Biopsy Monday

[Guest bigorangedog]

Well, it has not been a good day here. The backstory:

 

Tanner, our 13-yr-old boy, has been limping for a couple months now. Actually, first he had a short episode of limping back in late August that sent us to the e-vet. We did x-rays which showed no problems, so we decided he'd pulled a muscle, gave him Deramaxx, and he was okay again in a couple weeks. Then a couple months later, it happened again, same leg (rear left). Deramaxx, and okay in a couple weeks. Then in December, it happened again, but Deramaxx didn't right him.

 

We went to the regular vet, who poked and prodded, and said "Lumbosacral Stenosis." I had been thinking that myself. His bloodwork all looked great. So we did the Depo Medrol shots, and they seemed to help for about a week, then bad again. The vet thought we would have better luck with acupuncture (one of her own greyhounds did) so we started seeing an acupuncture vet in January.

 

The acupuncture vet did her own x-rays of his spine. Nothing showed up on the x-rays, so we concluded that yes, it was nerve pain. LS or Degenerative Myelopathy. We started doing acupuncture every 2 weeks, still on Deramaxx, but he really wasn't getting better.

 

So at his appointment last night, we agreed that this wasn't working. She spent about a half hour looking him all over, but didn't see anything. Finally, she decided that maybe his left hip felt different from his right hip. So we did another x-ray and there it was. A mass around his hip joint.

 

She aspirated it, and it showed tumor cells. We have a biopsy on Monday.

 

I have 7 greyhounds and a rotating number of adoptables, but this dog is my heart and soul. I wish I could have cancer instead of him. His spirits are still good, although he really can't walk much at all. He'll still play 'air snaps' with me from his bed. His appetite is still fantastic.

 

We are on Metacam and (as of yesterday) Gabapentin. He doesn't tolerate narcotics -- they make him VERY anxious and spaced-out. We're also taking Metronidazole because the pain meds upset his tummy.

-----------

 

So, QUESTIONS: If it is malignant, will there be anything at all we can do for him? (The vet said that it is not in a place that would allow for a leg amputation, even if I could consider amputating a 13-yr-old's leg.)

 

And how bad will the biopsy be? He is terrified at the vet, and shakes and shakes.

 

I just want my boy to be okay again.

Jen

[Guest GreytMuse]

Jen, I am so sorry that you are dealing with this diagnosis. I don't have any advice or experience, but please know you all are in my thoughts and prayers. Wise people will come along soon to offer advice -- please keep us updated and know we are here for you during this journey.

[Batmom]

If they're planning a bone biopsy, I would ask your vet those questions. You might want to reconsider because that is a very painful procedure with some recovery time involved. It can also weaken the bone. If there are no or limited treatment options, it might not be worth having the test.

 

If they're planning a fine needle aspirate, that is usually less invasive with minimal recovery involved.

 

Sending hugs and prayers for your pupper.

[VinnieAndRexsMom]

I second Batmom.

 

You know there are tumor cells, and the vet said he can't be a tripod. The only thing left would be keeping him comfortable, which you can do without adding the stress of a vet visit and the pain of a biopsy.

 

Vinnie had a tumor in his spine. Even the narcotics wouldn't take away the pain. I feel/felt about Vinnie the way you feel about Tanner. For Vin, all I could do was keeep him comfortable.

 

Probably not what you want to hear right now, and for that I am sorry.

Hugs to you and Tanner,

[RobinM]

I second Batmom.

 

You know there are tumor cells, and the vet said he can't be a tripod. The only thing left would be keeping him comfortable, which you can do without adding the stress of a vet visit and the pain of a biopsy.

 

Vinnie had a tumor in his spine. Even the narcotics wouldn't take away the pain. I feel/felt about Vinnie the way you feel about Tanner. For Vin, all I could do was keeep him comfortable.

 

Probably not what you want to hear right now, and for that I am sorry.

Hugs to you and Tanner,

 

 

I third this.

 

Polli was almost 10 when she was diagnosed with bone cancer. She tripped lightly on the steps, let out a scream becasue she fractured her leg. Her leg was amputated less than 12 hours later.

 

With the bone biospy which we did not do, there is always a chance that the leg will fracture because of the weakness in the bone. If you are not going to amputate, I personally see no reason to do the bone biopsy as it will only weaken an already weak leg. Just my opinion. Instead, you can offer your boy pain management to keep him as comfortable as you possibly can.

 

Many prayers for your boy.

[Houndtime]

No words, or advice. Just hugs for you and Tanner.

[Guest mike]

Being a vet and you can't amputate why would you do a bone biopsy? This is extremely excrutiating for the dog. It could break due to this. What's to gain from a biopsy besides putting your grey through more pain. I'm sorry but I see this differently than some. Why do it? Pain control should be the only thing you are concerned with. Get ahead of the pain. You already have the answer from the fine needle aspirate and xray.

[CaliforniaGreys]

No advice here, but sending lots and lots of prayers. Tanner is such a very special name to me.

Please keep us posted on how he's doing

[HopeForHounds]

I'm going to add my concern about the biopsy. Knowing what I do about cancer and greyhounds (way more than I want to) I don't see a need for a biopsy of any kind. Since you know you aren't able to amputate, withouth that chemo isn't going to accomplish much.

 

Pain management is the only thing I would concentrate on right now. That and making memories.

 

We're here for you no matter what you decide.

 

[Burpdog]

Sending lots of prayers.

 

Definetely "only" a fine needle aspirate. There is no need to do the other as Batmom suggested -- it is very painful and will weaken the bone. If I remember right, when Glynis and I talked last week about Winslow's journey, she said the only thing she would do different is not do a bone biopsy.

 

If it is in the hip, you will most likely have few options as surgery would be very invasive to the pelvic area. It depends on where it is. I see, reading back, that he is 13. As Janet said, I'd concentrate on pain management (must use a combination of drugs) and spoil him rotten. I, personally, would not even do a biopsy.

 

I would email Ohio State (not Dr. C as he is not doing oncology consults at this time) and see what is and what they suggest.

 

Edited February 14, 2009 by Burpdog

[MerlinsMum]

I have no direct experience of cancer with my greys, so I can't offer any advice... I just wanted to say that I'm so sorry

 

We're here for support :grouphug

[Guest greytkidsmom]

So sorry about your news.

 

I echo the advice given above. Don't do a test if you are not planning to change treatment based on the result.

 

 

[Guest bigorangedog]

Thanks everybody for the advice and thoughts. How do I know if what they are doing is a "bone" biopsy? They haven't used that term specifically. From what we can see on the x-rays, the tumor is in his hip, but I don't think we know for sure what structures/systems it is attached to (bone, muscle, lymph, etc).

 

Here's the pathology report, not that it makes much sense to me. This is (thank god) my first experience with greyhound cancer, so I am a total novice at this.

 

<<

Diagnosis: Atypical round proliferation with evidence of chronic hemorrhage/congestion and bone lysis

 

Comments: The atypical round cells are overall, relatively bland in appearance and their origin is unkown. Consideration is given to a histiocytic origin or possibly a mesenchymal cell origin (bone tumore often have a round cell appearance for example). Give the physical exam and radiographic findings they are concerning for malignancy. The multinucleate giant cells are most consistent with osteoclasts but could represent neoplastic cells. Inflammatory cells such as neutrophils or lyphocytes nor etiologic agents are observed to suggest this might be an inflammatory lesion but rarely, foci of pure granulomatous inflammation can appear cytologically suspicious and concerning for malignancy. Biopsy of the lesion is recommended for definitive diagnosis.

>>

 

If anyone knows what the heck that means, I'd love to hear it. All I understand is "concerning for malignancy."

 

But we will talk with the vet on Monday morning before going for the biopsy about what, exactly, doing the biopsy will get us. I agree that if there's not going to be anything to do for him other than manage pain, there's no point to do it.

 

Unfortunately, he had a rough night. The meds we are on don't seem to be managing his pain terribly well. But we've tried narcotics with him before for other injuries (Tramadol, Torburtrol) and they have bad effect on him. Tramadol makes him pant hard and act like he is hallucinating (eyes darting around the room, ears up). And Torbutrol we tried 1/4 the regular dose and it knocked him out so hard that we were almost unable to rouse him.

 

We just talked to our regular vet (not the one who diagnosed and will be biopsying) and she said to try a Sentinel pain patch. But we'd need to drag him in to the vet for that, which I hate to do. Ideas?

 

Is there anyone in particular we should talk with at Ohio State? Anyone have the contact info handy? Thanks!!

[HopeForHounds]

Thanks everybody for the advice and thoughts. How do I know if what they are doing is a "bone" biopsy? They haven't used that term specifically. From what we can see on the x-rays, the tumor is in his hip, but I don't think we know for sure what structures/systems it is attached to (bone, muscle, lymph, etc).

 

Here's the pathology report, not that it makes much sense to me. This is (thank god) my first experience with greyhound cancer, so I am a total novice at this.

 

<<

Diagnosis: Atypical round proliferation with evidence of chronic hemorrhage/congestion and bone lysis

 

Comments: The atypical round cells are overall, relatively bland in appearance and their origin is unkown. Consideration is given to a histiocytic origin or possibly a mesenchymal cell origin (bone tumore often have a round cell appearance for example). Give the physical exam and radiographic findings they are concerning for malignancy. The multinucleate giant cells are most consistent with osteoclasts but could represent neoplastic cells. Inflammatory cells such as neutrophils or lyphocytes nor etiologic agents are observed to suggest this might be an inflammatory lesion but rarely, foci of pure granulomatous inflammation can appear cytologically suspicious and concerning for malignancy. Biopsy of the lesion is recommended for definitive diagnosis.

>>

 

If anyone knows what the heck that means, I'd love to hear it. All I understand is "concerning for malignancy."

 

But we will talk with the vet on Monday morning before going for the biopsy about what, exactly, doing the biopsy will get us. I agree that if there's not going to be anything to do for him other than manage pain, there's no point to do it.

 

Unfortunately, he had a rough night. The meds we are on don't seem to be managing his pain terribly well. But we've tried narcotics with him before for other injuries (Tramadol, Torburtrol) and they have bad effect on him. Tramadol makes him pant hard and act like he is hallucinating (eyes darting around the room, ears up). And Torbutrol we tried 1/4 the regular dose and it knocked him out so hard that we were almost unable to rouse him.

 

We just talked to our regular vet (not the one who diagnosed and will be biopsying) and she said to try a Sentinel pain patch. But we'd need to drag him in to the vet for that, which I hate to do. Ideas?

 

Is there anyone in particular we should talk with at Ohio State? Anyone have the contact info handy? Thanks!!

 

 

Use the link at the bottom of my siggy to get the OSU contact info. Copy the pathology report to them and someone will get back to you. Also, express your concerns about his pain and they will likely be able to give you some suggestions for your vet.

[greyhead]

I know absolutely nothing useful, except that side effects to painkillers can go away in a short time (unless a particular drug is truly imcompatible with the dog, and then there are others to try).

 

Just offering many prayers and huge hugs for you and your heart dog.

[Burpdog]

Will they come out to the car and put the patch on? Excuse my ignorance, but is the patch in the same family as torb & tramadol?

 

 

[Guest KyGrey]

[crazygang]

Sending prayers to you and your special boy......

 

Whatever you decide there is a great support system here on GT

 

[Guest bigorangedog]

Will they come out to the car and put the patch on? Excuse my ignorance, but is the patch in the same family as torb & tramadol?

 

Yeah, I don't know what family it's in. Our regular vet suggested the patch this morning, we called her at home (but VERY unfortunately for us, she is right now on her way to Las Vegas for some veterinary conference for a week). We called the other vet (the one doing the biopsy) to ask about that, and they thought we should try Tramadol again first. They're going to have us start with a really small dose and see what we can work up to without getting the panting. Husband is on the way to pick that up now.

 

Thanks for the contact info for OSU. I just sent them a very long email... I'm hoping someone will get back to us before Monday afternoon, but I don't know how realistic that is.

 

This whole thing just kills me, because his mind is still perfect, and his appetite is still GREAT. I just brought him a turkey and cream cheese sandwich from Brueggers and he scarfed it right down from his bed. Every time I walk into the kitchen, he puts up his ears and watches me hopefully, but doesn't get up anymore to follow me like he always would. He wants to walk, and seems like he doesn't quite understand why he can't. But when he's lying down, he's just regular Tanner.

 

We just did a full senior blood panel the first week in January. Wouldn't something have shown up on there if he has cancer?? Sorry if this is a dumb question -- I really have no knowledge of cancer at all (and hoped never to).

 

Jen

[RobinM]

Unfortunately, the only way to determine the osteo is through the x-rays. Polli's bloods were beautiful according to the vet.

 

continued prayers for your big boy.

[VinnieAndRexsMom]

Will they come out to the car and put the patch on? Excuse my ignorance, but is the patch in the same family as torb & tramadol?

 

Yeah, I don't know what family it's in. Our regular vet suggested the patch this morning, we called her at home (but VERY unfortunately for us, she is right now on her way to Las Vegas for some veterinary conference for a week). We called the other vet (the one doing the biopsy) to ask about that, and they thought we should try Tramadol again first. They're going to have us start with a really small dose and see what we can work up to without getting the panting. Husband is on the way to pick that up now.

 

Thanks for the contact info for OSU. I just sent them a very long email... I'm hoping someone will get back to us before Monday afternoon, but I don't know how realistic that is.

 

This whole thing just kills me, because his mind is still perfect, and his appetite is still GREAT. I just brought him a turkey and cream cheese sandwich from Brueggers and he scarfed it right down from his bed. Every time I walk into the kitchen, he puts up his ears and watches me hopefully, but doesn't get up anymore to follow me like he always would. He wants to walk, and seems like he doesn't quite understand why he can't. But when he's lying down, he's just regular Tanner.

 

We just did a full senior blood panel the first week in January. Wouldn't something have shown up on there if he has cancer?? Sorry if this is a dumb question -- I really have no knowledge of cancer at all (and hoped never to).

 

Jen

Vinnie's mind was still sharp, his body was in fine shape, except for his back leg, which had withered a little. It was the day before Mother's Day and three days before his 10th birthday. I had to send a beautiful , healthy looking dog to the bridge, and it nearly killed me. He was my heart. And then I saw a Vinnie on here who became an angel and he was just a baby. You can't concentrate on how he looks; it has to be how he feels. I know you know this. You are moving through all the emotions associated with just finding out your sweet boy has a tumor. And your questions are not dumb. You need to ask. It's part of the process.

Hugs,

[Guest MorganKonaAlex]

My Morgan also didn't tolerate any opiates. Neurotin was the only pain med. we could use. You may be able to increase the dosage. We had to increase Morgan's a few times until he was on 200 mg x 2/day.

 

 

[silverfish]

Here's the pathology report, not that it makes much sense to me. This is (thank god) my first experience with greyhound cancer, so I am a total novice at this.

 

<<

Diagnosis: Atypical round proliferation with evidence of chronic hemorrhage/congestion and bone lysis

 

Comments: The atypical round cells are overall, relatively bland in appearance and their origin is unkown. Consideration is given to a histiocytic origin or possibly a mesenchymal cell origin (bone tumore often have a round cell appearance for example). Give the physical exam and radiographic findings they are concerning for malignancy. The multinucleate giant cells are most consistent with osteoclasts but could represent neoplastic cells. Inflammatory cells such as neutrophils or lyphocytes nor etiologic agents are observed to suggest this might be an inflammatory lesion but rarely, foci of pure granulomatous inflammation can appear cytologically suspicious and concerning for malignancy. Biopsy of the lesion is recommended for definitive diagnosis.

>>

 

If anyone knows what the heck that means, I'd love to hear it. All I understand is "concerning for malignancy."

 

Means they're not sure what it is. There are some odd-looking, definitely abnormal cells in there, but they could be cancer (neoplastic) or they could be an inflammatory response (granulomatous) which can look like cancer. Only way to find out for sure is with a biopsy - but I agree with the others, if there's not going to be a major surgery or other initiative to get rid of it, why do that to a thirteen year old who hates the vet?

 

I would talk through your concerns with the vet and ask him/her to go through this report with you and give you their thoughts.

 

Unfortunately, he had a rough night. The meds we are on don't seem to be managing his pain terribly well. But we've tried narcotics with him before for other injuries (Tramadol, Torburtrol) and they have bad effect on him. Tramadol makes him pant hard and act like he is hallucinating (eyes darting around the room, ears up). And Torbutrol we tried 1/4 the regular dose and it knocked him out so hard that we were almost unable to rouse him.

 

Tramadol is known to cause aural hallucinations in people - and I've experienced this myself. I actually answered non-existent conversations, and drifted off to sleep one night 'listening' to a woman talking in my ear. That could explain the 'ears up, looking around the room' thing.

 

 

 

 

Unfortunately, the only way to determine the osteo is through the x-rays. Polli's bloods were beautiful according to the vet.

 

But x-rays are not always reliable. Renie didn't have osteosarcoma, but she did have a tumour on her spine. She went in for x-rays because she was in so much pain, and they came back beautifully clean. The tumour showed up on an MRI, clear as day. Her bloods were beautiful, too.

 

 

[Guest MZH]

You know he has an inoperable tumor so it seems quite pointless to do a painful biopsy in addition to what you've already done.

 

As Mike (the vet) says in post #7, "Pain control should be the only thing you are concerned with. Get ahead of the pain. You already have the answer from the fine needle aspirate and xray."

 

Me here: I'm so sorry. He does sound like he's in a lot of pain.

 

Marcia

[Guest MZH]

PS I'm wondering if the "granulomatous inflammation" is a form of sarcoidosis in the hip. (I Googled "granulomatous inflammation hip" and came up with this.)

 

One of the the treatments is corticosteroids. Wouldn't it be great if that worked to relieve the pain and help clear that inflammation up? I know depo medrol packs work wonders for me when I have flareups of whatever is wrong with me -- and sarcoidosis is on the short list. Come to think of it, my hip hurts sometimes....!

 

Marcia