FHO Recovery, Osteosarcoma and the Path Forward

I haven’t written since sharing the results of the Princess Pooch’s bone biopsy. I was in a kind of fog for awhile, and then I began doing what academics do: reading everything I could find on osteosarcoma in dogs. In addition to all that’s available on the internet–general veterinary publications and people sharing their own experiences with their dogs–I am fortunate to have access to a university library and all the wonderful databases that are available. I found a number of studies published in the journal of Veterinary & Comparative Oncology particularly informative.

After getting recommendations for veterinary oncologists from our regular vet, I called the folks at Integrative Veterinary Oncology. When the person I spoke to said their first available appointment was August 16th, my heart sank, but she then informed me that the doctor held times open for urgent cases and once she received the necessary records from our vet and the hospital where the Princess Pooch had surgery and had time to read them, I would get a call about finding an opening much sooner. True to her word, I received a call that evening. The doctor had received all the necessary records, taken the time to read them, and could see the Princess at 3:00 on Thursday. Whew!

By Wednesday I had read everything I could wrap my mind around, so I decided to make a list of the things that brought the Princess joy. I wanted to have this list when we spoke to the doctor so I could be clear about what “quality of life” meant for the Princess. Also, and anyone who knows me will not be surprised by this, I wrote up a list of questions and concerns. I did this so if I fell apart during our discussion with the vet, I could hopefully return my focus to what the Princess needed.

Thursday was a big day for us and for the Princess. First, we had an 8:30 am appointment with her surgeon for a post-op visit and to remove her staples. She’d been such a good dog about leaving her incision alone. I’d caught her licking it a few times, but as soon as I said “leave it,” she’d stop. I also was diligent about keeping an eye on her throughout the day, then putting the e-collar on her overnight. So that morning, Mr. Desert lifted her into the car and onto the bed we had there for her and off we went. She was excited to be in the car but was a good girl and mostly stayed in her bed which we appreciated because we didn’t have to worry about her slipping and sliding around.

Once we arrived at the hospital, we didn’t have to wait more than a few minutes before a tech took her back to remove the staples while we waited in an exam room. When the surgeon brought her back, he told us there were no staples to remove! We were both shocked; in fact, I think we both asked if he was sure. I knew the staples were there when I put the e-collar on her and tucked her into bed the night before, so where the hell did they go? Thankfully, her incision was healed and the surgeon was pleased with her progress, so we headed home. 20140181_10155343574666071_5728962414438881682_nHere’s a photo of her happy on her sofa for the first time since her surgery.

After we got home and got her settled, I decided to dig around in her bed: sure enough, I found five staples! I don’t know how many were in the incision, but she’d clearly pulled them out as we drove to the hospital. The little sneaker took advantage of the fact I wasn’t really paying attention anymore because we were on the way to get the things out! She’s one smart pup!

Oncology Consult
We arrived for our appointment a bit early, and the vet ended up running a bit late, so we spent some time in what is a lovely waiting area with big comfy sofas and chairs, cold bottles of water, coffee, a table with jigsaw puzzles, and a big glass door that opens into a room where the house kitties available for adoption. Yesterday there were 4 young adult tuxedo cats romping around, playing, and flying up and down the cat tree. We also met a couple of folks whose animals were being treated. One woman had an 8 year old cat who had been undergoing treatment for a year, and another woman said her dog had been undergoing treatment for 4 years and was now 11 years old. She couldn’t say enough about how fabulous Dr. Hershey is and how much she’d helped her dog. Her dog finished up his treatment before we went in to see the doctor, so we got to meet him. He’s a handsome grey and white pitbull. He ran up to his person with a big smile and a powerful tail wag. So by the time we were called back, we were feeling more hopeful.

We were taken to a huge room with more comfy sofas and easy chairs, and when the doctor came in she introduced herself, shook our hands then sat down on the floor to greet the Princess. She checked her out as she talked to us about her observations and what she’d learn from reading the records she’d received. She was very down to earth and clear, so much so I didn’t even open the notebook I’d brought!

In some ways, she said, the hip fracture was good because it drew attention to the bone which in turn helped them diagnosis the cancer early. She was clear that there is no cure for oseosarcoma, and that the goal of any treatment is to address pain and provide extended quality of life. She talked about recent studies, confirming what I’d been reading; answered my questions about the various drugs used to treat the cancer; and explained why she was recommending a particular treatment plan. Essentially there are 3 drugs used to treat oseosarcoma in dogs: Carboplatin, Doxorubicin and Cisplatin. Although Doxorubicin is the cheapest of the 3 drugs, it can cause irreversible injury to the heart, so it’s not a good choice. She explained that Cisplatin used to be the drug of choice because the cost of Carboplantin was prohibitive–often exceeding $1,000 per treatment while Cisplatin cost between $300 to $500 per treatment. The problem with Cisplatin, however, is that it is distributed widely into the liver and kidney and so requires tests on renal concentrating ability, azotemia and presence of abnormal numbers of granular casts in urinary sediment; because of the effects on the liver and kidney, a fluid diuresis pre treatment of several hours is required. Fortunately, the price of Carboplatin is no longer prohibitive, and studies show it is as effective if not a bit more so in treating Oseosarcoma. And, it doesn’t require fluid diuresis pre treatment; this is particularly important for the Princess Pooch because last year she was diagnosed with early renal disease.

So, the treatment plan is as follows: treatments of Carboplatin every 3 weeks for a total of 6 treatment and blood work and chest x-rays at specific times during this treatment to monitor her white cell count and to look for metastasis in the lungs. These are ways of assessing how effective the treatment is. In addition to being a board-certified veterinary oncologist, Dr. Hershey has also studied traditional Chinese veterinary medicine with Dr. Xie at the Chi Institute in Reddick, Florida and combines conventional Western therapies with acupuncture, herbal medicine, nutrition, ozone therapy, ultraviolet therapy and other therapies. Here a video of an interview with Dr. Hershey where she talks about this training.

The Princess Pooch had her first treatment yesterday afternoon, and other than some lethargy has had no side effects. The good news about chemotherapy and dogs is that side effects such as vomiting and diarrhea are rare, and if they do occur usually last a day or two.

In the meantime, her recovery from the FHO surgery is progressing well, and we’re hopeful this treatment plan will give her good quality of life for at least a year. Given her age, 12, that would be a wonderful gift.

 

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