On Saturday, April 6th, Jabba-bear passed away peacefully at Oldtown Veterinary Hospital in the loving presence of his mom and dad.
Friday morning, we gave Jabba-bear a few doses of Tramadol in hopes of alleviating some of his pain. It seemed to help quiet his labored breathing -he had been altering between healthy pants, small squeaks, and a honking sound that was reminiscent of a child with a very bad lung infection. You could hear a rattling sound in his lungs. Although he was clearly struggling, Jabba-bear was still very much aware of his surroundings. He still had a happy glean in his eye and would wag his tail in our presence, attempting to roll over for a belly-rub. Later that day, we took Jabba-bear back to Reynolda Village for a short walk. It was a glorious day (a pleasant surprise considering the tumultuous, apocalyptic weather that we experienced on Thursday-snow, sleet, hail, rain, etc.). Jabba-bear didn’t make it very far. He found a cool patch of ivy to lay in. We placed a blanket on the ground and sat with him for a while, petting him, allowing him to soak up the sun, while watching passersby with their pups. Jabba didn’t feel like making new friends that day, but he seemed to offer a knowing nod to the dogs as they walked past us.
Jabba-bear at Reynolda Village.
A close up of our beautiful boy.
Soon, Jabba was ready to go back to the car. He loves the car, especially his dad’s fast BMW. We drove around town, stopping for pizza from 2 different restaurants. We ordered a total of 4 thick-crust pizza pies, smothered with cheese, bacon, and pepperoni (Jabba’s favorite). Then, Jabba’s dad went to the grocery store and bought cupcakes, donuts, bacon, turkey pepperoni, premium Nathan’s hot dogs, and sliced turkey (from the deli). That night, we decided to celebrate Jabba’s life by lifting the no-carb ban and allowing him to eat all the “junk food” he desired. When we got home, Jabba eagerly devoured 2 pieces of pizza and snacked for the rest of the night on various goodies.
After midnight, his breathing became extremely erratic. Jabba’s mom sat up next to him, placed her hands on his side and sang to him, whispering the words “quiet, quiet, quiet” while attempting to transfer all the loving, healing energy in her body to him, through her touch. As hokey as that may sound, it actually seemed to work. Jabba-bear soon fell asleep and started dreaming-his front two legs twitching periodically and his ears flicking with delight. Several times throughout the night, Jabba-bear sat up and cried out loud. He was uncomfortable. Maybe it was all the pizza? At one point, he did let out an impressive belch before collapsing on his side, content, and falling back asleep. By 5 AM, Jabba’s discomfort was wearing on both of us, and we called the emergency vet (Carolina Veterinary Specialists) to schedule his euthanasia. We told Beyonce to prepare herself to say “goodbye” to her brother. She responded by letting out a blood curling howl and then grabbing her lamb chop chew toy and throwing it in the air, settling next to Jabba’s head, with her paws on his front legs. As soon as we hung up the phone, Jabba-bear seemed to stabilize. After 10 minutes, we cancelled the appointment, deciding to try and “hold out” for Jabba’s primary vet (Oldtown Veterinary Hospital)-we had already scheduled an appointment for 9:20 AM on Saturday. In an effort to distract ourselves from the impending doom that consumed us, we watched “All Dogs go to Heaven” on Netflix. When it finished, we still had nearly two hours until our appointment at Oldtown. Jabba seemed to be resting comfortably with his dad on the floor of the living room. We had surrounded him with pillows, propping him up until we found a position that allowed him to breathe more easily.
Shortly before it was time to leave for the vet, Jabba’s paternal grandpawrents arrived to say “goodbye” to their favorite grandson. In the background, we played the Lion King soundtrack to comfort Jabba-bear (it was a trick that had worked in the past). At this point, we were all very emotional. Even though we were dreading this final moment, it also came as a relief since we knew that soon Jabba-bear would no longer be suffering. We fed Jabba-bear hot dogs for breakfast, and his dad cooked him half a package of thick bacon to feed to him in the car ride to the vet. Jabba savored every bite. On our way, we sang Hanunka Matata and I Just Can’t Wait to be King, and Jabba-bear stuck his head out the window, as he so loved to do. He closed his eyes and enjoyed some final good sniffs.
Jabba-bear in the car, so serious.Looking toward the light.Finally at peace.
Note: the above photos were taken the day before, during our trip around town. We thought they were symbolic of Jabba’s transition to heaven.
When we got to the vet, Jabba-bear let us know that he was ready to go. He normally rushes to hide behind a chair (or in the corner) when the vet-techs enter the room to take him to the back. On this day, he laid on the floor, gasping for air. He was not scared. He just seemed tired of fighting. There was no question that we were doing the right thing. When the time came, they lifted Jabba-bear onto a table. He faced a painting on the wall- a well trodden path through the forest. It reminded us of our trip to Pilot Mountain. Perhaps Jabba could pass away thinking that he was back on the trail, climbing the mountain. 3 injections later (1 flush, 1 sedative, 1 dose of a pinkish euthanasia liquid), and Jabba-bear had passed. The staff at Oldtown were compassionate and completely professional. They helped ease the difficulty of the situation. We are, and always will be, extremely grateful to them.
Jabba’s food bowl. His paternal grandpawrents placed this beautiful flower in his bowl while we were at the vet. It was a sweet touch.
Friday night was extremely difficult for us, but we were deeply touched by the incredible support that we received from so many of you in the Tripawds community. Thank you.
Thank you, not only for your support, but also for taking the time to read our posts. Writing this blog over the past several weeks has been extremely cathartic for us.
We hope that you find value in what we have written about our journey with Jabba-bear. We are happy to answer any questions that you may have, now or at a later date.
It is with a heavy heart that we share this news: Jabba’s condition has taken a rapid turn for the worse.
Yesterday morning (April 4th), while lying in bed, petting Jabba-bear, his mom noticed a lump inside his upper right lip.
We took him the vet in the afternoon, preparing ourselves to hear bad news, but hoping, nonetheless, that it would be a benign gum abscess (after all, Jabba-bear’s teeth were well over due for a cleaning). Later that evening, Jabba’s doctor called to confirm that it was, unfortunately, metastatic osteosarcoma; the nodule was emanating from his jaw bone, not his gum. We were worried because the tumor literally appeared overnight, suggesting that it was quite aggressive. Jabba’s doctor reassured us that against all odds, Jabba seemed to be doing fine; he was not showing any signs of pain. However, she did warn us that his condition could turn on a dime. . . She said that the lump could stay the same size for a month or more, but if the cancer started to spread to his sinuses, she would have to recommend that we put him down. She reminded us that the goal was to preserve Jabba’s quality of life. And we agreed.
After Jabba’s brush with death in January, we decided that we would seriously discuss his “end of life plan” if it became clear that he was no longer interested in food. If there is one thing that motivates Jabba-bear, it is food. . . of any sort (but pizza, peanut butter, and steak are his favorites!). This morning, Jabba didn’t get up for breakfast. When he heard the sound of kibble rattling inside Beyonce’s bowl, he slowly hobbled to the kitchen. We filled his bowl with his Hill’s n/d Prescription diet and placed it in the bedroom, closing the door to give him privacy. We checked on him 10 minutes later, and he hadn’t touched the food, save to spread some of it around the bowl on the floor. We tried feeding Jabba by hand, while petting him. He ate a very small amount. We tried feeding him kibble, again by hand. He ate a few morsels. We asked him if he wanted to go for a walk. He went to the door, but then laid down in the front yard, barely taking 10 steps. At this point, our hearts bursting with sadness, we began to have that dreaded talk about the logistics of Jabba’s euthanasia.
Jabba-bear this morning (April 5, 2013). He has little to no appetite, and his energy level is very low.
We decided to give him one more day. We took him back to Reynolda Village and laid with him on a blanket, petting him as a cool breeze ran through his fur. Jabba’s dad took him for a car ride all around town, and Jabba made a valiant effort to stick his nose out the window for some good sniffs (he seemed to perk up a bit when we passed a shopping strip full of fast food joints). Tonight, we will have a pizza party, and we will spend the evening holding him, loving him, saying our goodbyes.
We don’t want Jabba-bear to suffer any more than he has already. He is now having a lot of trouble breathing. Every few breaths, he lets out a small cry, like he did the day after his lobectomy. It is absolutely gut wrenching to see him like this. His fight, although well-fought, might be drawing to an end.
We have an appointment scheduled with the vet for tomorrow morning. We are still not sure what will happen.
Thank you for all of your support during these difficult times.
On Friday March 15th, Jabba-bear went for a short drive across town to Reynolda Gardens, where he frolicked freely in the fields.
Jabba briefly explored the trails surrounding the Reynolda house, but he was more interested in meeting new friends (Reynolda Village is a popular dog-walking attraction). We laid down in the grass for a while and basked in the sunlight, enjoying every moment of the bright, beautiful weather. It was clear that Spring had finally arrived!
The following pictures highlight Jabba-bear at his finest:
Jabba-bear resting in the field in front of the Reynolda House.Look at that Big Goofy Smile!
Did someone say the word “Treat“?What a handsome profile.
That afternoon, when we got home, Beyonce welcomed Jabba-bear by licking his ears profusely (until they “stood up” on their own). We have to recognize that Beyonce has been extremely tolerant of all the extra attention Jabba-bear has been receiving over the past few weeks. She genuinely seems to understand what is happening to her beloved brother and best friend.
Later that evening, Jabba’s breathing pattern became noticeably irregular. He seemed to be wheezing more than normal, gasping for air. But, we rationalized it as a side-effect from the lobectomy, telling ourselves that Jabba-bear was still adjusting to his smaller lung capacity. He still seemed eager to go for walks and to protect the neighborhood from the “evil” man in uniform who approaches the house each day with stacks of oddly shaped paper in his hands, leaving them in a box on the front porch. Disclaimer: the mailman is not evil by any means, but Jabba-bear has never taken a liking to him. As a result, the mailman probably thinks that Jabba is the Godzilla of dogs (a 180 pound guard dog that would rip his throat out if given the opportunity). I wonder what he would do if he realized that the source of the now familiar earth-shattering growl was really a 50 pound fur ball with 3 legs. . .
Three weeks after Jabba’s lobectomy to remove a large portion of his metastatic osteosarcoma, he was given a “bill of good health”, at least a temporary one. At this point, we decided to put Jabba back on metronomic therapy (i.e., frequent, low doses of chemotherapy) since he had tolerated it well for such a long time (almost 2 years!).
We started giving him cyclophosphamide (9 mg), the primary chemotherapy drug, first, since we still had a full bottle of it leftover from January. Note: Jabba’s doctors told us to withhold chemotherapy until he had sufficiently recovered from his surgery because these potent drugs that attack rapidly dividing cancer cells may prevent or limit wound healing (at the cellular level, the active ingredients in the pill cannot distinguish between a growing tumor and healthy tissue regeneration-it kills them both).
We debated putting Jabba-bear back on Palladia (50 mg) because of the sheer expense ($323.85 for 30 pills), but we eventually gave in and ordered the pills. Note: Jabba had previously been taking 70 mg of Palladia, but, since he lost a significant amount of weight prior to the lobectomy, we adjusted his dose accordingly. Although it should have been slightly higher (closer to 60 mg), we decided that we would start with the 50 mg capsule.
Because indigestion is one side effect of the metronomic therapy, Jabba-bear also receives 10 mg Pepcid or a generic anti-acid 2x daily. We still catch him eating grass occasionally though, which suggests that his stomach is not entirely settled.
In summary, Jabba-bear currently receives cyclophosphamaide and Palladia after breakfast on alternating days. He also takes 10-20 mg of Pepcid per day depending on his symptoms. In addition, Jabba-bear is still taking Prednisone (20 mg), which serves two purposes: (1) to help reduce any residual swelling in his joints from the lobectomy and/or systemic inflammatory reaction to the metastatic osteosarcoma, and (2) to keep his temperature in the normal range (it is currently hovering in the high 102 degrees Fahrenheit).
As you can probably imagine, Jabba-bear has accumulated quite the extensive collection of drugs in his “medicine cabinet”. In addition to his metronomic therapy, he also has a stash of pain medicine (Tramadol), various antibiotics, metronidazole (for diarrhea), heartworm medicine, flea medicine, etc.
Jabba-bear’s medicine cabinet. Also shown in the above image is his thermometer which we used frequently to monitor his persistent fever and his jar of Royal Treats.
Jabba-bear is very good about taking his medicine. We have a nice system worked out. Every morning after breakfast, Jabba’s mom says, “time for your medicine, sweet prince”, and Jabba runs to the kitchen, drool spilling from his bottom lip, because to him, medicine = a tablespoon of peanut butter.
Jabba-bear’s drug delivery system. Peanut butter, disposable knife, and medicine!
The disposable, plastic knife is a good tool for delivering the chemotherapy drugs because it is not a good idea to touch them with your bare hands (as they are toxic!!!), and the knife is not too sharp, so Jabba can successfully lick off the peanut butter without hurting himself.
Jabba getting his daily dose of medicine after breakfast. He gobbles it up with delight!
Overall, Jabba-bear seems to be doing pretty well on metronomic therapy. However, it is important to acknowledge that we are fighting a losing battle. The metronomic therapy will not cure Jabba-bear. His metastatic disease is serious and quite aggressive. . . At best, this combination of medication will slow the progression of his cancer. Maybe it is working? Today marks 6 weeks since his lobectomy! We are blessed to have had him so long. We are not in denial about the gravity of Jabba-bear’s situation, and we recognize that the choices we made to prolong his life may not be viable options for everyone (we have accumulated a significant amount of debt over the past 3 months). Nevertheless, we hope that some people may find this information useful. Thank you, once again, for your support.
When Jabba-bear was diagnosed with metastatic osteosarcoma, we vowed to do everything we could to ensure that whatever time we had left with him was well-spent. Unfortunately, doctors orders prevented us from doing anything really fun with Jabba for at least two weeks after his surgery (although we bent the rules a bit and took him on some very short walks since he begged for them). Once Jabba-bear was deemed healthy enough to resume normal activity, we promised to take him for daily walks (as long as he had enough energy), to schedule regular play dates with his friends, to give him as much steak and cheese as he wanted, to shower him with new plush toys (which would inevitably end up as a pile of shredded animal parts, loose thread, and stuffing within seconds), and we promised to take him for weekly adventures so that he could live out his Bucket List.
Our first adventure occurred two days after Jabba-bear had the staples from his lobectomy removed (on Saturday, March 9th). Early that morning, we asked Jabba-bear if he wanted to go for a hike. He responded by initiating a very excited happy dance (i.e., rapid fire stomping of his two front legs: pitter patter, pitter patter, pitter patter), which we interpreted as a resounding, “YES!”. So, we decided to take Jabba to Pilot Mountain, where he could run free, off-leash and scale the mountain at his own pace.
Jabba-baar had a wonderful time at Pilot Mountain that day. He definitely exceeded our expectations. He must have hiked close to 2 miles (of his own volition); his endurance was remarkable. We were so happy to see him climbing the mountain, wandering off occasionally, but never straying to far from his pawrents, yet we recognized that this may be his last climb.
The following pictures and videos capture the fun that we shared on our trip to Pilot Mountain:
Jabba-bear smiling on his way to Pilot Mountain. Click on the above image to view a video of Jabba-bear climbing a trail Pilot Mountain.Jabba resting happily on the first “leg” of the hike.Jabba-bear on “Pride Rock”.Jabba and his dad perched on a ledge.Jabba getting a back-rub from his mom during a break from his hike.Jabba at an overlook near the summit. He posed with his best cute smile and begged for some potato chips from a passerby who was enjoying his lunch.
Jabba near the peak, licking his nose.Jabba-bear is all smiles near the end of his hike.Click on the above image to view a short video of Jabba climbing steep stairs at Pilot Mountain.Jabba and his mom taking a break after a long climb.Jabba in the car on the way back home.All tuckered out!
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.
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).
