Seamus the Wonder Dog: Hope on Three Legs
On New Year’s Day 2017 we loaded our three dogs into the car to go for a walk in Garden of the Gods, near where we live in Colorado Springs. Later that evening our golden retriever began to limp and favor his right hind leg. I suspected he may have injured it getting out of our SUV and hoped he would feel better after a good night’s rest.
Luckily our vet, Dr. Ricia Walker [CSU DVM], was able to see him the next day. After physical examination she suspected he had torn his cruciate and put Seamus on Prednisone and Tramadol. If it turned out to be a minor injury, this course of treatment along with absolutely no exercise for two weeks, should help him feel better. If he didn’t improve, she’d send us to an orthopedic veterinarian.
Two weeks later we found ourselves at the orthopedist where Seamus was examined and imaged. Dr. Lee Wilwerding walked into the room with a grave look on his face and uttered the fateful words, “I’m afraid that Seamus does not have a torn cruciate. Let me show you what is going on.” He pointed to a mass in Seamus’s tibia, continuing, “I suspect this is osteosarcoma, which is very painful, and because it is in the bone, cancer cells are being shed and transported around the body. At the very least, Seamus will need to have his leg amputated.”
It felt like we were hit with a sledgehammer.
“We went home, and I did what I do best when feeling overwhelmed. First I cried, and then I did some research. ”
He told us to go home and think about it but not for long. He told us he had done the surgery numerous times and that dogs were incredibly resilient, and if there was a bright side, losing a back leg is a little easier than a front leg because of the distribution of weight.
We went home, and I did what I do best when feeling overwhelmed. First I cried, and then I did some research. Dr. Walker had complete confidence in Dr. Wilwerding, but she was also a graduate of CSU and suggested that as an alternative, even though it was two hours away in Fort Collins, we consider taking him there for a definitive opinion. The second phone call I made was to my dear friend, Barb Rose, who works, ironically and fortunately, as a research associate in oncology at the CSU Flint Animal Cancer Center. I had met Barb years ago through a neighbor when I lived in Berthoud. Barb moonlighted as an overnight petsitter and as such she knew all our animals well. She was a trusted resource.
Barb informed me that our timing was good, if there was such a thing, because there were two cancer trials in progress. Working with the clinical trial nurse, Kara Hall, we received comparative details on the two different trials. One week later on January 31, 2017, we met with oncology resident Dr. Brendan Boostrom to have Seamus examined for amputation and trial eligibility. Based on our meeting, we preferred one trial (the COXEN trial of Drs. Daniel Gustafson, Douglas Thamm, and Kristen Weishaar) over another because to us novices it seemed more promising, and it was especially appealing that participating in a trial would benefit both human and veterinary medicine.
“Cancer is a sobering leveler. As soon as the C word is spoken, one begins the grieving process even while our precious pets are still with us.”
Seamus was scheduled for amputation just two days later. It was explained that cancer tissue would be typed to determine sensitivity and resistance to two chemotherapies, carboplatin and doxorubicin. Based on the result, he would get one or the other or both in alternation. “This trial uses genetic expression analysis on osteosarcoma tumors to predict their most effective chemotherapy drug(s).”
Along with all the other daunting fine print, Dr. Boostrom further explained that generally 20 percent of dogs survive beyond one year.
Cancer is a sobering leveler. As soon as the C word is spoken, one begins the grieving process even while our precious pets are still with us. Loving them as we do, we strive not to be greedy; we strive to know them best and to do the right thing. When given this news, we don’t think years ahead, we think instead in smaller increments “I want Seamus to be in that 20 percent who make it beyond a year.” How wonderful it would be to hang Seamus’s stocking on the mantle at Christmastime…
Dr. Walker was cautiously optimistic about us entering the trial, and she gave us “permission” to always put Seamus first should he not tolerate the therapy.
Don’t get too far out ahead. One thing at a time.
Seamus returned to CSU on February 2, 2017, to have his leg amputated. Fortunately there was no evidence of metastasis anywhere else and his blood work was “unremarkable.” I lingered with him in the waiting room feeling the heavy burden of decision. Who are we doing this for, you or us, Seamus?
Seamus was an estimated 11 years old at this time; I had him for seven of those years, having adopted him from Golden Retriever Rescue of the Rockies. Seamus (then “Buddy”) was one of eight dogs we were to meet that fateful day, but Seamus turned out to be the first and only. When we took him for a trial walk, we walked him back to our car to meet our fussy English setter, Charlie, who was waiting there to meet him. Our dog, Kira, had died just three months earlier and Charlie had been lonely being an only dog. Seamus immediately jumped right into the back of the car, with Charlie not protesting at all, and that was that. Seamus chose us. We learned that he had been abandoned out in the wilderness near Cañon City, his previous owner located and relinquishing. Understandably, Seamus came with abandonment issues and needed much reassurance.
One year later, the tables turned, and Seamus rescued me when I had fallen on ice in our driveway in the dark and in just 17 degrees. Seamus and I had walked out to the road to pick up mail when I fell and was knocked out, concussed. When I came to, Seamus was curled up by my side, keeping me warm. Unable to walk because the stars were swirling like Van Gogh’s Starry Starry Night, Seamus let me crawl holding onto his back so that I could make it inside to call 911, our bond forever sealed. I would do for him whatever he needed, his loyalty and concern repaid.
Seamus made it through amputation surgery performed by Dr. Ruth Rose and a team of gifted clinicians, fellows, residents, and students. Just one day later, he was ready for discharge. The team went over instructions for medication, wound cleanliness, and physical therapy, some of which we would do on our own at home, and some of which we would have done at the orthopedic practice first visited in Colorado Springs.
“Prognosis: Median survival time with amputation and chemotherapy is one year.
Follow-up Plan: Once his tumor sequencing is back in two to three weeks Seamus will have his suture removal and chemotherapy recheck with CSU Clinical Trials.”
To the marvel of all the witnesses in the waiting room, Seamus literally pulled me out of the hospital on three legs just one day after amputation! Zoom! Any second-guessing of the decision to amputate was immediately laid to rest.
Seamus’s recovery was clinically “unremarkable” but truly inspiring for everyone else around him. In spite of the worry over wound cleanliness (easily remedied by a t-shirt worn backward from hind end toward front and pinned relatively tight around the chest), he settled into a routine of healing and regaining his strength, aided by temporary pharmaceuticals to manage pain.
About three weeks later, on February 21, 2017, Seamus returned to CSU to begin chemotherapy and was assigned to the doxorubicin/carboplatin alternating protocol. His CBC was unremarkable and he received his first doxorubicin without complication. Dr. Walker in Colorado Springs performed a CBC one week later (as she would come to do routinely after chemotherapy to save us a trip to Fort Collins) to see if his blood count was in normal range. With no further problems, Seamus would return to CSU in three weeks for his first carboplatin chemotherapy.
“Seamus’s recovery was clinically “unremarkable” but truly inspiring for everyone else around him.”
By early April, Seamus was not on any medications.
“Assessment: Seamus continues to do great while undergoing chemotherapy. He looks good on physical exam today. CBC was unremarkable and adequate for chemotherapy. He received his 2nd dose of doxorubicin IV without incident.”
By the end of April:
“Assessment: Seamus continues to do great while undergoing chemotherapy. He looks good on physical exam today. Thoracic radiographs showed no evidence of metastasis. CBC was unremarkable and adequate for chemotherapy. He received his 2nd dose of carboplatin IV without incident.”
By May: “The owners have no concerns, as Seamus has had normal energy and appetite. He has not had any vomiting or diarrhea. He is not on any medications.”
And so it went, alternating doxorubicin and carboplatin for a total of six treatments until June 5, when he graduated from chemotherapy, going home with a bright green bandana as a badge of honor.
Recheck upon recheck, unremarkable was the word we longed to hear, and that we did on July 31, September 25, November 20, and January 8. Unremarkable blood work and clear X-rays. The lungs, we were told, are prime targets for metastasis. We were now around the one-year survival mark; we had made it to and beyond Christmas with his stocking hung by the chimney with care, and his life has been shockingly good. Whenever we mention the “W” word, Seamus is the first to the door, begging to go for a walk with his pals. Believers in acupuncture for both humans and pets, we sought local acupuncture to help Seamus with general wellness and any muscle tightness in his back that he might experience from compensating for a missing leg. He has been a regular patient of Dr. Dani Waite’s [CSU DVM] at Powers Pet Rehab in Colorado Springs. It is certainly one of the reasons why Seamus’s energy has been good and he continues to be playful, goofy, loving, and happy. Love and companionship from his pack of two other dogs and two cats have no doubt played a key role in his joie de vivre. He and his kitty pal, Kaboodle, have developed the most awe-inspiring inter-species relationship of love and companionship. Wherever Seamus is, Kaboodle is sure to follow. Their cuddling configurations have been the inspiration for countless photos.
But on March 5, when Seamus returned to CSU for his regular every-eight-week recheck as part of the trial, Dr. Amber Wolf-Ringwall upon physical examination found a small mass in the soft palate area of Seamus’s throat. Since I had fed him earlier that morning, putting him under full anesthesia to remove it was not an option, but Dr. Bernard Seguin of the surgical oncology team was consulted and excisional biopsy of the mass was elected to “debulk” it and send a biopsy off to pathology.
Seamus returned home and we awaited news, this time dreaded. Dr. Wolf-Ringwall called to tell us that preliminary histopathology of Seamus' oral mass confirmed a diagnosis of oral melanoma, incompletely excised. Initial results were presented to Dr. Seguin and the Radiation Oncology team (Dr. Benoit Clerc-Renaud), and we were given the following options to consider:
· Additional surgery with the goal of complete excision
· Intense and targeted radiation therapy
· Palliative radiation to decrease the size of the mass
Melanoma is not responsive to chemotherapy and though there is an immunotherapy option in the form of a vaccine, CSU doesn’t offer it and it has only a 30 percent success rate.
The Oncology Clinical Trials team (Drs. Weishaar and Thamm) were briefed on the finding of an oral melanoma, and we were then told that we could continue with chest x-rays every two months on the COXEN trial, as long as we agreed to a necropsy upon his death. Seamus already had a high likelihood of death from cancer, but without a necropsy it would be impossible to know whether it was osteosarcoma or melanoma metastasis.
Of all the information presented, I was most unprepared to hear about necropsy. He was still very much alive, and even for the sake of science, I just couldn’t imagine our pal in a lab, not to mention how we would muster the gut-wrenching final drive from Colorado Springs to Fort Collins with him in the back of our car. The cost of periodic x-rays that had been a covered expense as part of the trial was inconsequential to us now. Right now we had a more immediate problem, what do to about this melanoma.
After having a conversation with Dr. Seguin, we felt reasonably assured that removing the melanoma surgically was the best way to go. I had reservations about putting him through radiation and I wasn’t resigned to just giving into the cancer and letting it grow unchecked, not if we could do something about it. Once we received the histopathology on the tumor and learned that it was unfortunately a very aggressive type, we proceeded with surgery. He returned for surgical removal on March 22, and was put under anesthesia, only to find that in just two weeks, a mere matter of days, the tumor had grown significantly since biopsy, and was found to be wrapping around his jaw. Moreover, it was no longer freely movable and appeared to be fixed to the underlying bone. Given these changes, surgery to remove the mass would also require the removal of part of his jaw. We decided that we would draw the line at that and asked them to send Seamus home with us, where we would opt to keep him comfortable for his remaining days.
By now Seamus had amassed an entourage of clinicians and students rooting for him because he has the most indomitable and affectionate spirit. Everyone who knows him loves him. We proudly call him Seamus the Wonder Dog because he is one of the lucky ones who, given his circumstances, has surpassed life expectancy. I can’t possibly name all of the special people who have been a part of his journey, sharing their gifts of knowledge and craft paired with genuine care for the animals in their charge. One day when I was leaving the hospital with him, a veterinarian was walking across the parking lot, and she called out, “Is that Seamus?” I had no idea who she was, but she knew him, and proceeded to tell me how he had quite the fan club. I can’t help but feel that all animals seen at CSU have a fan club. I have witnessed so many stories of resilience, love, and human-animal bonding in that waiting room, and I have witnessed many miracles of reunion and acts of human kindness, including the sweet volunteers who break the sometimes long hours of tense waiting and worrying with an offer of coffee, tea, or the mother of all elixirs, M&Ms. On several occasions I was offered a quiet meeting room or an unoccupied office so that I could do my work while waiting.
After Seamus returned from unsuccessful, incomplete surgery to remove the melanoma, our hearts were so heavy over what seemed to be the end of the road. To come this far with osteosarcoma only to get melanoma; it just wasn’t fair for a dog so loving and so loved. After a sleepless night, I made the call the next day. I wanted to try a remaining option, that of the 0, 7, 21 palliative radiation protocol, in hopes that we could shrink the tumor or keep it from growing and interfering with eating. If he tolerated the first treatment (Day 0), we’d proceed with the second (Day 7), etc. Since he was such a rock star during chemotherapy for osteosarcoma, why not give radiation a try.
“Thank you for bringing Seamus in to see us today! He is such a sweet boy and appears to be friends with just about everyone in the hospital. He received his [second] radiation therapy without any issues. His mass does not appear to have changed much compared to last week. With some masses, we suspect that they may have been much larger without radiation therapy and with others it takes a couple of doses of radiation before we see a change in size. Seamus is scheduled for his final fraction of palliative radiation therapy on April 17th.”
His CBC, chemistry panel, and chest x-rays were unremarkable. After the third radiation treatment was completed, Seamus donned a new bright red bandana signifying his graduation from radiation treatment, but unfortunately, about one week later became as sick as we’d ever seen him, and not because of the melanoma itself. He developed a nasty infection in his mouth at the radiation site and couldn’t eat. Not even Gerber chicken baby food could nudge him. When your dog won’t eat the irresistible, you know it’s bad. I brought him to his primary vet, Dr. Walker, who gave him subcutaneous fluids and injection of antibiotics two days in a row. And on the third day, he literally rose again and began to eat pureed food and antibiotic pill powder made into a slurry and squirted into his mouth via syringe. He miraculously rebounded with the aggressive antibiotic treatment. Dr. Walker supplemented with probiotics and also told me to pick up some CBD oil to give to him daily. After locating some without THC, I brought the vial back to her clinic so that she could adequately dose him per weight.
On May 14, my spouse, Tim Burke, who had alternated with me the many trips to Fort Collins from Colorado Springs over the last 17 months, returned to CSU for a post-radiation check, and texted me this ecstatic, profanity-laden message while I was at work (with apologies in advance):
“Holy F***ing S***! NO EVIDENCE OF ANY REMAINING TUMOR in the mouth. Small hole in his jaw where tumor was, X-Rays: CLEAR! No need to refill antibiotics. Recommend antibacterial mouth rinse. Giving pain block injection for multiple days of pain relief in jaw. Otherwise: ‘He’s doing great!’”
This was truly a miracle! Seamus must have a swarm of angels looking out for him!
We’ve had insensitive people tell us what they would have done if Seamus were their dog and they received the diagnosis of osteosarcoma. One neighbor would have put him down on the spot; another friend would have taped up his leg in a splint, spoiled him for two weeks and then put him down. Fortunately, Seamus isn’t their dog. People reading this might think we were excessive; only Tim’s and my opinion count because we see him every day and know his quality of life. The ratio of good days to bad has been absurdly positive considering all he has been through. I wavered twice through this entire journey, once when we learned that his melanoma had been so aggressive that it was inoperable, and then when he was fighting that nasty infection and gave up on eating. If he hadn’t responded to antibiotics, we would have had to consider that a sign of suffering, which we would not tolerate for the pal we love so much.
Seamus didn’t give up on me on that cold, icy night back in January of 2012, and I’m going to remain his most vocal cheerleader a dog could ever have. When a dog embodies the ideals of hope, resilience, and gratitude and is the centrifugal force of a family, every day with him in it is indeed a very good day.
With profound gratitude to the entire CSU Flint Animal Cancer Center Clinical Trials, Oncology, and Radiation teams; our dear friend Barb Rose; Dr. Ricia Walker of Pets First Animal Hospital in Colorado Springs; and Dr. Dani Waite at Powers Pet Rehab in Colorado Springs for physical therapy and acupuncture. You’re all angels for those of us who need our animal friends to make us better humans.
Feel free to share your own experience with your special four-legged friend.
