Osteosarcoma and Amputation: myths and facts
Updated: December 20th, 2018
In my last blog, I gave my recommendations about osteosarcoma (OSA) work up. Now it’s time to talk about treatment.
Conventional treatment for OSA targets:
- The primary tumor with local treatment (surgery and/or radiation)
- The likely micrometastasis with systemic treatment (chemotherapy)
Today, I am going to talk about amputation.
The main goal of local treatment, whether surgery and/or radiation, is to prevent recurrence and control the pain dogs inevitably feel with OSA. Osteosarcoma hurts.
The tumor destroys the normal bone — and that pain decreases the quality of life of the dog.
Remember, many dogs are stoic and hide their pain. As pack animals, they don’t want to be perceived as sick or weakened, so they will hide their symptoms for as long as possible. This is why it can seem like dogs “get sick overnight.” But the reality is that they only start acting sick when they can no longer mask their pain!
Amputation, as radical as it may sound, is usually the best treatment option for OSA. The complete removal of the affected limb prevents a possibly sudden and painful fracture, and effectively removes the source of deep, aching bone pain. It helps restore quality of life.
As a vet and oncologist, I know that amputation is a source of pain relief – it removes the pain that a dog bears with each step and improves the comfort for the dog. I was taught this in vet school and during my oncology residency: the affected bone cannot be removed, so the only way is to remove the cancer is to remove the whole leg. I was also taught that dogs did amazing afterwards. I still remember the movie Dr Delahunta at Cornell showed us (on a projector and reel) of a Border Collie still herding sheep. The dog ran so fast, you could barely tell a leg was missing.
I’ve been a vet for about 15 years, and I am really comfortable making this recommendation. I see how much happier the dog is without the painful leg, and guardians tell me they have no regrets. But it is never an easy decision for the owner to make, at first.
While I was taught I needed to educate owners about the surgery, the recovery, and that most dogs adapt well, I was never taught was how uniformly negative the reaction is by pet Guardians to the concept of amputation. Guardians think it is cruel, barbaric, mutilating and unfair to amputate.
I’ve learned there are a lot of myths out there:
Myth: My dog has arthritis or had knee surgery, so they are not a candidate for amputation.
Fact: Most dogs, even older dogs with average, moderate arthritis, usually do well on three legs. The best thing to do is have an orthopedist do a good orthopedic exam prior to surgery.
Myth: The surgery is too painful.
Fact: While the surgery is painful, pain management is part of both surgery and post-op care. Patients are kept comfortable with injectable pain meds while in the hospital and oral pain meds at home. Since we know it is better to prevent pain than treat it, protocols are designed to be pre-emptive and include fentanyl skin patches, continuous rate infusions, and epidurals.
Myth: Amputees have poor quality of life after amputation.
Fact: Amputation results in an improved quality of life since they are no longer in pain with each step they take. Dogs typically adapt very well to the loss of a limb, and can still use stairs, run, play, and even swim.
Myth: Large dogs do poorly as amputees.
Fact: While small dogs and cats do well across the board, large dogs also do well as a rule. There will be exceptions to this, but doing well after amputation is the norm. In addition, many dogs are already walking on three legs before surgery, due to the pain. I have many older patients and many large and giant breed dogs that have successfully undergone amputation. Do not let someone tell you that breed, size, age or weight is reason enough to avoid amputation.
Thinking It Over
If it is hard for you to contemplate amputation, you are not alone — most owners simply cannot imagine how their dog could live a good life without all four limbs. It’s important for you to know that most owners are happy they make this choice. There are many great online resources. Two that I really like are www.tripawds.com and www.bonecancerdogs.org
For more useful information on Osteosarcoma, get a copy of this informative seminar
What You Need to Know
It’s also important to point out that your dog will have a LARGE amount of hair shaved for the surgery, and the incision will be large. In addition, the incision is often bruised and can actually get worse the first few days after surgery. This fades, of course, as natural healing takes place.
One idea to help with this is to ask your surgeon to put an old t-shirt of yours on your dog before they bring your dog out after surgery. I have a lot of clients who are uncomfortable seeing the incision and the t-shirt helps. They can avoid the immediate shock when they reunite with their dog, and then look at the incision after, when they are reassured that their dog truly is OK.
I recently posted a question on my FB page if you would consider amputation. Of the 95 responses, 72 (76%) did/would do the amputation, 17 (18%) would consider, and 6 (6%)would not or did not. While I am not claiming this to be scientific and my readers may be skewed towards those that would treat, I found the 58 comments really interesting. Most that did the surgery have no regrets. Here’s a sample:
- Charlie’s eyes told he it was not his time to go. He has thrived on three legs. His quality of life is excellent and he is pain-free. I encourage all pet guardians given amputation as an option to consider it.
- His recovery was amazing, and we have no regrets!
- We chose amputation without a second thought and have no regrets. The surgery was 4 weeks ago and to see her running around, jumping up on the furniture and appearing very happy and pain free lets us know we made the right decision.
- Off with the leg! Save our pooch!
- IT WAS THE BEST DECISION WE EVER MADE FOR HER!! She walked out of surgery and her pain was gone. We treated her with some chemotherapy, and prepared to spend our ‘last months’ with her – BUT THAT WAS 11 MONTHS AGO! She swims and runs and howls and climbs up on the couch even better than she did before she was diagnosed. Tomorrow is Lorrie’s 6th birthday, and she and her four legged Golden Retriever sister will be eating cake – if there’s any chance of living even a few months past the surgery, I would always recommend it; dogs have the most incredible resilience!
- Oliver is a 40 lb Standard Schnauzer and 18 months post amputation. Although it was difficult to see him go through the surgery, it gave him his life back. His pain prior to surgery was so severe and difficult to watch. He went through 8 rounds of chemo and is now on metronomic therapy. He runs, plays, and is so happy. The interesting thing is, when we are out walking, people rarely notice he is missing his hind right leg. He can do everything he did prior to surgery and lives every day to the fullest. I have learned so much from him – resilience and determination. Amputation was the best option for us as Oliver has so much more life to live!
- I will admit the first 2 weeks after the amputation are rough, but beyond that mine did SO well on 3 legs and everyone who knew him said that he seemed happier than when he was limping on 4. He had the amputation and 4 rounds of chemo and just recently died 6 months post op (cancer spread to spine). At first it was hard for me to believe that Sunny would live happy and pain free on 3 legs, but he hopped around with an endless smile on his face…it was a great 6 months and I have no regrets.
- YES! WE WOULD DO IT! We have NO regrets, and want to let others who face this decision, that dogs adjust well after such surgery.
Amputation may not be right for every dog, however. Dogs with very severe arthritis and some neurological conditions may not be able to walk well after an amputation.
In the next blog we will talk about other conventional treatment options, including radiosurgery and palliative radiation. And don’t forget that The Dog Cancer Survival Guide is a must-read if your dog has osteosarcoma.
Get a copy of the Dog Cancer Survival Guide for more helpful tools and information!
Sue Ettinger, DVM. Dip. ACVIM (Oncology). Dr. Sue is a boarded veterinary medical cancer specialist. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), she is one of approximately 400 board-certified veterinary specialists in medical oncology in North America. She is a book author, radio co-host, and an advocate of early cancer detection and raising cancer awareness. Along with Dr. Demian Dressler, Dr. Sue is the co-author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity.
I forgot to mention our border collie had a temp of 104 degrees when he went in and they gave him the antibiotics.
Our dogs front leg was amputated almost a month ago due to cancer. A few weeks ago he had the stitches out and had a pocket of blood. He was given meds. Just a few days later he was swollen huge and it’s hard. Now after 5 days he is on antibiotics and anti inflammatory meds and it’s not any better. What is this? It’s whole incision area hard and really huge. It came about in about one or two days after stitches came out.
I recently lost my dog last week after her amputation. I heard all of these success stories and feel that my sweet girl must have been the small percentage that didn’t heal properly. I have so many questions. Everyone was super confident yet she passed likely from clotting hours after her surgery before I could ever see her again and take her home. I am not sure if it was where I took her or that her cancer spread too much already and she wasn’t actually a good candidate for surgery.
She had a bigger biopsy (2nd one as the 1st one missed detecting the cancer) and 3 days after she had abnormal pooling of fluid on the inside of her front leg (the tumor was high in the shoulder) and more extreme swelling. It had me wondering if the cancer spread to the lymph system. She was given a strong steroid shot, which helped along with pills to help rid the fluid. Do you think they should have done more tests other than just an xray to determine her healthy enough for surgery? I didn’t even get to meet with the vet prior to surgery as they said he would go through it all the next day. And when I arrived to fill paperwork it mentioned doing bloodwork, which I thought was odd since it takes several days to get that back. Could have the in depth liver panels and other tests helped avoid this horrible situation? I am so devastated and looking for closure somehow. He was a 5 year old Amstaff mix at a healthy weight. Thanks so much!
Hi Rebekah … I’m so sorry to hear about your girl. You must be devastated. Please don’t beat yourself up. Abnormal bleeding after surgery is a normal risk of surgery itself, and there isn’t necessarily a way to tell ahead of time that it will happen. I personally have had to find out the hard way that my blood clots very slowly — so I happen to KNOW that this is a risk for me in surgery. Unfortunately for your girl, and for you, this was something you found out the hard way. Please try to set your mind at rest. You did the absolute best you could, and it sounds like you got a great team together to care for your girl. Sometimes bad things just happen, and they are no one’s fault. This article might be useful for you right now. Sending comfort and rest your way. https://www.dogcancerblog.com/articles/grief-loss/anything-else-done/
Sorry to hear about your dog and the cancer. My daughters dog, a ridgeback had to have his front left leg amputated. Very very upsetting. But now a year later he is still the mongrel he was before. He gets around fine. He did well. For 2 weeks after the surgery he was up and around. The meds are rough on them but all is fine. He’s still my beast friend. Love them forever and the surgery will take away the pain that they don’t have to live with. Best of luck. Siberian huskies are great
Our 11 year old Siberian Husky has been having a recurring tumor on his right hind leg, which was tested as being spindle cell sarcoma. After having it removed surgically 4 times, this time it has come back with a vengeance. It used to come back in the size of a ping pong ball, and maxed out at the size of a golf ball. It is now wrapped around his leg. We have been told that amputation is the only way to stop metastasis. Is there really no other way?
Our 10 year young lab has just been diagnosed with osteosarcoma. I realize we have to remove his leg. I am struggling with treatment options chemo, or chemo with immunotherapy vaccine. Does anyone have any experience with the AT-014 vaccine vs the EFGR/HER2 vaccine? With these being newer treatments which has a better track record? Do the side effects make it untenable as a adjunct therapy?
My 13 year old has an aggressive osteosarcoma in her mouth on her lower jaw (right in the middle). She’s been through two biopsies because the first was inconclusive. My vet gave me the option of palliative surgery to remove most of her jaw but he felt that, with how advanced the cancer is (it has not reached her lungs yet, thankfully) that it would be better just to put her on serious pain killers.
I struggle with this a lot every day. I really don’t know if I’m doing the right thing and it kills me. Do you have any advice on this situation?
Thanks for writing, and many readers struggle with the same question. We often wonder if we’re doing the right thing and if we’ve made the right choices. This is why Dr. Dressler suggests that we know our personality as a dog guardian and understand it’s importance for your dog with cancer and why we should undergo a treatment plan analysis.
By going through this process, we understand that we’re making more knowledgable decisions for our dog based on our personality, our dog’s personality, treatment plan options, and a number of other factors. 🙂
Thank you. Currently faced with this decision – Charlie’s already getting around on 3 legs so the operation tomorrow will at least ease his suffering. You’re right, though, it’s a thing for humans to get their heads around. 🙂
My dog. A Rhodesian ridgeback has a tumor and it was cancer. Had the leg amputated. He is doing good. He would be dead by now. It’s a sad thing for them and us. I didn’t want this to happen but I’m glad he’s still around. I wish you the best. Take care of your dog and be there for them. Good luck. Joe