Chocolate Kisses

Charley had his chemo #2, Lomustine, yesterday afternoon and he is doing fine!

Lomustine is an oral chemo that is also referred to as CCNU.  It is commonly used to treat some cancers of the brain (it can cross the blood-brain barrier), lymphoma, mast cell tumors, and non-resectable soft tissue sarcomas.

Because Lomustine has a greater impact on myelosuppression (a condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets).  Charley will start antibiotics (cefpodoxine 200mg) on day 5 (12/23/13) after chemo.  He will take the antibiotics for 7 days to prevent an infection because of low white blood cell count (leukopenia).

Charley will have to have his blood work done between 7-10 days (at nadir) and he will also need a liver profile since Lomustine can impact liver function.

Charley is scheduled for chemo #3 (Doxorubicin) on Thursday 1/9/14….and then we will be at the half way mark!

Charley’s Great Dane buddies, Beau and Cayman, and their mommy and daddy (Cindy and Will) sent him a beautiful Christmas ornament.  The ornament is a “chocolate” stained glass paw print that was hand made locally where they live in Maryland.  The ornament is very beautiful!  I love it!!!  It is hanging front and center on the Christmas tree.

Charley gained almost 5 pounds since his last chemo 3 weeks ago, so we are going to cut back a bit on his food….and he’s not going to be happy!   He weighed 69.5 pounds which is still a good weight for him, but he doesn’t need to gain any more!  We wanted him to gain a few pounds so we increased his food, but I guess I didn’t factor in all the cream cheese he gets to hide all of his supplements in.  I think he’s going through a block of Philly cream cheese every 2 weeks, so that’s a lot of extra fat grams and calories.

Here’s a few pictures from yesterday after we got home from the oncologist.  The long car ride and all of the waiting really wears him out!

Thank you for all of your prayers, positive thoughts, hugs, and kisses.  It is greatly appreciated and we can’t thank you enough for all of your support!

♥  Hugs from me and chocolate Labby kisses from Charley!  xoxo  ♥

Sorry it’s been awhile since I posted an update.  Charley is finally back to his happy Labby self!  Yippee!!!

The doxorubicin hit him a bit hard (he had no side effects at all from his 5 rounds of carboplatin).  We gave him Cerenia, but there were still days when the saliva would just drip out if his mouth….he was lethargic and you could tell he didn’t feel well and couldn’t get comfortable….although in typical Labby fashion he never lost his appetite.  He wanted to lay outside in the cold on the deck by himself and did so for hours which is not like him at all (he typically does not stay outside at all unless we are with him).

Charley had his blood work done last Saturday 12/8 (day 10 for nadir) and his neutrophils and platelets were low (still in the range to not have to delay his next chemo), but his onco isn’t worried about the numbers because they should rebound fine.

Charley is scheduled for chemo #2 (Lomustine) this Wednesday 12/18….and then he only has 4 more to go!

Thank you for all of your prayers, positive thoughts, hugs, and kisses.  It is greatly appreciated and we can’t thank you enough for all of your support!

♥  Hugs from me and chocolate Labby kisses from Charley!  xoxo  ♥

I love this picture….especially his soulful eyes!

Handsome Charley!  This is the photo he is submitting with his Harvard application!  He looks so ivy league!

Today is Charley’s 37 Month Ampuversary!  I am so proud of Charley for being the OS Warrior that he is and has been for over 3 years!  I’m so proud of his courage, strength, and resiliency!  I’m blessed to have been given an additional 1,126 precious days with Charley since his amputation!  I’m in awe of the lessons that Charley has taught me along this journey!

Charley is in the midst of battling OS for the second time in his short 5-1/2 years of life, but I know that he is fighter and he has a lot more living left to do!

Since today is Thanksgiving, Charley’s ampuversary holds even more meaning for us today.  We are so blessed and extremely thankful that Charley is here with us to celebrate another holiday season!

Happy Thanksgiving to all!!!

Thank you for all of your prayers, positive thoughts, hugs, and kisses.  It is greatly appreciated and we can’t thank you enough for all of your support!

♥  Hugs from me and chocolate Labby kisses from Charley! xoxo  ♥

Thank you for keeping Charley in your thoughts and prayers! Charley had his 1st round of chemo (Doxorubicin) this afternoon and now he’s relaxing at home.

When Dr. Buss (onco) tried taking Charley back, Charley had other ideas. He put on the breaks and tried to run to me….all while crying and yelping…he’s a bit of a momma’s boy (and a bit dramatic)!!! I had to walk back with Charley so he would go with Dr. Buss.

We have 4 doses of Cerenia, so Dr. Buss said to start Charley on it tomorrow before any nausea and vomiting would start…which is in 3-5 days. Charley tolerated Carboplatin well without taking Cerenia, but Doxorubicin is harder on the GI system.  Charley will have his blood work done in 7-10 days to check his blood counts (nadir).

His next chemo, Lomustine (oral chemo), is scheduled in 3 weeks on Wednesday 12/18 pending his blood work. Dr. Buss said that Lomustine is back ordered and hard to get but he will be able to get it.

Dr. Buss said that he’s attacking Charley’s metastatic OS with these two different chemos so Charley will hopefully be around for many more years! I really hope so too….and to be honest, when Dr. Buss said this I couldn’t help but smile since his approach is always straight forward without any hint of subjectivity!

Here’s a few pictures of my very tired chocolate boy!

Here’s Charley sporting his preppy sweater since it’s been really cold here and his fur hasn’t grown back yet.  As you can tell by the look on his face, he’s not thrilled!  The sweater is a dark hunter green, but you can barely see it since he’s so dark brown!

We bought Charley his very own T-bone steak to eat tomorrow on Thanksgiving!  He’s going to be super excited!  We have so much to be thankful for and Charley is #1 on the list!

Happy Thanksgiving to all!!!  Even though I’m not Jewish, I wanted to wish a Happy Hanukkah also to those who are!

Thank you for all of your prayers, positive thoughts, good karma, hugs, kisses, etc.  It is greatly appreciated and we can’t thank you enough for all of your support!  We couldn’t go down this road alone….and again….without all of you!

♥  Hugs from me and chocolate Labby kisses from Charley!  xoxo  ♥

We had Charley’s appointments this afternoon with Dr. Luther (surgeon) and Dr. Buss (oncologist).

Charley’s staples were removed…Yay!!!   Dr. Luther was excited that she got clear margins and after explaining to us how she had to cut the tumor out by feel and by using the CT imaging, it is amazing that she got clear margins especially since the tumor was around his Brachial Plexus (the nerves and arteries for his missing front leg that come off his spinal cord).  Dr. Luther gave us a tour of the facility which included the ICU, chemo room, Ultrasound, x-ray, and surgical suites (just got to peek through the outer windows).  It was very cool to get to see all the “behind the scenes”.  I asked if I could see Charley’s CT scan, so Dr. Luther brought Joe, Charley and I to her office and she went through the entire scan with us level by level which was really cool!   I gave Dr. Luther a big hug when I was leaving and thanked her for doing such a great job with Charley (twice)!

Now, on to the oncology visit…..

Dr. Buss does not think the tumor was a hemangiosarcoma, nor was his original leg tumor.  He believes the tumor that was removed was an osteosarcoma metastasis…..specifically, Telangiectatic OS…..from his primary OS tumor that was in his proximal humerus (removed in October 2010).

There was an area near the bottom of Charley’s incision site that had scabbed over.  Once the scab was removed to get to the staples, the incision was open.  Since the incision was open, Charley was not able to start chemotherapy today.  He will have his 1st chemotherapy next Wednesday 11/27, which will be i.v. Doxorubicin.  His next chemo will be 3 weeks later and it will be the oral chemo Lomustine.   Charley will alternate between the 2 chemos every 3 weeks for a total of 6 rounds (Doxorubicin, Lomustine, Doxorubicin, Lomustine, Doxorubicin, Lomustine).

Dr. Buss said that we can continue giving Charley the Immunity4Pets and Artemisinin/Artemix during chemo, so we will continue with his holistic regimen too.

Here’s your oncology lesson of the day:

Subclasses of osteosarcomas are determined based on the characterization of the cells as well as the type and amount of matrix present.  Subclasses include osteoblastic, chondroblastic, fibroblastic, poorly differentiated, and telangiectatic osteosarcomas; however, there is no evidence of different biological behavior between the subclasses.

Telangiectatic osteosarcoma is an unusual variant of osteosarcoma, forming 3% to 10% of all osteosarcomas.  Radiographically, these tumors appear as purely lytic destructive lesions located in the metaphyses of long bones.  The location and x-ray appearance of telangiectatic osteosarcomas are reminiscent of an aneurysmal bone cyst and can test the acumen of a diagnostic radiologist. Distinguishing between the two entities microscopically can also be quite challenging. Telangiectatic osteosarcoma shows dilated blood-filled spaces lined or traversed by septa containing atypical stromal cells, with or without production of a lacelike osteoid matrix.

Charley is and will always be our hero….our Super Dog, our Cancer Warrior, our miracle boy.  He has defied the odds for over 3 years and he has no plans to quit now!  We will continue our fight traversing down the familiar chemotherapy path again!

We will pray for a miracle and hope for the best!

We will pray that Charley’s journey here is far from being over, that he has many more people to inspire and bring hope to, and that he has plenty of life lessons still to teach us.

We’re not finished fighting and either is Charley.  We will continue this battle with Charley as long as he wants to fight!

Thank you for all of your prayers, positive thoughts, good karma, hugs, kisses, etc.  It is greatly appreciated and we can’t thank you enough for all of your support!  We couldn’t go down this road alone….and again….without all of you!

And most importantly, Charley is back to his Happy Labby self….and boy did we miss that smiling face!  He’s back to counter surfing, stealing food, barking loudly, jumping on the furniture, bringing us his babies, and he’s even started to do his “zoomies” again!

♥  Hugs from me and chocolate Labby kisses from Charley!  xoxo  ♥

Hi everyone!

I called Charley’s surgeon this afternoon to inquire about the histopathology from his mass removal and lymph node removal.  The results were in, but she did not call to tell us the results since the oncologist will be the person to discuss treatment options.  She didn’t want to go into any more detail than was given in the report since we meet with his oncologist tomorrow afternoon.  I’m glad that I called today so I could read over the report before our appointment tomorrow and have time to digest the information.

Here are Charley’s histopathology results….skip this section if you don’t want to read medical jargon!!!

__________________

DESCRIPTION:

1.  5 cm mass removed at incision (amputation) scar:

Representative sections are examined on 4 slides.  There is a somewhat multifocal and variable coalescing infiltrative neoplasm identified within the deep subcutaneous tissue.  Some areas of the neoplasm is densely cellular, other areas loosely dispersed.  Neoplastic cells are poorly differentiated and irregularly spindle-shaped with indistinct cell margins.  In some areas the cells form relatively solid haphazard sheets, sometimes with interspersed blood-filled cleft-like spaces.  In other ares the neoplastic cells form larger vascular type spaces containing variable numbers of erythrocytes.  There is little interspersed stroma.  In a few areas a small amount of collagenous-type stroma is observed.  There are also some areas where streams of eosinophillic amorphous stromal material reminiscent of ostoid are observed  within the neoplastic infiltrate.  The mitotic rate is up to 3 per high power field and the mitotic index is 22.  Mutifocal generally small areas of necrosis and hemorrhage are observed within the neoplasm.  There are some areas where small aggregrates and lobules of well-differentiated adipocyctes are identified intimately interspersed amoingst neoplastic cells/tissues.  The narrowest clean deep margin is approximately 2 cm in relation to the neoplasm.  The narrowest clean lateral margin identified is approximately 1 cm in relation to the neoplasm.

2.  Left prescapular lymph node, 1 x 3 cm tissue specimen with node

The section of lymph node with surrounding adipose tissue is examined.  Moderate hemosiderosis is observed within the lymph node.  There is also an area of vascular-like tissue proliferation within and mildly widening the subscapular sinus of the node.  Mesenchymal cells forming vascular-like spaces exhibit minimal to mild anisocytosis and anisokaryosis.  No mitotic figures are seen.

MICROSCOPIC FINDINGS:

1.  Left Prescapular Incision Site:

Poorly Differentiated Sarcoma.

Locally infiltrative.

Hemangiosarcoma versus Telangiectatic Osteosarcoma.

2.  Left Prescapular Lymph Node:

Chronic congestion with area of mildly atypical sinusoidal vascular-like proliferation.

COMMENTS:

The mass of the left prescapular incision site most likelu represents the recurrance of the the prior primary osseous sarcoma.  The recurrant mass may represent telengiectatic variant of osteosarcoma.  However, morphologically is somewhat more suggestive of hemangiosarcoma suggesting that the prior mass may have indeed been hemangiosarcoma of bone origin.  Margins in relation to the mass were clean in examined sections.  I am also suspicious of local metastasis to the subscapular sinus region of the prescapular lymph node.

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In a nutshell, the good news is that the surgeon was able to get clean margins!!!  Yippee!!!!  The expected news is that were are most likely dealing with a metastasis of osteosarcoma….the unexpected news is that Charley’s original bone tumor could have been an hemangiosarcoma instead of the poorly productive osteosarcoma that was originally thought.

The bottom line is we are still dealing with a highly aggressive sarcoma as we expected.  Charley sees the surgeon tomorrow at 3pm CST  to remove his staples (he is going to be so excited because he’ll be able to move without the staples pulling) and then we see Dr. Buss, his oncologist, to discuss treatment options.  Hopefully the treatment option will be the oral chemo that he mentioned previously which is Lomustine (also known as CCNU).  I will keep everyone posted after our visits tomorrow!

Thank you for all of your prayers, positive thoughts, hugs, and kisses.  It is greatly appreciated and we can’t thank you enough for all of your support!

♥  Hugs from me and chocolate Labby kisses from Charley!  xoxo  ♥

Sorry it’s been a few days since I updated everyone.  No news is good news because Charley is doing well!  He finished his Rimadyl yesterday and he’s pretty much off of the Tramadol.  We did give him about 1/3 of a 100mg Tramadol last night because he couldn’t get comfortable.  We think the discomfort now is more due to the staples pulling when he moves.  Charley’s incision is healing well.

It was hard seeing Charley in a drug induced loopy state when he was on a higher dose of Tramadol and we really missed his personality and happy Labby self.  Fortunately we are now finally seeing a bit more of his personality and his tail is wagging a lot more.

Today is day 8 since surgery.  Here’s a picture from day 2 post surgery.  I love this picture because his face looks like a puppy (even though he looks a bit loopy)!

Here’s a picture of his incision from a few days ago on 11/14.

This Thursday 11/21 (day 13 post surgery) Charley has an appointment with his surgeon (Dr. Luther) to get his staples removed and immediately after that we meet with his oncologist (Dr. Buss) to hopefully start another chemo.  The pathology report isn’t back yet, but I will keep everyone posted as soon as we get the results.

Thank you for all of your prayers, positive thoughts, hugs, and kisses.  It is greatly appreciated and we can’t thank you enough for all of your support!

♥  Hugs from me and chocolate Labby kisses from Charley!  xoxo  ♥

Charley has been getting around well since he’s been home and he’s not having any issues walking!   Charley was the rock star as always and within an hour of being home he wanted to eat and drink and then went outside and peed and pooped.  We didn’t have to wait long at all for the Happy Poop Dance!

Friday night was rough since Charley wasn’t sleeping much at all.  We tried having a slumber party on the floor, but Charley would not sleep for more than an hour at a time…so needless to say, we didn’t sleep at all either.  I spent quite a bit of time sitting with Charley overnight outside since he wanted to lay in the cold, wet grass.  He seemed happy, but I was rather cold!

We noticed a big difference from yesterday (Saturday) to today (Sunday) with Charley.  Yesterday when it was getting close to the 4 hour mark after giving him Tramadol, he began panting and looking more restless and by the 5 hour mark he was definitely looking more uncomfortable.  Today, we’ve been giving Charley his Tramadol every 6 hours and he hasn’t been panting or looking uncomfortable even when it’s getting close to giving him the next dose.  Charley is acting more like himself which is quite amazing since his surgery was only 2 days ago!

Here’s a few pictures of Charley rocking his crop tops!!!

 

Charley’s home!  I just wanted to update everyone and let you all know that he is doing well!

Charley has already peed and pooped!  Yay!!!  He’s had a little to eat and drink and keeps going back to his food bowl.  I’m sure he’s hungry since he hasn’t eaten all day, but I don’t want to give him too much and make him sick to his stomach.

He seems a little uncomfortable so we gave him his pain meds a little early to stay ahead of the pain.

We are all exhausted, but happy we are all at home together!

Thank you for all of your prayers, positive thoughts, hugs, and kisses.  It is greatly appreciated and we can’t thank you enough for all of your support!

♥  Hugs from me and chocolate Labby kisses from Charley!  xoxo  ♥