Joshua’s story: taking pain seriously

Joshua, a sweet 3 year old Beagle, had been seen by 3 different family vets to find the source of his pain.

His owner described bizarre signs: trouble wagging and lifting his tail; difficulty urinating and defecating.

Joshua would occasionally chew at his back leg. “Because he was in pain” his owner thought. But nobody would take her seriously.

Overall, the condition seemed to get worse with time, despite several medication trials.

Beagles are prone to slipped discs, but Joshua did not fit the picture. His neurological exam was totally normal except for pain in the lower spine.

That’s when I met Joshua. His physical exam was normal, except that he had mild and consistent pain in his lower spine. Stretching his tail over his back would also cause pain. There were no other significant findings.

I wanted to take Joshua’s pain seriously, so I had a heart-to-heart with his owner. There was clearly something wrong with Joshua. An MRI was the next logical step… and a big leap of faith. His owner consented to it.

The MRI report described that young Joshua (again, a 3 year old) had a mass, most likely a tumor, in his lower spine (between lumbar vertebrae L5 and L6). Even worse, the tumor seemed to be attached to his spinal cord.

Because she really wanted to help her dog, Joshua’s owner elected surgery. We found exactly what the MRI report had described.

The tumor, which was almost 1 inch in length, could not be completely removed.

WARNING: THE NEXT PICTURE IS GRAPHIC !!!

Therefore, we carefully took 3 biopsies of the mass, which in effect, decreased the size of the tumor by two thirds. So we “debulked”‘ the mass, i.e. we removed the bulk of it.

Removing more tumor would have put Joshua’s ability to walk in serious jeopardy.

Spinal surgery is very delicate, so we typically expect worsening of the signs initially. Miraculously, just a few hours after surgery, Joshua stood up and walked! He went home a couple of days after surgery.

One week after surgery, the biopsy came back: Joshua had a bizarre type of cancer called chondrosarcoma, which is an aggressive cancer of cartilage. Luckily, it was slow-growing, or “low grade.”

Two weeks after surgery, Joshua came back to the clinic for staple removal.

His owner was thrilled by his progress, since he had no sign of pain anymore. He was now able to lift and wag his tail. His neurological exam was completely normal. The only concern was occasional fecal incontinence, which we are trying to control with a special diet.

Beyond surgery, there is no good treatment for a “low-grade” chondrosarcoma of the spinal cord. Neither chemotherapy nor radiation therapy is a good option. However, Joshua might benefit from low doses of cortisone.

As your pet’s best advocate, you need to keep pushing until you get the answers you and our pets deserve. If you are not satisfied with the answers you’re getting, you owe it to them to ask more questions, to demand better answers, and, if needed, to be referred to a specialist.

As I always say, “pain is not acceptable.” We have multiple ways to decrease pain, which may or may not involve medications.

Joshua is a perfect example of this philosophy: his owner kept pushing until she found somebody who took her seriously.

This may seem to be a sad story, and it certainly is in a way. But Joshua’s owner and I would rather look at the glass half full: he is currently pain-free and happy, and his owner enjoys her pain-free dog… one day at a time.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Cartier and the giant surprise…

Cartier, a 12 year old, 10 pound Shih Tzu, was originally seen by her family vet for a walnut-sized mass on the right side of her chest. It looked like a simple skin mass.

But she soon developed some rather troubling symptoms that had her owners seriously worried. She became lethargic, had difficulty breathing, and even passed out on occasion. What was happening?

Cartier was taken back to her family vet, where X-rays and blood were taken to find out what was going on. The blood work was normal, but shockingly, X-rays revealed that Cartier’s skin mass extended deep into her chest. It was so large, that it crossed to the other side of the chest!

The X-ray below shows the skin mass (green arrow), the chest mass (red arrow) and the heart (blue arrow).

A cat scan of the chest was then performed to better understand what was going on inside the chest, and to make sure the mass had not spread anywhere. There was only one mass (between the colored arrows) but it was almost three times the size of her heart! This explained her symptoms. The only option to help Cartier was to remove the mass.

So I was called in to perform the surgery. On X-rays and on the cat scan, the mass appeared to involve a single rib, but that meant that several ribs would have to be removed in order to successfully remove the mass.

A total of 3 ribs had to be removed, along with the mass, without damaging the heart, the lungs, or any other vital structure. And remember, Cartier only weighed 10 lbs…

By the time we got done, the defect in the chest wall was so big, that it was not possible to put the remaining ribs back together. So the defect was reconstructed with nylon mesh in order to close the chest cavity.

Next, air from her chest had to be removed to allow her to breathe on her own once anesthesia was over. So we used a special plastic drain called a chest tube. Surgery was delicate, but it went well and Cartier bounced back remarkably quickly for an older lady. This is a video of her, walking around the day after surgery (chest tube still in place).

 

The chest tube was removed a few days after surgery and she went home safely.

The mass was sent to the lab to be biopsied. One week later, the results came back as bone cancer (osteosarcoma). This was one of the 2 most likely diagnoses. The other most likely possibility was cartilage cancer (chondrosarcoma).

One month after surgery, Cartier’s owners were happy to report that she had more energy, ran around, had bright eyes, and seemed to be back to normal. Her personality had come back, she had a hop in her step, seemed much more comfortable and no longer struggled to breathe.

Twelve year old Cartier now had a new lease on life.

Her owners said: “we couldn’t have asked for better results.”

Addendum:

I am thrilled to report that as of July 2019, Cartier, the now 13 year old, is still doing well.

This is 7 months after surgery.

 

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified