Osteosarcoma (bone cancer) is one of the most aggressive and most painful cancers that can afflict our dogs. It's onset is often masked by stoic dogs (like many greyhounds), so it can appear seemingly "out of the blue." There are different ways to deal with this horrible disease, some of which I will not go into here, since this is the story of Topaz's battle with bone cancer.

Topaz after osteo 
diagnosis

TOPAZ'S OSTEOSARCOMA DIARY

Topaz was ten years old and had always been in excellent health, but one Saturday morning (March 25, 2000) my husband and I were awakened by the sound of her screaming in pain. She was trying to stand up, but she couldn't do it. Any time she attempted to put weight on her right foreleg, she screamed again. We carefully assisted her upright—raising her up and then setting her gently on her feet. She wasn't willing to use the right foreleg at all. We gently probed up and down her leg, trying to find the site of the problem. She didn't react. We racked our brains, trying to think of some way she could have injured herself. No luck. My husband carried Topaz into the yard so she could relieve herself. She didn't want to move much, but she did hobble a few steps. Feeling like my heart was breaking, I made an emergency call to the vet, telling them that I was very afraid my dog had bone cancer.

Within the hour, the vet was checking Topaz over, probing her leg as we had—except he continued his probing up into the shoulder region, since she showed no reaction on her leg. Once he applied gentle pressure to her shoulder, Topaz shrieked in pain. No, we didn't know of anything she could have done to injure herself, which is why we feared the worst. The vet x-rayed Topaz's shoulder and after what seemed to be forever, brought her back to us and showed us the x-ray.

Our worst fears were all but confirmed. From the shadow showing in the x-ray, the vet was almost certain that Topaz had osteosarcoma. Only a biopsy could make the diagnosis more certain (and even those are not infallable—I know of a few dogs where the first biopsy was negative and the dog did indeed have osteosarcoma). Other problems with a biopsy were mentioned: it would involve anesthesia; it could break the bone in question; and then there was the expense of the procedure. We tearfully asked what the treatment options were.

Our options were:
  • Amputation alone. This would remove the primary tumor and the source of her pain. However, there is some evidence that the removal of the primary tumor may cause any metastisized tumors to grow faster. And since osteosarcoma is so aggressive, the chances were very good that it had already metastisized, most likely in her lungs.
  • Chemotherapy alone. This would hopefully kill off, or at least slow the growth of, any existing cancer cells.
  • Amputation combined with chemotherapy. Perhaps the most effective option. With the evidence that the removal of the primary tumor may cause any metastisized tumors to grow more quickly, sometimes chemo is actually begun before amputation takes place.
  • Pain management through palliative radiation. This is a non-invasive pain management technique. Its effectiveness varies from dog to dog.
  • Pain management through medication. Given the pain associated with osteosarcoma, this on its own probably wouldn't be effective for long.
  • None of the first three options came with a good prognosis—no matter what we chose, chances were that Topaz only had around six months to live. When asked what he would do if she were his dog, the vet told us that since Topaz was already somewhat shaky in her hindquarters, he really wouldn't advise amputation. He knew of some dogs that for a time had had some pain relief through palliative radiation, so he thought that might buy her some more time. The vet gave us Rimadyl to help with Topaz's pain and sent us home to think through our options and decide what to do. We started Topaz on shark cartilage. The vet said that it wouldn't hurt her, but he didn't say one way or the other as to whether he thought it would help her or not.

    Through Saturday and Sunday, we weighed our choices. Since the vet didn't feel amputation was wise for Topaz, that was fairly easy to rule out. We would have liked to do chemo, but we just didn't have that kind of money. This left us with only the option of pain management. On Monday we called the veterinary oncologist Topaz had been referred to, and she saw us a few days later.

    Palliative Radiation

    We took a rug along so Topaz could stand or lay on it while we waited our turn at the vet's office. It cushioned the floor a bit when Topaz laid down and allowed her to stand up again (with assistance) without her feet slipping on the tile floor.

    We had a fairly lengthy discussion with Dr. Prescott, who re-explained all the options to us (including the costs) as she examined Topaz's x-rays. The cost kept us from doing chemo, but we felt we could manage to come up with the money for palliative radiation. We wanted to give Topaz just as much pain-free time as we could. Dr. Prescott told us to expect a series of three treatments: the first two a week or so apart, with the third following two weeks later. The treatment was described as a "very intensive x-ray" that was expected to shrink the tumor somewhat, so that there would be a lessening of pain. It would not increase Topaz's life expectancy, nor slow down the spread of the cancer. Topaz would need to be lightly anesthetized, and for the first treatment she'd be shaved on the underside of her shoulder, with a "target" marked in green. The treatment itself would cause her no discomfort. We were warned that there was no guarantee that these treatments would be effective, and if they were, there was no way to tell how much good they'd do or how long they'd help. The vet had lost her own dog, a golden retriever, to osteosarcoma not much earlier. It was clear she knew exactly how we felt. We asked about shark cartilage, and Dr. Prescott said essentially the same thing as our regular vet. She had no problem with us giving it to Topaz, so we continued to do so. It wouldn't hurt, and who knows—it might help.

    The First Treatment—March 29, 2000

    Dr. Prescott led Topaz gently away for her treatment as we returned to the waiting room. We spoke with quite a few people who were dealing with various forms of cancer in their pets, as well as other serious problems. It helped to talk with others who had agonized over their decisions as we had.

    Topaz after her 1st 
radiation treatmentAbout two hours later, a slightly wobbly (from anesthesia) Topaz was led back to us and we set up her appointment for the next week. The fact that she'd been somewhat shaved underneath wasn't really obvious unless she laid on her side. At this point, we were giving Topaz 75 mg of Rimadyl twice a day. She seemed to be moving around okay, but we did use a ramp to get her up and down the few steps into the yard. We didn't want her to do anything, especially jumping, that would put any extra strain on her shoulder.

    The other dogs seemed very concerned about Topaz. Whether inside or out, you could usually find Topaz close to either Jonesy or Comet. We didn't take any chances, though, and closely supervised the dogs at all times. If we weren't home, the younger dogs were crated (and Topaz restricted to the same room the crates were in) to be sure nothing would happen. One of our biggest fears was that Topaz might cry out, and that her cry might awaken the "pack instinct" of the others and they might turn on her. This never happened, but having seen pack instinct in action before, we continued to be careful.

    Topaz & JonesyTopaz & Comet

    The Second Treatment—April 7, 2000

    Eight days later we returned to Dr. Prescott for Topaz's second treatment. Topaz had been doing fairly well—I suppose the biggest thing is that she was no worse. Topaz didn't need to be shaved again, and her "target" lines were still visible, so off she went for round two. Once again we spoke with the people in the waiting room, comiserating with them regarding the horrors of cancer, and hearing how much they trusted the vets at this hospital, and how much success they'd had. It made us feel hopeful that perhaps we would be able to gain more time for Topaz.

    An hour and a half later, a still-wobbly Topaz was returned to us, and we were told that she appeared to be doing well. We should expect that the irradiated skin would be pink and we shouldn't be surprised or worried if the hair on the unshaved outside of her shoulder started to come out. After consulting with the vet, it was decided that we could try reducing the dose of Rimadyl. We began breaking the 75 mg caplet in half, continuing her twice-a-day routine.

    Topaz before 3rd 
treatment; shoulder getting bareA week later, Topaz was showing no signs of pain. We reduced the Rimadyl again, to half of the 75 mg caplet once a day. Topaz was acting more lively, actually doing some trotting around the yard. We began taking her on short walks, building up to all the way around the block. The hair in the shaved area wasn't growing back, and her skin there was quite pink and was starting to flake, so we added Dermcaps to her food to help with the flaking problem. The hair on the outside of her shoulder was starting to thin.

    The Third Treatment—April 21, 2000

    In another week's time we went back to see Dr. Prescott. She was very happy to see how well Topaz was doing. She suggested that we stop the Rimadyl and see how Topaz did without it—we could always start it up again whenever she needed it. Topaz stood up on her rug with no obvious effort, and she didn't walk back for her treatment—she trotted! You could tell she was feeling much better than she did a few weeks earlier. An hour and a half later we loaded the slightly wobbly Topaz into the van and went home.

    As time went on, Topaz acted very much as she had before that awful March morning. We knew it probably wouldn't last, but we held onto the obscure hope that maybe, just maybe, Topaz would manage to beat the odds. Maybe the shark cartilage would work a miracle. We spoiled her absolutely rotten (not that she wasn't spoiled before [grin]). We spent as much time as possible with the dogs as we could, and treasured each and every day with her.

    The shoulder's almost 
bareAs we'd been warned, Topaz did lose all the hair in the irradiated area. You could lift it off in clumps, leaving flaking skin behind. She looked a bit strange with a bald shoulder, and we needed to explain what was happening to her almost every time we took her for a walk. In May we celebrated Topaz's eleventh birthday—a real milestone that, given the events of late March, we had seriously wondered if she would reach. In fact, Topaz was doing so well that we decided we could take her to the GPA/MD Greyhound Reunion. We were very careful to keep her out of situations where there were lots of dogs milling around—essentially we found a shady spot to spread our blanket and then either Jack or I stayed with her, along with one or both of the other dogs. We had to do a lot of explaining as to why our greyhound's shoulder was naked [grin].

    The fur grew back, but it was white.Through the months of June and July, Topaz continued to act like the Topaz of old. She ate well, enjoyed being outside in the yard and enjoyed her walks. The hair started to grow back (it was white, though) where her skin had been irradiated. One day the dogs nearly gave me a heart attack by flushing a rabbit in our back yard, and all three evaded my attempts to stop them and took off after it. Fortunately for my panicked state of mind (Ack!—Topaz shouldn't be coursing a rabbit—she could break that weakened shoulder and that would be the end of the line for her!) the rabbit soon found its way out, escaping under the gate. Although I'd been petrified of the potential outcome, the fact that Topaz ran so freely was a testiment to how good she felt.

    Unfortunately, it wasn't to last. By the beginning of August, Topaz began to favor her right foreleg once more. We had to decide what to do. We could try the palliative radiation again--it did give her four pain-free months. Topaz didn't act as though she was ready for us to send her on. She was bright-eyed, alert, wagging, mooching attention, and was eating and drinking. We started up the Rimadyl again, and scheduled a return visit to Dr. Prescott. Since Topaz had done so well with the palliative radiation the first time, it was felt that she'd be a good candidate for a second series of treatments.

    Dr. Prescott told us that this time Topaz would receive shorter treatments, and only two of them. But in spite of the treatments, and in spite of increasing the dosage of Rimadyl, Topaz's limp continued to worsen.

    Her second course of palliative radiation wasn't as effective as the first, and not even Rimadyl combined with Torbutrol was helping. I spent a few nights sleeping on the floor with her; her last night she couldn't get comfortable at all and she cried almost constantly. Dr. Prescott told us that it could take a few weeks (although it didn't the first time) for the palliative radiation to "kick in," but we couldn't wait any longer—it just wouldn't have been fair to Topaz. Since we could no longer control her pain, it was time (September 10, 2000) to send Topaz to the Bridge. Jack and I were with her when she peacefully slipped away.

    Jeez, I miss my sweet little girl!

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