Ruby Soho's (Greyhound) Osteosarcoma Journey

In June 2021, our beloved (then six-year-old) greyhound was diagnosed with osteosarcoma. In May, my partner and I were on the road for a week and some friends kept Ruby for us. When we picked her up, she was limping a bit. We thought she hurt her leg while playing with our friends' greyhound, but the limp didn't go away and started to get worse. We took her to the vet and the vet thought she had a soft tissue injury. We were instructed to limit her exercise so the injury could heal. 

A couple weeks later, she was out in the front yard and took off running (she was probably energetic from not being able to exercise much). She stopped in the neighbor's yard and starting screaming and crying and my partner had to carry her inside. We called the vet and she said Ruby probably reinjured the leg, so we made an appointment to get it checked out. After taking more x-rays, the vet called and said she noticed slight changes between the previous x-ray and this one, but it was probably nothing to be concerned about. 

Ruby continued to limp and we had more follow-up x-rays done a couple weeks later. While my partner and I were out running errands, the vet called and said there were more changes to the bone and it was most likely osteosarcoma - bone cancer. Ruby is our first greyhound (we've had her for five years), but we had been part of the greyhound community long enough to know how common osteosarcoma is, and we hadn't heard many stories of positive outcomes. We were devastated.

The vet referred us to the University of Illinois Veterinary Teaching Hospital (3.5 hours away). She said they were doing an osteosarcoma clinical trial there and that we could try to get Ruby accepted. She had to meet certain criteria, so we weren't sure if it would work out, but we wanted to give Ruby the best possible chance at quality of life and long-term survival. We were connected with the clinical trial team and they wanted Ruby to be on two different medications (a pain medication and an anti-inflammatory) for two weeks before they would evaluate her for the trial. Osteosarcoma is aggressive and spreads fast, so we needed to do all of this as quickly as possible. Our vet's office didn't have the medications on hand, so we had to wait for them to be ordered. When they came in, we were traveling for my partner's job and a friend picked up the meds for us and started giving them to Ruby. As soon as she started the meds, we called and made an appointment for her to be evaluated for the trial at the University of Illinois.

It ended up being about three weeks between when she started the meds and when we were able to get an appointment. We were very nervous because we weren't sure if she would even be accepted to the trial (for example, she needed to have a visible limp but still had to be putting weight on the limb, and sometimes she would put weight on it and sometimes she wouldn't). We took Ruby to her first appointment and she was fortunately accepted to the trial. The goal of the treatment was to spare the limb while stopping the growth and spread of cancer, and in past cases, the treatment had shown success. We left Ruby at the University of Illinois for a week so she could receive her first treatment; the staff there is amazing and called us every day with updates. When we went to pick Ruby up, we noticed she had lost weight while in the hospital because of the treatment and refusing to eat (she also had severe diarrhea as a side effect of the treatment), and it was a struggle to get her weight back up. We went to a local natural pet food store in town and got her some freeze-dried raw food and raw milk (mixed with a bit of kibble) and she was finally willing to eat. Medication (metronidazole) helped with the diarrhea. 

We took her back for a checkup and everything looked good. She was getting some of her energy back and seemed like she was in less pain, plus there were some days where she would run and/or not limp at all. Her next appointment was for treatment and, as usual, we got up early to take her (her appointments were typically at 8:30 a.m., so we would have to leave the house around 4:45 a.m.). Ruby was fine when we left the house, but when we stopped for a bathroom break right outside of Champaign, IL, she wouldn't put any weight on the leg. Her oncologist was obviously concerned and decided to do some x-rays before proceeding with treatment. 

Unfortunately, the x-rays showed that, at some point during our trip, Ruby fractured her leg at the tumor site. This disqualified her from the clinical trial and, because osteosarcoma erodes the bone, there was no chance of the limb ever healing. Our only option was to amputate and start chemotherapy. We were devastated all over again and had to leave Ruby at the hospital for surgery and recovery. It was awful to drive back home without her, and choosing amputation was one of the hardest decisions we've ever had to make. Even with amputation and chemotherapy, the "average survival time [for dogs with osteosarcoma is] just a little less than one year with 20% of dogs still enjoying a good quality of life two years after surgery" (Davies). We didn't want to take away Ruby's quality of life or make her remaining time be painful, but we also wanted to give her the best possible chance to beat the disease. Ruby's surgeon said that "dogs are born with three legs and a spare" and assured us that they do quite well with three legs, so we moved forward with the amputation.

We weren't sure what to expect when we went to pick Ruby up after her surgery and recovery. The most shocking part was probably the surgical scar; because they removed Ruby's front left shoulder and limb, the scar was quite long. In addition, much of her hair was shaved and she was purple all over. She also had seromas (areas where fluid has built up after surgery) which, along with the scar, made it difficult to use the harness the vet gave us to help her get around (it had a padded section that went under her chest and handles for us to hold as she walked alongside us). We were so nervous walking with her at first and we weren't sure how to get her in the car to go home, but she jumped right in all by herself. Ruby is a trooper.

The first two weeks of Ruby's recovery at home were rough. Here are the parts that stand out the most (and some advice if you are going through this with your greyhound):

• Because Ruby was in the hospital and received lots of fluids, she had to potty A LOT right after we picked her up. Since they are supposed to rest and it's difficult to get them outside post-surgery, make sure they fully empty their bladders when outside. 
• Ruby is unique in that she doesn't mind taking medicine; we were able to successfully give her all her meds with just a little peanut butter. 
• We have hardwood floors at our house and Ruby had a difficult time with the slippery floors when she first came home. We took all the rugs in our house and arranged them so she always had a carpeted area to walk on. She did much better with the hardwood floors after a couple months. 
• Ruby's surgeon told us to limit Ruby's activity for the first two weeks post-surgery. She was only supposed to get up for potty breaks and to get water. Because of this, we created what we called "Camp Grey" in our living room. We put down rugs and Ruby's favorite beds with lots of pillows and blankets and then blocked off the room so she could only move around in the living room. We also moved her water and food bowls in, although I would sit on her bed with her and feed her when it was lunch or dinner time. Someone was with Ruby at all times for the first two weeks of her recovery. 
• Ruby experienced what we called "phantom limb pain." Sometimes she would start screaming out of nowhere (often in the middle of the night) and other times she would drink water or cough and start screaming. It was very sad to witness, but I think she was mostly surprised and just trying to get used to her new body. She would usually calm down after a quick cuddle or some pets. It's important to keep up with the pain medication regimen prescribed by the vet (Ruby took gabapentin for pain).
• The medication prescribed to keep Ruby calm (trazodone) knocked her out. She was so tired from the meds that we couldn't get her up to go outside. We only gave her these meds for a couple days before stopping because we were struggling to get her up and outside for potty breaks.
• Ruby enjoys a strict routine and wanted to stick to it even after coming home from the hospital. This meant she would only potty in certain areas - the very back of our large backyard or in the field across the street from our house. She refused to go potty anywhere else, so the potty routine was very difficult. We have some front steps leading up to our house and we had to pick her up to take her down the stairs. This took two people to accomplish - one to use the harness to hoist her and the other to actually pick her up. One of us would then walk with her using the harness as she found a place to potty. This would sometimes take 20-25 minutes and she was exhausted by the time we got back inside. Ruby is stubborn and we had to adhere to her routine because it was so difficult getting her in and out of the house; we weren't going to come back in unless she went potty, and that required us going to her favorite spots. 
• Ruby was constantly trying to lick her surgical wound. The vet sent her home with a "reverse" cone (that went back toward her body rather than toward her head), but it was rubbing her incision and it was impossible for her to move around or lie down comfortably. I ended up going to Goodwill and buying a couple boy's small t-shirts for her to wear so that her wound was covered and protected and so she couldn't lick (I had to use a rubber band to hold up the back because the shirts were too big, and I had to make the necks smaller so they wouldn't slide down and expose her incision). Despite this, she did try to lick her incision through the shirt after about three weeks. We had to buy bitter spray to put on the shirt, but even that didn't always keep her from licking, so we had to keep a close eye on her. 
• This might seem silly, but a friend at a greyhound organization reminded us over and over that Ruby was still the same Ruby and to treat her like nothing had changed. Another friend who is a physical therapist told us that the only way Ruby would get used to her new body was to try things for herself, fall, adjust, etc. We tried to let her experiment as much as we (safely) could so she could adapt to three-legged life as quickly as possible. 

Ruby Soho on her seventh birthday in August 2021! When she was first diagnosed, we weren't sure she was going to make it to her next birthday, so she was spoiled extra. She is about two weeks post-amputation here and is wearing one of the Goodwill t-shirts I bought for her.

Ruby's post-surgery plan was to receive four rounds of chemotherapy (one round once a month for four months). One week after the surgery, we took Ruby back to the University of Illinois for her first chemotherapy treatment. Dogs actually tolerate chemotherapy quite well, and after her first treatment, she just experienced a bit of fatigue and some diarrhea. Before her next chemo treatment (a month later), we took Ruby to our local vet for a CBC and everything came back normal, so we took her to the University of Illinois for chemo. Unfortunately, she had a UTI and couldn't receive chemo, so they sent her home with antibiotics and we went back a week later. She was able to receive the chemo then, but she was still battling the UTI. Before her next chemo a month later, we had our local vet do a CBC and check her urine and both came back normal, so we took Ruby to the University of Illinois for chemo. At that visit, they found that the UTI had returned (even after antibiotics), so she was not able to receive the treatment and we were sent home with more antibiotics. They gave her stronger antibiotics for a longer period of time, and that did knock out the infection, but the vet was trying to figure out why the infection kept returning. The vet eventually determined that the problem was with Ruby's incontinence issue (a problem she's had since we adopted her); she takes medication (DES) for this issue once a week, but the vet figured out that the small dosage wasn't enough, so we bumped her up to two times a week (and she stopped getting UTIs). Ruby was able to get her third round of chemo in October 2021, and we took her back for her final round right before Thanksgiving.

We took a trip to celebrate our ninth wedding anniversary in October and, of course, brought Ruby with us. Here she is going on a walk at the University of Kentucky in an old harness that no longer fits very well (see below for information about the new harness we got for her).

At her appointment for the final round of chemo, the vet took scans of Ruby's chest to check for any signs of spread. We were very nervous for this appointment since we know how aggressive osteosarcoma is (and how quickly the disease can spread), but we were so relieved to hear that her scans came back clear. Her care team brought her out after her appointment and everyone was celebrating, plus she had an adorable orange bandana that said, "The Cancer Care Clinic at Illinois LOVES Me." (The last chemo treatment was the hardest for Ruby, and it took her a few days to bounce back from the fatigue she experienced). We met with the vet and she reminded us that even though Ruby is in remission now, the cancer could come back. They consider osteosarcoma to be a terminal illness, and the goal with amputation and chemo is to extend life as long as (comfortably) possible. If we had done nothing after Ruby's diagnosis, she probably wouldn't have made it past two months. With the treatments she had, the average extension of life is 8-12 months. However, we are hoping and praying hard that Ruby has beat this disease for good. We took her back for a follow-up right before Christmas and her scans were still clean. She goes back for another checkup and re-scan at the beginning of February. No matter what happens, we are just glad to have more time with our best girl. 

Ruby wearing her University of Illinois bandana right after her last chemo treatment where we found out her cancer is in remission!

Ruby (impatiently) waiting to see the vet at her most recent checkup at the University of Illinois (wearing her new, better-fitting harness).

Here are a few things we noticed in the weeks following Ruby's amputation and chemo (plus a few pointers if your greyhound had a front leg amputation due to osteosarcoma):

• It took forever for Ruby's hair to grow back after she was shaved for surgery. We started wondering if it would ever come back, and it eventually did, but it took almost four full months to fill back in completely. 
• Dogs really do adapt well to having only three legs. We were amazed by how quickly Ruby got back to her favorite activities. She digs huge holes (with only one front leg!), runs like a champ, and jumps and plays with her toys. She really doesn't have any trouble getting around, and she can still run very fast.
• That being said, Ruby doesn't go on walks like she used to. First, her gait has changed and she does much better with a faster pace (or a trot, as we call it). When walking her on the leash, we have to hustle a bit to keep up with the pace that is comfortable for her (we've talked about getting a longer leash, as well). She also becomes tired more quickly with only three legs, so our walks are much shorter. The harness we got for her when we first adopted her doesn't work anymore (with the leg missing, it's too big and slides down over her head when she leans over). This is the harness we ended up getting for Ruby post-surgery; it stays in place and has a handle so we can help her on the stairs or on slippery surfaces. We love it so far.
• As any greyhound owner knows, greyhounds need sweaters and coats for cold weather. We have a few lighter sweaters for Ruby and a winter coat, and none of them fit her very well anymore. With the shoulder and leg missing, she's much flatter on that side and all her sweaters and coats slide to the left and we are constantly adjusting them. If we order new ones, we will need to go down a size (I could also alter the sweaters we already have so they fit better, but I haven't tried that yet).
• Ruby's appetite didn't really go back to normal. After she started the clinical trial, we tried several new things to get her to eat so her weight would go back up. After she gained a bit of weight, we couldn't go back to just kibble (with a bit of water/broth) because she refused to eat it. In addition, we were warned about having too many carbs in her diet since, as the vet told us, "cancer feeds on carbs." As a result, we switched Ruby to a mostly whole food diet. She eats a meal around noon and then again at 5:00 p.m. and we mix a little bit of kibble with some wet food. We use this kibble from Fromm (although we rotate the protein, so we alternate between pork, fish, and chicken) and we mix in this wet food from Open Farm (and we also rotate the protein between beef and chicken, although she definitely prefers the beef). We also add Ultra Oil to her lunch and put a little pumpkin puree in her dinner. With this diet, she is back to eating like she did pre-cancer (and we feel good about what we're feeding her). 

This osteosarcoma experience has been incredibly difficult. The most difficult part was making the decision to amputate, and I was so worried we were making the wrong choice. Ruby is now five months post-amputation and we are so glad we chose that route. First, we didn't realize how much pain she was in when she still had the leg with the tumor. After the surgery, it was clear she was finally pain-free and was able to get back to running and playing like she did before the cancer. Second, the amputation hasn't impacted her mobility like we thought it would. If you are going through this with your greyhound, just know how adaptable they are. As sad as you will be, and as difficult as the situation will be, you will make the choice you know is best for your dog. 

The other thing I want to mention is pet insurance. Without our pet insurance policy, this situation would have been even more taxing (and I'm not sure we would have been able to make the same treatment choices). We have a policy through Healthy Paws and they have been excellent. Because of Ruby's age, we pay around $60 a month for the policy, but we have a $250 deductible and the insurance plan covers 80% of care costs. Up to this point, Ruby's treatment has cost around $14,000, so we are incredibly grateful for the insurance.

If you have a greyhound (or any dog) that has been diagnosed with osteosarcoma and you have questions or concerns, please don't hesitate to reach out through this site or through social media (see the Pages tab). It's a tough road, but you (and your dog) will get through this!

Ruby Soho has an Instagram page where we post frequent updates; if you want to stay up-to-date on her journey (or check out old posts), follow this link!