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!!!

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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  ♥

 

 

 

 

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! 🙂

 

 

Charley’s Halloween costume is “Superman Cancer Warrior”.  It’s amazing how white electrical tape and a lot of cutting can transform an off the shelf costume into something wonderful!

 

 

We took Charley to a local pet boutique, Treats Unleashed, and he won 1st place in their costume contest.  Here’s some pictures of Charley sporting his costume!

We felt that a family portrait was in order since it was a special day for all of us!

Charley was so proud of his 1st place prize!

 

We had planned to have Charley’s 3 Year Ampuvesary Party and my mom’s Birthday Party together yesterday, but instead we had a change of plans and we only celebrated my mom’s birthday yesterday.  Monday, October 28th, which is Charley’s actual 3 Year ampuversary is when we decided to celebrate his special day.  Monday is also the day we should get the pathology report back on the aspirate from his new cancer “lump”, so we thought we’d celebrate his 3 Year Ampuversary and “Cancer Warrior” status that day regardless of the results!

 

This Thursday, October 31st, Charley’s has surgery scheduled to remove his new cancer lump (pending the path results).  We thought since Thursday is Halloween, he’d wear his “Superman Cancer Warrior” costume into the surgery center that morning as a “pawsitive” omen…and to show that he is going to battle!!!

 

 

We’re still praying that Charley has an operable soft tissue sarcoma so he can continue on his journey of hope inspiring others and proving that OS doesn’t have to be a death sentence and that you can live happily with cancer!!!

 

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  ♥