I know the last post was extremely long and technical, so here is a summary of key points:
-Hill’s n/d prescription diet is the only commercial diet specifically formulated to both a)slow cancer growth and b) be palatable to dogs undergoing chemo
-We did not know about n/d until recently, despite Jabba having cancer for 2+ years, so you may have to take initiative to ask your vet. It also probably works better when given long term.
-Hill’s n/d is very expensive, running $180 a month for a 50 lb dog…
-But it is tasty! And supported by hard science.
-We are still working on it, but making a comparable home concoction of Hill’s n/d would be very difficult.
Please don’t hesitate with any questions or comments!
On Thursday, March 7th, Jabba-bear had his staples removed (from the intercostal split they performed during the lobectomy). The incision site looked fantastic! We were very impressed. That day, the prescription diet dog food that we ordered arrived at Oldtown Veterinary Hospital, and we fed it to Jabba for dinner.
Prescription diet dog food. It is specially formulated for dogs undergoing chemotherapy.
This food is supposed to be ideal for dogs undergoing chemotherapy. Keep in mind that Jabba has been off cyclophosphamide for approximately 6 weeks (and he has been off of palladia since November 2012).
It was a little drier than we expected, but Jabba-bear devoured the entire can. When he finished, he licked his lips, wagged his tail, and looked up, drool spilling from his mouth onto the floor. He was adamantly begging for more food! Happy to see our boy eating again, we gave him a little bit of his usual diet (Nutro Natural Choice). Jabba-bear has eaten Natural dog food since he was 7 weeks old (when we officially adopted him). Once he outgrew the puppy food, he started eating Large Breed Adult food (Chicken, Whole Brown Rice, & Oatmeal Formula). When Jabba lost his appetite in the middle of January, we tried feeding him the limited ingredient Sensitive Skin and Stomach line (Venison Meal & Whole Brown Rice). Initially, he seemed to like this food, but only if we spoon fed him. Beyonce, on the other hand, loves it!
For more information on Nutro Natural Choice products, see the following website: http://www.nutro.com/natural-dog-food/natural-choice-dog-food.aspx
The following paragraphs summarize the research that Jabba’s dad did concerning the potential effectiveness of the Hill’s Prescription Diet:
Way back when, when Jabba was first diagnosed, we did a lot of reading about diets. Being grad students/budding scientists in biomedical fields, we are able to read and understand most scientific literature fairly well. There actually isn’t that much info out there, especially for dogs, but one thing that turned up was a ketogenic diet (very low carb/high protein/high fat), which was shown to be potentially effective in mice and human children with brain cancer. The logic is that cancer cells are heavily reliant on carbohydrates for energy, and are much less efficient at metabolizing ketone bodies, which was used instead of carbohydrates in organisms in a state of ketosis.
NCSU actually offers diet formulation services, which run $75 for commercial diet recommendations (I’ll come back to this, but LOL at them wanting $75 to tell you the name of a brand of dog food), and about $250 for homemade diet formulations. I had always planned to ask them about formulating a homemade ketogenic diet, but with our busy lives and Jabba doing so well for so long, sadly this never got done earlier.
Now, over two years later Jabba’s cancer has returned with a vengeance and with it the extreme motivation to do everything possible. So we did some more research and got in touch with NCSU. Here is the initial email exchange:
Hello,
Can the diet forumation service be used to formulate specific diets at the request of the client? Basically I am interested in formulating a ketogenic diet for my 4 year old dog with osteosarcoma. I am willing to pay the $231 fee for a ketogenic diet plan (or something based on the same principle), but I not interested in a standard homemade diet formulation. Is there a way to check with a veterinarian first if a) a ketogenic diet would be safe for my dog, and b) if NCSU CVM has experience and expertise in formulating this type of diet, and C) are there any other recommended specialty diets for dogs with cancer? Thank you very much.
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Response:
Mr. Taylor –
Yes an owner can directly request a homemade diet formulation. If you live outside of NC, the medical records for your dog must come from your local vet.
Yes the formulations are done on an individual patient basis.
A ketogenic diet can be formulated but it is very difficult to create ketosis in the dog and rarely indicated.
There is a general suggested nutritional profile for cancer in general. A homemade diet can be formulated with that profile and there is one commercial product made with that formulation.
Please complete and return the attached request form to us and please request that a copy of the most pertinent medical records be sent to us by fax (919-513-6905) or email (best) (NCSUVetNutrition@gmail.com).
After receiving this info, we will email or call you if we have questions before sending the recommendations to you.
Thank you,
R Remilllard, PhD, DVM, DACVN
It was interesting to learn that ketosis is hard to produce in canines, I did not know that before, and it kind of rules out the idea of a ketogenic diet. At this point, a lot of googling had turned up Hill’s n/d prescription diet as the only commercial dog food specially formulated for dogs with cancer, so I assumed the commercial diet they mention in #5 was Hill’s n/d. I just asked bluntly in a response email, and they confirmed it was Hill’s n/d (kindly without charging me $75), so that’s when we did some more research on Hill’s.
Hill’s n/d is pretty interesting because it is basically based on a single scientific paper from what I can tell. But I guess that is better than being based on nothing (which believe me, happens, there is a lot of snake oil out there)! It is a pretty good paper though; a double blind, randomized study, which is the gold standard as far as clinical trials go.
Hill’s (perhaps slightly biased) brochure which explains the paper and rational for the diet:
In this packet, Hill’s makes the claim that “To achieve levels of omega-3 fatty acids found in Prescription Diet® Canine n/d®, typical pet foods need to be supplemented with 30 fish oil capsules per day for a 10-kg dog.” Sure Hill’s, thats what you want us to think so we’ll buy your dog food, 2x $3.50 cans/day for a 50 lb dog, dog food… right? Well lets look at the original paper this is based on to see if Hill’s is being honest.
Effect of Fish Oil, Arginine, and Doxorubicin
Chemotherapy on Remission and Survival Time for
Dogs with Lymphoma
A Double-Blind, Randomized Placebo-Controlled Study
http://www.catoils.net/v1/links/1916.pdf
Here is the breakdown of the nutritional content of the diet:
break down of fish oil fatty acids in experimental diet
Fish oil contains fatty acids, and the main ones they focus on in this paper are EPA and DHA. These are rough calculations so please let me know if anyone sees a mistake. Most dog diet recommendations are based on calories, so we need to convert this to calories. Fat is 9kcal/g, CHO (carbs) and protein are 4kcal/g. So if we multiply this out, every kg of food has 2934 kcal from fat (326g x 9kcal), 1512 from protein (378g x 4kcal) and 864 from carbs (216g x 4 kcal). Total is 5958 calories. Jabba, being a mostly sedentary 50-60lb dog, needs 1200-1300 calories a day, 1200/5958/kcal = about 1/5 .
CONCLUSION: Hill’s claim of approximately 30 pills a day is pretty accurate. Damn. Not to mention the arginine which is not shown in these calculations but also present in Hill’s. I guess this is how they can charge $3.50 a can. I am still looking into it, but there may be better sources of high yield liquid EPA/DHA that could be more cost effective and easier to implement (rather than shoving 30 pills down your dogs throat).
The rest of the paper shows a modest increase in survival times for dogs with lymphoma given the special fish oil/arginine diet:
You can see that the average and max survival is substantially higher, although there is an overlap around the 25% survival mark, so it is anything but a guarantee. What is nice about this study, and I want to re-emphasize, is that it is double blind/placebo controlled, so these results are pretty believable, even if the sample size is pretty small and the effect isn’t that huge.
Another interesting figure shows a very strong correlation between fatty acid concentration in the animals blood and survival time:
Unfortunately it doesn’t really seem feasible to constantly measure your dogs DHA levels to see if the diet is working.
IN SUMMARY: the paper has pro’s and con’s (this is a different type of cancer, although the basic premise should work in different types of cancer), but overall I think it is enough to justify trying the diet and also Hill’s price.
I asked our family vet about Hill’s and she said she liked it but that at this point it probably wouldn’t do much to change Jabba’s outcome. We still felt it would be worth it to try, even if it just gave him a few extra good days.
Hill’s is specially formulated to be pallatable for dogs undergoing chemo, and Jabba definitely loves the taste. We did find one review that was a little dubious on the quality of the ingredients but oh well. Finally the cost: about $90/2 weeks so $180 a month. Yeah, not cheap. One other remark is that Jabba has definitely been gassier since starting Hill’s n/d!
In conclusion, Jabba-bear goes bonkers for the Hill’s Prescription Diet. He does his “happy dance” around feeding time to signify that he is really ready to eat (he alternates lifting his two front legs and rapidly stomps on the wood floors, creating a “pitter patter, pitter patter, pitter patter” rhythm that resonates throughout the house). This is one of Jabba’s most lovable qualities. He hadn’t “danced” in nearly 2 months.
On Monday, February 18th, Jabba-bear was admitted to Carolina Veterinary Specialists (CVS) upon referral from his primary veterinarian (Oldtown Veterinary Hospital). By that point, Jabba’s condition was critical. It was clear that if we didn’t act fast, he would die…soon. That day, the doctors at CVS performed an ultrasound of his abdomen, to try and visualize the mass in his lung for a biopsy.
Jabba-bear at CVS during visiting hours. The small patch of shaved skin on his side shows where the doctors attempted to do a blind biopsy of the mass in his lung (following the ultrasound).Jabba-bear loves to push on our feet as we rub his belly! This was the most energetic he had been in 3 weeks. We felt that he was showing signs of improvement.
This procedure was, in some ways, a gamble because lungs are ill-suited for ultrasonographic examination given that they are typically full of air (and ultrasound doesn’t work well through oxygen). As such, the doctors were unable to get a good look at the mass. The next viable option was lung surgery. As detailed in a previous post, Jabba-bear spent nearly one week at the “hotel” (CVS), receiving ample IV fluids and pain medicine, as he bravely withstood test after test after test. Eventually, it was determined that Jabba was healthy enough to sustain surgery (no organ failure, no noticeable masses in his liver, etc.), although there was still some risk involved as Jabba-bear had been so sick for such a long time, and we were not sure what was causing his illness. On Thursday, Februrary 20th, Jabba-bear had a lobectomy. Specifically, the surgeon removed the caudal lobe of Jabba’s left lung.
We were not allowed to visit Jabba-bear the day of his lobectomy, but we went to check on him Friday morning. This was a very difficult visit for us. As soon as the technician left us alone with Jabba, he starting crying…Loud, wailing, cries. We had never heard him make those sounds before. We didn’t know what those vocalizations meant. Was he in pain? Was he suffering? Was he yelling at us for putting him through yet another major surgery? We felt helpless. We looked at each other and wondered if we had made the wrong decision. The technicians assured us that Jabba was not in pain, that he had spent the whole day resting comfortably (and quietly). However, he was still not very interested in food. We asked if we could try to feed him. The technician brought us quite a selection of wet and dry food. To our surprise, Jabba-bear ate it all! This lifted our spirits. We stayed there petting Jabba-bear as long as possible, until it was time for him to go back on his IV fluids.
The next day, February 23rd, we checked Jabba-bear out of the “hotel” and brought him home!
Jabba on the way home form the vet (after the lobectomy). The blue bandages covered the incision site.
Jabba-bear was happy to see the car. He had never been boarded before, and this was the longest he had ever gone without seeing his pawrents. When we got close home (turning onto our street), Jabba-bear perked up. He lifted his head, looked at the road, and started smiling!
The doctors sent us home with pain medicine (Tramadol) and steroids (Prednisone) and told us to limit Jabba’s physical activity for at least two weeks (no jumping, climbing stairs, running, etc.). We weren’t too worried about this since Jabba-bear is an extraordinarily lazy dog. Even though his sister, Beyonce, was waiting for him, we knew that they would be OK. Honestly, Jabba-bear and Beyonce do not interact much, save for the occasional forced cuddling on Beyonce’s part.
We spent that whole day laying on the floor with Jabba-bear, scratching behind his ears, petting his backside….letting him know how proud of him we were. He is such a brave boy!
Jabba resting on his pillow. Beyonce giving him a concerned look.
By Sunday morning, Jabba-bear seemed to have improved significantly. His appetite had returned, and he seemed more energetic. Jabba kept rolling onto his back, begging for more belly rubs. As a result, he wiggled out of his bandage and exposed the incision site of his lobectomy. Although the below picture might look gruesome, the incision site was neat and clean. We thought the doctors did an excellent job!
Jabba’s incision site exposed! Beyonce stayed close to her brother, making sure he was OK.
We took Jabba-bear back to CVS to replace the bandages, since it was recommended that they remain on for one week.
Jabba’s new threads!
The following Thursday, Februray 28th, we took Jabba’s bandages off to allow the incision site to “breathe”. By this time, Jabba-bear had figured out how to jump on the couch again, and well….we let him.
Kisses from Beyonce.Close look at the incision site.There’s that goofy smile again! (one week after the lobectomy)What a handsome boy! So serious.Brother and sister on the couch. Jabba loves to look out the front door.Jabba’s idea of resting comfortably.Lion-bear?
All things considering, Jabba-bear is doing very well. He started the high protein diet (Hill’s prescription) a few days ago, which we will write more about soon.
He is no longer taking pain medicine, and he is tapering off the steroid treatment. We are still thinking about the next step for Jabba-bear (i.e., whether to put him back on cyclophosphamide and/or palladia).
Thank you so much for all of your support over the past few weeks.
When we began Jabba-bear’s battle with osteosarcoma, his primary doctor, Oldtown Veterinary Hospital (http://www.oldtownvet.com/), gave him a very special gift: a guardian angel charm for his collar. He loved this charm so much! One day the charm broke off his collar, but we have kept it on a shelf next to his bed. Every day we look at it, and we are reminded of how lucky we are to have Jabba-bear in our lives. He has made it this far largely because of the outstanding care that he has received from the doctors and staff at Oldtown Veterinary Hospital. We are incredibly grateful to them for all that they have done, especially over the past 2 years. Jabba-bear’s osteosarcoma has been an unusual and difficult case to treat. Nevertheless, Jabba-bear continues to persevere…throughout it all, his goofy smile continues to warm the hearts of everyone he meets.
Guardian angel charm for dog collar. Protect this dog (back).
This is an example of a personalized appointment reminder that Oldtown courteously sends out. We thought this was such a beautiful card that we’ve saved it on the “Jabba-bear” side of the refrigerator (above his food bowl).
A reminder that Jabba-bear had a heart worm antigen detection test scheduled for January 2012.
For Jabba-bear’s 1 year Ampuversary, Oldtown sent us a celebratory card! It was very kind of them, especially considering that Jabba-bear had spent most of that year seeing doctors at North Carolina State University College of Veterinary Medicine (as part of the OSA clinical trial).
The card that Oldtown sent Jabba-bear to celebrate his 1 year Ampuversary!
Just a quick recap of the previous post since its LONG!
-Jabba’s x-ray was clear nearly two years after amputation (January 4th, 2013). During this entire period he was on metronomic cyclophosphamide, and for most of the second year he was on Palladia (70mg). He had come off of Palladia for financial reasons in November 2012.
-a few weeks after this x-ray, Jabba became sick with fever, lethargy, loss of appetite, pU/pD (excessive thirst and urination), arthritis, and eye discharge.
-these symptoms were initially suspected to be pneumonia, along with the sudden appearance of a large mass in his lungs.
-surgical removal of the mass and biopsy confirmed it was osteosarcoma, which had also spread to his lymph nodes. Cancer can cause the symptoms we saw by triggering a generalized, hyperactive immune response (i.e., paraneoplasticsyndrome). For more information on this syndrome, see http://en.wikipedia.org/wiki/Paraneoplastic_syndrome.
-steroids and removal of the mass have controlled the symptoms for now.
For anyone who was been at this stage, what do you recommend? Do we put him back on metronomic therapy? High-dose infusion chemo? Or just treats?
Here is the update that we have so wanted to avoid writing. . .
As mentioned in a previous post, Jabba had an X-ray shortly before his 2 year ampuversary (Jan 4th) showing that against all odds, his lungs were still clear – save for a small nodule that had not changed size or appearance in the year since it had first become visible. We were beginning to think he may have actually beaten cancer!
A few weeks later, Jabba began showing signs of illness: he was drinking a lot, peeing in the house (more than usual) and he started developing eye boogers. At first, we weren’t too phased by this, as the symptoms were mild. However one night it became obvious Jabba was very sick: his eyes were red, his nose very warm, and he was hardly moving. We took him to the emergency vet fearing some kind of organ failure. We spent the bare minimum to rule out kidney failure (a $30 test), and planned on taking him to his family vet the next morning (in an interesting side note, the ER vet who saw Jabba was actually the former intern who first saw Jabba at NCSU 2 years ago, what a small world!). Here is the report from the ER:
Presenting Illness : Jabba Bear presented for evaluation of increased thirst and urination that was first noticed three
days ago, as well as lethargy, mild coughing and redness of his eyes with mucoid ocular discharge that was noticed
today. Jabba has a history of osteosarcoma of the left hind leg that was diagnosed approximately 2 years ago. Jabba
underwent an amputation and a course of chemotherapy. After the initial chemotherapy was completed, Jabba was
started on metronomic therapy consisting of cyclophosphamide, piroxicam and palladia. Since November of 2012, the
metronomic therapy was decreased to cyclophosphamide only. During the course of Jabba’s treatment he has had
several episodes of lower urinary tract signs which have been diagnosed as both sterile hemorrhagic cystitis and urinary
tract infections (based on culture). In November of 2011, Jabba completed the course of the OSA study he had been
enrolled in at NCSU CVM and radiographs taken at that time revealed a single possible nodule, repeat radiographs taken
(most recently in December of 2012) revealed that the nodule had not grown. Since Sunday, his owners report that his
water intake has been significantly increased and he has needed to go outside to urinate approximately every 2 hours
and has been producing a large amount of urine each time.
Exam: Wt. 56.8lb, T 104.9, HR 144, RR 24, MM/CRT p<2
EENT – corneas clear OU; mild mucoid ocular discharge; mild scleral erythema; no nasal discharge; ears clean AU; no
abnormalities on limited oral examination; throat palpates normally
PLN – all peripheral lymph nodes palpate soft, small and symmetric
CVR – no murmurs or arrhythmias noted; femoral pulse strong; normal lung sounds ausculted over all fields
MSI – ambulatory x3 with no lameness noted; adequate, symmetrical muscling; no pain on palpation of long bones;
haircoat healthy; integument intact; no evidence of ectoparasites
GI/UG – no pain on abdominal palpation; no masses or organomegaly noted; neutered; no abnormalities on rectal
N – BAR, appropriate mentation; no CN or proprioceptive deficits noted; full neuro examination not performed
Assessment:
1) Fever
2) PU/PD
3) Ocular discharge and redness
SWO – explained that while the PU/PD could not be easily tied to the other symptoms noted, it was probably the most
significant symptom and would be the initial focus of diagnostics. Discussed causes of PU/PD including renal
insufficiency, diabetes mellitis/insipidus, Cushing’s, Addison’s, pyelonephritis, hypercalcemia, hepatic insufficiency, etc..
Recommended CBC/Chem/L/UA and thoracic radiographs. Despite recheck thoracic radiographs being performed
relatively recently, new cough and possible pathology warrants rechecking. CBC/Chem/L/UA best way to determine
cause of PU/PD. Owners expressed financial constraints and inquired about waiting to have Jabba evaluated with
primary veterinarian in the morning; explained that without knowing the cause, I could not give them a prognosis.
Recommended checking BUN/Cre at a minimum to r/o renal insufficiency, if renal values are normal, would still
Presented: 01-29-13, 8:12p
recommend additional diagnostics, but other differentials would be less critical to treat immediately. Owners approved
BUN/Cre only.
Treatment:
1) BUN/Cre – within normal limits (BUN 11, nl 7-27; Cre 1.3, nl 0.5-1.8)
SWO – renal values within normal limits which makes primary renal insufficiency and other kidney problems such as
pyelonephritis unlikely. Cannot ruleout other causes of PU/PD as previously discussed. Other causes are still significant,
but renal insufficiency would be the most critical to treat immediately. Owners declined additional diagnostics and will
monitor at home overnight with a plan to follow up with their primary veterinarian in the morning. Discussed starting
antibiotics due to fever, would not recommend starting at this point without a better understanding of the cause if they
are planning to pursue additional diagnostics in the morning. Recommend monitoring at home overnight and bringing
back if any new developments or worsening symptoms, otherwise follow up with primary veterinarian in the morning
for additional diagnostics.
Client Instructions:
As we discussed, there are numerous causes of increased thirst and urination and we cannot determine the cause of
Jabba Bear’s symptoms at this point without performing additional diagnostics. We checked Jabba’s renal values which
were normal and this rules out some of the more important causes, however, additional diagnostics to further evaluate
these causes was declined tonight in favor of monitoring at home and following up with your primary veterinarian in the
morning. As such, please keep a close eye on Jabba Bear over night and do not hesitate to call or bring him back to
AESFC if you have any concerns about how he is doing at home.
Please follow up with your primary veterinarian tomorrow morning to discuss additional diagnostic and treatment
options.
The treatment Jabba Bear received today was based on assessment of the presenting signs and diagnostic procedures
that were performed. Keep in mind that there can be complications that develop due to changes in the existing
condition or presence of underlying condition not apparent at the time of the treatment which can be severe or even
fatal.
So Jabba did not have kidney failure, and the next morning we took him to his family vet. His Dr. told us she suspected an infection, which would explain his fever and PU/PD (medical term for drinking and peeing a lot). An x-ray showed a mass in his lung, which the vet suspected was pneumonia. After all, his lungs were clear less than a month before, and this large, singular mass did not look like the typical presentation of osteosarcoma (many small mets). Jabba was prescribed antibiotics and we went home happy, thinking “at least he only has pneumonia!”
Note: In the above image, Left and Right are reversed. We have delineated the boundaries of the suspected infection in Jabba’s left lung. For a comparison, the red dot in Jabba’s right lung highlights the first suspicious lung met that appeared in early 2012, but remained constant for over one year.
Once Jabba was diagnosed with pneumonia, we decided to stop his metronomic chemotherapy (9 mg cyclophosphamide every other day), in an effort to improve his ability to beat what we thought was an opportunistic infection. After all, Jabba-bear had been immunosuppressed for 2 years.
Unfortunately, after two weeks and several different antibiotics, Jabba’s fever and lethargy did not subside, his appetite became almost non existent, and he had lost a significant amount of weight. A second X-ray showed the mass had remained relatively stable. We should emphasize that Jabba-bear’s primary doctor did not suspect that the mass was metastatic lung cancer for several reasons:
(1) The apparent physical characteristics of the mass were less consistent with metastatic osteosarcoma (normally characterized by an abundance of small lesions throughout the lung, like the original suspicious lung met highlighted in the above X-ray, not one large well-defined mass in the caudal most portion of the lung).
(2) The mass appeared suddenly (sometime between 1.4.13 and 1.30.13). If this were metastatic disease, we would have expected to see at least a hint of it early in January. Whatever this was had gone from 0-60 in a blink of an eye.
(3) The mass had not changed much in size or shape in a week and a half (see the below X-ray). The only noticeable difference between the X-rays on 1.30.13 and 2.11.13 was that the boundaries of the mass were slightly thicker at the later time point, possibly reflecting the development of an abscess around the infection site. If this were metastatic lung cancer, it was clearly aggressive. . . meaning that we would have expected it to grow significantly in the time between these two images. And, it did not.
Again, we have delineated the boundaries of the mass in Jabba’s left lung. 12 days after it first appeared on X-ray film, it is approximately the same size (about the size of a golf ball).
Because this supposed infection was antibiotic-resistant, we opted for a tracheal wash, which would capture whatever bacteria was causing the infection, and allow for tests to see which antibiotics would be effective against it. After 5 longs days, the results came back: there was no bacteria in Jabba’s lungs. At this point, Jabba’s fever had been hovering in the 104 range for over a week. It was time to consider the possibility that Jabba’s condition was more serious than we anticipated. Therefore, we were referred to a specialty vet: Carolina Veterinary Specialists (CVS).
Being an emergency and “referral only” vet, the attitude at CVS was a little different than what we were used to dealing with, but they came highly recommended. During our consultation, the doctor told us that she had reviewed Jabba’s X-rays (shown above) and was quite convinced that Jabba had lung cancer. The question was whether or not it was metastatic disease. This distinction is important. If it were a primary lung tumor (i.e., unrelated to Jabba-bear’s osteosarcoma) then there was a relatively good chance that removing the tumor would “cure” Jabba’s condition and that he could live a long(er) life. If, however, it were metastatic osteosarcoma, then there would be little that we could do besides love what little time we have left with him. Upon physical examination of Jabba, the vet confirmed another symptom that we had suspected but were unsure about: Jabba’s joints were swollen, which was a form of arthritis caused by systemic inflammation. The vet determined that the first step in diagnosing Jabba was to try and biopsy the mass in his lung using a needle and ultrasound. This was unsuccessful. Surgery to remove and biopsy the mass was presented as the only feasible option; or euthanasia. We were not given very much time to mull over the decision, being told in effect “this is very urgent.” At this point, the CVS vet was “highly suspicious” that the mass in Jabba’s lung was cancer, the logic being that cancer can cause an systemic immune response than can create fever and arthritis, etc. But, hearing the words of Jabba’s primary vet in our ears, we held out hope that this may in fact still be something else, and opted for surgery.
Before surgery, Jabba needed blood work to see if he was healthy enough to sustain the potentially invasive surgical procedure. We were informed that his blood tests showed evidence of liver failure, so again the option was more expensive tests, or euthanasia. An ultrasound of the liver showed no overt tumors present, so at the advice of the vet we had a bile acid tests done to examine liver function, and a joint tap to confirm the cause of his arthritis (I am still not sure the point of this test before surgery, but at this point we are in so deep, what the hell). Two days later the test results came back showing that Jabba’s liver was functioning well, so he was deemed fit to undergo surgery immediately. At this point he had been staying at the hospital for 3 nights, and receiving IV fluid to help lower his fever. The vet also put him on steroids to lower the fever, something she had been reluctant to do as if it was an infection, steroids would make it worse. The surgery was to be laproscopic (small incision and guided with a scope), but we agreed to allow them to make a larger incision and open the ribs if need be.
The next morning we got a call saying his fever was down in the 100’s, and he would be going to surgery soon, but also that the mass appeared larger upon x-ray. We should expect a call in about four hours. Two hours later we got a call from the vet, saying the mass was too large to remove without damaging the lung, and if we still wanted them to take some for biopsy. We were devastated, but told them to go ahead. An hour later, the surgeon (different from the vet) called and told us that, while he had gone for the larger incision and intercostal split, he had in fact removed the entire lobe of that lung, and gotten the entire mass. Suddenly hope came back, although the surgeon also informed us that there were suspicious looking lymph nodes near Jabba’s heart, which he also biopsied. The biopsy results would be back in a few days. We weren’t allowed to visit Jabba that night (we had been twice a day every day that week), but went to visit the next day and took him home the day after that (now Saturday, he had been at CVS since Monday).
Jabba’s X-ray just before surgery. The surgeon informed us that the mass was about the size of a baseball. Given its size and location, the surgeon believed that it had been growing for more than 6 months. . .
The good news is that Jabba is doing well after surgery (now almost two weeks ago)! The bad news is that the biopsy results confirmed this was highly aggressive osteosarcoma, which was present in his lymph nodes. Here is the biopsy report:
Histopathology, Full Written Report
Biopsy
DESCRIPTION/MICROSCOPIC FINDINGS/COMMENTS:Microscopic Description:
Sections of a lung mass are examined on 3 slides. There is a
partially delineated neoplasm within pulmonary parenchyma composed of
ovoid to fusiform or occasionally stellate mesenchymal cells forming
broad interlacing bundles and trabecular arrays. The cells form thin
trabecula of osteoid and a few cell are entrapped with osteocytic
lacuna. The cells have pleomorphic hyperchromatic nuclei with coarse
chromatin stippling. There is a high mitotic rate. Several smaller
nodules are dispersed in the adjacent pulmonary parenchyma.
Sections of lymph node are examined. Nodal architecture is
effaced by the same type of neoplastic cells described above.Microscopic Findings:
Osteosarcoma, multifocal, lung, lymph node.Comment: The osteosarcoma has metastasized to the lung and lymph node. The prognosis for metastatic osteosarcoma is poor.
So, that’s where we are now. Jabba will have his surgical staples taken out in a day or two. He is generally doing well, even going for a long walk the other day and dragging us to see his friend down the street. Either the removal of the mass or the steroids are managing his symptoms well for now. His energy level is not what it used to be, and he is still tender from the surgery and/or arthritis, but his appetite is back and most important, he seems happy.
We know that we put Jabba-bear through a lot over the past month, but we were trying to save his life. We believed that our miracle dog had, against all odds, beat osteosarcoma. We couldn’t bear to “let him die” from pneumonia when he had survived bone cancer. We celebrated his 2 year Ampuversary and we have cherished every day since. Although we should have expected that Jabba’s disease would, at some point, metastasize, we were not fully prepared for this news. We are all still fighting this horrible disease.
There are still options to consider, which we welcome opinion and insight on. Jabba has been off his metronomic therapy for a while: cyclophosphamide for a month, and palladia for several months. We may soon put him back on one or both. Another option we are resistant too, but have not completely ruled out, is going back to the stronger, infusion style chemotherapy. Also he will start on a commercial diet soon recommended for dogs with cancer (Hill’s n/d, I will write more about this soon).
Before we discuss the events of the past two weeks, we think it is appropriate to mention a few important highlights of 2012.
In January 2012, Jabba-bear’s mom adopted a greyhound named Beyonce Knowles. She raced on the Celebrity Track in Florida (hence her name), but she wasn’t very fast. This lead to her having a relatively short racing career. Beyonce was described by the kennel as a “DIVA”. She was a little wild, jumpy, and playful. The owner of the kennel called her Bouncy Beyonce. Basically, she was different from the rest of the greyhounds and a lot to handle. We (Jabba’s pawrents) thought it would be good for him to have a playmate, so the fact that Miss Beyonce Knowles was energetic was actually a major attraction for us. Before finalizing the adoption, we took Jabba to meet Beyonce. Jabba-bear was the first non-greyhound that Beyonce had ever seen. To prepare for the meeting, and since we didn’t know how she would react to Jabba, Beyonce wore a muzzle. When she saw him, her pupils dilated and she had a whole body reaction. She lunged at Jabba-bear (as if she wanted to attack him). Jabba calmly approached Beyonce, looked her in the eyes, put his face next to her muzzle, and let out a deep, authoritative growl to let her know that he was the alpha dog. After that was established, they played together for nearly an hour. Two months later, Beyonce came to live with Jabba-bear. The delay was due to the fact that she tested positive for heartworm and needed to be treated (and kept quiet) for a couple of months before she could resume normal activity.
Jabba and Beyonce’s first walk together in Winston-Salem, NC.
Beyonce quickly made herself comfortable in Jabba’s house. As soon as she moved in, her wild side dissipated, and she became quite calm. Perhaps Jabba-bear set the tone for the house. In any case, Beyonce turned out to to be just as lazy as Jabba-bear.
Queen Beyonce asleep in her new home
Beyonce adores Jabba-bear (although we still are not quite sure how he feels about her).
Shortly after she moved in, Beyonce started curling up with Jabba-bear, wrapping herself around his body, nuzzling the site of his amputation. It was almost as if she knew that something was missing.
Beyonce loves her tripawd brotherBeyonce holding onto Jabba’s “stump”
If she had it her way, she would do everything with him.
Two peas in a pod (looking out the window)
Beyonce does demand a lot of attention (she really is a DIVA), but she is a sweet, loving dog. And she certainly is cute!
Overall, the last two years of Jabba’s life have been wonderful. He had many great days and his smile touched the hearts of everyone he met (people and pups alike).
These are some photo’s from the dog party Jabba had to honor his 3rd year:
All of Jabba’s best friends were able to attend his birthday party.
Other dogs using Jabba’s ramp! They loved itJabba and YeshuaPuppy Jabba and Yeshua (3 years ago)Jabba-bear and his friend Bear about to make a wish and enjoy some cake!
The following photos illustrate some of the other good times that we had:
Jabba-bear attended a CureSearch walk in the Spring. He made a lot of children happy that day.
Jabba after the CureSearch walk for children’s cancer
Jabba-bear went as Yoda for Halloween!
Yoda-bear
A father’s love for his dog:
What sweet boys!
Beyonce can never resist a good group hug!
Some of Jabba’s great poses on his couch(es):
What a sophisticated pup!Upside down Jabba!Who could say “no” to that face?
