Broken humerus

[Pete]

Our 7yo girl hound broke her front left leg, humerus bone.  She was running around the yard, zoomies.  Ran toward me, lost her footing I think and banged into me.  But however she landed with her front arm out it caused the break.  Was awful.  Got her to emergency vet and two days later they put a plate in and gear.  No tumor / cancer.  They didn’t biopsy but felt it was not due to cancer.  That was in late October 2021.  It’s healed.  Problem is she won’t use it.  She was making some slow progress but has pulled back again.  Vet says it’s likely pain she’s feeling in shoulder.  They upped her Rimadyl.  But she needs to start using it and I’ve tried numerous methods and tricks and it’s not working. She gets PT and we do PT at home.  Range of motion has improved. But she’s not really using it.  We likely have only a limited window of time to get her using it.  So any thoughts from any greys that had a similar front leg break or damage and how to get them using it?  Thanks. Btw, she’s happy and healthy otherwise.  It’s me who’s not.  And I’m getting tired of the looks from people.  

[Time4ANap]

Not sure what PT they are doing, but if there is a practice with a water treadmill in your area I would check into that if you aren't already using one. Most veterinary orthopedic practices will either have one or have access to one. Good luck! 

[FiveRoooooers]

Have you had the leg and shoulder x-rayed recently? I would start there. Best of luck and please keep us posted. 

[ramonaghan]

4 hours ago, FiveRoooooers said:

Have you had the leg and shoulder x-rayed recently? I would start there. Best of luck and please keep us posted. 

This. Speaking from experience.

[greysmom]

Yeah.  First place to start is imaging of the shoulder.  If you're still under the care of your surgeon, I would start there with asking for an exam for further injury.  I would say it's highly likely she has some deep tendon or ligament injuries, on top of the muscle loss from being in a cast for 10 (or however many) weeks.  Further imaging will also expose if she does actually have osteo metastisizing in the shoulder or neck.

It also might be that she needs to have the plates and fixators removed now that they have done their job.  It means an even further extended recovery time, but sometimes they have an allergic reaction to the metal, or some other issue with the plate itself, and it has to be removed to stop the reaction.

BUT - fwiw - My girl broke her hock at an LGRA race in Nov 2020.  She had surgery with plates and screws, and was in a cast until Feb 2021 (12 or 13 weeks total).  She recovered nicely with hardly any muscle loss, and needed only minimal rehab.  And it still took her several months to begin using the leg normally again.  You can see how the ligaments did not mend completely as her foot and toes are flat on the ground, and I don't expect that to get better with time.  She tripodded around the yard for several weeks, and still will hold that leg up in very cold weather.  So it could be your girl just needs more time to get used to using that leg again.

I agree that swim therapy or a water tank would be beneficial.  She can rebuild muscle and use the leg without bearing any weight on it, and it would encourage her to get back in the swing of things.

[Pete]

Good responses. Thanks. The PT does not yet entail water treadmill but will soon.  Her skin is so thin at the elbow they wanted to wait.  She had images again about six weeks ago and they said it’s healing “as expected”.  And she was just back to the surgeon (and her vet) last week and both think the issue is pain in the shoulder from muscle atrophy (she never had a cast) that occurred with the fracture.  We lowered her pain meds around the holidays and was doing ok, slowly improving.  Maybe it was too soon?  But she was on them for two months plus by year end.  So they recommended we up her rimadyl again.  So back to rimadyl.  The surgeon is very good and supposedly did a masterful job on her fracture, nice guy too.  He did say her range of motion has improved nicely.  We also do PT at home daily, she tolerates it just fine.  She broke her hine right hock racing about four n a half years ago. That’s how we got her.  And you reminded me of that period with your girl. And I recalled that it did take her many more months than anticipated to really start using that leg and she was obviously favoring it for close to two years on.  Uses it with no issue now.  So maybe I’m just being too worried here?  Give it more time.  Just that they all constantly tell me she’s “behind” where she should be.  We’ll see.  Thanks. 

[greysmom]

You're the third person I've heard about in recent months with a dog who did not have a cast on a broken leg following surgical repair.    When did this get to be a thing???    

The biggest problem is that soft tissue injuries aren't going to show on xray.  So, given how traumatic the actual accident was, I think it's highly likely there *may* be further trauma than just the broken bone.  It would take something like a CT scan or MRI to diagnose something like that though, both spendy tests and requiring anesthesia.  Worth a discussion with surgeon I think and/or rehab folks I think.

[BandM]

Ref not casting a surgical repair. Our grey broke fractured her humerus and was operated on.

The vet was reluctant to use a cast post surgery due to increased risk of infection (if memory serves), so I took his advice.

[Pete]

What caused the fracture?  New vet telling me now it’s cancer.  X-Ray.  Says he’s 90% sure it’s cancer, 10% infection.  I don’t know anymore what to do. 

[greysmom]

Send all your medical records to Dr Guillermo Couto through the Greyhound Health Initiative.  He is a noted greyhound expert and well worth the fee for him to do a review and give you his opinion.  He'll tell you what he thinks and what should be done next.

But, if you're still dealing with this, I would suspect it's most likely to be osteosarcoma, with no good outcome after this long without treatment/chemo.

GHI - For Owners/Adopters

[BandM]

3 hours ago, Pete said:

What caused the fracture?  New vet telling me now it’s cancer.  X-Ray.  Says he’s 90% sure it’s cancer, 10% infection.  I don’t know anymore what to do. 

An awkward landing when she jumped/escaped out of a tub during a wash. On a side note, she was suffering with an auto immune disease and a potential side effect of the medication was a decrease in bone density. I didn't know this when she was prescribed the meds.

We have since lost her and I do wonder how many potential underlying issues there were, I really hope you come to the bottom of your troubles.

[ramonaghan]

7 hours ago, Pete said:

What caused the fracture?  New vet telling me now it’s cancer.  X-Ray.  Says he’s 90% sure it’s cancer, 10% infection.  I don’t know anymore what to do. 

Sweep's story is quite similar. Broke her leg last March running in the yard. E-vet, which is also a specialty clinic, saw no evidence of cancer. Even consulted the oncologist and radiologist. They repaired the break, saw no bone deterioration during surgery either, and the biopsy was negative.

Two months later at her recheck, they said the bone wasn't healing like it should be. Cancer suspected. Dr. Couto agreed something was amiss, although it still wasn't 100% conclusive. Another month later, it was confirmed and we started chemo. The repair was still holding and she wasn't in pain, so we didn't amp at that time. I wish we had. In August she broke her leg again jumping into the car. We had to amputate at that point. 

The good news: she finished chemo and she is doing well. We are a year into this ordeal and 7 months post-amp. Lung metastases showed up in January, but oral chemo is keeping them stable. She is 12.5, so she has some old age issues but is mostly a happy girl.

You still have options. You just need to make some hard decisions very quickly.

It sucks, and I am sorry you're facing it. Best wishes to you and your girl.

[Pete]

Thanks for posting your story, much appreciated.  Similar story indeed.  No sign of cancer, no bone deteriorating from cancer etc…. Except her fracture has healed “as expected”.  But she’s been back and forth using it.  She also had an infections post op.  That was bad with lots of puss buildup.  I was pushing puss that out of her for days.   But it completely cleared up.  Could that have left the mark showing up on the x rays now?   That was about 6 weeks post op.  The leg is thin with atrophy from the fracture still such that amputation probably wouldn’t be a big procedure.  She’s 7.5 yo so she’s young enough that it’s worth it.  But two things… how do I know it really is cancer?  And second…. How do I know if it’s worth putting her through it all?   We are prepared to make hard decisions.  The shock is wearing off and we’re focused.  So glad your hound is happy now.  Our girl is actually very happy, strong and eating and doing well.  She shows no signs of being sick at all.  We just had a 45 min walk (three legs for most part).  

[macoduck]

Pete, this is where the consult with Dr Couto should give you an answer.  Unless he suggests it, I would not to a fine needle biopsy on that leg.

[greysmom]

You often *don't* know for sure if it's cancer or not until the leg is sent to the lab for analysis post-op.  Many vets will recommend a FNA or bone biopsy, but neither are good options for greyhounds with their thin bones.  Taking out enough material for a punch biopsy will often weaken the leg enough to break it when healthy, let alone under stress.  And a Fine Needle Biopsy depends on the very fine needle being inserted into *exactly* the right place, to pull out any cancerous cells to be seen on a slide.

Only you can decide what's best for your dog - you know her intimately, you know your family situation, you know your physical set up in your house, you know your financial status.  We can tell you our experience, but it won't reflect your reality, only ours.

This is what we do know for sure: osteosarcoma is very *extremely* tremendously painful.  We know this from human children who have had nearly the same disease.  The entire purpose of amputation is to remove the source of the pain the dog is experiencing - the primary tumor in the leg.  Amputation doesn't "cure" osteo (though it can - very rarely - cure other kinds of bone cancer, though you won't know until post-op analysis, and maybe not even then).  Amputation and follow-up infused chemo may give you several months to a couple years more quality time with your dog.  Not always, but sometimes.  Even when you do amputate, by the time a tumor is able to be seen on a long bone, it's nearly 100% certain that the cells have spread throughout the body, waiting to metastasize at any time.  Once your dog is diagnosed with cancer, it's the beginning of a very long goodbye.

It's also a very expensive option.  Particularly if you don't have insurance, but oftentimes even if you do.  When our boy went through the amp/chemo route in 2011 the final cost for us having him for 9 more months was about $20,000.  We had just inherited some money when he broke his leg, otherwise we would have had to make a different decision.  But he was a social butterfly who loved going to the vet and being fussed over, and who was basically healthy otherwise - no arthritis or other leg issues, no spine/lumbar issues, nothing to make dealing with three legs a burden rather than a relief.

If you opt not to amputate and do palliative care, your average survival time is a few months.  You're basically providing hospice care for her at home with pain medications and exercise restrictions and close monitoring.  There are treatment modalities that can help - a good canine oncologist can help advise you - but again, it's basically a longer time to spoil her.  This is a more affordable option.  You do still face the risk of a catastrophic leg break at home though, so it takes advance planning for this option.

But you need more information, so I would advise having some tough discussions about options, and seeing what Dr Couto advises.  Research if you have access to a canine oncologist or specialty hospital in your area.  Read through the Osteo Thread that was linked above (or in your other thread).  And it *may* turn out that she doesn't have cancer, but a Valley Fever infection, bone infection, or some other reason why the bone isn't completely knitting together as it should.

It's a hard road no matter what you choose.  {{{hugs}}}

[ramonaghan]

All good points above from Chris. This was true for us:

Quote

You often *don't* know for sure if it's cancer or not until the leg is sent to the lab for analysis post-op.  

We knew a fungal infection was highly unlikely in our area, and nothing showed up in tests. We knew the bone had weakened to the point that the original repair was no longer effective. We knew age, breed, and location were not on our side. All the specialists were telling us "if it looks like a duck..." But until the post-amputation biopsy, we did not know for sure it was osteosarcoma.

Chris is also right on about the expense; we're at about $21,000. We have pet insurance, which has been tremendously helpful with our decision-making. 

One thing I took away from your posts is that Fiona is already used to walking as a tripod. If Dr. Couto agrees with the presumptive diagnosis and you do decide to amputate, this will help so much in her recovery. Sweep was using her bad leg right up to the day they removed it, so she took longer to adjust. Still, within two weeks, she was doing solo potty breaks and getting around pretty well. That trademark greyhound stubbornness helps a lot.

We're all hoping Dr. C gives you good news. Please keep us posted; we're here to support you no matter what you decision you make.

[Pete]

Hopefully we can get enough information to make decisions this week.   We are inclined to put her to sleep vs putting her through all this only to see her vulnerable and then shortly gone anyway.  She relatively young at 7.5 and so beautiful and fun.  It’s tough stuff to even contemplating such options.  My wife wants to try antibiotics and see if it’s an infection first considering she had a bad infection few months ago about six weeks post op.  Their concern then was the infection might be on the gear and they’d have to take it out.  It cleared up.  Don’t know, grabbing at any glimmers of light we can.  

[BatterseaBrindl]

 

[cleptogrey]

1 hour ago, Pete said:

Hopefully we can get enough information to make decisions this week.   We are inclined to put her to sleep vs putting her through all this only to see her vulnerable and then shortly gone anyway.  She relatively young at 7.5 and so beautiful and fun.  It’s tough stuff to even contemplating such options.  My wife wants to try antibiotics and see if it’s an infection first considering she had a bad infection few months ago about six weeks post op.  Their concern then was the infection might be on the gear and they’d have to take it out.  It cleared up.  Don’t know, grabbing at any glimmers of light we can.  

we too had the same diagnosis- maybe an infection- that seems to be the norm but when osteo is suspect- it's osteo. emily was just 8 when we lost her to osteo.  here on GT there are a few lucky creatures who have overcome the odds and led a good long life after amputation. but only a few. 

think quality of life, not quantity.

i've lost 2 girls to osteo, the second one showed no signs and jumped off the bed onto carpeting and horrifically broke her rear leg. that's not the route you want to go- it was awful for both annie and the two of us. hugs- and remember breeders breed for speed not health and longevity. that is an unfortunate reality in NGA greyhounds.

[Pete]

We’re dying here contemplating losing one and you had two.  So sorry. Realizing from reading up how the industry caused all this cancer from breading so narrowly.  Non race bread greyhounds have little of this cancer.  Or so I read.  Dr Couto has been very responsive, seems like a good guy. His consult fee is reasonable. He’s still gathering info but he’s suggesting it’s cancer.  Her latest radiographs have abnormalities consistent with either a bone tumor or with an infection (osteomyelitis) but that it’s uncommon for a greyhound to fracture their humerus and it’s common for cancer, OSA, to develop there (humerus).  But he also said that OSA fractures do not cause this type of fracture Fiona has  (comminuted, or small pieces).  He also said a “chronically infected bone” (she had a nasty infection in December) doesn’t look much different than OSA on radiographs.  He said he’s still going thru everything but that I might want to get an FNA.  

[GreyPoopon]

I'm glad you're consulting with Dr. Couto. I hope his information gathering swings his opinion back to the non-cancer side.  

[Pete]

The oncologist believes is OS. Still it’s a challenging diagnosis because it could be an infection related to the bad infection she had last December while the fracture was healing. 

[GreyPoopon]

 

[FiveRoooooers]

Checking in to see how your girl and you guys are doing since your last post? OS is such a horrible, painful disease. I hope you can keep her as comfy as possible. 

(I've read and reread this thread and maybe I'm missing it, but what is your girlie's name?)

[Pete]

On 3/27/2022 at 6:54 PM, greysmom said:

 

Hi,  so we have been waiting a week for oncologist to come back tomorrow.  They said her lungs and other x rays were clean.  I want them to do a needle aspirate on the cite per Dr Cuoto recommendation.  Fiona is in good spirits, energy and enthusiasm and no issues with pain (rimydl and 200mg gabapentin every 12 hours) at all.  She’s eating and drinking well.  Has diarrhea though.  Did a 40 minute walk this morning.  She was great.  It’s unreal to look at this beautiful greyhound and think she has Osteosarcoma.   It’s so depressing.   Many on GT have gone the amputation and chemo route and it help get them anywhere from 6-12 months.  I’m not sure we are going to choose that if it’s certain she has bone cancer.  I’d do anything if I knew she would be alive but in five months we would all be dying inside again with worry.  This is just awful.