical if it weren’t so tragic. I lifted him into and out of the car, then got him in the house and settled on our bed. His poor little tongue was stuck outside his mouth until I wet it and pried his jaw open to put it back in. He slept the afternoon away and finally came around enough to have dinner.

As it turns out, Wednesday’s meeting was a $453 misunderstanding. I got an email from the oncologist on Thursday morning that summarized everything we talked about. This letter indicated that chemotherapy is not a standalone treatment method, the prognosis with surgery alone is 5-6 months, and the prognosis with surgery + chemo averages 12 months. Furthermore, the exact cost of the chemotherapy drug Carboplatin was provided and the cost is $4800 (not $3000). We were back to square one. The cytology was a $233 (not $60) hail Mary that failed. The test came back as confirmed osteosarcoma. Our spirits were low last night.

My heart is broken that Argus is dying. I have additional heartburn because Greg and I are no longer on the same page about his treatment. With the new information in the summary letter, I believed that the cost is too great to amputate and/or pursue chemotherapy. Even doing nothing, the pain medication will cost us somewhere around $2000 if he lives six months. Greg has been adamant on pursuing amputation, even with its hefty price tag. I approached the subject via IM today, hoping to diffuse some of the emotions that are inevitable with this kind of conversation. The good news is that he finally agreed that spending $4000 (on top of the $1200 that we’ve already spent) is too much to only buy a few extra months with Argus. WHEW! That said, we also agreed to exhaust all possible options for a cheaper amputation facility.

I got in touch with the vet teaching hospital at UC Davis this afternoon and got some very good news. Their cost for the amputation surgery is $750 all-inclusive: two nights in the hospital, anesthesia, surgery, and pain medication (morphine) post-op. I tried to mask my amazement and delight when she revealed that number. Dr. Sutter agreed that this is a very good option for us to pursue and got to work on getting Argus’ records faxed to them. We will find out on Monday whether our case has been accepted. Our fingers and paws are crossed!

In the meantime, Argus and I went for a walk today and he seems in good spirits. He was excited when Greg came home from work and he still has quite an appetite, watching us intently as we prepare his dinner. I am relieved that his pain seems to be under control for the most part and things seem reasonably normal. Greg and I are getting ready to go out to dinner tonight and we feel much better and more hopeful than we did a week ago at this time.

If anyone has any other ideas for remedies pre- or post-amputation, please share them with me in the comments section!

Five Years Old

October 15, 2010 Fido 4 Comments

Today is Argus’ 5th birthday! I love celebrating birthdays, even if the person having the birthday doesn’t know and/or does not want to celebrate. People in my life who fall into these categories include Argus and Greg, respectively.

Argus has been limping for about three weeks now. We were pretty sure he’d sprained his “wrist” leaping off the deck into the new lawn to chase off the squirrels. We have restricted his exercise since then, avoiding the $50 office visit to the vet who would inevitably tell us, “Keep him off of it.” But last night he had a bit of a freak-out in the middle of the night and ended up snuggled in between me and Greg on the bed. I think the Latin term for this is dogus comebetweenus.

When I got up this morning, he was holding that paw up and not wanting any weight on it. This is quite difficult for a 97-pound dog who carries 60% of his weight on his front legs… So, I made the call to the vet. He could see us at 11:30.

Hurry! I could get in a 30-mile bike ride and be done with all of these obligations by noon if I got in gear. I fed Argus a raw egg in lieu of the three treats he would receive like clockwork from the mail person and wrapped up his bum leg with an ice pack. He doesn’t like moving around with this get-up on and I knew it would keep him immobile while I was gone.

Home from my bike ride, I scrambled around to change out of my spandex and into street clothes, then cajoled Argus into the car. It is heart-breaking to watch a lame dog walk, especially when he’s your side-kick. We got to the vet and he bucked up a little, trying to lead me on a walk away from the doors leading into the clinic. Gotta love him!

I really like our vet. Dr. Sutter has been our go-to guy since we brought Argus home in January 2006. He owns several Labs himself and has a great bedside manner. He did the usual visual/manual examination, then brought Argus back for x-rays. If Argus would hold still, he wouldn’t need to sedate him. I’m thrilled this was the case! In about 10 minutes, Dr. Sutter came to get me to come back and look at the films.

I’m no stranger to x-rays after my run-in with a pickup while on a bicycle. Dr. Sutter relieved me by saying that the pain reflex that was triggering in Argus’ elbow was not, in fact, arthritis. Whew! But we knew the real issue was the swollen part on his wrist. He explained to me about bone tissue and soft tissue and how there was hard tissue outside of the bone itself. I listened to what he said and responded, “Okay. I see what you’re talking about. So, is that a bone spur or something? What do we do?”

With watery eyes, Dr. Sutter looked at me and said, “Oh. No. It’s cancer.”

I obviously wasn’t picking up what he was putting down. Why would I even care about arthritis in the elbow when there’s cancer to talk about?

Right there I started to melt, just like sugar does when it gets wet. I was dissolving. My breath had been taken away. I thought he was going to tell me we’d have to have surgery to remove the dog’s version of a bunion or something. I REALLY THOUGHT THAT. I quickly tried to catch my breath along with all the swear words that were coming out of my mouth. I apologized and he looked squarely at me and said, “It’s okay. I am giving you bad news.” He was matter-of-fact, but at the same time so apologetic and caring.

He took me back into the examination room to have the rest of a Very Hard Discussion.

At some point during this discussion, it was revealed that the only treatment was amputation. BLOW #1. He continued talking, I continued crying. It was then revealed that if we did not amputate, the prognosis was approximately three months. BLOW #2. If we did amputate, we could hope for 6-12 months. BLOW #3. He then gave me the decision tree for everything that Greg and I would need to talk about over the weekend.

$264 later, I left with two bottles of pain meds and a heavy heart. I tried calling Greg from the car, but he didn’t answer. It was his lunch break; he was probably out running. Argus and I got home and I fried up some turkey bacon that I could hide his meds in as a tasty “birthday treat.”  With this, he quickly forgave me for that awful trip to the evil vet. He then fell into a blissful drug-induced state and I continued to dissolve.

I don’t know what we’ll do. Greg is diligently researching our options. Friends are calling, emailing, and texting with their concern. Jane dropped by with a care package — a bottle of good wine for me, a craft beer for Greg, and a marrow bone for Argus. WE ARE LOVED. Especially the four-legged one.

Argus turned 5 today. By the “standard” measure, that’s 35 in human years — my age, at least for a couple more months. Life and good health are fragile things. There’s no such thing as “too young” or “not my time.” You never know when it will all be taken from you. My advice: seize the day!

Or, as the Latin say, carpe diem.