Chocolate Kisses

CHARLEY’S OSTEOSARCOMA HISTORY, DIAGNOSIS AND TREATMENT

 

Charley started limping at about 20 months old and the limping was on and off for a few days.  We took Charley to the vet after my husband was playing with him and he hugged him around his front legs and he yelped in pain.  We requested x-rays immediately (instead of the recommended course of anti-inflammatory meds and a re-check in 2 weeks).   X-rays revealed a lytic lesion in his left mid-humerus that looked like osteosarcoma except that it was not in the typical location of “away from the elbow and towards the knee”.

 

We were referred to Dr. Buss, an oncologist, and he did a FNA (fine needle aspirate) of the lesion and it was not cancer but rather an aneurysmal bone cyst, which is extremely rare (there are only a few documented cases).  We went back to Dr. Buss every 1-2 months to monitor the aneurysmal cyst, which was resolving on it’s own, when 7 months later Dr. Buss noticed a lytic lesion in his left proximal humerus (same bone at the cyst, but up towards his shoulder) on the x-ray.  Dr. Buss put Charley on antiobiotics for 3 weeks in case it was a bone infection (his humerus bone was already compromised because of the aneursymal cyst and an infection was a possibility) and x-rays showed improvement after week one, but worsening of the lesion after week 3.  Dr. Buss did a bone biopsy of his left proximal humerus because Charley’s history was so atypical.  The histopathology results from Charley’s bone biopsy stated:  “primary malignant neoplasia of bone; most consistent with Poorly Productive Osteogenic Osteosarcoma”.…and so began our unwanted OS journey.

 

Charley was 2-1/2 years old when he was diagnosed with OSA on 10/19/10.  He had his left front leg and left scapula amputated on 10/28/10 followed by 5 rounds of i.v. Carboplatin chemo every 3 weeks apart.  Charley started chemo on day 13 after his amputation, immediately after his staples were removed.  Charley’s blood work after chemo was always fine and he tolerated the Carboplatin chemo well without any side effects.  Charley had follow-up appointments with his oncologist and chest x-rays to check for lung mets every 3 months for the first year after his amputation.  After the first year post-amputation, Charley’s follow-up appointments with his oncologist and chest x-rays moved to every 6 months.

 

Unfortunately, we found out on 10/24/13 that Charley’s OS came back as a met underneath his amputation scar…. almost exactly 3 years to the day after his amputation.  Charley had surgery on 11/8/13 to remove the cancerous mass (and prescapular lymph node) and the surgeon was able to get clear margins around the cancerous mass (1cm at the narrowest margin because the tumor extended down to his Brachial Plexus; and 2cm at the widest margin).

 

The histopathology report from Charley’s cancerous mass  removal stated:  “The mass of the left prescapular incision site most likely represents the recurrance of the the prior primary osseous sarcoma.  The recurrent 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.”

 

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 and specifically, Telangiectatic OS, from his primary OS tumor that was in his proximal humerus (removed in October 2010).

 

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.

 

Because Charley had Carboplatin after his amputation, Carboplatin can not be used again because it will not work anymore because some cancer cells survived after that chemo initially and were dormant before becoming metastatic OS.  Dr. Buss explained that he would attack this metastatic OS with 2 different chemo agents for 2 reasons:  1)  to attack the cancer from 2 different angles; and 2) to minimize the side effects of each chemo.

 

Charley’s chemo was  alternated between i.v. Doxorubicin (Adriamycin) and oral Lomustine (CCNU) every 3 weeks for a total of 6 rounds (Doxorubicin, Lomustine, Doxorubicin, Lomustine, Doxorubicin, Lomustine).  Charley has had 5 of 6 rounds of chemo (11/27/13: Doxorubicin; 12/18/13: Lomustine; 1/9/14: Doxorubicin; 1/29/14: Lomustine; 2/19/14: Doxorubicin).  His next and FINAL chemo #6 is Lomustine and is scheduled for 3/12/14.

 

Charley did take Cerenia (anti-nausea) starting on day 2 after the Doxorubicin for 4 days since the Doxo is harder on the GI system and GI side effects are the worst from days 3-5.   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 starts antibiotics (cefpodoxine 200mg) on day 5 after chemo for 7 days to prevent an infection because of low white blood cell count (leukopenia).   Charley had his blood work done between 7-10 days (at nadir) after his first 4 rounds of chemo as well as a liver profile after his first 2 rounds of Lomustine (since Lomustine can impact liver function) and all has been fine.  Charley does not need to have blood work after his last 2 chemo rounds per Dr. Buss.

 

Charley is now 5-3/4 years old and he will celebrate his 40 Month Ampuversary on 2-28-14 and his 6th Birthday on 3/29/14…so he has lived over 1/2 of his life as a Tripawd and with OS, so miracles can and do happen!

 

 

CHARLEY’S PROTOCOL (3+ Year OS Warrior)

 

My goal with Charley’s protocol is to accomplish 2 things:  1) to support and strengthen his immune system in order to fight the cancer; and 2) to kill any rogue cancer cells by apoptosis; which will in turn give him a better quality of life and hopefully a much better quantity of life!  🙂

 

Here is my disclaimer about Charley’s protocol:
Every dog is different and no two cancers act exactly the same (even when comparing OS to OS, lymphoma to lymphoma, etc.).  I still tweak Charley’s protocol and nothing is written in stone.  Some pups tolerate lots of supplements without any issues and others don’t….too many supplements are not always a good thing in my opinion.  You have to do what works for you, your dog (or kitty), your family, your finances, etc.  Most importantly is to always remember to NEVER GIVE UP HOPE!!!

 

Since Charley’s OS returned this past October, I’ve added in Immunity4Pets and I’m back to giving the artemisinin/Artemix/Butyrex or artemisinin/artemether/Butyrex on a daily basis.  I’ve also moved his vitamin C and vitamin E from breakfast to lunch because you can’t give vitamin C within 2 hours of the Immunity4Pets.  I’ve also doubled his K9 Immunity Plus Chews to 4 chews per day.

 

Charley’s Protocol (68 pound, 5-3/4-year-old male neutered Lab):

 

Charley eats Orijen Six Fish kibble 3x day and we give Charley bottled water, not tap water because of the fluoride.

 

Breakfast: 7:00am
-20mg generic pepcid about 20 minutes before breakfast
-Orijen Six Fish Kibble 3/4c

-Immunity4Pets: 4 tsp sprinkled on food; dosing on container by weight (immunity4pets.com)
-Berte’s Green Blend (b-naturals.com); dosing on container by weight
-(2) K9 Immunity Plus Chews (iHerb.com)

 

Lunch: between 12-2pm
-Orijen Six Fish Kibble 1/2c
–Berte’s Ultra Probiotics (b-naturals.com); dosing on container by weight

-500mg of Vitamin C (Esther C)*
-400iu of Vitamin E*
-(2) 1000mg of fish oil
-(2) K9 Immunity Plus Chews

*Vitamin C and E are given daily to help flush the system so you can give the artemisinin/Artemix on a daily basis.

 

Dinner: between 5:30-6:00pm
-20mg generic pepcid about 20 minutes before dinner
-Orijen Six Fish Kibble 1/2c
-(2) 1000mg of fish oil

 

4-5 hours after dinner (between 10:30-11:00pm)
-Charley gets artemisinin (Holleypharma.com) daily with or without Artemix/artemether (Hepalin.com) wrapped in Philly Cream Cheese
-200-300mg of artemisinin along with 4 Butyrex* (pureformulas.com); when I add in Artemix or artemether I give him 1-2 caps for a total of 40-80mg of artemether

 

*Butyrex enhances the effect of the artemisinin/Artemix.

 

**Charley does not tolerate the fish oil at the 6500mg range and he gets the runs (based on the recommendations for cancer of 1000mg per 10 pounds), so he gets 4000mg/day.

 

 

I am one of the moderators on the artemisinin_and_cancer Yahoo group.  If you want more info about dosing the artes (including Artemix/artemther which is toxic at high doses), please consider joining the arte group.

 

 

 

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 had chemo #5 today, 2/19/14, which was Doxorubicin (Adriamycin).  This was his 3rd Doxorubicin so he is now finished with this chemo agent!  YIPPEE!!!  Charley will start on the Cerenia for anti-nausea tomorrow and will take it for 4 days (nausea from the Doxo typically hits days 3-5).

 

Since Charley’s last 4 bloodworks and his 2 liver profiles have been fine (he had bloodwork done after his 1st and 2nd Doxo and his 1st and 2nd Lomustine), he does not need any more bloodwork after this chemo or after his next chemo.  YIPPEE  again!!!

 

Charley has his last and final chemo on 3/12/14 which will be Lomustine (CCNU) which is an oral chemo pill and then he will be officially done with chemo!  Another YIPPEE!!!  I asked when Charley would need chest x-rays and Dr. Buss said we would most likely do it 1-2 months after his next chemo!

 

Dr. Buss, his oncologist, said and I quote, “Charley looks GREAT!!!”  That made my week again!  I told Dr. Buss that Charley will be 6 on 3/29/14…and that would be his 4th birthday since his OS diagnosis which is amazing!  Dr. Buss agreed that Charley is indeed amazing!  🙂

 

Charley LOVES the snow (but it has all melted now), so here are some recent snow pics!

 

I love the wavy fur along his back.  🙂

 

Wanna play??

 

One of my favorite all time pics…look at that happy smile!

 

Cheese!

 

Hi there! 

 

Snow face!

 

 

My little chocolate Valentine!

 

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 had his 3rd (of 6) round of chemo, Doxorubicin, on Thursday 1/9 so now he is officially at the 1/2 way mark for chemo!  YAY!!!  Charley started taking Cerenia on Friday to help with any nausea or vomiting since Doxo is really hard on the GI system and so far, so good.

 

Dr. Buss thought Charley looked great and said he was “perfect” during chemo and he just layed on his side (although he’s an anxious maniac mess in the Lobby…go figure)!  Blood work again in 10 days and if his counts are fine for the 3rd time in a row, we won’t need anymore CBC’s done for his remaining chemos of Lomustine and Doxo!

 

Charley had so much fun playing on the snow last weekend!  St. Louis got close to 10-12″, so he had lots of snow to play in.  Unfortunately the “Polar Vortex” made the high temps Monday of -2, so his outside time had to be limited to less than 5 minutes or his paws would get too cold and he would hold up a paw.  I think he looks super handsome in his puffer jacket!

 

Here’s a few snow pics of Charley from Sunday!  The golden in the one picture is our neighbor, Louie!  Charley with 3 legs can run circles around Lou!  Charley steals all of Louie’s balls from him…when Charley sees their garage door open, he bolts over there goes into their garage roots through their children’s large storage container of balls and then helps himself to what he wants.  It’s quite embarrassing that Charley has about 10 tennis balls that are Louie’s and sweet Lou doesn’t mind.  I do take them back, but I swear Charley counts the balls and knows that I returned a few!  LOL!

 

Charley and our neighbor’s golden, Louie!

 

Charley doing zoomies in the yard!  Notice Louie, the golden, way in the background! 🙂

 

Charley doesn’t seem to be cold!

 

Charley’s so happy that he’s smiling!

 

Charley says, “The snow tastes so yummy!”

 

My FAVORITE snow picture!

 

The is the last picture because he was getting ready to jump on me to tell me,  “Enough pictures, Mom!”

 

…and a video!

 

 

Charley did a great job cheering on the Colts last weekend and this weekend, but since the Colts lost and won’t be advancing to the playoffs he’ll have to cheer on Peyton Manning with the Broncos!  Go Broncos!  Charley doesn’t have a Broncos jersey, but his Colts jersey is Manning jersey so that’s going to have to count!

 

 

 

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!

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  ♥