Stewart, Osteo, and Sadness

Stewart is no stranger to limping. He has, in his older years, been having issues with hyperkeratosis, where the pad material on his feet grows more than it should, and he gets corn-like growths on the sides of the pads.  He's a sensitive boy, and they bother him, making him limp if he's walking on a hard surface. I dremel them down as I can, use Dr. Scholl's corn remover on them, and it's all just part of life for us. The first few episodes of this were on his back foot, and so I was disappointed late this summer when he had it on his front foot as well as on his back foot. At the same time, which I'm sure made him miserable.  He was also standing a bit oddly on his back legs, like something hurt, but I couldn't tell what. And then, one night, I turned them out to potty after feeding them, and noticed urine on the floor, a few feet away from Stewart's food bowl. It wasn't enough to be a potty accident, so I assumed Jesse must have marked, which just seemed so odd.  It happened again, and I knew that Jesse had already been outside, and so the urine was originating from Stewart, while he was eating. I took him in to see our vet for a senior exam, a blood panel, and a dental.  The vet examined him, and noticed tenderness in his lower back, and said that he might be experiencing arthritis issues, or the very beginning of lumbosacral stenosis (LS), which can cause bladder issues due to nerve compression.  While he was under for the dental, they dremeled the hyperkeratosis spots, and removed all of the extra growth on the pad on the front foot, and also trimmed his nails.  The day after the dental, I noticed the limping stopped. I figured his pads felt better, and that he had the typical arthritis issues from being older, and didn't worry about any of it. A few weeks later, while I was getting ready to move, Stewart cried out from the front yard, and I ran out to him; he was holding his left front leg up, and clearly in pain. I checked his foot, his leg, and while he was scared and in pain, there was no apparent cause. I thought it was the hyperkeratosis, and thought maybe there was a corn growing inside the pad that I couldn't yet see. And so, I didn't worry much about it. We had another episode the day the moving truck loaded, and this time I was much more concerned.  Because there was still no visible hyperkeratosis growth. But there was no time to take him to the vet before I left for Oakland the next day, and so I decided to keep an eye on him, and get him seen as soon as possible after I moved, if it continued. In the new place, he and Jesse tried to go out the back door at the same time, and Stewart nearly tripped over Jesse.  As he tried to avoid him, he cried out, and again held up that same leg, his left front leg.  I felt his foot, checking for tenderness, and he didn't react. I felt his shoulder and neck, and he didn't react. I really didn't know what to make of it. The last straw was when I came home from lunch on Friday, the week after Thanksgiving; as I unlocked the door, Stewart was crying in pain. When I opened the door, he was standing in the middle of the living room, with his left leg held up. I knew he had been sleeping on the couch, heard my keys, and jumped off the couch to come greet me, and hurt his leg when he jumped onto the floor. That's when I knew I needed to get him in for xrays, right away. If it was arthritis, then I would know what it was, and I could get him on pain meds for it, and I would be able to relax. Because when a greyhound has an unxplained limp, the very first thing that comes to mind is osteo.  As soon as I got back to work after lunch, I started looking for a vet. I had only been in the Bay Area for not quite three weeks, and hadn't had much success in finding one that had a good reputation yet.  But now, with the need more urgent, I started heavily researching, pulling up online reviews, and making a list of questions. I found a small practice that had a lot of very glowing reviews on Yelp, and was only 2 miles from my house, so I called them first. I spent about 15 minutes on the phone with the receptionist, asking if they had greyhound clients (one or two, no major issues), if they had experience with LS, if they had experience with osteo.  Did they do bloodwork in house or send it out? What lab did they use? On and on. By the time I'd worked through my list, I felt comfortable scheduling an appointment for an exam and xrays for Stewart. We made an appointment for first thing Monday morning, and went home to cuddle Stew and to try to not worry. By the time the appointment rolled around on Monday, I was sure it was osteo, it just didn't seem like arthritis to me, with the way it came and went, with the level of pain he was experiencing intermittently. He loaded into the car just fine, but when I tried to get him out at the vet's office, he was having NONE of it. I had to muzzle him and pick him up, and scoot out of the back of the Tahoe with him in my arms, with him growling the whole time. I was terrified I'd slip and drop him, and hurt him.  He walked into the vet's office, but wouldn't go into an exam room, he did his bucking bronco impersonation instead. I picked him up and carried him in, much to the amusement of the people in the waiting room. We met the new doctor, who was wonderful, well educated, and who was really thorough  And who also wasn't a greyhound vet, and who didn't have much experience with greyhounds at all. Sigh. But, on the positive side, she was open to learning, and knew that they were different from most breeds, and said that she would research issues as needed. She examined Stewart, and he was, for the first time, gentle and easy going. Even when the vet was moving his head around and seeing if he had neck pain. If *I* did that to him, he'd probably try to eat me!  The more she examined him, the more it became apparent there was no pain in his feet, or in the leg itself on his left front leg. The minute she started manipulating his leg to test his shoulder, he cried out.  She tried it again, and again he cried out.  She stopped, and we talked about xrays.  We decided on two views of the shoulder, and two views for his lower back, to check for arthritis or LS. I debated pushing for views of the entire left leg, but it would require four more views, and she was fairly confident the issue was in the shoulder, not in the lower leg, and I could see that. He needed to be sedated for the xrays, and so I left him there, and made arrangements to pick him up later that afternoon. While I worked that day, I convinced myself that it was arthritis, because he wasn't limping that morning, because he wasn't in pain when she examined his lower leg, because arthritis seemed a very reasonable explanation for the shoulder pain. I left work early, and arrived at the vet's office just in time for the appointment to review the results. The vet was running a little behind, so I made small talk with the people in the waiting room (even the other clients at the vet's office were super nice!!). There was a Bouvier laying on the benches, looking more like a bear than a dog, we all laughed at his funny antics and expressions. Then Dr. Eklof came out, and called me into the exam room. I could tell immediately by her demeanor and what she wasn't saying that it wasn't just arthritis, but I clung to my optimism. Before she said much, she put the shoulder xray up on the viewing box, and turned on the light. I saw the spot immediately; the head of the long leg bone had a large spot that looked hollow. My heart sank. She said she didn't know what it was, but it looked suspicious to her, and she wanted to get a radiologist's opinion.  She said it wasn't as obvious as cases of osteo she had seen, and she didn't want to say it was definitively that without getting a consult.  But then, she said there was no evidence of arthritis in the shoulder. Or in the lower back.  Which was as telling as the empty spot in the bone. We made the arrangements for the radiologist consult, and she prescribed Metacam for the pain. She said the spot on the xrays could be a fungal infection, a different sort of bone tumor, it wasn't necessarily osteo, so maybe we still had options. I, however, knew that an older greyhound with a limp and a suspicious xray nearly never has a final diagnosis of anything other than osteo, so much so that greyhound specialty vets will rarely even do a bone biopsy or a fine needle aspirate unless the treatment plan involves amputation. Stewart and I went home, sad, tired, and teary. He was in his usually post-anesthetic haze that night, and wouldn't get up to eat dinner. I finally got him to go out to potty before I went to bed, and he was clearly in a lot of pain from the exam and xrays. When he came back inside, he got back on the couch, and no cajoling could get him to come to bed in the bedroom. Sigh. The next morning, Tuesday, I started the Metacam, and went to work. At lunch, he didn't seem much better, and I started to really worry.  When I put my key in the lock, he didn't even get off the couch, for the first time ever.  I called the vet's office to see when the radiologist would read the report, and they told me I'd hear back from Dr. Eklof that evening. I tried calling again before the clinic closed, but was put on hold, and had to hang up after waiting for 10 minutes because I had work issues to attend to. I steeled myself for another evening of waiting. At 6:30, Dr. Eklof called me. The radiologist confirmed the spot was osteo, and said it didn't even warrant further testing for identifying it, because it was very clear. Dr. Eklof said I could pursue a bone biopsy for staging, and I told her I was very concerned about increasing the chances of a spontaneous  pathological fracture from further weakening the bone, and she agreed.  She told me amputation was not an option, due to the location of the osteo, how much bone they'd have to remove from the scapula, and his existing limping and back leg issues.  We talked about chemo and radiation, but due to his anxiety and fear of going to the vet, we agreed that wasn't a good choice for him. That left pain management as the only treatment option, followed by letting him go when the pain wasn't controllable any more. Unfortunately  managing the pain is only half the issue; the other half is fear of the bone shattering as it gets more hollowed out and more brittle.  The shattering can happen from something as simple as the greyhound getting on or off a couch, or a bed, or tripping, or running in the yard.  And it's unbearably painful for the dog. I thanked Dr. Eklof for calling me, since I knew the office was long closed, and I made arrangements to pick up Tramadol to add to the Metacam. Today, Wednesday morning, I talked to the president of the group I've been working with for so many years, and asked for her advice on all of it.  She said exactly what I knew she would; the pain meds don't completely control the pain, and it's cruel to let the dog suffer while trying to find the right adjustments of medications, or towards the end when the pain is just not controllable. And she reminded me of the fear of the leg shattering, and how painful that can be. She suggested I make plans sooner than later, which is exactly what I was thinking, but didn't want to say out loud. Dogs with osteo usually survive about 3-4 months post diagnosis, but diagnosis can happen early or late, and so it's hard to calculate exactly how long they have.  Xrays can be helpful in tracking the progress, but can be stressful on the dog.  Once the cancer has metastasized to the lungs, it's time, and the only way to determine if there are mets in the lungs is through xray.  Every time he gets xrayed, he has to go through the trauma of the vet visit itself, and then be put under for the scans, which is hard on him. I'm more concerned about the quality of his life than I am about keeping him around for every possible day I can, because there will never be enough days, no matter how this goes.  It's not like it will get easier after 30 more days, or 60 days, or even 365 days. It will never be easier. I keep reminding myself that he lives in the here and now, and he isn't planning for tomorrow, or next week, or next year.  He doesn't understand that the pain is cancer, and that it is just the new way of being.  He doesn't know that the trauma of the vet and exams and xrays are to help him through this. I'm still trying to come to terms with all of this, to understand the ramifications, to remind myself that a day early is better than a day too late. I'm so sad, and so tired, and scared for him.  I just need the end to not be horrific or traumatizing for him.  I'll send off the digital xrays to Dr. Couto at OSU tomorrow for a consultation, and go from there. And hopefully I will gain some peace in my decisions. I can't even think yet of how much I love him, and his quirky ways, and how much I am going to miss him. I'm not ready yet to deal with that.