Musings of a Veterinarian

Archive for March 17th, 2010

Out on a Limb: The Difficult Decision to Amputate

March 17, 2010 By: Dr. K Category: Opinion

A few weeks back I highlighted my current case of a 6 year old golden retriever, Goldie Hawn, who I diagnosed with bone cancer in her femur. Her x-rays were pretty convincing for cancer and I performed biopsies. Bone biopsies can result in inconclusive answers a third of the time. Sure enough, the bone biopsies came back as “new periosteal and endosteal growth and proliferation.” In other words, not completely normal but the pathologist could not call it cancer. This is a very frustrating situation for veterinarian and owner alike.

X-rays on 2 different dates showed a progressive lesion. The scenario went as follows: We had a highly suspicious lesion in the distal femur, one I was was convinced was a particularly aggressive form of cancer called osteosarcoma. We could rebiopsy, but the chances of getting a diagnoses were no greater than the first biopsy. We could send Goldie to a specialist who would evaluate her x-rays and most likely recommend biopsies. We could repeat x-rays in a couple of weeks to see if the lesion had progressed. And finally, we could amputate the limb in hopes to catch the cancer early prior to its spread to the lungs.

It was an agonizing decision for both the owner and me. The owner knew waiting on a potential aggressive tumor could mean the difference between life or death. However, without a definitive biopsy there was a very real possibility we would amputate a leg that didn’t have cancer. We walked through the surgery and options at least three times leading up to the decision. I reradiographed the limb one more time, saw even more changes in the femur, and the owner very nervously elected amputation.

The permanency of amputation gives me agita. I thought about the surgery in the weeks leading to it, the night after, and the waiting period for biopsy results. Goldie’s case kept me up multiple nights. My biggest fear was getting back an inconclusive biopsy report and having nothing to show her owner. After a three week wait on pathology results, we got our diagnosis of very early osteosarcoma. I was relieved then saddened with the diagnosis.

This case reminds me medicine is a process that doesn’t have all the answers. As much as we want it to, disease doesn’t always follow the textbook. I frequently tell my clients that just because it looks like a duck doesn’t mean it quacks. Sometimes we’ve gotta put a little faith in our instincts and other times take that educated guess.