Should we get a second opinion on OS diagnosis? MRI? Amputate?

[Gatorade]

My 6.5 yr old greyhound, Gator, developed a limp about 5 days ago. Like many, I assumed he had injured himself because he's always been pretty clumsy. As the limp remained, I tried to determine the source. I pushed, squeezed, and pulled on each toe, bone, joint, etc. Gator didn't really give any reaction to help me find where, other than his front left leg. I did all the research, and came up with a lot of things it could be.   

I took Gator to the vet. They thought his shoulder was swollen and suggested x-rays. Now they think it could be a tumor, but didn't really seem sure (see attached x-rays). They talked about the idea of amputating. They gave him some pain meds. He doesn't seem like he's in a lot off pain. He will still go sprint in the backyard. Just keeps limping. 

I asked if there were different ways to know for sure? I had them run some bloodwork. We just had some in June, which was all fine, so they can at least compare the numbers. I should have that back tomorrow They talked about getting an MRI as another way to "know for sure".

Do you think its worthwhile getting an MRI? Should we amputate the leg if it is OS?

Gator is my first greyhound.

[zimsmom]

Have his xrays sent to Dr Coutou.  I don't recall his contact information.  Put his name in the search button and you will find  lots of posts about him.  I would not do an MRI until I heard his opinion.  

[zimsmom]

https://www.coutovetconsultants.com/.  Here you go. 

[Gatorade]

9 minutes ago, zimsmom said:

Have his xrays sent to Dr Coutou.  I don't recall his contact information.  Put his name in the search button and you will find  lots of posts about him.  I would not do an MRI until I heard his opinion.  

Thanks. I actually found his name before in other posts and already sent him an email! Hopefully he get's back to me soon. I'm sure he gets inundated with emails.

[macoduck]

Bloodwork won't tell you much if anything regarding a bone cancer.  In the first image, up beside the head of the humerus, see that little white dash in the soft tissue? Did your vet comment on that? My girl had a calcification like that that was discovered after finally doing an xray. She limped on that leg too. Vet said nothing to worry about as the discomfort would ease over time and it did.

Have you checked the affected leg for corns on his for pads?

Dr Couto is good. He's found some rather rare things in my greyhounds. He usually gets back to owners in 24-48 hours.

Ditto on not doing an MRI yet.

How greyhound savvy is your vet?

[BatterseaBrindl]

7 minutes ago, macoduck said:

Bloodwork won't tell you much if anything regarding a bone cancer.  In the first image, up beside the head of the humerus, see that little white dash in the soft tissue? Did your vet comment on that? My girl had a calcification like that that was discovered after finally doing an xray. She limped on that leg too. Vet said nothing to worry about as the discomfort would ease over time and it did.

Have you checked the affected leg for corns on his for pads?

Dr Couto is good. He's found some rather rare things in my greyhounds. He usually gets back to owners in 24-48 hours.

Ditto on not doing an MRI yet.

How greyhound savvy is your vet?

    

[greysmom]

I'd be more concerned about changed in the bottom of his shoulder blade, but it's really hard to tell through all the soft tissue.  Also a soft tissue tumor won't show on xrays, you will only be able to image changes in the bones.  I don't see any of the characteristic "moth eaten" looking bone which would definitely be osteo.  BUt Dr Couto should be able to guide you forward - he may need different views or digital vs copies, but he will be able to give you a next step.

As far as what you do then, it's really entirely what you decide is the best for you, your family, and your dog.  I will say, right off the bat, that the amp-chemo route is going to be the most expensive - because it's something we unfortunately have to consider.  Ten years ago our boy's surgery and after care ended up costing us around $20,000 and gained us 8 months of time with him.  There are tons of new treatment options now, and vaccine trials, new pain protocols, but it's still an expensive route to take.

Amp-chemo is really all about one thing - removing the primary source of pain (the tumor) and helping your dog be comfortable for a longer period of time.  It also reduces the chance of a catastrophic break during the normal course of physical activity.  I believe The Greyhound Health Initiative has a free chemo program, and that is another cost to consider.  But still, once a primary tumor is seen it pretty much means the cancer cells are throughout the body.  By doing amp-chemo you're just extending the pain-free time you dog will have, it isn't a curative procedure.

Choosing palliative care is a perfectly viable option, if that what you decide is best for your family.  There are plenty of new treatments to give your dog a good amount of pain free time (though you still have to watch for a catastrophic break).

I'll try and look up the latest Osteo Thread for you to look through.  This was a series of threads we had going for several years as many of us went through what you are doing now.  Our discussions might help you.  There are also a lot of links and information in the first post of the thread.

In the meantime, try and keep your boy quiet and don't let him do zoomies or go crazy running outside until you have a better idea what you're dealing with.  Did your vet offer nsaids along with the pain meds?  Offer any other medicinal help for your boy other than further diagnostics?  They won't help in the long term if her has osteo, but they will help keep him comfortable now.

Good luck.

[Gatorade]

9 hours ago, macoduck said:

Bloodwork won't tell you much if anything regarding a bone cancer.  In the first image, up beside the head of the humerus, see that little white dash in the soft tissue? Did your vet comment on that? My girl had a calcification like that that was discovered after finally doing an xray. She limped on that leg too. Vet said nothing to worry about as the discomfort would ease over time and it did.

Have you checked the affected leg for corns on his for pads?

Dr Couto is good. He's found some rather rare things in my greyhounds. He usually gets back to owners in 24-48 hours.

Ditto on not doing an MRI yet.

How greyhound savvy is your vet?

 

Thanks for your response. My vet did mention it. Said she wasn't exactly sure what it was, but could be something, may not. SHe was more concerned with the spot below the shoulder. We checked pads and so did vet. No signs of corns or anything else that would impact it.

Dr. Couto already has gotten back to me. Thought there was some supraspinatus tendon mineralization (chronic tendinitis), but couldn't tell from the bones with what i sent him. I ended up sending them in another digitized format, hopefully that will help and we'll get another set of eyes on it from that perspective.

Vet is fairly familiar with greys. We are also thinking abotu seeing another person with more experience.

[Gatorade]

9 hours ago, greysmom said:

I'd be more concerned about changed in the bottom of his shoulder blade, but it's really hard to tell through all the soft tissue.  Also a soft tissue tumor won't show on xrays, you will only be able to image changes in the bones.  I don't see any of the characteristic "moth eaten" looking bone which would definitely be osteo.  BUt Dr Couto should be able to guide you forward - he may need different views or digital vs copies, but he will be able to give you a next step.

As far as what you do then, it's really entirely what you decide is the best for you, your family, and your dog.  I will say, right off the bat, that the amp-chemo route is going to be the most expensive - because it's something we unfortunately have to consider.  Ten years ago our boy's surgery and after care ended up costing us around $20,000 and gained us 8 months of time with him.  There are tons of new treatment options now, and vaccine trials, new pain protocols, but it's still an expensive route to take.

Amp-chemo is really all about one thing - removing the primary source of pain (the tumor) and helping your dog be comfortable for a longer period of time.  It also reduces the chance of a catastrophic break during the normal course of physical activity.  I believe The Greyhound Health Initiative has a free chemo program, and that is another cost to consider.  But still, once a primary tumor is seen it pretty much means the cancer cells are throughout the body.  By doing amp-chemo you're just extending the pain-free time you dog will have, it isn't a curative procedure.

Choosing palliative care is a perfectly viable option, if that what you decide is best for your family.  There are plenty of new treatments to give your dog a good amount of pain free time (though you still have to watch for a catastrophic break).

I'll try and look up the latest Osteo Thread for you to look through.  This was a series of threads we had going for several years as many of us went through what you are doing now.  Our discussions might help you.  There are also a lot of links and information in the first post of the thread.

In the meantime, try and keep your boy quiet and don't let him do zoomies or go crazy running outside until you have a better idea what you're dealing with.  Did your vet offer nsaids along with the pain meds?  Offer any other medicinal help for your boy other than further diagnostics?  They won't help in the long term if her has osteo, but they will help keep him comfortable now.

Good luck.

Thank you very much for the information. Its definitely a lot to take in, especially when we don't 100% know what we are dealing with. Dr. Couto already has been in touch and I sent the files in a format I think he needs. Hopefully we'll know more soon.

It seems like an impossible decision. I guess its important to get as much of the facts as possible before we make any decisions.

Gator is on both pain reliever and NSAIDs. I asked to have some blood work done to compare to blood work we had about 4 months ago. Even if bone cancer doesn't show up, on the slight chance something else does that gives some answers.

The vet mentioned other type of imaging or biopsies are sometimes done, and set me up for a consultation with another vet (and now I'm also working with Dr. Couto).

Good idea to try and keep him calm and not allow him to run around much.

[HeyRunDog]

Silly question but does he limp on all surfaces or just hard ones?

 

[Gatorade]

19 hours ago, HeyRunDog said:

Silly question but does he limp on all surfaces or just hard ones?

 

All surfaces. He seems a little better today on pain meds and anti-inflammatories.

[zimsmom]

Any update?

[Gatorade]

On 10/26/2020 at 6:06 PM, zimsmom said:

Any update?

Thanks everyone! Dr. Couto was able to look at lab work and x-rays. He doesn't think that it is OS which is a huge relief! He thinks the limp could be due to the mineralization of the supraspinatus tendon (the little white crescent moon shape on the x-rays). He also thinks the oval shading in the x-rays could be a deltoid tuberosity (a normal anatomical landmark) - this is what the first vet thought could be cancer.

So we have one vet saying cancer, and Dr. Couto saying its not. Given his expertise, I'm guessing its not. I was hoping to get one more person to weigh in and my original vet put in an emergency referral for me.  I had a follow up with a specialist scheduled for today, and it got canceled last minute and now I have to wait another week.

Gator seems to be much better on the pain meds and anti-inflammatory meds.

[Beachbum1]

Can a FNA (Fine Needle Aspirate) be done?

 

[zimsmom]

21 hours ago, Gatorade said:

Gator seems to be much better on the pain meds and anti-inflammatory meds

That is what matters most.  

[EllenEveBaz]

Just sending ear scritches to Gator and cyberhugs to his family.  Love Gator's ears!

[Gatorade]

Hi all! Thanks for the support. 
 

We had our appointment today with the surgery consult (my first vet set up this referral). They ended up retaking some New xrays. Long story short, they don’t think Gator has any signs of a tumor! So I think with 2 out of 3 vets thinking it’s not cancer, that’s what I’m going with!

 

The agree that he has some mineralization/calcification and believe his bicep tendon could be chronically inflamed (though not sure why?!). The one thing they thought was off was that he showed more signs of discomfort when extending his leg as opposed to flexing it (which I guess is opposite of what they would have assumed). They thought perhaps he may have been overcompensated and hurt his tricep? 

 

Either way, we have some nsaids to use as needed if he is limping or seems in pain. He still seems to be limping when not on meds but I’m hoping that improves. 

 

They also talked about if that doesn’t work, or he is needing to use the nsaids too much, then there are injections they can try or as a last resort, do a surgery to release the tendon. 
 

Anyways - thank you all. I’m glad I found this forum and I’m sure will be referring to it often!

[greytpups]

Glad to hear it’s not OS, but hoping you continue to keep his pain under control.

[BatterseaBrindl]

10 hours ago, Gatorade said:

Hi all! Thanks for the support. 
 

We had our appointment today with the surgery consult (my first vet set up this referral). They ended up retaking some New xrays. Long story short, they don’t think Gator has any signs of a tumor! So I think with 2 out of 3 vets thinking it’s not cancer, that’s what I’m going with!

 

The agree that he has some mineralization/calcification and believe his bicep tendon could be chronically inflamed (though not sure why?!). The one thing they thought was off was that he showed more signs of discomfort when extending his leg as opposed to flexing it (which I guess is opposite of what they would have assumed). They thought perhaps he may have been overcompensated and hurt his tricep? 

 

Either way, we have some nsaids to use as needed if he is limping or seems in pain. He still seems to be limping when not on meds but I’m hoping that improves. 

 

They also talked about if that doesn’t work, or he is needing to use the nsaids too much, then there are injections they can try or as a last resort, do a surgery to release the tendon. 
 

Anyways - thank you all. I’m glad I found this forum and I’m sure will be referring to it often!

As a human with a chronically inflamed biseps tendon, I sympathise with Gator.  Mine is also worse with extension and little to no pain with flexion. 

Thankfully I don't need my arm to walk! 

Along with NSAID, stretching and strength building exercises have been very helpful  for me. 

 

[cleptogrey]

"The agree that he has some mineralization/calcification and believe his bicep tendon could be chronically inflamed (though not sure why?!). The one thing they thought was off was that he showed more signs of discomfort when extending his leg as opposed to flexing it (which I guess is opposite of what they would have assumed). They thought perhaps he may have been overcompensated and hurt his tricep? "

 

annie had mineralization of her shoulder bone and it started to cut/irritate the muscle after an awkward jerk. yes, quite painful and yes Dr. Couto diagnoses it as he consulted w/ the ortho person i used(my request for the consult). it was formed as a result of an accident/injury- she had a horrific scar on the opposite side of her chest. it must have been when she was knocked down. 6 weeks of crate rest/anti-infamitories she was fine. i opted not to have the calcification removed. no problems after that.

 

i hope your fix is as easy. GH are the very best when it comes to crate rest. don't feel guilty.

 

[cleptogrey]

On 10/27/2020 at 6:34 PM, Gatorade said:

Thanks everyone! Dr. Couto was able to look at lab work and x-rays. He doesn't think that it is OS which is a huge relief! He thinks the limp could be due to the mineralization of the supraspinatus tendon (the little white crescent moon shape on the x-rays). He also thinks the oval shading in the x-rays could be a deltoid tuberosity (a normal anatomical landmark) - this is what the first vet thought could be cancer.

So we have one vet saying cancer, and Dr. Couto saying its not. Given his expertise, I'm guessing its not. I was hoping to get one more person to weigh in and my original vet put in an emergency referral for me.  I had a follow up with a specialist scheduled for today, and it got canceled last minute and now I have to wait another week.

Gator seems to be much better on the pain meds and anti-inflammatory meds.

exactly the same diagnosis- i'm reading the comments both down and up. we used metacam/tramadol/gabapentin and a dog bed in the crate. and a harness for walking - be ware annie slipped her harness even though it was on really tight! that's another conversation. 

Edited November 10, 2020 by cleptogrey

[Gatorade]

So we’ve had quite the up and downs. 
 

Not long after we had 2/3 vets saying no cancer, Gator was hit by a car after escaping from the fenced back yard. 
Miraculously, he ended up with some cuts, scraps and bruises and got a couple dozen stitches and some rest had him feeling better. 
 

somehow getting his by a car made his limp go away! This was gone for a few weeks. It returned about a week and a half ago. 
 

we took him to the vet again, more x-rays, now the original vet thinks cancer again. They feel the top of the bone now looks Moth eaten. so more consults and more follow up. 

[BatterseaBrindl]

   

[palmettobug]

Oh, no, I hope it's good news, you have been thru so many ups and downs.

My new youngster, Roman, is having limping issues with his front leg, and based on this thread, I'll have the vet look for calcification. I think he did have a couple of knocks on the track.

[racindog]

I went through osteo with my first greyhound but I am no way convinced that is Gator's issue.  Actually I would be inclined to think it is something else unless it is definitively PROVEN otherwise.  My vets and the cancer specialist told me the only way to know for sure was a biopsy which incurred risk of its own.  After a biopsy it was indeed confirmed and she had her leg amputated.  IT WAS ABSOLUTELY THE RIGHT THING TO DO.  She was 9 and we had a whole year of healthy pain free good times that are HAPPY memories.  She actually WON the trick class at a pretty big greyhound event as a tripod! It never handicapped her in the least.  We had always run together prior to the amputation and within 4 days she was up and at 'em.  We ran just like we had before and one day she looked back at me and said come on! " I've only got 3 legs and YOU STILL can't keep up."  We did do chemo treatments initially as recommended and she suffered no ill effects from them.  It is different than people chemo.  Anyway as young as your guy is and knowing what I know from experience I would say YES to amputation.  Remember Charlie on here?  He gave us all many happy memories after his amputation.  Prayers for your boy!!!!! BTW Ivy's limping was intermittent prior to diagnosis. It was not constant. I tried to put her picture up but couldn't get the pics shrunk down enough.

 

Edited January 26, 2021 by racindog