We lost Tuni in January... http://vetrescue.blogspot.com/2011/01/two-coats-are-only-good-when-painting.html .
We lost Raven just weeks ago... http://vetrescue.blogspot.com/2011/03/raven.html .
Just after losing Raven, my Golden Retriever, Ellie, started licking her foot. She has always been an obsessive foot licker, so I did not pay much attention. Two weeks ago, I heard Missy ask Ellie why she was licking. She walked over and felt her foot and asked me to take a look at it. I felt a small nodule between two of her toes about the size of a bebe. I put her on antibiotics in the hopes that she had stepped on something, and had a small abscess or infection, but they didn't help.
After a few days with no improvement on antibiotics, I decided to take a fine needle aspirate of the lesion which was now the size of a pea. I placed a needle into the small nodule and pulled back on the syringe. The suction created will withdraw cells from the lesion into the needle. I then ejected the cells onto a glass microscope slide. By pressing the slides together, we make smears of the cells on the slides and send them to the lab in hopes of gaining a diagnosis. It is less invasive, less costly, and less painful than a biopsy.
I anxiously awaited their impression of the smears (no pun intended). Two days later, the report came back... Plasmacytoma. As usual this diagnosis has it's good side and it's bad side. It is benign, but locally invasive.
Plasmacytomas are an odd little tumor that are considered benign because they do not commonly travel to other parts of the body with the frequency that a malignant tumor does. But a plasmacytoma is locally invasive so it needs to be surgically removed before it causes too many problems in their current location. A surgeon must remove a lot of the skin and tissue around this tumor in order to be certain that all the tumor has been removed and it will not regrow in this location. Almost any part of the body would be a better location to have such a lesion.
Location is where the problem lies with Ellie's tumor. There is not a lot of extra skin around the toes. In order to remove enough tissue to be certain the entire tumor has been removed, there would not be enough skin left in order to be able to close the incision for proper healing.
I consulted with another veterinarian who specializes in cancer, a veterinary oncologist. He and I discussed removal of her outer two front toes. The tumor was nestled between them. The consensus was that she "should" be able to get around without those two toes, as long as one of the two weight bearing toes was left to support her weight. Dogs place most of their weight on the two central toes of the forefoot, and Ellie is a ninety pound dog. That is a lot of weight to bear on an incomplete foot. People who lose toes, often have to learn to walk again.
Last week, on the morning I was planning to do the surgery, I palpated the lesion. That is when I realized how rapidly this tumor was progressing. The lesion had quickly spread to the third toe from the outside. The lesion now included both of her weight bearing toes on that leg. Needless to say, I had to cancel her surgery. All of this is transpiring within a two week span.
Tomorrow, Ellie and I are heading to Iowa State University College of Veterinary Medicine to talk to the oncologists about her foot and possible treatments. The way I see it, there are few treatment options:
- Full forelimb amputation with or without chemotherapy.
- Chemotherapy in the hopes of shrinking the tumor so we can remove just the toes.
- Chemotherapy alone, and keeping her as comfortable as possible.
- Do nothing, and euthanize her when her comfort level is unacceptable.
My Ellie is a nine year old girl. I was worried about the difficulty and comfort level of her recovery from toe amputations. I am terrified of making the decision to amputate her leg.
I absolutely believe that dogs and cats are born with three legs and a spare. But removing an entire leg so late in life, and on such a large dog has me very concerned. I know there are many people that have chosen this option and their pet has done well despite age, but it is SO different when it is your baby that needs the surgery. I guess it is my turn to rely on another doctor and trust in them.
I, of course, will do what I can and what I believe is best for my girl. She has been a wonderful companion for me and my family, tolerating ear pulling, doggie climbing, and tail lassoing kids.
I, just like you, still worry that I will make the "wrong" decision despite my education and experience. In my heart, I don't think there is a wrong decision if it is made from the heart, but I still fear making it! I am quite good at second guessing myself. I have been practicing second guessing for years.
Ellie is currently on pain relievers. She started limping the day the biopsy results came in. She is still playful, eating and happy, but you can see her lift her leg a bit in this video of her with Kirby from this morning.
I am hopeful that another aspirate and another opinion will reveal that this lesion is not cancer at all. By this time tomorrow, I should have more information.
Some good news is that Ellie had been rather...round. She has been on a diet for a while now and is losing weight. The weight loss will be in her favor if we do need to do a major surgery, and will aid her recovery.
I have to admit, the urge to give her all the treats she wants right now is incredibly strong! I guess I will have to indulge for her...
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13 comments:
Hate choices, Have had to make many. Out of all the "choices" you have,amputation of the leg or toes would be my last choice, that's just me,but I have found that old animals,like people do not adapt as well with body parts gone. My thoughts are with you, Whatever choice you make will be the right one for you and Ellie
Poor ellie! I will be praying and hope all goes well for her. Hugs to both of you
I dont think I stopped crying the whole time! There is nothing worse then a family member who you know is ill and not knowing how to make them all better. I can only offer the love and prayers of a fellow pet lover. Spoil that puppy every moment!
praying.....
We'll think of you and Ellie. I trust the specialists, after examining Ellie tomorrow, will guide you in your decision to do what is best for Ellie. Hopefully the news will be good, but regardless of how it turns out, Ellie will know you are putting your heart and soul into helping her. She'll somehow understand, no matter what your decision is.
My thoughts and prayers will be with you and Ellie , I know first hand how difficult the decisions can be when making them for our own pets , I know you will do the right thing for you and Ellie
We amputated one of Blacky's toes when he was 18, he did fine and lived till 20.
Ellie is so adorable but she can be a tri pod and be just as adorable.
Ellie seems to be in good spirits still. You will know the best course of action to take - she'll tell you! Mary D
I comment often on your blog under anonymous, some times with suggestions or questions
and you never reply.
I understand you are busy, but I think a reply would be nice.
Thank you all for your concern and for reading! Ellie is going to do chemo and a lump removal.
I don't usually comment here, because I am not sure if you get this. Can you let me know if you receive notice of this comment?
Thanks again for all of your support!
My black lab had an undefined growth on her left front foot at about 7 years old (three years ago). Instead of biopsy, the surgical vet put the fear of god in me and told me it should come off. The bump was between her two middle toes, so off those would come too. He suggested that to recover, we should tuck her front leg into her side. I was HORRIFIED. NO WAY. she came out of surgery OK (after a misidentification and the vet's office calling and telling me she had died on the operating table. In fact, it was another dog by the name of Koda. Again HORRIFYING!) First recheck went OK. I got really good at soaking and bandaging. Then...then, one evening she tripped. An hour later, the most god awful smell had me running back down to the ER. She had torn open the incision. As a result (because there is very little skin) she lost blood flow to her other two remaining toes...which over the course of several weeks, I had to eventually remove. We bandaged and bandaged and even did a skin graft. After 10 months of bandaging 3-6 times daily and still having a bit of an open wound, which I knew could become infected at any time, I was forced to consider full amputation. My primary vet (Doc Culver here in Des Moines) suggested laser light therapy. After about 10 visits, the wound had finally healed. During that time, I also discovered Medipaw -- a long sack type boot that I could put foam rubber in the bottom to provide cushion. After almost a year, we finally had a full walkable dog and I could stop supporting Walgreens with all my bandaging purchases.
On the other hand, for nearly two years all has gone well, until about a month ago. Koda, now 10, still thinks she's 3 or 4. She went bounding after a ball thrown too hard and torn her ACL on her rear left leg (same side as the toeless). She had surgery to repair it and we are doing 10 minute walks 2-3 times a day and she is coming along pretty well.
I offer all of this to give you an idea that toe amputation is possible and if it will help prolong the life of your Ellie, it can be done. However, it did require a lot of time and patience on my end. I've been a dedicated reader of your blog for quite some time and am always so impressed with the work you do, not to mention your writing skills! In these posts, it sounds as though you may have other pets who need a lot of attention, as well as a family. That may affect your decision.
At the time of Koda's toe amputation, it was just me and her. Since that time, I adopted another three legged, and just 2 months ago agreed to foster raise/train a black lab puppy that will go on to be a companion animal/medic alert dog for someone with diabetes. While the puppy may pose some "risk" for reinjury, a careful eye on them when together has so far, eliminated that issue and it seems to give Koda a little something extra to "look after".
Best to you. And thanks for all you do.
I am so sorry that you must make a choice. Several years ago we were faced with this same choice (though for a different reason) with our much loved 16 year old cat. Perhaps because we did not know many other cats, or dogs, with amputations, the decision was easier for us.. but then again, it's never easy. But you know, you whatever decision you make will be the right and best decision, because you have consulted your heart
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