Suddenly Stella

Stella was first diagnosed with osteosarcoma on October 15th, 2020, her right forelimb was amputated November 5th, 2020 (three days after her 7th birthday), and she finished chemotherapy at the end of January 2021.

It’s been over 19 months since we first found out she likely had cancer. The first vet who diagnosed her told me that she had 2-6 months without treatment and based on how rapidly her symptoms progressed, he felt that her timeline would be closer to 2 months.

50% of dogs with an osteosarcoma diagnosis are alive at 12 months.

I can’t put into words how much I have treasured this time. My heart is heavy for those pups and their families who haven’t fared as well as we have.

I don’t know why Stella has done so well, but I’ll share our experience in case it helps anyone else going through something similar.

I took so much comfort from browsing the Tripawds website and forums. Hearing about other people experiencing the same doubt, anxieties, and triumphs got me through many sleepless nights.

Since her chemo ended, we’ve taken Stella for an exam and lung scans every 3 months to check for lung metastasis and to evaluate her overall health (especially how the tripawd life has affected her arthritis).

She has been taking Apocaps and K9 Immunity (a few months ago we switched from the capsules to the K9 Immune Support powder) daily since her diagnosis for overall immune support and perhaps some cancer-fighting benefits. It’s very hard to say if these supplements have had any effect, but she has been healthy and happy.

We also added VRS Omega Benefits to her diet to help with her arthritis at the recommendation of our vet. She has been on glucosamine since her dysplasia/arthritis  diagnosis at 3 years old. Again, it’s hard to say how much these supplements have helped, but she walks one mile every weekday (in addition to lots of backyard fetch and playing), with longer (sometime very steep) hikes on the weekends.

There were a few occasions, especially when it was quite hot last summer, where she didn’t want to go. I used to get quite distraught when this happened, but just like people, Stella has good days and bad days and sometimes she just isn’t feeling up to it. I always let her take the lead.

Our vet has also provided an ongoing prescription of rimadyl and gabapentin for arthritis pain relief. I have needed to use these quite sparingly (typically only after she’s had quite a long hike or if she is acting as if she’s hurting). Stella has had bloodwork three times a year to make sure she’s tolerating the rimadyl, and so far she’s looked great.

We did get her elevated food and water bowls and an orthopedic bed, which I would highly recommend for tripawd comfort.

We also had a custom cart made for her from Eddie’s Wheels, a few months after her amputation (I wanted to make sure we had an option for her mobility in case her arthritis wouldn’t allow her to function well after amputation). This was such a fantastic company to work with. They were very responsive, helpful, and compassionate. Stella has refused to use the cart (I believe forelimb amputations present more difficulties with carts because of weight distribution, but plenty of one or no-forelimbed dogs do great in them). I’m still glad we have it in the event she needs it, but she has gotten around just fine on her own.

I feel so incredibly grateful that we have gotten the time that we have with Stella. If you would have told me that we would get 19 months + with her when she was diagnosed, I would have been SO stoked. But the time goes by so quickly and I’ve realized that truly, there will never be enough time with my girl.

On November 5th, 2020, we woke up early in the morning and drove an hour in the dark to drop off Stella for her amputation.

I felt so many mixed emotions: relief that we were finally taking action against what we now knew for certain was cancer; guilt that I was sending her to have her leg removed and she had no idea; fear that something would go wrong during the procedure or that she wouldn’t do well afterward. Stella’s arthritis primarily affected the elbows in her forelimbs. Dogs’ forelimbs carry around 65% of their weight, so by removing a front leg, we were putting 65% of Stella’s weight on one arthritic limb. What if mobility issues got her before the cancer did?

The what ifs were endless.

This experience taught me that sometimes, there are no definitive answers. No one was there to tell me that we were doing the right thing. No one could tell me for sure what the outcome would be. Stella couldn’t advocate for herself, so the only thing I could do was make a decision based on all of the information I had and hope that it was the right one for her.

The good news is that the leg that was coming off was also the leg most affected by her arthritis. That leg has consistently given her the most trouble, so I felt relieved that if one had to go, it was that one.

Again I handed over my sweet girl to a masked vet tech in the office parking lot. I still had never been inside the building nor met any of the vets who had participated in Stella’s care. They told us that they would call us when she was ready to be picked up.

We drove away and I think I cried on and off for hours (I am sure that the pregnancy hormones were not helping to reel in the wide range of emotions I cycled through during that day..).

We got the call in the early evening that the procedure was completed, and that Stella had done very well. They were sending her leg and more lymph nodes for testing to see if they could get a better idea of how far the cancer had advanced and what her prognosis might be. We drove the hour back to the vet as the sun went down.

When they brought Stella out to the car, she was walking on her own, but obviously very loopy from the sedation. I saw her standing on three legs, looking confused and very unlike herself, and immediately I began to cry. The reality of the situation hit me- she no longer had four legs and would never have four legs again. And I had made the call.

We brought her home and she went right to sleep on her bed. She cried out a bit that first night, clearly in pain. She got herself up around 2am and hopped to the door, asking to go outside.

I took this as a good sign- she was already able to navigate on three legs mere hours after major surgery. I do think the fact that she had been unable to put much weight on her bad leg for a few weeks had prepared her for life without it completely.

Stella’s incision was very difficult for me to see. It looked painful and it was hard to believe it would ever heal. For the first few weeks, Stella cycled through my workout t-shirts, which helped keep her from licking her wound and provided a bit of a barrier from potential bumps and snags.

For the first two weeks, I wondered if I had made a mistake.

Stella’s personality can only be described as effervescent. She loves people and cannot help but smile her signature ‘Stellvis’ grin (a named coined by my brother as she curls up one side of her lips and bares her teeth) while giving full body wags whenever we return home, or just enter a room after a period of time. But now she was subdued and glassy-eyed. She spent most of her time while she healed sleeping on her bed in my office, while I worked from home. She was on a cocktail of pain medication: rimadyl, gabapentin, and tramadol, which had her feeling grumpy and out of it.  I had to remind myself that she was healing from a very significant procedure, and anyone would be feeling less than their best under the same circumstances.

After those first two weeks, she began to initiate games of fetch with her ball in the backyard, and she would play tug of war with her other two canine siblings. We started out with short daily walks, no longer than 1/2 mile and always monitoring her and respecting her need to stop to rest or turn around if she got too tired. I could see that I was getting my girl back.

We began chemotherapy two weeks after her amputation, to give her body a chance to recover. She received 4 total IV infusions of carboplatin every two weeks and in general tolerated the chemo very well. Typically there would be a day 2-3 days after her treatment where she wouldn’t want to eat or go on a walk, but she’d be back to herself the following day.

As she continued to heal and grew stronger and stronger, I was truly in awe of Stella’s perseverance, tenacity, and spirit. She loves life and she loves her family and she didn’t let loosing a leg slow her down. As the weeks passed, her spirit returned in full and we were back to daily hikes, games of fetch, and her bounding into the kitchen for her breakfast every morning.

Looking back, I can confidently say that we made the right decision to amputate and put her through chemotherapy, but that decision felt like such a leap of faith at the time.

 

 

After Stella’s biopsy, I felt my hope grow. I tried not to raise my expectations too high, but I wanted to stay positive. The idea that this whole thing was a mistake was something I wanted so badly to be true.

A week and a half passed. Our vet called at the end of the day on Friday; he had the results.

It was cancer.

I felt like I was right back in that initial vet’s office, hearing the news for first time. My immediate thought was that the biopsy was a mistake and we wasted all of this time! We could have had the leg off and already started treatment, but I knew I had made the best decision I could have at the time.

I fought tears as he gave me the options. We could try to get an appointment at WSU for a limb sparing surgery or we could set up an appointment for amputation.

WSU was 5-6 hours away and it was winter. She would need multiple appointments and I was 7 and a half months pregnant. My greatest fear was that something unexpected would happen with the pregnancy (by that time, the baby could come at any moment) and I wouldn’t have the ability to make multiple trips to make sure that Stella got everything she needed.

I made the appointment for the amputation for November 5th.

 

 

In October of 2020, Stella developed a significant limp that wasn’t getting any better with time. She was 6-years-old.

I wasn’t too concerned as it wasn’t unusual for her be a bit stiff after a challenging hike or a long session of fetch. At 3-years-old she was diagnosed with congenital dysplasia and has suffered from arthritis as a result. Stella has always done everything all-out in spite of her pain, and I assumed that she had pushed herself too hard.  Her limp favored her “bad leg” that had the most significant dysplasia, so I attributed it to arthritis and made an appointment to have it checked out.

On the morning of October 15th, 2020, I took her to the vet who took a few scans of her shoulders,  hips, and elbows to see how far the dysplasia and arthritis had progressed. Stella LOVES going to the vet. Anytime she can visit with people is a good time, no matter the circumstances, and this day was no exception. She gave plenty of smiles and tail wags as he examined her. Her scans actually looked much better than the vet had anticipated and he thought her limp may be due to a soft tissue injury caused by joint instability from the dysplasia. There was not much to do in this case beyond waiting for the injury to heal on it’s own.

We were about to head the front desk and wrap up the appointment when he stopped me and pointed to her front right leg. He asked how long that bump had been on her wrist, and I said I hadn’t even noticed anything (she has bumpy wrists…). He wanted to get a scan of the area because he didn’t like the way it looked. I had no idea what that meant or what he was looking for. As he looked at the X-ray he frowned and pointed at a black spot on Stella’s distal right ulna, directly at the wrist joint.

“What am I looking at?” I asked

He answered, “It’s osteosarcoma.”

“What does that mean?” my panic growing, knowing it meant cancer.

“It’s a very aggressive bone cancer with a prognosis of 2-6 months without treatment.”

I felt like the wind had been knocked out of me and I couldn’t possibly be hearing him correctly (did I mention that I was 7 months pregnant?). I immediately began to cry as he told me really the only option was amputation or limb-sparing surgery. I couldn’t get past hearing 2 months. TWO months. That was 8 weeks. That was…nothing. My due date was in 2 months. I completely broke down and tried to blame it on the hormones as he gave me the information for the closest veterinary teaching hospital (WSU, 5 hours away). He mentioned that they often were booked out for months.

I sobbed all the way home.

I immediately began calling other veterinary offices, desperate for a second opinion. I spoke to three other vets after sending them her scans. One was a family friend who compassionately explained what an osteosarcoma diagnosis meant.

There was a 5-10% chance that this disease would not kill her. With amputation and chemotherapy, there is a median survival time of 1 year after an osteosarcoma diagnosis. HALF of dogs who underwent the most extensive treatment possible would be alive in 12 months. The cancer had most likely already spread microscopically, and even with amputation and chemo, it would likely eventually metastasize in another part of the body.

Again, I felt like the wind had been knocked out of me. There wasn’t a cure. This felt like a death sentence.

He also explained that osteosarcoma is incredibly painful and without any treatment, euthanasia is typically chosen well before the cancer causes death because of an extremely diminished quality of life (he likened the feeling to that reverberating pain that occurs after  being kicked in the shin…but unrelenting).

The reality was that if I wanted to keep her alive and address the immense amount of pain she was experiencing, her leg had to come off. It was obvious  that she was hurting; in a matter of days, she had stopped using her right leg almost entirely.

He also let me know that unlike what I thought I knew, dogs typically tolerate chemotherapy very well, experiencing very few side effects. Chemo isn’t given to dogs in a curative amount, as the goal is simply to slow the metastasis and increase life expectancy while maintaining quality of life.

Remember those two other vets I called and sent Stella’s scans? Well one of them called me back after having had a chance to look at the area of concern and told me that he wasn’t convinced it was cancer. He said there were some things about the image that looked like osteosarcoma, and some that didn’t. He recommended getting a biopsy and offered to set up an appointment.

The problem was that he was two and half hours away and she’d have to have an initial appointment and examination before the biopsy. And it was winter in Montana and the roads were terrible.

We had recently moved to a rural part of Montana where vets were limited (and certainly vets who had experience with oncology) and I had tried three clinics I didn’t love in the area already. The vet who told me that Stella had osteosarcoma? That was our first visit ever. There was no relationship or trust established, so I didn’t feel as  though I could just take his word for it and amputate her leg.

I made the appointment with the vet who wanted to do the biopsy and in the meantime, I got a call from the final clinic who received her scans. They wanted me to come in for additional scans to be sure it was cancer. They were only an hour away, so I decided to go for it.

The vet tech came to my car and took Stella into the clinic. This was in the middle of Covid protocol so not only could I not go in with her, I couldn’t even meet the vet face-to-face. I was just going on gut instinct. I sat in the car and waited for what felt like years before my phone rang. I was shaking as I answered it.

“We just love this girl! She has been all smiles and getting lots of attention and cookies.” the vet said. I thought surely she wouldn’t sound so chipper if it were bad news.

“When were these first scans taken?” she asked. “A few months ago?”

I felt my heart sink as I responded, “Those were taken three days ago.”

She said she was quite concerned about the amount of change she saw on the scans and recommended that we amputate as soon as possible.  I felt panicked at the idea that the cancer was spreading so quickly and made the amputation appointment. The vet who would be performing the procedure was yet another vet at this practice, and someone I had never met.

On the morning of her appointment, we left the house in the dark at 6am. I felt sick the entire way as I knew that Stella had no idea I would be dropping her off to have her leg removed. We pulled into the office parking lot and called to let the techs know that we were here. A few minutes later, we received a call from the office. It was the vet who would be performing her surgery. He let me know that he had taken a look at her scans and he didn’t feel it was definitively cancer.

I was floored.

He said based on what he saw, it could be  a bacterial or fungal infection, which would not necessarily mean amputation and would certainly carry a much better prognosis. I felt a bit of hope creep back; maybe it wasn’t cancer and everything was going to be ok. He recommended Stella undergo a bone biopsy instead of amputation that day.

He said there were a few risks involved with the procedure. He had to get a good sample that would contain the cells in the questions, which could be difficult depending upon how degraded the bone was. This could also lead to fracture at the site of the biopsy, which would cause significant pain. There was also the risk of putting her under and her recovery would be painful.

That being said, I felt that I had to know for sure it was cancer before we amputated as she was so young, she has arthritis, and it was hard to say what kind of a strain amputation would put on her joints. In short, the vet said that we didn’t want to amputate the noncancerous limb of a dog who may have years and years of life left and would be left with potential mobility issues that would impact her quality of life.

I couldn’t shake the idea that every second we waited, the cancer was spreading, however. Part of me just wanted to take the leg off because we would have to wait 1-2 weeks for the results of the biopsy and that seemed like an eternity. The vet assured me that this time should not make the difference in her outcome, however. I told him to go ahead with the biopsy.

The procedure went well and he also took a sample of axial lymph nodes to check for metastatic indicators there. I took Stella home to recover and felt a sense of relief. That was all I could do at the moment. We just had to wait. A week and a half went by and I felt myself having hope that maybe this WAS just a bone infection, maybe everything would be ok.