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Thabiso’s mom, Allison Smith, shared their story after Thabiso was diagnosed with osteosarcoma.
Thabiso’s first neuro checkup appointment
Thabiso was a rescue lab, we adopted him when he was three and a half and he had so many health issues over the years. He had developed a neurological disease and it greatly impacted his hind limbs. He was at a neuro recheck appointment and the neuro said that he was limping a little on his front leg but it was barely noticeable. I couldn't even detect the limp, it was that slight. This was on a Wednesday and by the weekend, he was barely weight-bearing and the neuro had just assumed that it was a progression of the neuro disease.
It wasn't even on his radar to do any further testing or anything else.
Watch the video of interview here: https://www.youtube.com/watch?v=vKt2u-Gkv4U&t=1166s
In search for the correct diagnosis
On Monday, he had an appointment with his acupuncture vet and she's certified in rehab as well.
She did a thorough exam and it became clearly obvious that his pain was coming from his proximal humerus, and I suspected already because of how rapid the change was — I suspected it was bone cancer.
Of course, she just didn't say anything. I said, “Are you going to tell me?” and she said, “What if I don't want to?”. I said, “Well, I think I already know what you're going to say, so just spit it out”. She said, “You need to get him seen immediately. At his size with his neuro disease, we just can't let this progress”.
The best option for us was to call back his neuro specialist and begged and pleaded with him to get Thabiso in for an x-ray. So the following day on Tuesday, I brought him to the neuro specialist. He had the x-rays, they have a board-certified radiologist who at that and looked at the MRI.
The unfortunate news, diagnosed with osteosarcoma
He had six to eight weeks. I don't remember the exact date prior at another facility because we weren't able to do the testing there and gave us the grim news that the x-rays clearly indicated osteosarcoma as did the prior MRI.
So sadly, had we known, we could have alleviated all of the pain, because we would have already started treatment prior but that neurologist chose not to send imaging out for a board-certified radiologist.
Importance of a board-certified radiologist
Learned a tough lesson that day about always having images reviewed by a board-certified radiologist. From that point forward, any image we've ever had of any dog always goes to a board-certified radiologist.
It was explained to us that a board-certified radiologist often has no clue what even the dog is there for. They look at the complete picture, they look at every single spec of the image, and find anything that's on there, whether it's what you were initially looking for or not. That's the reason to have them do it. They would have seen the tumor back then, and the neurologist who reviewed the MRI didn't because it was not what we were focused on.
We were looking at his spine and his hind limbs, he was not looking at his forelimb. So there was no reason for him to look there and see it. It was small, but it was shown to me and clearly there.
Looking at the treatment options
So that was a lesson learned. Because of the neuro disease, amputation and surgery were off the table. The neurologist's recommendation to us was he's already limping so badly, we could try slinging his leg up and seeing if he could manage on three legs. He said, "I doubt he's going to be able to, but you can try it.”
We tried it and he could not manage at all with three legs. He remained barely weight-bearing, only because he couldn't use the leg like some dogs you see. He had to put some weight on it,
We started doing research right away. The neurologist laid out all the options. He didn't lay out any options of clinical trials at that point, but he told us about palliative radiation. He told us about medical management, amputation, stereotactic radiation, chemotherapy, and all of the different options.
We all were in agreement that probably our best bet for him is going to be radiation of some form, be it palliative or stereotactic, is going to depend on what we can find and what they see when we do more imaging.
Finding an oncologist
So the next step was finding an oncologist. The closest oncologist to us was two hours minimum away. We're in upstate New York. We now have one that's an hour away, but at the time of Thabiso's diagnosis, the closest one was two hours away.
We started calling them for appointments and also researching stereotactic radiation because Thabiso, despite all his health issues, had been doing fantastic up to that point. We wanted to give him the best chance of extending his life with good quality.
I also was researching facilities that had stereotactic radiation. The closest one of those was four and a half hours away and it happened to be the CyberKnife Center in Malvern, Pennsylvania.
We did not get an appointment there, but Julie, the person you spoke with there, was amazing in sharing information with us. So we already had contact there. We ended up seeing, going to, it was at that time, Veterinary Cancer Center in Norwalk, Connecticut.
We knew at that point we wanted to pursue radiation and they had a radiation oncologist on staff, but they could only do palliative radiation. So we were able to set up our initial appointment with the radiation oncologist versus the medical oncologist.
Preparation for the therapy
He was diagnosed on a Tuesday, on Thursday we had the appointment scheduled, on Friday the radiation oncologist called us to get more information and our appointment was on Monday.
He already, over the weekend, has been in touch with the CyberKnife Center, Dr. Heaney was his mentor. So he had called her about to be so his case, and then when we got to the appointment, we did the CT scan. They found what they said were three questionable spots on his lungs, they did not think they were anything and turned out they were not and found that the tumor was both bone-producing and bone-destructive. The amount of lysis in the bone was such that he was a good candidate for stereotactic radiation.
Thabiso’s stereotactic radiation
You know, if it had to have been extremely lytic, then the radiation would have probably fractured the bone. So we were lucky we were able to proceed. He did the first zoledronate infusion at that appointment. and while Thabiso was having that, he was setting up his appointment with Dr. Heaney at the CyberKnife Center for us.
So that was a Monday and then on Thursday, we had our consultation by phone with Dr. Heaney, again, tons of information. The following Monday, we left at four in the morning to get down there. We had his CT done for the 3D imaging, met with Dr. Heaney and stayed overnight. The following day, he had his stereotactic radiation delivered all in one fraction.
By 36 hours after we got home, he was already improving, and every day after for two to three weeks, he continued to improve until he had no limp whatsoever. We got him off the pain meds completely. He never ever limped on that leg again, he just did amazing on that particular leg.
Enrolling in a clinical trial
We then followed up with chemo and at that point, our goal had always been to do the Listeria vaccine clinical trial. I had not heard of the Yale clinical trial at that point in time. We proceeded with the chemo and at the end of chemo when it came time for figuring out whether he was eligible for the Listeria vaccine, it turned out that because of the steroids he was on for his neuro disease, he was ineligible.
In hindsight, I'm glad it worked out that way. What happened was we continued with Arzilleginate, every three months x-rays, and maybe about a month after that, I saw a post on one of the bone cancer groups. Somebody posted about the Yale vaccine and it was Mike Rossi. He was going to Norwalk as well and it just happened that we had been sitting next to him for our appointment.
I didn't know it was him. We had conversed in the group but we didn't realize we were at the same location or anything like that.
When I got home, he had posted about the happy news about his dog, so I right away contacted him and I said, "I recognize that dog. We were sitting next to you." He gave me the information and so then I called back about, "Is Thabiso eligible for this?"
Initially, we were told no because of the steroids again. I ended up contacting Prof. Mamula, and he said, "Yes, Thabiso is eligible." At that point, Dr. Ettinger had left, and our medical oncologists had been changed over to Dr. Post. We told Dr. Post, "Hey, you're part of this. We want this."
A few mishaps before the vaccine
We were all set up to do that and then Thabiso with his major medical issues, ended up getting a nail bed infection. Almost lost his toe in his foot because the infection was so bad.
So, we were dealing with that and they had to culture it. Initially, we didn't think it was a nail bed infection because the x-ray showed a foreign body in the toe. It looked like a small needle in his toe and it was metallic. That was the thought of what was causing all the issues.
A surgeon determined that it literally was looking for a needle in a haystack. He could not operate, so all we could do was try to fight the infection and hope that whatever the object was worked its way out.
Well, it ended up that the object was just one of those red herrings that had nothing to do with it. It took about two and a half months, two and a half to three months, to resolve the infection. So, it was April before he actually got the first vaccine.
Production of antibodies
Every three months, x-rays, no issues, no limping, no, no nothing. He did not produce antibodies on the first blood samples. It wasn't until the final blood sample at eight weeks that he produced antibodies. So again, as Mark said, you know, Thabiso was unique in just about everything he did and so he was a bit unique that way. He never had the abscess that others have had issues with.
Literally, we didn't realize he had had a vaccine. You know, there was just nothing other than we knew he was producing the antibodies.
A new health problem
Unfortunately, and again, his health was continued. It turns out that December of 2018, he ingested one of his toys unbeknownst to us. He had destroyed it and my husband thought he had got all the pieces and thrown them out.
But in June, he started having major abdominal issues, and not eating. Ultrasound was suspicious, but they couldn't really pinpoint what they were seeing. It was more shadows, they didn't know if it was cancer and they didn't know if it was an object. So he was treated for two weeks to see if anything improved, if not re-ultrasound.
Second ultrasound, it was clear there was a foreign body. He had also started limping again during all this time on his other front leg, so we're dealing with all that. We had an amazing IM vet who at eight and a half months pregnant, spent two and a half hours on her feet, retrieving the toy frog endoscopically, so he didn't have to go through surgery.
Dealing with the new limp
And then we proceeded to deal with the other little limp and Thabiso’s quote, go big or go home. He had a second proximal humerus tumor. Because of the location on the bone, it was determined to be a second primary tumor, not a metastasis.
It wasn't in an area where there would have been blood flow to have it be a metastasis. So he went through everything again and because it was primary, he did the same carboplatin chemo again. They said had it been a metastasis, they would have treated it with different chemo.
But because it was considered a primary tumor again, the line of defense was exactly the same. He had stereotactic radiation again, this time the CyberKnife machine was down. The VCC now had a linear accelerator, so Dr. Rare did the radiation the second time, and he did it in two fractions separated by a day.
Cost of treating the cancer
The first time, he ended up having two CTs because we wanted to have the first one, even though we knew we'd have to have a second one when we got there to do the 3D planning, but we didn't want to go all the way through the appointment if it was going to turn out that he wasn't eligible. So we had to do two CTs and the radiation and I believe it was around $8,000 total, including the CTs.
I can't tell you the second one because Dr. Rare, I still cry thinking about it, he just discounted it extremely. He said that he had the ability to do that in rare cases and because Thabiso was a rare case, he wanted to do that for us. So we paid very little the second time. I tell people this often, we were going to take out a home equity loan to pay for it and I'm from a very tiny small town. When I went into our local bank, the bank manager said, “Do you mind if I ask why?”. I explained and she said, “Oh, tell me all about your cars, please. I can do much better for you.” And we ended up refinancing our car to pay for it.
It was painless because we still had car payments, we just extended them for an additional four years at the same exact amount. It was just the easiest way imaginable to pay for it.
Our car didn't get paid off when we had planned, but it was something that was already in our budget. We didn't have to come up with the huge sum all at once. It was just an amazing, amazingly easy way to pay for it.
Dealing with the new tumor
Now we have a second primary tumor. The first one's still doing fantastic, no limp on that leg at all, but really struggling with the other four limbs because now he's got cancer in one limb, neuro disease on the back two legs, and now cancer in the other four limbs.
This time, the local specialty center where our neurologist was able to get an oncologist on staff, it was only an hour away. We did transfer to her for the medical oncology portion. We still saw Dr. Post occasionally until he left. First Dr, Ettinger left, and then Dr. Post left.
We did still follow up with him because of the Yale vaccine, but we did the chemo through the more local one. It was just so much easier for Thabiso to not have to travel so extensively.
Chemotherapy and its effects
The first time through, he did chemo at the max dosing and didn't miss a beat. The very first chemo, he had nausea for about 12 hours and other than that, there was nothing. Complete opposite experience the second time around. We ended up eventually going with the lowest dose possible because he just had major issues.
In hindsight, we believe the GI issues he had had with the toy that was ingested had created an ulcer. We thought the ulcer had been healed and in hindsight, we're pretty sure the ulcer was not fully healed. That was the reason, because even with metronidazole he had cerenia and ondansetron both for the nausea, until we added sucralfate he didn't have any relief so we're pretty sure that the ulcer was actually the reason that he had so much difficulty with chemo.
I always try to put that in there because people get scared about chemo because of how it is with humans. I always try to explain that even though he had a difficult time the second time, we didn't think it was so much the chemo as it was the unhealed ulcer that caused him to have such difficulty. We debated with our vet team several times whether or not to continue the chemo and everybody's consensus was let's keep going, so we did.
The radiation worked the same way, by three weeks out he was not limping, he was off painkillers. At that point Dr. Mamula said we can do a booster if he needs it but let's check his antibodies. We checked his antibodies, he was still producing antibodies so we didn't do a booster, and a couple weeks after he finished chemo he had a fantastic day and went on one of the longest walks he'd been on in quite a while.
An unexpected turn of events
The next morning, he woke up and couldn't get up, the leg had just collapsed and the bone had collapsed. We don't know if it was related to the radiation, we don't know if it was related to just where the tumor was located, that maybe it was more of a bone-destructive tumor than the first one was.
Our previous lab had been enrolled in Cornell in the Labrador Health Study and had gone there at the end for necropsy so we were very familiar with Dr. Castellano at the genome center there. So, we contacted her and said you know, would it be possible to bring him there for a necropsy. She agreed that they would very much like to do that, so he did go there for necropsy.
The thorough necropsy found zero signs of metastasis anywhere in his body. The bone was in such bad condition, that they agreed that it was likely a primary tumor. They said that the bone was extremely necrotic, and so what they called it was versus pathological fracture, they called it a bone collapse.
Short of amputating his leg, which we couldn't have done for the same reason, there was nothing we could have done for him. So he woke up that one morning, we took him to our vet to be evaluated and had to put him down the following morning because we just ran out of options.
Remembering Thabiso as the joy-giver
He had turned 12 and a half, just a few days before actually. He was doing so great. He was a registered therapy dog. He did 888 therapy visits. His love was school. He loved the elementary kids like they were all his own. The treatment we had in 2018 gave him the best year at school he ever had.
The kids were amazing, knowing what he was going through. The teacher was amazing. He worked with the entire fourth grade, so he had 45 kids that were his. He, it was just an amazing year, like a bonus year.
He was doing well enough following the radiation of the second tumor that in the fall, we had started back to therapy visits. We dropped some that required a lot of walking, we got him a cart because of his hind-end mobility from the neuro disease, and he wore his cart to school.
The ups and downs of his cancer story
The week we lost him, he had three therapy visits scheduled the following week. That's how well he was doing. My comment to the oncologist, every visit, you know, they say, how's he doing? My comment was always, that if we didn't know he had cancer, we would never know he had cancer.
I don't know if we were just lucky or if it was just part of him and his personality. I mean, when we adopted him, he had two torn CCLs that nobody had noticed because he was so stoic and hid things so well. So whether it was just part of his mental makeup, I don't know. But like I said, day to day, we had no clue that he had cancer once the radiation worked and he lost his limp.
Those three weeks and the week prior to getting him, so for a month, it was horrendous. I have never seen an animal in pain to that extent. He tried to hide it, but it was there and he was on hydrocodone, but it didn't touch the pain. So when people say that they can manage medically, I don't know how. Honestly, maybe in a different location, it's different, but for him, there was no way to manage the pain medically.
We didn't know what to expect with the stereotactic radiation. We were hopeful it would take away all the pain and, both times in our experience, it did. To see him go from basically non-weight-bearing other than he has to put it down to move to having no limp was just utterly amazing.
His favorite thing to do was we call it slaying water bottles. His water bottles were his favorite toy in the world and during those four weeks, he didn't play with water bottles, he barely wanted to eat. Once he felt better, he was back to slaying those water bottles and he liked to squeeze it until it would pop and then just chew it and crunch it up.
He would sometimes have a 10 water bottle night and we were like, "Oh, he's feeling really good today," because he's just slaying water bottle after water bottle. He would bark and demand another one.
A year-long battle with cancer
In 17 months from when we knew the first tumor was there, the original CT was the first week of July 2018. You know, how long before that the tumor was there, we have no way to say. It was fairly small then, but I'm sure it was there, at least a month or two or more before that. We lost him at the end of November 2019, roughly a year and a half after he lived with the original tumor.
Other than that one-month time frame, waiting to get diagnosed, you get the appointments, and then for the radiation to fully take effect, we just didn't know. For him to have no metastasis with two primary tumors, I mean, I wish there was a way that we could definitively say it was the vaccine.
Prof Mamula does have his tumor samples. They were able to get samples of both tumors on the necropsy. I think it's just timing-wise, and if you think about it, he got his vaccines in April and we found out he had the tumor the first week of July.
So my guess is again, you know, he didn't have any more CTs in between. He had x-rays, but they weren't x-raying looking for a tumor on the other leg. So some of the x-rays had the other leg in there peripherally. Everybody looked at them to try to see if they could pick up on the tumor there and the views just weren't in a way that they could tell if it had been there prior.
So the thought is that it probably was already there when he got the vaccine and he didn't start making antibodies until the end of May. So there was only a one-month time frame from when he started making antibodies to when he was diagnosed with a second primary tumor.
I think the timing was just not there for the vaccine to have prevented that from being worse. Almost a year later he had the second tumor and then in November of 2019, we lost him.
I know Prof Mamula has done stuff with the tumors and is trying to isolate stuff in relation to the vaccine. I don't know what he's come up with or if they were able to come up with anything to definitively say that there was any effect from the vaccine on those tumors. I think the vaccine had to have helped prevent the metastasis though, because it's just pretty unheard of for a dog to have osteosarcoma for that long.
Fulfilling his mission in life
I was a Peace corps volunteer in Lesotho in Southern Africa. Thabiso means bringer of joy and we knew when we adopted him that we wanted to make him into a therapy dog, so the name just suited him.
It was the perfect name for him. That was his mission in life to bring joy everywhere he went. He was the most intuitive being I have ever encountered. Even when he was dealing with cancer he would be at the vet. The specialty center near us is also an emergency facility, so one side is emergency and one side is the specialist.
He detoured to somebody and the vet tech was like “Come on let's go” and I'm like “Nope, you have to let him go where he wants to go”. It was somebody waiting on the emergency side that he just sensed needed some comfort and he chose that moment to go. The person kind of looked at me like what's he doing and I was like “Just go with the flow, he thinks you need him so just pat him” and you can tell the guy did need him. Everyone was watching. Finally he was done “he’s okay now”. And Thabiso started marching toward the door.
He does this everywhere.
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