Gsod And Limping

[RedFawnMom]

 

I haven't looked into Angell Memorial, I'd actually never heard of them, but I will, thank you.

I am pretty sure we've used them for our NE chapter of our group and had good experiences with them. So a very vague second on that rec.

 

How's your girl feeling lately?

 

She seems to be feeling well. She missed a dose of the Metacam (I ended up having to be admitted after my surgery on Wednesday and my mom came to stay with her overnight, but didn't know to give it to her) and seemed to be fine even without it, which is encouraging (we're giving half doses now since she seems improved, but I didn't want to just stop it cold turkey). So I think at this point, the plan is to get new X-rays toward the end of next week and go from there. I just hope they can get them without sedation (though of course I wouldn't want it to be painful for her) since it took her a good 24+ hours to get over the sedation last time and she seemed so weak.

 

Depending on what the X-rays show, I'll figure out where to take her next. I just figure that it makes more sense to get a better quality, digital X-ray somewhere local, then take her up to Boston or wherever for further assessment if needed. And I'm hoping OSU will have more staff available after New Year's, so I'll send the repeat X-ray images over to them, too.

[Guest kydie]

I think you are doing a greyt job,, and opinions are good,, but everyone has their own, even on G.T. I vote with you,, I would wait the 10-12 days and repeat digital xrays

keep us posted!

[RedFawnMom]

Update: I scheduled an appointment for Wednesday evening with a great ortho vet that our group recommended. It's not nearby - 1 hr 40 mins away - but I have a good feeling about them; they said they would call our vet to get Lucy's chart and that they would try to speak to Lucy's vet to get her take her on it before our appointment, and none of the other specialists have offered to do that. The vet is very greyhound savvy and the photos on their website had lots of greyhounds! They are also open 7 days/week, and until 9 pm during the week, which I really like, since there will always be a vet I can talk to if anything happens on a weekend. I'll let you all know how it goes. It should be an interesting trip for my husband, who will have both Lucy and me (on crutches) to help get in and out of the car, through doors, etc.

[Houndtime]

Good luck with your appointment. We hope it goes well!

[robinw]

Keep us posted, OK? Enjoy the ride!

[RedFawnMom]

Ok, here's the latest. We saw the ortho our group recommended earlier tonight. She did additional X-rays (digital and much higher quality), examined Lucy and this is what came of it:

 

Before new X-rays:

 

-She was very pessimistic about it when she came into the room initially and was telling us it was most likely osteo even though it wasn't looking typical on the X-ray, because she's a greyhound

 

-She did not think FNA would be possible because the bone appeared to be very dense on the outer layers (based on the X-rays). By the time osteo/bone tumors are usually discovered, it's very easy to do an FNA because the outer layers of bone are not strong and easily aspirated, but Lucy wasn't in that bad a shape

 

-She said a biopsy would be the only way to get a definitive answer, but that since an FNA would likely not be possible, we'd have to think about what our treatment choice would be, since if we'd choose palliative care no matter what, then it doesn't make sense to put her through the pain of a core biopsy since it wouldn't change treatment. However, if we thought we might go the amputation route, especially if it were another type of sarcoma that could be "cured" by an amp, we'd obviously need the biopsy since it would have to be done ASAP to potentially be curative (I cannot remember the type of sarcoma she referenced as a possibility). DH and I are on the fence about how we'd treat, but he is very uneasy about amputation, but I would absolutely do it if it would be curative or give us several more years with her. So, we need to discuss that further.

 

After new X-rays:

 

-She came into the room looking puzzled but less bleak

 

-We got MUCH better images. There have not been any changes in the 12 days since the last X-rays; it hasn't grown!

 

-I asked for chest X-rays even though she said they'd be clear. They were clear.

 

-The lesion was not even visible on one of the views, which means it's fairly isolated within the bone (does that make sense?) which is a very good thing

 

-One of the X-rays that shows the lesion most clearly shows that it definitely goes TO the joint, which is indicative of a subchondral cyst (but could still be osteo)

 

-She tried to do an FNA and said there is no way, it's impossible, the bone is too strong

 

-She said it could very well be an old racing injury that caused a little trauma in the bone, especially because of where it's located (rear right leg, which apparently is where racers usually get injured while running, since they always run the same direction), and she could have very well been limping from a little soft tissue injury, and we just happened to find this on the X-ray

 

-She found some bone spurs/something else lower down in her leg on both sides - she actually said that one of the lumps feels like something metal that was implanted, like maybe she had a break at some point that was fixed (??? We have no record of this, but she didn't come with much info) But she said it has nothing to do with the lesion, but may be indicative of a fairly major injury prior to us adopting her

 

-She said the fact that Lucy's pain improved is a huge, positive sign

 

-She palpated over the lesion and Lucy got a little nervous, but didn't respond like this vet typically sees greys with osteo react (she palpated the same spot on the other leg to compare, and Lucy looked nervous there as well, but slightly less reactive)

 

-She basically said that this is extremely unusual, but given the above, she is skeptically optimistic. She said that she does not try to give any sense of hope to owners of greys who she suspects have osteo, since it's such a bleak diagnosis/she doesn't want to mislead people since it's not curable, but that she was hopeful for us, even though it could still go either way.

 

The plan:

 

-She is putting the digital images on VIN and will get a report from a few radiologists by tomorrow. She won't be in tomorrow, but a tech will fax me the report, and she will call me on Monday to give me her interpretation of the results

 

-I am going to send the new images to Dr. Couto tonight and let him know that they couldn't do an FNA, and ask him to advise (he actually got back to me this morning and advised FNA, so I will Email him directly. He is such a nice guy, we are so fortunate to have him as a resource)

 

-Unless we get strong opinions from Dr. Couto or the radiologists, we will repeat X-rays in 3 weeks, and talk about how we'd approach treatment if the lesion has grown. Because I think we'd aggressively treat any sarcoma that had a chance of being cured (with amp, radiation, chemo, etc) or at least a chance of giving us more than 6 - 18 months, we'd need to biopsy to know what we're dealing with, to start treating ASAP. However, she said that if the lesion grows, an FNA may eventually be a possibility since the bone will weaken, so that is another option if we are totally against a biopsy, though she didn't think that was the best approach. I will discuss with Dr. Couto.

 

So overall...I'm skeptically optimistic. Most importantly, though, I like this vet and I trust her. She is by far the most grey savvy vet we've ever seen, and respectful of me doing my own research and consulting with OSU, which is very important. I asked some very specific questions and we had a good discussion when she realized I knew a lot more about this than most owners do, since I have been obsessively worrying about it.

 

 

This is somewhat off topic, but get this....when she mentioned it could be a subchondral cyst, she said "I actually have one in my tibia..." and I of course was shocked since that is exactly what I just had removed last Wednesday. She had the exact same surgery that I just had last week and is now considering the more complicated surgery that I also considered (her surgery failed; she started running too soon). We spent a good 10 minutes swapping questions since we are in exactly the same boat. Maybe I'm crazy, but I kind of take that as a sign that we've found the right specialist, after getting so many opinions and being completely unsure of who to trust.

 

Thanks again for keeping Lucy in your thoughts. I'll post again when I hear back from Dr. Couto.

[TheFullHouse]

Well my gosh, that sound a lot better than having so many different people give so many different ideas. Being comfortable with your vet is the #1 most important thing in my book, that and having them know what they're talking about.

 

Keeping Lucy in my thoughts and prayers.

[tbhounds]

This new vet sounds like a homerun!! Sounds like a wonderful plan.

[NeylasMom]

Did she happen to mention a bone infarction? That may be another possibility although they're very rare.

 

Glad to hear it's lookign more and more likely it's not osteo.

Edited December 23, 2010 by NeylasMom

[Guest LindsaySF]

Sounds like the visit went really well. It's great to have a vet that you can trust and feel comfortable talking to.

 

Where did Lucy race? It's possible that she had an old racing injury and the lesion is from that. The bone spurs the vet found lower down on both legs, were they in the hock joint? I've seen that before in ex-racers, it's not uncommon.

[carronstar]

This new vet sounds like a winner. She listens, she is open to ideas, and is willing, if need be to tell you the harsh truths and happy to be wrong if that is the case. A little Christmas miracle of your very own.

[Magdalyn58]

That is really such positive, hopeful, wonderful news!

[robinw]

Much more positive!!

[Remolacha]

I am so glad you found a good vet you like. That is so important, especially in a confusing case like this. A much more cautiously optimistic outlook!

 

This is an extreme long shot since you are in CT, but is there any chance she was ever in AZ or CA? I am thinking of Valley Fever, of course, which often looks similar to osteo on the bone.

[RedFawnMom]

I am so glad you found a good vet you like. That is so important, especially in a confusing case like this. A much more cautiously optimistic outlook!

 

This is an extreme long shot since you are in CT, but is there any chance she was ever in AZ or CA? I am thinking of Valley Fever, of course, which often looks similar to osteo on the bone.

That was one of the first thoughts I had - unfortunately no, from what I can tell based on the paperwork she came with, she was born in KS and was also trained in KS, then sent to FL to race.

[BauersMom]

I'm glad Dr. Dudley worked out for you - I will keep my fingers crossed for Lucy!

[duncan41]

I have re-read this entire thread and am exhausted! Holy cow, Jess! First, how are you? How is the ankle? How is Lucy doing? Any input from the VIN posting? Any response from Dr. Couto? Still sending prayers and healing white light to both of you.

[RedFawnMom]

I have re-read this entire thread and am exhausted! Holy cow, Jess! First, how are you? How is the ankle? How is Lucy doing? Any input from the VIN posting? Any response from Dr. Couto? Still sending prayers and healing white light to both of you.

 

It sort of turned into a novel, I know, I'm sorry. Something about putting all of the details down in writing made me feel like I was "doing" something when there wasn't much else I could be doing other than waiting.

 

I'm fine, ankle is fine, my post-op is tomorrow so hopefully stitches will come out. Lucy is doing better today - she had a rough weekend with a GI issue, who knows what caused that. But we managed to avoid the E-vet and she's feeling much, much better. She doesn't seem to have any pain in that leg and isn't on any pain meds now.

 

I have not heard anything about the VIN posting yet - tried to call the vet today but the office was closed for the day due to the blizzard. They open tomorrow at 7:30 a.m., guess what time I'll be calling? A tech was supposed to fax me a report on Thursday, but that didn't happen, so now I'm in "call and check up on everything until it gets done" mode.

 

Dr. Couto thinks it's some form of sarcoma based on the radiographs. Too irregular to be a cyst, he thinks. He said a needle biopsy should be possible even on dense bone but might require a special type of needle and ultrasound guidance. Is "needle biopsy" and "FNA" different? Are there types of needle biopsies that are not FNA? He said he'd advise the vet on how to do it, so I'm going to ask her to call OSU. But just saying "Here, please call OSU so you can do this procedure the way they advise," and not being involved in the conversation and not knowing if she spoke with the right person at OSU and got the right information and will do the procedure the way they suggest, drives me crazy. I am being a micro manager, I know. But no one cares as much about this as me, and if I'm not on top of it, things don't get done or don't get done quickly and I can't stand it! I hate to be that person that calls the office multiple times a day to see if something has been done yet, but otherwise, the ball gets dropped.

 

This whole thing has been such an emotional rollercoaster. I left the ortho vet feeling cautiously optimistic and hopeful. Then Dr. Couto looked at the X-rays and now I feel deflated. He's the expert, but he also didn't examine Lucy. The ortho vet is experienced, but less experienced in this particular area than Dr. Couto, but she had more background info and the benefit of actually seeing Lucy. But, Dr. Couto is the expert, so I'm not feeling very hopeful that it could be benign at this point. I've moved on to hoping it's a less aggressive type of sarcoma.

 

So, we'll see what the vet says tomorrow.

[duncan41]

First, do not apologize. From a control freak like me, I feel your pain, but wouldn't do it any other way. FNA is the same as a needle biopsy but beyond that, I am clueless. (Sounds like a perfect time to become educated on the subject - the OSU way.) Wonder if you can get the information in writing (email? ) from OSU? FWIW: If phone consultation happens, I would ask to be an observer, but that's the control freak in me talking.

 

Maybe the VIN results will shed some light or provide some influence on which way to go. Questions I would have: What are the odds of a successful FNA - meaning getting enough representative cells to make a diagnosis? If the FNA was unsuccessful in rendering a definitive diagnosis, what would be the next step? With this suspected "sarcoma", if you did nothing, what would be the progression and timeline? What are the treatment options? What are the survival rates?

 

Will continue hoping for answers and praying that it's not a sarcoma! Please keep us informed.

[RedFawnMom]

I spoke with Dr. Dudley a little while ago, and get this: the radiologist that reviewed the images (via VIN) says the appearance is typical of a deep bone infection or possibly a fungus, but that a sarcoma could not be ruled out given the breed. She is strongly suggesting a biopsy at this point, since an infection is curable and isn't the sort of thing you take a "wait and see" approach with. If it is an infection, they'd culture the bacteria to determine which antibiotics to give, then would surgically go in and clean out the abscess and fill the space with bone graft. It's not a minor thing by any means, but is curable. She also said it's possible there was an infection at some point that she "got over" on her own, and what we're seeing on the X-ray is just the aftermath of that, but she said it's not very likely given the size of the lesion and the amount of bone activity around it. Still, though, it could be a sarcoma.

 

I told her about my discussion with Dr. Couto regarding the aspiration technique and she said she'd be happy to consult with them on the case. I also would like OSU to weigh in on this latest theory and perhaps suggest other diagnostics (wouldn't an infection be evident in bloodwork?). She said she'd call them tomorrow afternoon and call me after. She also faxed me the radiologist's report, which I'll send to Dr. Couto tonight to give him a heads up.

[Remolacha]

you must just be I hope once your vet consults with Dr C, they will have a plan

[NeylasMom]

To answer one question, no, a bone infection would not necessarily show up on blood work. I'm surprised about the course of treatment - I know bone infections are difficult to treat, but I would think the first course of action would be to just try a very strong course of antibiotics. However, my experience is incredibly limited. The only time I've dealt with it is a foster who developed a staph infection around his hardware (used to fix a broken leg) and it was treated with antibiotics.

 

It could also be fungal, which I understand can also be difficult to treat b/c anti-fungals can be pretty nasty, but both are much better than a lesion!

 

I just wanted to add, I felt like I was constantly being a pain in the ass when dealing with Neyla's vets, but in the end, you are your dog's advocate so don't worry about being controlling. You do what you need to do to feel educated and comfortable with the choices you're making. Hang in there.

[Houndtime]

What an emotional roller coaster you are on! Just sending good, positive thoughts your way.