Bone Biopsy Question

[Zoolady]

I am sorry to report we had to take our ten year old Ben to the hospital last evening. Around 2 pm I saw bruising in his belly area above his penis. By 4pm it had spread down his legs. By 5 pm it was turning black and spreading so off we went. Our vet is open 24 hours and some of the day staff was still there. We met the night doctor and she was very knowledgeable about greyhounds and we were comfortable.

 

She said his gums were a little pale and he was dehydrated. Tuesday prior he was playing in the back yard with the others, turned, fell and yelled. She thought Tuesday to Saturday was quite a stretch to show bruising.

 

They did all kinds of blood tests, chemistries, clotting tests, coagulation tests, urinalysis and xrays (chest, spine and pelvis. Everything they did came back okay and clear except for the pelvis. From the report: "Pelvis: aggressive lytic and proliferative lesion cranial aspect right ilium." Translated it's sort of the right hip bone.

 

They told us we would need a specialist which would be another animal hospital in Coral Springs. We took our Wonder there when we discovered he had osteosarcoma and were very impressed. We didn't amputate but the pallative care went well until the tumor was bigger than a baseball and we had to let him go.

 

On the osteo thread and other places during my years on GT, I was feeling that it's not a good thing to do because many times they come back inconclusive, it's painful and other things can happen because you've done it. Apparently though if it is an infection, they need to culture it to make sure they throw the right antibiotic at it because bone infections are supposed to be hard to get rid of.

 

Tomorrow I will be asking the regular vet to send the xrays and reports to the specialist and see what he says.

 

Has anyone ever had success with a bone biopsy? Ben cannot have anesthesia so they would have to do it with a local. He almost died during a dental with an elevated heart rate that almost killed him.

 

He is now on 50mg of Tramadol twice a day and Amoxicilian.

 

Anything positive to be said for a biopsy? Is the pelvis different from a leg biopsy? I just don't know what to think at this point. I am thankful that out of the four, Ben has insurance being the oldest.

 

I will definitely update.

[BauersMom]

I would probably have OSU look at the films before going the biopsy, or rather, fine needle aspirate (FNA) route. If they think there's a chance it can be an infection, I'm sure they will have some advice on the FNA.

 

Here's the link to the consult form:

 

https://greyhound.osu.edu/consultationservice/

 

Good luck

[tbhounds]

I agree with the above poster but, I also wanted to comment that I really don't think you can do a bone biopsy of the hip on an awake dog no matter how good natured they are.

Edited to add- I'm sure a fna would be tolerated if its even possible because of the location of the lesion.

Get chest rads before pursuing any further diagnosis.

Edited January 9, 2012 by tbhounds

[Batmom]

Might be able to do an FNA with a local, though.

 

Unfortunately, FNA's on bone lesions are often inconclusive. Better for soft tissue masses.

 

If the specialist and/or OSU are uncertain as to whether it's osteo vs. infection, you might run your dog's last anaesthesia protocol past them as well. Some anaesthesia meds have less of one or the next effect so chances are he could be put under again with minimized risk.

 

Hugs and best luck to you and your sweet boy.

[Zoolady]

I did join and sent an inquiry to OSU. The cd with the pictures has many and I think too big for me to send, even if I knew how. I'm thinking to ask the vet to send them to OSU tomorrow too.

 

The diagnostics done yesterday were a complete blood count, chemistry profile, tick diseases, coagulation tests and urinalysis. Everything came back fine. They also did 3 radiographs with results of: "normal thorax. Pelvis: agressive lytic and proliferative lesion cranial aspect right ilium."

 

Will ask about the prior anesthesia and get things moving tomorrow morning.

 

My signature is so old but Ben is in it on the right. His face is pretty much white now but he still loves to cuddle. On weekends he will get in the bed, lay as close to me as he can, and put his head either on my shoulder or share my pillow.

[krissn333]

We did a FNA on Pinky for her osteo, and also for Sutra. While the results are not always SUPER conclusive, it would certainly be able to tell you if you're dealing with SOME type of cancer vs. an infection. Both FNA's came back as "a sarcoma of some type."

 

Both of them had it done with very light sedation and they were given morphine afterward because it can be painful for a while after its done.

 

Bone biopsies are not generally recommended, they're very invasive, requires general anesthesia for the animal, and often can weaken the bone.

 

Keep us posted on sweet Ben

[Zoolady]

Will definitely update as soon as we know anything. Thank you all for helping.

[Batmom]

Re sending files: These days you can send a pretty big file through most email services although you may not be able to send several at once. Wouldn't hurt to try as it's so much faster.

 

Keeping up the good thoughts for your sweet boy.

[Zoolady]

We have a 3:00 appointment with a specialist tomorrow.

 

I called OSU to find out if I should have the xrays and tests sent now or wait until they respond. The operator had me leave a message for Dr. Marin which I did.

 

Also asked current vet what anesthesia he had for his dental years ago and they said isoflorane. (not sure about the spelling).

 

Will keep you updated.

[NeylasMom]

I would submit your request for a second opinion from OSU through their consultation service asap: https://greyhound.osu.edu/consultationservice/ and schedule an FNA in the meantime if you feel that would give you peace of mind. I would not do a biopsy.

[tbhounds]

Regarding the reaction to anesthesia -- Ben most likely had an adverse reaction to either the pre-med drugs or the induction agent they used. It's extremely unlikely he had a reaction to the iso. Try and get his entire surgical records including the pre-meds and the induction agent they used.

I'm sorry you and Ben are faced with this.

[Zoolady]

Got permission to leave work early tomorrow. Haven't heard from OSU Consultation Services yet but really didn't expect to hear anything so soon. I know also that Dr. Marin is very busy.

 

I will call my vet tomorrow to see if we can get the full information on Ben's dental records. The girl I talked to today was new and a little dismissive but I can certainly overcome that. Never thought about pre-meds or induction meds. Thanks.

 

About 5:30 this evening, Scott said Ben was laying on a thick orthopedic bed and let out one GSOD and continued laying down. He had his pain med at 7:30 this morning. He is sleeping now but if he wakes up soon may give him his medicine a little earlier tonight.

 

Scott was able to rearrange his schedule so will be able to go with us tomorrow which is good. It's a long drive and I'm a cryer.

[tbhounds]

I'm sorry your dealing with this. I would feel bad of I didn't mention this. You know the old saying-- if it looks like a duck and quacks..... I think you should start to consider how you are going to approach things if your Ben receives the diagnosis we all fear.

Have you been to the Osteo thread??? There are some wonderful, informative posts that you might find very helpful and may help you prepare for the future.

Hopefully, you don't find my post to blunt and callous- not my intention. Wish I could make it all go away for you. I understand all to well to have to deal with a beloved hounds illness. It's like walking around with a punch in the gut feeling that just won't go away.

Btw- I'm a cryer too- nothing wrong with it.

May I ask what pain meds Ben is currently taking?

Good luck tomorrow- keep is posted!

[Zoolady]

Unfortunately we were members of the osteo thread. I shared our beautiful fawn boy Wonder's osteo of the shoulder area until we gave him the final act of love.

 

I'm still hoping we don't have to renew our membership.

 

Don't worry about suggesting the osteo thread. It is very helpful and I know you are helping by suggesting it.

 

Ben is on amoxicillian and the pain med is 50 mg Tramadol, twice a day.

 

We went pallative with Wonder and had many changes in meds, dosages, bone support, etc. The vets were amazing and kept him comfortable for longer than we thought possible.

 

To be continued for Ben .....

[joejoesmom]

I did join and sent an inquiry to OSU. The cd with the pictures has many and I think too big for me to send, even if I knew how. I'm thinking to ask the vet to send them to OSU tomorrow too.

 

The diagnostics done yesterday were a complete blood count, chemistry profile, tick diseases, coagulation tests and urinalysis. Everything came back fine. They also did 3 radiographs with results of: "normal thorax. Pelvis: agressive lytic and proliferative lesion cranial aspect right ilium."

 

Will ask about the prior anesthesia and get things moving tomorrow morning.

 

My signature is so old but Ben is in it on the right. His face is pretty much white now but he still loves to cuddle. On weekends he will get in the bed, lay as close to me as he can, and put his head either on my shoulder or share my pillow.

Did you send a consult request via the web form? If so, you can attach up to six files to the form (a total of 2MB). If not, you need to submit a consult request via the web form. They no longer respond if you just sent an email or place a phone call. It has to do with streamlining their process and collecting metrics.

 

I would not wait until you hear from them to send the x-rays. You can overnight them to Dr. Marin or complete another consult form and attach the files.

 

Jane

 

By the way, you do not need to be a member of the GHWP to send a consult request nor does it speed up the consult time. But the funds are used to provide the service so they greatly appreciate the people who join the GHWP.

[Burpdog]

Just now seeing this. Sending prayers!

[Zoolady]

Just got home. Dr. Moore was just as helpful, kind and considerate as he was with Wonder. I'm sorry to have to report that the diagnosis and options are not good. Osteosarcoma of the right hip, starting at the top going about half way down the ilium. The good news is that it's not the side of the hip that is more weight bearing.

 

Apparently Tuesday when he was playing and collapsed, the bone got a tiny fracture and the bleeding showed up in his groin and legs which is what sent us to the emergency room Saturday.

 

We discussed the possibility of infection and he asked if Ben ever raced in the Mississippi or Gulf Coast region and he did not. Apparently there is a fungus problem that can infect bones but we ruled that out.

 

Then he asked if we needed a definite result and talked about the bone biopsy. Somewhat invasive and painful and could do more damage to the bone which we didn't want. He did not recommend FNA because you could hit an area where there is inflammation only and not pull any cancer cells out when indeed they are there. We said no to that.

 

We reviewed him not being a good candidate for anesthesia and he was cautious about that.

 

Next option was radiation to slow it down. Possible but could because of where the cancer is, the radiation could damage or inflame internal organs which would give us another not so good outcome.

 

We went to the next option that is surgery. He could remove the area where it is but the problem would be if he doesn't get it all, it could grow back within a few weeks. There is also the possibility that he could damage nerves and Ben would lose the use of his legs. No to that too.

 

Next option was chemo and he offered to let us talk with the oncologist. We talked about every 3 weeks he could have chemo and perhaps alternate with a bone builder. He would need blood work every time. This would not be a cure but perhaps give him more time here. The cost would be $600 to $800 a treatment. Thank God Ben has insurance and it would cost us only 10% after the deductible is met. The hospital takes care of all the paperwork but we have to pay them 25% up front and it all adjusts as the insurance company pays.

 

It is an hour's drive one way and I know from the osteo thread that sometimes they can't do chemo and send you away to try another day. Scott and I both work but I work at the University and have vacation time I could use as long as the new boss would be understanding. Scott is his own boss and must work so I would be doing the appointments.

 

Dr. Moore took Ben off of the Tramadol and put him on Rimadyl instead. He said he wants to save the Tamadol for when the Rimadyl isn't working as well.

 

He also saw something at the top of the other hip but wasn't sure if it was an old injury or if the cancer had spread to that hip.

 

He said to go home and think about it and then we will get back to him.

 

So, sadly, I will rejoin the osteo thread. Thank you for all your help, suggestions and support. It's nice to know you are here and always willing to help.

Edited January 10, 2012 by Zoolady

[NeylasMom]

I'm so sorry you're here again.

[tbhounds]

Did you get chest rads?? If there are mets that might help with your decision process. Also not sure why you wouldn't start the rimadyl with the tramadol-- much better to stay ahead of the pain--you can increase the tramadol dose as the pain increase-- you could also start with gabapentin too.

Sorry- crappy club to be in. Hugs to you and Ben.

[45MPHK9]

I'm so sorry to read about Ben's osteo diagnosis.