Continued from Part 1.
Dr. Couto was the first one to contact us. We had asked our vet to send him the rads when they sent them to the radiologist. They emailed him jpegs, which aren’t the best for his purposes. But he could tell two things right away: The right leg most likely was not a concern while the left like was most likely was. The white squiggly lines on her right leg were probably an infarct (dead tissue caused by lack of blood supply), which he has seen in greyhound bones before. There’s no clear reason why it’s there, but he disagreed with the radiologist’s interpretation of it looking like a secondary tumor. Lena’s left leg, however, had some shadowy areas near the top of the humous that coincided with the painful area. But even though he was 90% sure it was osteo, the only way to be 100% sure was to look at a sample of the cells in the bone (irrationally, we held out hope for that 10%). The bone looked strong (nice, well-defined edges with no obvious tumor growth), so we had either caught the osteo nice and early or it wasn’t osteo at all. Fingers crossed.
To get cell samples from the bone you have two options at this point; a fine needle aspirate (FNA) or a bone biopsy, and Dr. Couto recommended the former. Usually by the time you catch osteo the bone is so deteriorated that you can puncture the periosteum (outer surface of the bone) without much effort and may only need a local anesthetic to complete it [Note: it’s this weakening of the bone that makes it so likely that the bone will break before your dog ever lets you know there’s a problem]. The drawback is that it’s a smaller sample size. A biopsy is a bigger needle and therefore offers a bigger sample size, but requires a general anesthetic. Our vet couldn’t do either until Monday, and there was a possibility that Dr. Couto could do it during The Greyt Escape, which would also give him the opportunity to review the cytology (reviewing small clusters of cells) first-hand. Weighing all of the factors, we opted to go to the GreytEscape any keep a close eye on Lena.
The event was busy and we never got the opportunity to go to UVS where Dr. Couto works to get the samples. So we took her in on Monday to have the FNA done. But that’s where we hit a wall or, more accurately, a bone. The small aspirate needle couldn’t break through the bone to get a sample of the cells within. This could have been for several reasons: The most likely was that she (our vet) couldn’t find the soft spot in the bone caused by the cancer (hitting a 3D target based on a 2D image can be tricky) or, hopefully, we had caught this so early that the bone hadn’t begun to seriously weaken yet. The third, least likely option is that it wasn’t osteo at all. In any event, having tried so many times and failing to break through the bone, even going so far as to bend the fine tip of the needle at one point, we opted to get a biopsy. My take at this point was that this was encouraging —her bone was so healthy they couldn’t get what was supposed to be an “easy” sample to take. The general anesthetic only last a very short while and we were on the road in no time. The results, however, would take 2-3 days to get back from the lab. We did also get some samples to put on a slide so Dr. Couto could review the cytology right away. Of course, they were inconclusive. This was either due to the sample having missed the cancerous area of the bone or, maybe, there was no cancer. Fingers, again, crossed.
In the back of my head I was thinking that we should proactively make a surgical appointment just in case we needed it so there would be no delay. Suzie and I had already been discussing “what if’s”. With both Nellie and Maggie, our two previous osteo hounds, the decision to amputate and do chemo was a no-brainer: they had both been about 6 years old and otherwise perfectly healthy. Lena was not in the same boat: She was 10 years old, had corns on both back feet that already caused her some distress when walking and she was also missing a weight-bearing toe on one of them, which caused periodic lameness of her back right leg (she was just as likely pull her leg up when running as she was to actually use it). Given all of that, we weren’t sure she was a good candidate for surgery or that would make a good tripod. She did have a few things going for her, though: The front left leg is the one she broke on the track* which had a plate and screws in it until a couple of years ago and it the “wrist” didn’t bend more than a few degrees and her right leg was perfectly healthy so it seemed this was the better of the two to be walking on if we had the choice. She’s also fairly tiny for a greyhound, at about 55lbs. But we were both trying to be realistic about her quality of life post-amputation. Hopefully, we wouldn’t have to make this decision. Still holding out for that 10% chance that it isn’t cancer.
We had had Lena on Rimadyl since the previous Wednesday and they seemed to be helping. She was no longer limping on any of her legs (apparently it was helping with the pain from the corns, too. Good to know.) So Tuesday passed without incident. Most of Wednesday also went by unremarkably while we waited for the biopsy results. Until 8:35 PM. We had gotten in the habit of going out to the back yard with the dogs earlier in the summer when we began noticing a Disney-like parade of critters through our yard … squirrels, opossums, raccoons, skunks, and the neighbor’s cat all seemed to be taking turns hanging out in our yard. So when I heard Suzie take Lena outside I thought nothing of it. When she yanked open the door 5 minutes later screaming she needed help, my first thought was “skunk”. Then she yelled that she needed help with Lena and I hear the absolute terror in her voice. I ran outside to see Lena standing there with her front left leg hanging limp. As I got closer to her she tried to take a step toward me and screamed the most awful GSD I’d ever heard. Somewhere behind me Suzie was telling me what happened … something about Lena darting into the pine trees after some shadowy thing that ran in the other direction, Lena screaming and limping out … I missed the details because I was focused on Lena and not really listening. In my mind that 10% chance that this wasn’t cancer immediately evaporated — healthy bones don’t spontaneously fracture, even after a biopsy. Her face was lit up by the lights on the garage and the look in her eyes was one of pain and fear. She was hurting. We all were scared. Suzie immediately called our vet, which has 24-hour on-call emergency care. They hadn’t closed yet so at least one of the vets was still there. They told us to bring her right in.
*There is no clear evidence that injuries like this lead to bone cancer. It is likely genetic with a possibility that certain environmental influences might have a role to play. Determining the cause, as well as a cure, for osteosarcoma is the goal of ongoing research.