Treatment Plan Analysis in Real Life

Yesterday, a 13 year old Rottweiler came in to the hospital.

She had been limping, and there was a swelling in her front leg, down on the forearm.  It was firm and slightly warm to the touch.  The area was about 4 inches long.

We took X-rays of the sore leg.  The films showed a large area of bone in what is called a sunburst pattern.  This means that the bone expands and looks mottled and proliferative.

A sunburst pattern is usually caused by canine osteosarcoma, the most common cancer of the bones in dogs.

To absolutely confirm that this is the case, a specimen needs to be sent to a pathologist. In this case, I was worried that a surgical biopsy would weaken the leg to the point where it might fracture.

Bone tumors weaken bone.  One of the very horrible possible outcomes of osteosarcoma in the very late stages is what is called a pathological fracture.  This is a type of bone break which is not caused by trauma, like falls or auto accidents.

Pathological fractures are simply caused by normal movements on bone that is so weakened by invading tumor cells that it breaks during these normal activities.

This is one of the reasons removal of the affected leg in many cases of canine osteosarcoma is a life quality choice.  We remove the limb and the pain goes away.  There will be no possibility of a pathological fracture either.

So, back to yesterday.  We talked about it for a long time.  What to do?  This was a 13 year old large breed dog, with a normal life expectancy of about 12 years or so.  So we were beating the odds already.

I asked her human what kind of person he was…A, B, or C ?  These are groups of people described in The Dog Cancer Survival Guide in the treatment plan analysis section.  You must know what kind of person you are to operate successfully in caring for a dog with cancer.

A’s want life extension and are willing to tolerate side effects from the treatments.  B’s want some life extension and are willing to tolerate some milder side effects. C’s are only concerned with life quality and will accept very little life extension.  They want as few side effects as possible and only want comfort care.

And of course, people are allowed to change over time.

So he told me he was a C.  We discussed how there is no “right way” to do this. A veterinary textbook may not apply under these circumstances.

I went over amputation, chemotherapy, radiation and so on. We also discussed diet, supplements, and the many other aspects of cancer treatment discussed in The Guide.

The plan we opted for was The Dog Cancer Diet, Apocaps, Tramadol and Deramaxx to start with .  We had a budget to work with and we knew what our priorities were.  And we will reassess in 3 or 4 days.

Was it the right plan?  Yes.  It took the needs of everyone into account.

Best,

Dr D