A lot of patients we see on a day to day basis sometimes only need to be treated with medication, and will need little further investigation other than a good detailed clinical assessment by a vet. However, when medication fails to improve symptoms, or things don’t appear straight forward then we have to investigate further in order to reach a diagnosis. This was very much the case for this week’s patient that didn’t fit into the ‘common things that happen’ bracket.
Disley, a 9 year old Labradoodle, bounded into our consult room in March; despite the fact over the last few he had become lame. Apart from this lameness Disley was very much his usual larger than life figure and, didn’t show much pain in his affected fore limb after lots of bending and flexing of his joints. With this in mind, it was likely he had experienced a simple sprain and he was discharged with some pain killers and expected to show improvements in a few days.
When this niggling low grade lameness continued over the next 3 weeks we reviewed the still bouncy Disley and decided we needed further investigation. X- rays was the most logical next step and Disley was sedated in order to get the required views.
The results gave us all a surprise; as there appeared to be a growth in the bone of his lower fore arm. The major differential for this was a bone tumour and so after discussion with the owner we performed a biopsy of the site and we all anxiously waited for the results, whilst Disley went home to continue on his pain relief.
The result was a disappointment. Not because of the news it returned but because of the lack of it. As can happen on occasions, the tissue sample submitted lacked enough evidence for the laboratory to commit to a definite diagnosis. The result was discussed with the owners and we discussed the case with several specialists in orthopaedics and oncology in order to come up with a treatment plan that suited Disley.
The specialist opinions were clear and gave us several options. It was agreed that despite the biopsy result it was very likely his growth was a bone tumour and without treatment he may only have 4-6 months to live. The options were; to repeat the biopsies to definitely clarify the result, amputate his leg with likely limited improvement in survival times, perform major limb salvage procedures with specialist implants, add chemotherapy into these regimes or simply treat him with pain killers to ensure the best quality of life that he could have. No one plan fits all, and this all gave the owners much to think about in order to make the correct decision for Disley.
The owners thought long and hard about what to do next for Disley, who clueless about what was going on was still his usual energetic and happy self. They ultimately decided with the prognosis in front of them, to not put Disley through further surgery but to treat him with pain relief and to also use an intravenous medication advised by the oncologist that could delay bone resorption and hopefully keep the tumour affected bone as strong as possible for as long as possible. Disley was therefore prescribed multiple pain relieving and anti-inflammatory medications and started to visit us once a month for his intravenous infusion.
Disley continued with this regime for 7 months. He would come bounding in to the surgery as happy as any dog, leap at me and head-butt me in the midriff as soon as he saw me, and generally enjoy the attention of all the nurses that would fuss over him. Ultimately, despite him being in otherwise good health, Disley’s likely tumour grew and ultimately started to become painful.
Disley had done far better than anyone expected, and other than his sore and swollen leg was still in good health. We had to review our plan and yet again had a long discussion with his owners. They wanted to do anything for him and decided that if new X-rays didn’t show any further spread of the tumour, then they felt it would be in his best interest to have his leg amputated to save him from the pain and discomfort it was causing.
Disley was soon admitted and had his X-rays taken of his chest. The good news was there was not obvious sign of tumour spread and so we progressed to amputation. The surgery went well and we just had to see how Disley responded to such a major operation.
Disley woke up from the anaesthesia with an almost relieved look on his face. Within the hour he had jumped up and asked to go out to the toilet and by the very next day the owner reported he was so much happier. The growth was sent for biopsy once again and this time confirmed what had always been very likely, that the mass was a bone tumour. However, the good news is that Disley is doing much better than expected and has learnt to cope with 3 legs extremely well.
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