Dr. Phil Zeltzman is a traveling, board-certified surgeon in Allentown, PA. His website is www.DrPhilZeltzman.com. He is the co-author of “Walk a Hound, Lose a Pound” (www.WalkaHound.com).
AJ Debiasse, a technician in Stroudsburg, PA, contributed to this article.
Xena, a 4 year old female Rottweiler, was fun loving and extremely active. After playing rough, she occasionally would limp on and off. An evening of rest would most often improve the limp. Sometimes, it would require a visit to the veterinarian.
This was one of those times. After three days of limping around, Xena’s owner scheduled a visit to the vet. What they found was far from Xena’s usual muscle soreness.
The vet performed a full exam. Everything seemed to check out OK, except for some swelling above her right wrist, which was painful to the touch. The vet recommended an X-ray to investigate the bone structure. The results were most devastating.The foamy pattern at the end of the radius, the main bone in the forearm, was suggestive of osteosarcoma or bone cancer.
Just because cancer isn't suspected does not mean that we don't have any options. In Xena's case, we first needed to know more about her health, starting with blood work: a chemistry to check metabolic function and a complete blood count to check red and white blood cells. Second, chest X-rays were very important to check for metastasis or spreading of bone cancer, as it pretty much happens in 100% of patients sooner or later.
Fortunately, Xena’s blood work and chest X-rays came back entirely normal. So what was next?
Bone cancer is an aggressive disease, so treatment has to be aggressive as well. The gold standard is amputation of the leg and chemotherapy. In a perfect world, and when finances are not a prohibiting factor, a bone biopsy prior to amputation would be ideal. The goal is to exclude rare diseases that could mimic the changes seen in the bone, such as infection by a fungus or bacteria. But for Xena, waiting on the biopsy results would also delay treatment by at least a week.
After a heart-to-heart discussion, Xena’s owners and their family vet agreed that it was reasonable to amputate without the benefit of a biopsy. It was a compromise, no more, no less.
When amputation is performed without a prior biopsy, then the biopsy should be taken after surgery in order to confirm the diagnosis and to guide which chemo protocol to choose.
Amputation is no small thing and for Xena, it involved sacrificing the entire leg. Leaving part of a limb is not recommended in pets because of the concern for sores if they use the stump for balance or to get up. In addition, the stump really does not serve any purpose as 99% of pets (cats or dogs) function very well on three legs. There are countless online videos showing happy, comfortable, playful pets, that behave perfectly normally on three legs.
From experience, it seems that the biggest problem with the concept of amputation is in the owner's head. We often think about how we would react if we were to lose an arm or a leg. Xena and other pets don't think that way.
As I often tell my clients: “Don’t tell your pet he has cancer". Pets just want to be comfortable and able to walk. Sure, some pets need more assistance and re-learning than others, but the vast majority does surprisingly well. In fact, most pets start walking just a few hours after surgery.
With amputation alone for confirmed osteosarcoma (with a biopsy), the average survival is three to six months. With amputation and chemotherapy, we hope for an average survival of at least one year. When we recommend treatment, our goal is more about quality of life than quantity of life (aka survival time).
I’ve had to perform amputation for all kinds of reasons: cancer, as well as severe trauma. To this day, I have never met a client who has told me that they regretted their decision to amputate their pet. As long as we are on the same page, and we all decide as the pet’s advocate, we typically get good results, regardless of the amount of time left.
In other words, we would rather have three, six or twelve months of quality life, than three years of misery.
If you have any questions or concerns, you should always visit or call your veterinarian -- they are your best resource to ensure the health and well-being of your pets.