Tuesday, October 8, 2013

THE ROLLERCOASTER REPRIEVE



We had a follow up veterinary appointment this morning for D'fer and we have had some very, very good news.  What one vet and a radiologist thought was osteosarcoma may in fact be very severe osteoarthritis.  We sought out a second opinion this week, and had a second set of radiographs (the medical term for X-Rays is Radiograph) done today, ten days after the originals were taken.  What this allowed us to do is compare what his hips looked like ten days ago and what they look like now.  By finding out what the difference is we can find out one of two things; either the rate of cancerous growth is really fast and dangerous OR that perhaps the diagnosis of osteosarcoma was wrong and the diagnosis might be something else.  There are no significant changes between one and the other which means that most likely...we are NOT dealing with osteosarcoma.  We also did chest radiographs and there are no scary shadows on the film showing us that there has not been any cancerous spread to the lungs.  Phew!  Never the less, the radiologist did think that there is cancer in the bone, so we cannot dismiss that entirely.  If this is cancer, it is growing slowly enough that D'fer won't likely drop dead at any moment, and if this is not cancer, then we may have some treatment options that we hadn't had before.  And this brings me to the roller coaster metaphore for today.



D'fer with his celebration stick.  That would be the toy you buy when you get a different diagnosis than osteosarcoma.  Still not a great diagnosis, but better than death at any moment.

The injury that led to the osteosarcoma diagnosis was that Deef had been lame for a couple of weeks, off and on.  He had a sore shoulder and then he was gimping along on his left hip and then his right front leg looked a bit off.  Then one night, just about dinner time, I took D'fer out to pee and he asked me to throw his frisbee.  Normal D'fer stuff.  I took it and gave it back to him because he had been too sore to really play frisbee.  Then he trotted around the yard and did his thing, and brought me the frisbee again.  I took it and dropped it in front of him.  He launched himself into the air (much more forcefully than he needed to mind you!) and on his way up screamed in a way I had never heard him scream before.   He landed in a heap on his left hip.  When he got himself up he wouldn't put any weight on his left hind leg.  Off to the emergency room we went and they took a radiograph.  His left hip looked like scrambled eggs.  Not good.  I asked some questions and the emergency vet thought that he had severe osteoarthritis; a degeneration of the bone in the hip and sent us home with pain meds to keep him comfortable.  That vet visit is when we got onto the rollercoaster.


The injury happened on a Saturday evening so on Monday morning I went into my regular vet who looked at the radiograph and gave me the sad news that this might be osteosarcoma; a form of fast growing bone cancer.  He sent the radiographs out to a radiologist who confirmed his diagnosis.  My world fell apart, and I wrote last week's blog about how I was going to approach treating this.  D'fer's pain has been well managed and when his pain is under control, he really is a happy dog.  He is still quite lame, but he is a happy dog.  Even so, I felt like I was falling, falling, falling.
 

With the encouragement of friends, I sought out a second opinion; the second vet disagreed with the first vet and the radiologist.  Regardless of agreeing or disagreeing, a second set of radiographs would tell us if the image on the film was growing or staying the same.  That leg of the journey has been like the rollercoaster coasting along nicely and politely.  Things don't feel quite so disrupted or discouraging.  I feel quite a bit like I got my life back when I saw the rads today; especially the chest rads that don't show any cancer in D'fer's lungs.

Radiograph number one take ten days ago.  Compare the left and right hip joints; you will notice that one is nice and even and the other looks like scrambled eggs.  Or more technically "the left hip (right on the radiograph) presents with a  moth eaten appearance.  If you know about radiographs, this is a scary looking hip.

Now compare!  Don't worry that the bones aren't in the same exact direction as they were on the first radiograph; you can see that the problem joint is basically the same.  Now if you are like me, you expand this picture and then you look at it with a magnifying lens for fun!  The important part is that the joint didn't change between the first image and the second, even though D'fer was positioned slightly differently the second time.
 

So now we coast for a bit.  Some things have changed and will stay changed; we still have the radiology report saying that the image on the film looks a lot like cancer.  It still might be.  But it hasn't changed!  The vet cautioned us that we have to remember that it might just be.  Now we have a crate in the kitchen so that if we need to we can easily care for D'fer if he is in pain from his leg.  That will stay.  We are not turning D'fer out with other dogs in the yard because it just wouldn't be a good idea for him to get to running and chasing and rough housing with his friends given the state that his hip is in.  That is a change for sure.  We use the hip helper harness (http://www.hartmanharness.com/) to help him up and down stairs and in and out of the car and over curbs when he is stiff or sore.  Likely we will be using this more and more often as he ages and we are very happy to have it.  Probably the biggest change though is that we know that there will be more diagnostics and possibly more treatments on the horizon.
 
Happy D'fer on pain meds, with his cancer beating Frisbee and his hip helper.  One of the changes we have made is to make a rule that he cannot come upstairs without the help of his hip helper harness.  So nice to see him smiling again.  Good boy! 

 
Right now, D'fer's rads are being sent to the surgeon to see if they can remove the head of the femur and alleviate his pain that way.  IF, and it is a very big if, the surgeon thinks that she can successfully remove the head of the femur, then we will consult an internal medicine specialist and see if his heart is healthy enough to undergo anesthesia.  IF it is safe to anesthetize him, then we will work out a plan involving our veterinarian, the surgeon, the internal medicine specialist or cardiologist, and likely and anesthetist to remove the head of the femur.  This is a big hill on the Reprieve Rollercoaster, because a whole bunch of factors have to fall into place in order to be able to surgically help D'fer.  Knowing it is coming is stressful, and not knowing what the hill will surprise us with is even more stressful, but we are going to go up the hill and down the other side in the company of professionals who are educated and who care deeply about D'fer.

 
There are some important lessons in this experience that are not training related but they certainly do impact training.  The first is that you really need to know a little bit about your dog in order to advocate for him.  I have known for a long time that Deef has been "off" but have not been sure what exactly might be going on with him.  Once we had an injury, I count myself lucky on a number of fronts.  I know a lot about the basic anatomy and organization of the body, and how medicine works, so when the veterinarian wants to do something like taking a radiograph of my dog, then I have a good idea what she is talking about.  Also, I knew the emergency vet really, really well.  Those three things; knowing my dog, knowing a bit about biology and health and medicine and knowing my vet have paid off HUGE dividends this past ten days.  I have been able to talk to the veterinarians, I have been able to identify exactly how D'fer is not "himself", I have been able to ask good questions and I have been able to integrate what is being said so that I can advocate on D'fer's behalf.  When faced with an illness or injury being able to advocate for your dog like this allows you to return to training quickly and effectively.  This is really important.

 
Another thing to think about is that I had really clear boundaries about what I would and would not do to my dog before I needed to pull them out of my pocket and examine them.  I know that although I might amputate a dog's leg if it was injured or if it would buy him years of time, I am not going to amputate his leg to get a tissue sample (one of the options discussed when we had the osteosarcoma diagnosis).  I know that I will not engage in radical, painful, long treatment if it is not going to get us a great deal of benefit.  That means that for my dogs, although I might allow surgery, radiation or chemotherapy to happen to alleviate pain, or to significantly prolong life, I also know that I won't put being alive ahead of having what I consider a minimum level of quality of life.  I made this decision long before I needed it and I have discussed that decision at length with my veterinarian.  In fact I have decided these things about each of the animals I have responsibility for so that I can be certain that in a crisis I am not held over a barrel to make a choice I may not be comfortable with later.  Make your choices ahead of time where possible and then discuss them with your vet.  Doing so will save you a lot of headaches later on when you are faced with the decision and you already have a plan.

 
Finally, the most important thing that I did to prepare for the Rollercoaster Reprieve, was to carefully develop and organize a support system for myself.  This network is made up of close friends and family members, of dear and cherished clients, of veterinarians and technicians, of people on the net who have never met me but who have read my blogs and my articles and been to my seminars and who have reached out through this difficult time to help me, John and D'fer.  We are not out of the woods.  We may still lose D'fer imminently; he is after all ten years old with a heart condition.  He may or may not be a candidate for surgery.  He may over do it at some point tomorrow or the next day and fracture the neck of the femur, and we may be right back to where we were last week, when I wrote "IT WILL BE ALRIGHT", but I am confident that it WILL be alright because we have the support we need, we have good diagnostics and we have all the right things happening to help us to survive the Reprieve Rollercoaster and whatever it throws at us.  Thanks everyone; I couldn't have made it through this past week without you!

 



2 comments:

  1. We are saying big prayers for your boy. ...and sending hugs to you.

    Monty and Harlow

    ReplyDelete
  2. This is such, albeit tentative, good news!

    ReplyDelete