Recommendations For Diagnosing Possible Osteo

[Rickiesmom]

X-rays are a given. If they are not definitive, then what next steps make the most sense? As I understand it, the options (not mutually exclusive) are:

 

- CT scan (would confirm lesion more clearly, does it provide enough clarity for lesion type to be diagnosed?)

 

- FNA is the Dr. Couto recommended alternative to a bone biopsy, but is often not definitive. Is there any way it can be done to improve accuracy of results?

 

- Bone biopsy - if it is done with a 14-gauge needle, how risky is it, and what effect (pain, aftercare) does it have on the hound. It doesn't sound very appealing and has often been recommended against on this board.

 

- Is there any bloodwork or cytology of fluid in the joint nearest the affected bone, that can be done that is indicative of the three likely lesion alternatives (osteo (or other bone cancer), Valley Fever (not sure if there are other likely fungal issues) or bone infection).

 

From what I have read fungal is unlikely unless the dog has spent time in the Southwest, and bone infection is unlikely unless there has been a previous trauma to the affected bone. Also, in greyhounds, it seems if it's cancer, it is overwhelmingly likely to be osteo.

 

Your knowledge and experience would be greatly appreciated.

[seeh2o]

Great questions, I'm facing this with Carl right now. Going to the vet for second set of xrays today. Valley fever has already been ruled out, my vet suspects osteomyelitis as he had that toenail ripped off on that paw and same side of the bone where the shadow (not lacy) is, it was not treated as he had a bigger issue with a wound on his head, made worse by an incompetent emergency vet, that sent him to a different hospital landed him in the ICU for 5 days.

 

Sending good thoughts to you for your reasons for asking the questions.

Edited March 27, 2014 by seeh2o

[greysmom]

A CT scan would likely be determinate, but they are prohibitively expensive for most people. The problem with FNA's is that you must get the needle in exactly the right place inside the bone - not too high or low, not too far in, not too shallow. Otherwise, the results could be off. I don't believe there are any lab tests or bloodwork that can detect cancer in dogs as of yet, but I don't know about fungal or bone infection. Likely there would be an elevated level of white blood cells, but tons of things could cause that.

 

Bone biopsy is generally recommended against because of the chance of it weakening the bone further and causing a catastophic break post-procedure. But it probably has a better chance than an FNA of obtaining a valid sample for testing.

 

You can always send digital copies of your xrays to Dr Couto for his opinion. http://www.coutovetconsultants.com/for-ownersadopters/ Though I think he would most likely say that if it looks like it might be osteo, then, given the statistical prevelance of it in greyhounds, it probably is.

 

FWIW, I don't think many of us who have dealt with osteo have had a definitive diagnosis of it prior to deciding on a course of treatment. The diagnosis has most often come after the tumor has been sent to the lab following amputation. Alicia's Henry is the only one I know of - at least currently - who was NOT diagnosed with osteo, though he did have another type of cancer. The amp he had was probably curative instead of palliative, in his case.

[vjgrey]

A CT scan would likely be determinate, but they are prohibitively expensive for most people. The problem with FNA's is that you must get the needle in exactly the right place inside the bone - not too high or low, not too far in, not too shallow. Otherwise, the results could be off. I don't believe there are any lab tests or bloodwork that can detect cancer in dogs as of yet, but I don't know about fungal or bone infection. Likely there would be an elevated level of white blood cells, but tons of things could cause that.

 

Bone biopsy is generally recommended against because of the chance of it weakening the bone further and causing a catastophic break post-procedure. But it probably has a better chance than an FNA of obtaining a valid sample for testing.

 

You can always send digital copies of your xrays to Dr Couto for his opinion. http://www.coutovetconsultants.com/for-ownersadopters/ Though I think he would most likely say that if it looks like it might be osteo, then, given the statistical prevelance of it in greyhounds, it probably is.

 

FWIW, I don't think many of us who have dealt with osteo have had a definitive diagnosis of it prior to deciding on a course of treatment. The diagnosis has most often come after the tumor has been sent to the lab following amputation. Alicia's Henry is the only one I know of - at least currently - who was NOT diagnosed with osteo, though he did have another type of cancer. The amp he had was probably curative instead of palliative, in his case.

 

According to our oncologist, the ONLY definitive diagnosis you can get for Osteo, pre-amp, is through the bone biopsy, but he recommended against it for the reasons you mentioned. We did do a FNA, which confirmed Osteo. In our case, though, there wasn't much question - Gabe had a visible tumor on his leg.

 

I'd definitely recommend consulting Dr. Couto, although it sounds like you may have already?

 

I'm so sorry you're possibly facing this.

[Burpdog]

Bone biopsies are very painful. The fine needle aspirate, not so much.

 

I have done xrays and my vet sends them to a radiologist. If neither can say one way or the other, we re-xray in 2-4 weeks depending on how it progresses. Once you have a few of the osteo kids, you know before the xray confirms it.

[GreyPoopon]

I assume that amputation/chemo is a serious alternative, so what I have to say is going to be unhelpful at best, but...

 

I have ruled out amputation/chemo in all cases to date. When the diagnosis has not been clear, we have sometimes treated for a possible bone infection with Clindamycin. We've also repeated the x-rays, although the interval has varied depending on symptoms and the nature of the original x-ray. As Burpdog says, after losing a few to osteo, you get to know even when the x-rays lie. (I've also been wrong--I thought Pink was finished over a year ago. She's still here.)

Edited March 27, 2014 by GreyPoopon

[TwiggysMom]

I have heard bone biopsies recommended against as well, for the reasons listed above. It is also possible to miss the lesion doing a bone biopsy, albeit much less likely than with a traditional FNA.

 

When I took Twiggy to OSU for amp evaluation, we already had likely diagnosis via x-rays (which Dr. Couto had reviewed). They did an ultra-sound guided FNA, which helped them more accurately sample the lesion. They were not able to definitively diagnose osteo from the sample, but were able to tell it was cancer, and that amputation would be a good option in her case.

 

I hope you get answers that guide you toward a diagnosis and decision.

 

I am very sorry you are going through this.

[KF_in_Georgia]

A local greyhound adopter is going through this with her girl. The dog limps, has funky-looking leg x-rays (but pristine chest x-rays), and none of the experts (including Dr Couto) can state that it's cancer. The dog has even had an FNA and a bone biopsy--with indeterminate results on both. The mom has ruled out any more tests, but she still hasn't decided what to do.

 

The dog is a bounce who arrived here malnourished and with a limp. She's an older dog, and the adopter just wants the old girl to be comfortable for as long as she's got left.

[TwiggysMom]

A local greyhound adopter is going through this with her girl. The dog limps, has funky-looking leg x-rays (but pristine chest x-rays), and none of the experts (including Dr Couto) can state that it's cancer. The dog has even had an FNA and a bone biopsy--with indeterminate results on both. The mom has ruled out any more tests, but she still hasn't decided what to do.

 

The dog is a bounce who arrived here malnourished and with a limp. She's an older dog, and the adopter just wants the old girl to be comfortable for as long as she's got left.

You didn't say this, exactly, but it sounds like even if it is osteo, amp/chemo may not be high on the adopter's list of options for this particular girl, If that is the case, a definitive diagnosis may not be all that important.

 

Since the girl is limping, obviously a good regimen of pain meds is a good idea, and she is already probably getting that. It might be worth considering adding artemisinin, just in case it is osteo (as near as I can tell, there aren't any known side effects from the standard 100 mg daily dose, and it plays nice with most meds - except I think it is not supposed to be given in conjunction with radiation or iv chemo).

 

I also wonder if it might be worth discussing some heavy antibiotics in case it is a bone infection. Obviously, I'm not saying this should be done, but it maybe consult with her vets about this as a possibility.

 

Another round of standard x-rays might be a good idea in a few weeks, and if a lump develops that of course would be a more clear indication of tumor.

 

I hope they can keep this girl comfortable for a long time.

[KF_in_Georgia]

Yes, they're working out what to do with Dr Couto, I think. Or at least, with his input and with the local SEGA vet, who's had more experience with greyhounds than any other vet I know. (He's been treating SEGA's dogs for more than 14 years.)

 

I think the experts have about decided that it's a tumor, but not definitely a malignant one.

[Charlies_Dad]

I agree with all that has been written so far. I would not do a bone biopsy as Diane stated they are supposedly very painful. Also what she said about knowing your pup has it is too true. I knew right away and wasn't even home when Charlie started limping but the description of it after I grilled Lynn about it confirmed it in my mind. Also sending films to Dr Coutu is always a good idea. Good thoughts for your pup.