Chocolate Kisses

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!!!

 

Dr. Luther, Charley’s surgeon,  just called at 12:35pm CST and Charley is out of surgery.  The breathing tube has been removed and he is on a medication drip in the ICU and appears groggy, but comfortable.

The mass was not the prescapular lymph node as they suspected, but rather a separate mass next to that node.  Going outwards, the mass attached up to the skin through the fat and muscle along part of his amputation scar.  Going inwards, the mass went all the way to his brachial plexus (the area that contains his nerves and blood vessels that supplied his missing left front leg).

Dr. Luther was able to remove the entire mass that she could visualize using the CT scan.  She was able to get 2cm margins and she took off more of the already severed (from his prior amputation) brachial plexus, but she won’t know until the biopsy comes back whether there are cancer cells still along the nerves.  She did remove the prescapular lymph node that was next to the mass because it was enlarged and that will also be sent for biopsy.

She doesn’t know if the cancer started at the skin and went deeper internally…or if it started deeper internally and progressed towards the skin, and she doesn’t know if the biopsy will be able to tell us that.  She does still feel like this is an OS met and not another type of cancer and the biopsy will hopefully answer that question also.

The good news is that Charley is recovering and the mass is out.  We are not sure yet if Charley will be able to come home today because it depends on whether his pain can be controlled without a drip and with oral medications.  If we don’t here from MVRC by 4pm CST, then we need to call to find out the plan.  If they send a picture of Charley recovering, I will post that too!

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  ♥

Here’s a picture of Charley recovering in the ICU.  He’s well taken care of! 🙂

MVRC just called at 9:53am CST and Charley is under anesthesia and doing well. He’s going in now for surgery. I’ll keep praying for my boy and for another miracle.

It makes me feel so much better knowing that we are surrounded by love, hope, and prayers for Charley!

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

Charley’s surgery is tomorrow morning to remove the OS met in his lymph node that is near his amputation site.  He has to be there at 7:45am CST.  I’m not sure the exact time of his surgery, but I will keep everyone posted.  Charley can’t have anything to eat past 8:00pm CST tonight, so I fed him 2 dinners because he was not happy last Thursday when he couldn’t eat before his CT scan.  Charley thinks he hit the lotto…or his mommy is going crazy and forgot that he already ate his dinner.

We’re praying for the skill and wisdom of his surgeon, a successful surgery, clear margins (even though we are fully aware that the surgeon will may not be able to get clear margins), a quick recovery, and more precious time with our cancer warrior!

Positive thoughts, prayers, and keeping fingers and 3-paws crossed are greatly appreciated!  I will post updates tomorrow.

Here are 4 reasons that I believe are good karma for Charley’s surgery tomorrow:

1.  November is National Pet Cancer Awareness Month….maybe Charley could be their poster child!  🙂

2.  Charley won Penn Vet School’s Halloween contest on Facebook and I just found out last night!   His costume was, of course, “Superman Cancer Warrior”.  Charley’s prize is a package of Penn Vet swag.  Here’s the link to the post of Penn Vet’s FB page:

https://www.facebook.com/photo.php?fbid=10151694550011573&set=a.126537196572.115175.86740226572&type=1&theater

3. Penn Vet (University of Pennsylvania) is also where Dr. Nicola Mason is running the trial for the Bone Cancer Vaccine, so I’m thinking this is a sign!

It is now over 16 months since the first dog diagnosed with spontaneous osteosarcoma received an experimental bone cancer vaccine at the University of Pennsylvania’s School of Veterinary Medicine.  The results are highly promising and a larger phase II clinical trial is now being planned at Penn and at collaborating sites including Colorado State University and the University of Florida.  If you would like to learn more about the clinical trial, are interested in enrolling your dog, or wish to support Dr. Mason’s research, visit http://www.vet.upenn.edu/research/centers-initiatives/canine-cancer-studies.

4.  Charley received a very special present in the mail today….a beautiful handmade collar that reads “Together We Can Make a Difference” in support of Bone Cancer Dogs.  Chris O’Riley of Collars By Chris (Wellington, New Zealand) donates 50% of her profits to Bone Cancer Dogs for cancer research.  Until Chris raises $1500, she is donating 100% of her profits to Bone Cancer Dogs.

If you need a beautiful, high quality, and affordable dog collar please consider purchasing one from Collars by Chris: http://collarsbychris.weebly.com

Chris also dedicated a page for Charley on her website over a year ago!  I am still touched and honored that Charley continues to grace a page on her website.  http://collarsbychris.weebly.com/a-special-model-charley-the-hero.html

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  ♥

Here’s a few pictures of Charley modeling his new collar….and they are the “before” pictures for this surgery.  The next pictures that you’ll see after tomorrow he’ll be shaved (or at least 1/2 shaved).

….and my favorite collage that shows Charley’s personality!

The surgeon said the CT scan looks clear except for the cancer that’s in the prescapular lymph node.  Lungs, heart and everything else looked good.  There was some increased uptake along the border of his abdomen where she thought could be a deeper cancer or scar tissue, but she aspirated it and all she saw were fat cells.  The radiologist will have to review the scan to give a definitive, but and we won’t know until tomorrow (Friday) or Wednesday (Dr. Luther is out of the office Mon and Tues).

Charley is scheduled for surgery to remove the lymph node next Friday 11/8.  The surgeon obviously won’t be able to get clear margins because the structures near the prescapular lymph node are his jugular vein and trachea.  It would be considered a palliative surgery just like his amputation was considered (versus curative).  Dr. Luther (surgeon) has already consulted with Dr. Buss (oncologist) and the treatment options are chemo, radiation, or a combo of both based on the histopathogy of the lymph node tumor.  The surgeon says that it’s rare that OS mets to the prescapular lymph node (typically lungs or bone), but Charley’s case has not been typical since the beginning and he’s still here 3 years later.

All things considered, the news could have been worse.

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  ♥

Unfortunately, no surgery today for Charley. The surgeon said the cancer lump is the lymph node and that she thinks it goes into deeper structures because it’s connected at one end and that area feels hard. She said it could be scar tissue from his amp or more cancer.  A CT scan will show where the cancer is and how much is there.  I guess it’s an osteosarcoma met in a lymph node that’s not behaving typical???  Whatever it is, I just have a really bad feeling…

If they can even do surgery on Charley it wouldn’t be until end of next week. We most likely won’t have the radiology report from the CT scan until Monday.  Here’s some pictures of Charley wearing his Superman Cancer Warrior costume while we were waiting for the surgeon. Charley was just upset that he hadn’t eaten since last night!

MVRC just called and Charley’s awake and alert after his CT scan. He’s still in the ICU, but here’s the picture they sent. Dr. Luther, who did the MRI, will call sometime today. We get to pick Charley up this evening.

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’s surgery is at 9am cst tomorrow to remove the OS met that is near his amputation site.  He’s walking in to MVRC wearing his “Superman Cancer Warrior” costume too!

Positive thoughts, prayers, and keeping fingers and 3-paws crossed are greatly appreciated!  I will post an update 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  ♥