Osteosarcoma and Amputation: myths and facts

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:

1. The primary tumor with local treatment (surgery and/or radiation)
2. The likely micrometastasis with systemic treatment (chemotherapy)

Today, I am going to talk about amputation.

The Goal

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.

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The Myths

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

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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.

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