Bravo’s cancer journey continues, and I had to take some time to pull my thoughts and emotions together before sharing this. I hope that our experience will help other pet lovers with dogs dealing with bone cancer and the challenge of treating this disease. I’ve put together a video (below) rather than lots of pictures–it’s a way for me to celebrate his life to date–and going forward as a tripawd dog.
Bravo will have his right front leg amputation tomorrow. So let’s celebrate the four-pawed wonder in the video. They are, indeed, the “Least of These” and asked only to be loved. And after tomorrow, when his pain goes away, we’ll marvel at his new other-abled joy!
Bravo’s Cancer Diagnosis
We have had an emotional roller-coaster ride over the last few weeks dealing with Bravo-Dawg’s unexpected diagnosis of bone cancer. With the arrival of the new puppy, that not only complicated things but also brought some much-needed smiles to dry far too many tears. You can read more about Shadow-Pup here.
After several weeks of limping that Rimadyl (a pain medicine for dogs) didn’t seem to help, we scheduled a radiograph on May 28. I fully expected he’d either strained or torn a muscle, or suffered from elbow dysplasia. Instead, the Xray revealed a lesion (tumor) on the humerus, midway between his shoulder and elbow.
The radiologist recommended a bone biopsy to confirm the diagnosis. So we took Bravo to Dr. Brent Wilkins, at Dallas Veterinary Surgical Center in Plano, Texas. They shaved his leg, anesthetized him, and removed a plug-size sample of bone on June 5. The doctor sent him home with several pain medications:
- Carprofen (aka Rimadyl) 100mg: We give this every 12 hours with his morning and evening meal
- Gabapentin 600mg: Given every 12 hours at 9 am/pm
- Trazadone 100mg: 2 tablets every 8-12 hours for sedation
The medication helped enormously, and Bravo stopped limping. However, he very quickly learned that his pills helped him feel better, and began to ask for the medication, earlier and earlier.
The pathology report came back on June 10, confirming sarcoma.
Treating Bone Cancer: Bravo’s Next Steps
We met with the veterinary oncologist Dr. Zachary Wright yesterday morning in Dallas at the Animal Diagnostic Clinic. After reviewing all of Bravo’s records–Xrays of lungs (clear!) and leg, the biopsy–and examining him, he got rave reviews in terms of attitude and health. Other than his bum leg, he’s an energetic, vital, and handsome young dog. The technician told he Bravo INSISTED on meeting and snuggling with the entire staff. Now, I couldn’t witness that because — COVID-19, and masks, distancing, etc.
That’s right, because of the virus, we can’t be with Bravo at the vet. The masked and gloved staff collect him from my car, where I sit also wearing a mask. And then the veterinarian calls me after the exam to discuss options.
Managing Bravo’s Bone Cancer Pain
The oncologist offered two options. Having written on the subject of cancer in dogs for many years, I’d already shared general information with my husband. I’d also (of course!) received great support and information from veterinarian friends and colleagues, some who had also traveled this difficult path. Medicine, though, continually changes with new research so I’m encouraged that Bravo’s oncologist regularly includes research trials for patients. His recommendations for pain management included:
- Routine pain medications (Rimadyl, gabapentin, etc) as a starting point. But they’re rarely effective by themselves. I already see that Bravo’s comfort level doesn’t last as long.
- Acupuncture can be used as a piece of the treatment puzzle.
- Zoledronate is an injectable drug designed to kill the cells that are causing bone destruction. These cells are usually not the cancer cells but a response to the tumor. Consequently, zoledronate does not kill the tumor cells in most cases.
- Radiation therapy to the bone tumor is 90% successful in improving clinical signs. The pain relief lasts two to three months.
The oncologist confirmed my fear that pain relief might prompt Bravo to overdo and put too much weight on the affected leg. This could result in a pathologic fracture of the right forelimb. Pathologic fractures cannot be surgically healed and would require amputation or euthanasia at that time. All of these treatments will eventually be unable to relieve Bravo’s pain. At that time, other treatment options would be required.
Amputation Treatment for Canine Osteosarcoma
The second option for Bravo’s cancer treatment calls for amputation of the right front leg. The oncologist considers this the most effective pain control for canine osteosarcoma cancer. He also said, “Dogs are born with three legs and a kick-stand. They do extraordinarily well losing one limb.”
Bone cancer diagnosis more typically affects old dogs, but (lucky us–NOT!) a subset happens to young dogs like Bravo. Because of his good condition and positive attitude, the doctor expects Bravo to do very well with amputation and recover with “relative ease.” He said most dogs act back to normal in 1-2 weeks, and he believed Bravo would likely walk as soon as the anesthesia wears off.
From the moment our veterinarian said “bone lesion” I knew this would be our path. It took a bit longer for my husband to also accept this option. We’ve cried over this, and I happily learned he also researched to find out what to expect. We don’t like it–but amputation will give Bravo the best comfort for the time he has left. Treatment with amputation alone buys our boy 5-6 months.
Chemotherapy for Canine Bone Cancer
I learned that a primary bone tumor almost always has already spread to other areas of the body at the time of diagnosis. Even though his radiographs show clear lungs, Bravo may have tumors too small to detect. In fact, the oncologist explained that the primary osteosarcoma tumor sends out signals that suppress tumor growth anywhere else in the body. But once amputation removes that primary site, the others begin to grow.
Chemotherapy attacks the satellite tumors throughout the body. Most chemotherapy used in veterinary medicine doesn’t cause severe side effects because lower doses instead ensure the best quality of life. So hair loss won’t be a factor, for example.
The drug of choice for osteosarcoma is carboplatin. This drug is given every three weeks as an injection for 5 treatments. Bravo will travel down to Dallas every three weeks for his treatment. Adjustments to the treatment can be made at any time–it’s not like jumping off a cliff. Carboplatin’s main side effects are a drop in the body’s white blood cells and platelets. This may reduce the body’s ability to fight infection and to clot blood. So we’ll keep an eye on that, and can stop treatment or switch things out at any time.
The average survival time for dogs with osteosarcoma undergoing amputation and 5 rounds of
chemotherapy is 11-12 months.
What Happens After Chemotherapy?
Veterinary research and trials routinely focus on canine osteosarcoma. Not only a horrible, and very common disease of dogs, this condition also affects children. That makes my heart doubly ache. Because of the high interest, the oncologist says over the next several months there may be opportunities to enroll Bravo in one of these trials or studies. Wouldn’t that be amazing, for part of his legacy to help other dogs or even children?
We also can follow up the chemotherapy with maintenance therapy, some of which have come out of the research studies. Because they are all relatively new, survival benefits haven’t been well defined. But at this point, Bravo’s up for anything–as are we!
Our oncologist specifically mentioned Rapamycin, a new mTor inhibitor currently in a nationwide clinical trial for dogs with osteosarcoma (so results are not yet available). I had read about this (researcher in me!) and had it on my list to ask about. Bravo can’t be enrolled in the trial (that’s closed to new dogs), but the oncologist says that outside of the trial, the drug is commercially available as an oral pill given at home and is generally well tolerated. I believe it’s given for 4 days in a row, and then 3 days off. We’ll see …and yes, dear readers, I’ll update as I can.
Pet People Are The Best!
The outpouring of support and sympathy since sharing Bravo’s cancer diagnosis has stunned me. I’ve been hopeless, angry, heartbroken, and hopeful in turn. Every paw-step of the way, y’all have lifted us up. The unknowns drag us down, but we now have a path forward. And with your love for our beautiful big ol’ Bravo-Dawg (and for us…) we know this journey will be transforming for us all.
Thank you. And if you know of someone with their own challenging pet cancer journey, please share these posts if you think they’ll help. I hate cancer! But it won’t beat us. Not when we can live every moment with love.
An unexpected detour in the cancer journey brought a few smiles, and we needed that.
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