Oncologist With Zuri - *update: It's Osteo*

[NeylasMom]

So we're here. I'm annoyed with myself for multiple reasons, one of which is that the bloodwork is going to take much longer than I expected even though they can run it in house so we're in it for the long haul.

 

So we're going to see what the blood work shows and then unless the results send us down an obvious other path, we are planning to do a CT. They will be able to check carefully for lung mets, hopefully get more info about what's going on in both shoulders and we're going to throw in a quick look at his spine and pelvis for good measure.

 

They of course want to do a biopsy of the left shoulder as well presuming the CT points us toward cancer, but I'm still on the fence pending results.

 

I'm not thrilled about sedating him, especially not thrilled about a drunk dog on 3 bad legs navigating stairs, and the cost is daunting, but I feel like the CT is the best shot for getting the most info.

 

Any insights, input, or encouragement welcome. Or just feel free to tell interesting stories because we are going to be here ALL day. And my laptop screen is broken so it's just a phone and a book. At least I had the foresight to grab my phone charger at the last minute.

Edited May 26, 2016 by NeylasMom

[tbhounds]

Absolutely run the ct scan!

If I hadn't run a scan on my Stan there's a good chance I may have amputated when it wasn't warranted. His radiograph screamed osteo-3 clinicians all said the same thing (including Couto)-looks like a lytic lesion proximal tibia-he was non-weight bearing .... Had all the signs. I took him to

Metzgers-first thing they did was to attempt a fna-no go, the bone was to strong-so right to the scan.

Turns out he just has a weird marrow formation-nothing to worry about. The lamenes-strained iliopsoas muscle. Run the scan ;-)

Edited May 26, 2016 by tbhounds

[Burpdog]

If you do a biopsy, make sure it's a fine needle one. The other is extremely painful and I'll never do one of those again.

[winnie]

I can't offer any medical advice, but you and Zuri are in my thoughts today.

[NeylasMom]

Thanks Tracy! I feel better knowing you think it's a good plan.

 

If you do a biopsy, make sure it's a fine needle one. The other is extremely painful and I'll never do one of those again.

The vets here are really resistant to FNAs because they often don't give a clear answer like a biopsy does. I am on the fence - I have always been resistant to them, but she assuaged my concerns about the risk of fracture at least. The pain is another potential issue though.

 

I'm not sure yet whether she will be able to communicate CT results to me before deciding, but I get the impression not because they'll want to use the CT to guide the needle. In which case I'm going to try to outline with her ahead of time whether or not to proceed based on possible findings.

 

Or alternatively I could just let her decide based on her extensive experience. I'm sure they are already super annoyed with me. I'm trying so hard not to be a total pita, but it's hard for me.

Edited May 26, 2016 by NeylasMom

[sarabz]

I can't offer any medical advice, but you and Zuri are in my thoughts today.

 

x2 Many hugs

[NeylasMom]

Absolutely run the ct scan!

If I hadn't run a scan on my Stan there's a good chance I may have amputated when it wasn't warranted. His radiograph screamed osteo-3 clinicians all said the same thing (including Couto)-looks like a lytic lesion proximal tibia-he was non-weight bearing .... Had all the signs. I took him to

Metzgers-first thing they did was to attempt a fna-no go, the bone was to strong-so right to the scan.

Turns out he just has a weird marrow formation-nothing to worry about. The lamenes-strained iliopsoas muscle. Run the scan ;-)

I should maybe add, I so want to be hopeful about a possibility like this, but he just seems so painful. Twice now he has just stepped funny - maybe causing him to bear more weight than he wanted to and he yelps in pain and then limps significantly more for a period of time. When you factor in his current med regimen, I just can't believe a muscle injury would cause this much discomfort. Edited May 26, 2016 by NeylasMom

[tbhounds]

The scan will be able to determine the pathology of what's going on-can't determine exactly what type of cancer -if any but, you will have a better idea of which direction to follow.

The prep of a scan takes longer than the scan itself but overall it's a pretty quick procedure.

[NeylasMom]

Thanks. I'm sitting here making a flow chart of possible outcomes and what treatment options we'd have/I'd likely choose for each and which would require a biopsy.

 

Need to talk to vet, but I'm thinking if it looks like there's just a primary tumor in the left shoulder, in which case I would explore the possibility of stereotactic or if it's cancer but we need to differentiate osteo from myeloma then we do the biopsy.

 

Otherwise, I'd likely just do palliative care (bisphosphonates and maybe chemo or radiation depending) and am not sure we'd need the biopsy. Obviously if there are lung mets, no biopsy.

Edited May 26, 2016 by NeylasMom

[Jenbo]

Sending white light and love to your boy

[greysmom]

[Remolacha]

:candle

 

A lot of decisions to make, but don't worry about being a PITA, that's your job

[NeylasMom]

Blood work all looks good, basically rules out myeloma unless we see something unexpected on CT. So we're going ahead with the CT and I gave her the go ahead to biopsy if she feels it's warranted based on what they're seeing real time. We went through each sort of possible scenario and seemed to be on the same page on when it would or wouldn't be. She did say she actually prefers FNA and is willing to try, but she thinks they won't be able to get the needle through the bone.

 

I really hope I'm making the right decisions. She did say she could pop out right after the CT to run things by me so I can give a final yay or nay on the biopsy if I want, but it will have to be an immediate decision because he will still be under anesthesia. Wavering on that.

 

So it's going to be another hour or so until they're ready to take him down and start the pre-med protocol so if anyone wants to tell me I'm making a huge mistake, now's your chance.

Edited May 26, 2016 by NeylasMom

[Kestrel]

Sending good wishes to you both.

[MauCarden]

Yeah, but you are our PITA. I have listened to you and a few others here in the past and totally have brought up to vets what y'all have said, and have let your past PITA moments guide me in some decisions.

 

There with you and your boy in thoughts.

[XTRAWLD]

Sounds like a stressful day.

 

IMO if he's already under for the CT, do the biopsy if possible and if she thinks it's warranted. Why wouldn't you really, since he's already out like a light? Then you know exactly what you are dealing with. I have no experience with FNA in bone, in a surface tumour it was bad enough. I actually didn't know they could do that but it totally makes sense.

 

I've had lots of good luck with recovery after anesthesia, so hopefully he won't be too zonked for too long and can recover quickly. Poor chap. Scritches to - both of you?!

Edited May 26, 2016 by XTRAWLD

[Houndtime]

Just wishing you the best out come from the day's events.

[carronstar]

You are not a PITA. You are a well-educated doggy mama. I have had multiple vets tell me that they love greyhound parents because we always come in with the most knowledge and awareness.

 

Sending lots of good thoughts and prayers for you and Zuri.

[NeylasMom]

Well he's down with the CT folks. They should be starting soon. I am freaking out. They have a board certified anesthesiologist in there with him, but I can't help thinking about the what ifs between the anesthesia and the possible biopsy. I know, there's really nothing to worry about, but, anxiety.

[tbhounds]

Do they have a staff pathologist that could look at the sample today?

[NeylasMom]

Do they have a staff pathologist that could look at the sample today?

She didn't say. You'd think they would - they have everything else.

[tbhounds]

They should be able to read a cytology

[Remolacha]

 

Just remember, whatever decisions you make are the right ones, because you are deciding on what is best for him based on what you know at the time.

Edited May 26, 2016 by Remolacha

[MandysMom]

Thinking of Zuri

[kudzu]

 

Just remember, whatever decisions you make are the right ones, because you are deciding on what is best for him based on what you know at the time.

 

^ This ^ We do the best we can with the info we've got. You're all doing your best to get good info. Sending many, many good thoughts.