The Story Of Big D

[Guest synaptica]

I've been wanting to post the story of Dakota ('Big D') in Greytalk for a long, long time.. but I wanted it to have some sort of ending before I did. Today, the mystery was finally solved, and the story has come to an end. So, here it is:

 

In the middle of October 2010, my husband and I adopted Dakota Kid. He is 4.5 years old, and had been in Canada since March 2010, but had to be given back to the adoption agency because his owners were relocated overseas. About 3 days after we got Dakota, I noticed a limp on his right front leg. Initially, I thought it was because I had given him a bath, and he had jumped/fallen out of the tub. He didn't show any distress at the time of the fall, but it was the only thing I could think of that had happened to him since arriving at our house. I thought it was a soft tissue injury. Over the next week or so, the limp became progressively worse. I thought this was because Dakota had been playing in the back yard with our other 2 dogs. Finally, we confined him to an ex-pen so he could rest and heal.

 

On Hallowe'en, I let him into the back yard, and he slipped on the stairs on the deck. It was obvious that he'd injured the leg further. I still thought it was a soft tissue injury. The next day, however, the leg was swollen and red, so I took Dakota to the vet. X-rays revealed a pathological fracture due to an osteolytic lesion (i.e., a bone lesion caused thinning of the cortex of the bone to the degree that the bone was weakened and fractured as a result of what would normally be a minor insult). I should mention at this point that for the entirety of the time we'd had Dakota, the only symptom he'd ever shown was lameness. This will become important later.

 

The first thing anyone thinks when they see an x-ray like that is that it's osteosarcoma. However, osteosarcoma is rare is dogs as young as Dakota, and the specific site of the lesion (proximal radius) is not typical of osteosarcoma (more on the in a bit). Needless to say, we did chest x-rays, but those appeared to be clear. So, the first thing to do was rule out some of the "weird" greyhound diseases that can cause bone lesions. 4DX snap test was negative on all accounts (this tests for common tick-borne diseases). Blood was taken for a fungal panel (another likely candidate for bone involvement). A Jamshidi needle bone biopsy was performed (to see if it was osteosarcoma, and also to culture any organisms present). A CBC (Complete Blood Count) was done.

 

Fungal panel came back negative. Bone biopsy was inconclusive. Because the biopsy was done with a Jamshidi needle, minimizing the chances of further fracturing the already weakened bone, we knew there was a possibility that the sample would be too small to provide a representative cellular overview, and thus would not be able to provide a diagnosis (which was exactly what happened). Cytology and bacteriological cultures didn't reveal any infectious agents. CBC showed a possibly elevated white blood cell count. As we know, Greyhounds have weird blood parameters, and without a baseline (we didn't have one because we'd only had Big D for 2 weeks when this all happened), it was impossible to say if WBC was actually elevated. If it was elevated, it was only slightly so.

 

I should also mention that, because a bone infection is another primary cause for osteolytic lesions, Clindamycin was begun immediately. The leg was stabilized with a wrapped, padded splint.

 

The bandage needed to be changed about every 10 days. This required tranquilizing, so x-rays were done at the same time. The second set of x-rays showed neither improvement nor degradation. The third set showed the same, and at this point, we switched antibiotics (to Clavamox). Finally, the last bandage change, Dec. 6, the vet clinic where Dakota goes had just hired a new board certified surgeon who's specialty is... bone infections. So he had a look at the x-rays (4 sets in all). He did't think it was a bone infection, but did't know what it was. The vet and the surgeon disagreed on whether the x-rays show improvement, degradation, or nothing at all. They disagreed on whether a bone infection or a tumour was the more likely diagnosis.

 

So, I finally contacted a top Greyhound Osteosarcoma vet. He agreed to look at the x-rays. Keep in mind that he has seen literally thousands of cases. But he had never seen one like this.

 

He recommended that we do a new bone biopsy, but curette the bone, which means to take a way bigger piece. So we did (we actually took 4 pieces, bone marrow aspiration, and tissue sample for bacteriological culture.)

 

When the clinic got the results, the surgeon immediately phoned the pathologist who had done the lab work. The surgeon gave a detailed explanation of Dakota's case. After an hour on the phone, the pathologist was unwilling to commit to any of the possible diagnoses (at that point, the list included osteosarcoma, some other bone cancer, bone infection, atypical bone cyst, and benign bone tumour). So again, the results were inconclusive.

 

Here's a brief summary of why this was such a strange case at this point:

 

They didn't know what it is because, the most likely thing is osteosarcoma and:

 

1) osteosarcoma is rare in a dog as young as Dakota (4.5)

2) osteosarcoma almost never happens in the proximal radius (in fact, the osteosarcoma vet had NEVER seen it in that location)

3) osteosarcoma usually gets worse really fast, and this is so slow that the vets didn't even know if it WAS getting worse

4) osteosarcoma usually metastasizes to the lungs, and that hadn't visibly happened in the 2 months since the initial vet visit (but lung metastases start off very small and are impossible to see on x-rays)

5) with the bone biopsy, cancer cells should be (but are not always) evident. None had been found.

 

If it wasn't some type of cancer, it could have been a fungal or bacterial infection, an atypical bone cyst, or a benign tumour. Here were the issues with those options:

 

Infection:

1) generally, there are other symptoms, like loss of appetite, lethargy, etc (normal things you'd expect to see with any kind of infection). There had been no symptoms other than lameness.

2) a fungal culture came back negative (ruling out most types of fungal infections)

3) infections also generally drain out the skin somewhere -- that wasn't happening

4) with a bone biopsy, it is possible to culture infectious organisms from the sample. None had grown.

5) a bacterial infection should respond to antibiotics -- it was unclear if that was happening or not

6) infections should change things like white blood cell counts -- greyhounds have weird blood cell count parameters anyway, but it didn't look like they were changed too much, if at all, from normal

 

Bone cyst or benign tumour:

 

1) EXCEEDINGLY rare (like only about 7 reported cases of cysts in the literature, and a handful of benign tumours)

2) usually occur in the same spots as osteosarcoma (again, not the proximal radius)

3) unfortunately, hard to identify with histopathology

 

After the second inconclusive bone biopsy, a sample was sent from the lab here to the osteosarcoma specialist's pathologist. They couldn't make a definitive diagnosis either. At this point, my husband and I were definitely feeling the financial burden. So that, in addition to not wanting to subject Big D to further veterinary torture, made us decide to simply take him home and let him be a dog. And so we did.

 

As time wore on, Dakota's pathological fracture, against all odds, actually healed (verified by x-ray later). He got to a point at which he hardly limped at all. In March, we decided to take him for a new set of x-rays to see if anything had changed. Indeed, as I just mentioned, the fracture was healed. Unfortunately, the lesion had grown in size. My husband and I were torn as far as what we should do. The vet and surgeon were recommending yet another biopsy. The osteosarcoma specialist had recently had a very similar case that had unexpectedly turned out to be osteosarcoma, so he also was recommending a biopsy, but this time a trephine biopsy (an even bigger sample than the previous two). Finally, we reluctantly agreed. Unsurprisingly, the result again came back inconclusive (it had even been sent to an entirely different lab in hopes that there was something wrong with the first one). So once again, we decided to resume our regime of doing nothing.

 

Within a few weeks of the last biopsy, Dakota was again using the leg almost normally. He was happy to come on long walks with our other 2 dogs. All was as well as could be expected.

 

Dakota enjoyed a nice summer. Until late August, that is. While playing, he suddenly began to cry out, and was obviously in extreme pain. So, back to the vet he went. Upon x-ray, a new pathological fracture was evident. But what was most striking was the lesion, which had expanded considerably since the previous March x-ray. My husband and I decided that this wasn't going to get better (and even if the lesion were not cancerous, its location precluded any sort of limb-sparing). So we decided to amputate. On August 29, Dakota went in to surgery to have his right front leg removed. After some initial complications with bleeding, requiring a blood transfusion, Dakota has since been making a great recovery. He is adapting well, and today had most of his sutures and staple removed.

 

But the best thing was that today, we finally got a definitive diagnosis from the pathologist today (we had the whole leg sent off when it was removed). It wasn't cancer... it was an aneurysmal bone cyst. This is a diagnosis so rare that I can only find about 5 case reports in the literature (I am in science, and so have access to all the journal databases). It was the best possible news. We knew we couldn't have saved the leg, and anuerysmal cysts can apparently turn cancerous if left unchecked.

 

Now, am I happy I made all the decisions that I did? Not at all. I feel horrible for having put Dakota through all of those procedures. But at the same time, there was always some hope that the lesion was the result of an infection or something that might resolve itself. And it was so tempting to hope when he actually recovered from the first fracture. And he did get to enjoy a summer of 4-legged fun. But now it is evident that having 3 legs isn't really an issue for him. Part of me wishes we would have gone straight to amputation.. or at least done it much earlier. However, it is what it is, and all I can do now is help Dakota to have the best possible life, which, as a result of today's information, should be a long one

[Guest synaptica]

Dakota's x-rays through time:

 

November 1, 2010

 

 

November 21, 2010

 

 

December 6, 2010

 

 

February 28, 2010

 

 

August 25, 2011

 

 

Big D, 3 days post-amputation:

 

 

Big D, 5 days post-amputation:

 

http://www.youtube.com/watch?v=xGZlmsAJPDA

[Guest IrskasMom]

I have to clear my Eyes first before Typing . What a Story . This XRays are so clear . I was wanting to ask:Did you ever consulted with OSU and Dr Cuto ???

Anyway Dakota is Gorgeus

[Guest june]

I am so glad that Dakota is doing well. It is amazing how quickly they adapt to amps. It is obvious how much you love Dakota and he is blessed to have such a wonderful family! Thanks for sharing his (and your) story.

june

[TheFullHouse]

My gosh you all have really had a tough time of it. I'm so glad you finally have the answers. Dakota looks like he's doing very well now.

[racindog]

What a wonderful story! He looked happy to me- I love tripods-Ivy had her R front amputated too and it didn't phase her at all. She could and did still run like the wind and was also happy. He is so fortunate to have such a loving family that seen him through such an ordeal always putting him first. Hugs to all! Thanks for sharing. It is so good to hear of successful outcomes.

[BatterseaBrindl]

Thanks for sharing Dakota's story.

[Feisty49]

As bad as it is, having a final diagnosis is a good thing, and he obviously is getting around great! In our greyhound group, there is a girl who is missing one of her back legs (removed because of cancer), and she dies fine. Good luck with your beautiful boy!!

[MaryJane]

Thanks for sharing your story - I think it will be helpful to others that may face the same thing.

[Guest synaptica]

3 vids from today:

 

http://www.youtube.com/watch?v=5E0_0fP0Vgs

 

http://www.youtube.com/watch?v=-U9FsYUxQL8

 

http://www.youtube.com/watch?v=3K29skBu1To

[Batmom]

That is an incredible story. Scritchies to your boy -- so glad he is doing well!

[EllenEveBaz]

That 8/28 x-ray is just frightening.

 

Best wishes to Dakota on his new life.

[BauersMom]

Wow, what a story. That is definitely an odd location to see such a lesion!

 

Just a few things to clarify about osteo though, since I've seen these things comes up often enough for why a limp/lesion "can't be osteo" - osteo can be slow to progress, doesn't typically show metastasis to the lungs on x-rays immediately...and while seeing osteo in young dogs is not common, it has happened enough that I know of several.

 

And your case is also why I think most vets don't recommend the biopsy unless absolutely necessary - it's so hard to get a sample big enough to get a sense of what's going on without further compromising the bone, and sounds like that was the case here too.

 

I wonder if OSU would like to see the X-rays and pathology report, since they are asked to weigh in on a lot of odd/unusual cases?

 

I'm so happy it has a good ending.

[GreyPoopon]

As Batmom said, incredible.

 

I'm glad he's doing so well now. I'm especially impressed about his ability to do stairs--I have some four-legged girlies who don't manage half flights as well as he does.

[JJNg]

Wow, thanks for sharing your experiences with Big D. Very interesting case, and I'm so glad it has a good outcome. Now that you have the final diagnosis, it's easy to look back and wish you'd made different decisions. But you didn't know that at the time, and I know you made the best decisions you could with the info you had.

[Guest tmgukcatfan]

Big D's story is great, especially now that there is an ending. I love his white toes, too. Thanks for sharing and for giving Big D a wonderful life.

 

Teresa

[Guest synaptica]

Just an update on Big D. He's doing great! Here are some pics from today:

 

 

 

[Guest goofydog]

I missed your initial posts and have just finished reading through the ordeal you both went through. Reading it and looking at the xrays it's wonderful to see Big D running and happy. Such a handsome, shiny boy! Thanks for updating his story so those of us that missed it earlier can celebrate his fantastic recovery with you. Give that boy one of these please

[Guest greyers]

Love these pics

[Houndtime]

Thank you for sharing his story. What a hard time you all went through. Glad to see how well he is doing.

[heartdogs]

What a handsom boy! Glad you found out what the problem was & that things turned out well for Big D.

[jamngrey]

Thanks for sharin his incredible story. So happy you have your wonderful boy

[spottydog]

He looks so happy! Best wishes from Calgary.

Edited January 27, 2012 by spottydog

[kudzu]

Your boy is gorgeous!! Thank you for sharing him with us. His is an inspirational story indeed.

[racindog]

He is so beautiful and happy! Thanks so much for sharing his happy pictures!