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Staging- Abdominal Ultrasound

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We had a 10am appointment to drop off Atticus for his ultrasound. I loaded him up with Trazadone and Gabapentin, in the hopes he wouldn’t need to be sedated.

VCSS was busy, busy busy that morning. After calling to let them know we were outside it took a while for a tech to come out and get him. When our surgery tech, Trish, came out, she seemed frazzled, and let me know they were running behind because of an emergency surgery. That comforted me quite a bit. We were in the right place, a place that takes care of emergencies for their patients. We waved goodbye to Atticus, drove home, and waited for the call.

Several hours late Dr. Perry called. There were no tumors in his abdomen! Only one thing of note; a lymph node in his abdomen was slightly enlarged, but the lymph node closest to his tumor appeared normal. This could be a coincidental finding, or less likely be the cancer metastasizing. Unfortunately this was not a lymph node that could be biopsied without opening him up.

The lymph node worried me, but it didn’t change anything. He was in pain, and the amputation was the only thing that could fix that. We were going forward with it on Monday.

When he came out, Atticus was still pretty drunk. Of course he had to be sedated for the ultrasound. After all, this is a dog that has to be sedated to get a good look in his mouth. When we got home he went to one of his favorite places, our landing, and passed out.

I hopped on my computer to try to catch up on work. About 30 minutes later, Kevin called me down because he was worried about Atticus. He was still super gorked, and was shaking hard. I thought he was probably just coming out hard from the sedation, but Kevin was really worried, so we called the clinic. Our lovely surgery tech had us see if he would get it with some encouragement, and he did. She suggested we keep him warm, and give him some time. Sometimes older dogs have a harder time coming out of sedation, which I know from experience.

We got him upstairs to him room (well, our guest room, but it’s his now), settled him in bed under some blankets, and let him sleep it off.


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Oncology Consult

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On September 15th, Atticus and I set off on an hour long drive to Veterinary Cancer and Surgery Specialist (VCSS for short). VCSS is still observing COVID protocols, so he’d go in without me. While we waited for a tech to come out I saw a doctor (our doctor, it turns out) talking to a lady with a goldendoodle tripawd. That dog was happy and jumping around. I took it as a good sign.

A friendly tech came out, got a brief history on Atticus (they already had vet records and x-rays from our regular vet) and took Atticus in. Atticus is very friendly and brave, but gets very cranky and anxious for blood draws and temperature checks. But he’s very food-motivated, so I sent him in with a bag of Cheddar Jacked Cheez-Its.

My weird dog

After a short while, our new surgical oncologist, Dr. Perry, came out with Atticus. I immediately liked Dr. Perry. He told me that Atticus was in great shape, and a good candidate for surgery. His chest x-rays were clear, his bloodwork was good, and despite his age, the joints on the other three legs looked good. Surgery and chemotherapy

My three big questions were:

What would recovery from amputation be like?

The Answer: Dogs recover very quickly from amputation, in particular hind leg amputation. Recovery would be about two weeks. Some dogs are moving and mostly recovered in one week. In some dogs you see an immediate improvement, because you are removing a source of extreme pain.

If we didn’t amputate, how would the disease progress?

The Answer: his pain would get progressively harder and harder to control. Likely we would put him to sleep when it became unmanageable. He still had some good bone substance left, but the risk of pathological fracture would increase.

How would chemo affect his quality of life?

The Answer: Dogs tend tolerate chemo much better than people. Some get lethargic, lost their appetite, have nausea, vomiting or diarrhea.

I asked about doing more to stage the cancer. I didn’t want to put Atticus through the surgery if the cancer had already metastasized and we knew he only had a short time left. Dr. Perry recommended an abdominal ultrasound. With the ultrasound, we could find out the same things as a CAT scan, but it would be much cheaper.

After I asked all my questions, I told Dr. Perry I wanted to move forward with the ultrasound, and barring finding something there, the surgery and chemo. After he went in, one of the surgery techs came out with the estimate. Gulp.

The quote was actually close to what I expected (I’d already gotten a price range from someone on my Catahoula Facebook page ). I guess Portland is technically considered a high cost of living locale. Of course, before Portland we lived in the DC Metro area, which makes Portland seem cheap. I shudder to think of the cost of this whole deal in DC. In the interest of full disclosure, our quote for surgery and 4-6 rounds of chemo was a low/high range of $6700 – $10,000.

I have a hard and fast rule of not bargain shopping for veterinary care. I really believe what you pay for. I fully prepared myself to pay the high range. And I’m really grateful we had the means to pay that bill, and that cost wasn’t a limiting factor.

I left VCSS with our ultrasound scheduled for the next week on Thursday, and surgery tentatively scheduled for the Monday after that.

Finding an Oncologist

We got Atticus’ osteosarcoma diagnosis on a Friday afternoon, right before Labor Day weekend. I spent the long weekend ugly crying, especially when I could tell Atticus was in pain. A few times he seemed particular unsettled, groaning and struggling to get comfortable on the couch. After seeing that, I went out into our backyard and loudly sobbed. A big group of neighbors were outside socializing at the time. They probably think I’m really weird.

I’m in a Facebook group for Catahoula owners in the Pacific Northwest. I joined because I liked to look at pictures of dogs that look like Atticus. When I got the diagnosis, I posted there asking for advice and resources. I got a deluge of kind words, great advice and recommendations. One person recommended I check out Tripawds.com. Several others told me their stories about their Catahoulas with osteosarcoma and amputations. I got several referrals for veterinarians as well. Someone mentioned that this would be a roller coaster ride, which was so true.

I’m an analyst by profession, so I spent the long weekend researching. I read everything I could find on the Tripawds website. I read median survival times without surgery, with surgery, with chemo, etc. I read that the medial survival rate with palliative care only was 30 days. I soul-searched with Kevin. And of course, we spent a lot of time with Atticus. One thing was clear- he was in pain. His leg was swollen at the site of the tumor, and when he lied down he lay awkwardly with his leg out. Every groan was a knife to my heart.

Atticus and Spaghetti in our guest room. Spaghetti is showing off his left hind leg which is not riddled with cancer.

The idea of the amputation surgery was terrible, but more terrible to me was the idea of the progression of the disease without surgery. It meant the short time Atticus had left would be characterized by quickly increasing pain. I knew that I wouldn’t be able to let him suffer like that for long. So we decided to go all in for surgery and chemo if the oncologist thought he was a good candidate.

I woke up Tuesday with the goal to schedule a consult with an oncologist. I called the clinic my vet referred us to. The would be happy to see us, and their first opening for a consult was October 26th. I was calling on September 7th. It would take us almost two months to get in just for a consult (remember that 30 day median survival rate!). I made the appointment, but that wouldn’t do.

I called another clinic that someone mentioned on my Facebook post. I called to schedule a consult, and their first opening was October 21st. I started crying on the phone. They were an oncology practice, didn’t they understand what that sort of delay in treatment meant for osteosarcoma? The uncomfortable-sounding employee mentioned my vet could perhaps call and talk to the specialist about getting in sooner, but that was no guarantee the specialist would agree or have availability to see us any earlier. I didn’t bother to take that appointment.

The overwhelming grief started to take back over. I had committed, in my mind, to doing the surgery and chemo if the surgeon recommended it. But now there was a chance that no matter what I did, that might be out of reach because of the current demand for veterinary medicine. I had a quick break for an ugly-cry, then I put on my big girl pants and went to work. I would call every clinic in Oregon, Washington and California until I found one that would see us quickly.

I picked another clinic that someone had recommended. This one I will name, because they heard me say osteosarcoma, and immediately offered me an emergency appointment the next week. This was Veterinary Cancer and Surgery Specialists in Milwaukee, Oregon. I will be forever grateful to them (and the more we see them, the more grateful I become). One hurdle was down- we were seeing the oncologist!

The Diagnosis

We have another dog, a disaster of a Great Dane named Spaghetti. Spaghetti had a bad few weeks of being a clumsy hot mess. We were dogsitting a friend’s Westie and he stepped on her foot and made her sore for days. He was running up the stairs and knocked my husband Kevin down the stairs. It wasn’t surprising when I got home from teaching one evening and Kevin told me that Spaghetti ran into Atticus, and Atticus had a sore leg.

Spaghetti has too much face.

The next day I kept an eye on Atticus, and he seemed fine until I let him outside during lunch. My heart sunk when he came in three-legged lame, holding his left hind paw up. I called our regular the vet the next day, and they could only fit him for a drop-off appointment two days later. I gave Atticus some carprofen we had on hand, and in two days he was weightbearing, but still slightly off. I debated cancelling the appointment, because he was so improved. Ultimately, I took him in because I had a nagging worry he had done something bad like torn his CCL.

I dropped Atticus off at 8am, and they would work him in for an exam and probably x-rays in between appointments. Atticus is pretty crabby when it comes to vet exams, so I thought it was likely he would need to be sedated for x-rays, and he’d be there a while. It was a little disconcerting when 4pm rolled around and no phone call.

Atticus and Spaghetti terrorize Maggie, our Westie friend, by blocking her way up the stairs. This is the last photo I took of Atticus before he came up lame.

I called the vet, and they put me on hold for the doctor. He picked up, and got right to it.

“I’m sorry I haven’t called. I have some bad news.” My heart dropped. He tore his CCL, I thought. How much is surgery to repair? There goes $5000. Maybe he can get rehab instead…. The vet kept going. “When we did x-rays, we found an osteosarcoma tumor.”

I couldn’t breathe. I had dropped him off because he sprained his leg. It just couldn’t be osteosarcoma. A good friend lost a dog to osteosarcoma. She took her dog in for what she thought was a sprain, found osteosarcoma. The dog was put to sleep that day. Would I even get to bring Atticus home?

My husband got home a few minutes after I got off the phone. I had to tell him the worst news  imaginable, and see his heart break. We both had the reaction. “Any dog but Crunch.”

We pulled ourselves together and went to pick up Atticus. Our vet showed us the X-rays, and told us the poor prognosis. He cautioned us about the risk of pathological fracture, and how at this point the cancer had probably already spread to his lungs, even though couldn’t see it on x-ray. He told us that this was awful for us, but Atticus didn’t know his terrible diagnosis, and wasn’t sad about it. He also gave us information and encouraged us to speak to an oncologist.

My sweet, broken Crunch hobbled out to see me- exactly the same as when I dropped him off, but know I had the terrible knowledge about the insidious thing hiding in his leg. I hugged him, and he buried his head in my chest, like he always does. I knew at least, for this weekend, we’d be together.

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