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Pofi: Peripheral Nerve Sheath Tumor Amputation

Jun 07

We have our dancin’ shoes on, because U of MN Veterinary Oncology says there is nothing to be concerned about on any of the 3 slides of lymph node aspirate.  Nothing to see here folks, move along.  Just biggish lymph nodes.  NBD – No Big Deal!!

And this is how we feel about that news!!!

And this is how we feel about that news!!!

Jun 06

So Pofi had his CT scan today and his paperwork says he was a very good patient for them today.  The (sort of) good news: there are no clarion clear signs of remote metastasis to lungs or lymph nodes.  There are some bright white light points in the lungs that are calcification – osteaomas – and are not a worry.  There are just 3 or 4 less bright tiny spots that don’t seem to be blood vessels, but could be the same sort of process that results in the osteomas.  Or could be very, very early mets.  Just not nearly conclusive to say anything and way, way to small for biopsy.  And while lymph nodes could be a bit large, they aren’t really large and it is not only the ones located near the cancer.  Seems impossibly preposterous to the oncologist that there could be metastasis to all of them  at such distance.  So not particularly indicative of cancer.  There is one he was able to aspirate and that is off to pathology: for good or for bad, this could give us something more definitive…or the same fuzzy, wispy, not at all sure view my expenditure procured today.

Really, it is more good than bad.  I have lest existential angst than I did before (I am never completely without existential angst, that’s just how I roll).  For now, radiation therapy is still a future decision.  Perhaps a CT in 4 to 6 weeks (this was discussed) and meanwhile, we will up the chemo game.  Adding Piroxicam to the cocktail for the anti-inflammatory benefit in Metronomic approach, skipping the Doxycyclene.  And seriously considering Palladia.  We would stagger the Cytoxan and Palladia (at new, lower dosage protocol) trying to inhibit cancer in different ways.  We will likely start on it this week after giving his system a day or two to recover from today’s GA.

A funny note, the veterinary oncologist asked me what my job was today and when I said I was a Project Manager in the Finance industry, he asked if I had any sort of science background because I am following and taking in everything he was explaining so well.  I said, “No, just critical thinking skills honed as an English major and Philosophy minor”.  Score one for the too frequently maligned and disregarded Humanities BA degree!!

To lighten the mood and remind us all to live in the moment, here is Pofi living large at the dog park yesterday:

Resting after romping in Mother Lake, 6/5/16

Resting after romping in Mother Lake, 6/5/16

 

And an always enjoyable roll in the lush green ground cover!

And an always enjoyable roll in the lush green ground cover!

Jun 05

Where we are now…

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Literally, right now, Pofi and I are in my home office and he is lying on my foot.  My sweet boy became a Tripawd dog one month ago yesterday at the age of 11.5 and the result of a malignant peripheral nerve sheath tumor in the brachial plexus.  A mouthful, isn’t it?  Essentially, a soft tissue sarcoma located on the nerves in his armpit.  Had to be painful, but boy, did he mask it well.  At this very moment, he is not in pain – not at all.  His personality has come back in force and his mobility is great, which it has been since we came home.  We are beyond lucky in this regard.  Confession: against all the rules and doctor’s explicit orders, he has been going up and down stairs since the night he came home, 48 hours after amputation.  He would not be talked out of it despite all my preparations to keep him in a confined area and sleep downstairs with him.  He was just going to stand all night until I agreed to let him go upstairs to our bed where he has slept all his life.  For the first few days, of course, I did control this activity with baby gates and doors and limit it and oversee it.  He’s a big lad, so there was no carrying him and especially given the pressure that would put on his surgical site.

He is a Lurcher – a cross bred dog with Greyhound or Saluki in the mix and was likely bred for mushing.  He is also quite clearly has a lot of sled dog in him – likely Malamute based on size and also those silly DNA tests.  He ran like a Greyhound.  Like the wind.  Like poetry.  And he is, though I am, of course, biased, magnificent looking.

This is Pofi, who is named after the small town in Italy my mother’s parents hailed from, climbing a tree.  Yes, climbing a tree.  As a younger dog, he was not only greased lightning, but he was sure footed and graceful.

Tree climbing Lurcher, St . Patrick's Day, 2007

Tree climbing Lurcher, St . Patrick’s Day, 2007

 

Tomorrow, I will be dropping him at U of MN Veterinary Medical Center for a CT scan under anesthesia, which fills me, again, with dread.  The post amputation pathology showed us no love, no mercy.  The tumor was uncharacteristically large, aggressive and not “well encapsulated” – translation, poor and incomplete margins – and it had enveloped part of a rib and destroyed a lymph node (both removed in addition to the limb, the mass and atrophied muscle).  Graded for these reasons Stage III of III with regional metastasis.  “We didn’t get all the cancer,” were my surgeon’s words, tinged with her regret and empathy.  It cannot have been easy to tell me that after the earlier misses on this hard to diagnose cancer and then the recognition of what this was with the hopeful caveats (from several vets) that this type of tumor was generally slow growing, localized and rarely metastasizes.  Amputation is often considered curative…

Not for us, though.  Radiation treatment is considered most beneficial if we are hoping to prevent or delay a local recurrence (which is highly likely if not inevitable) given his case.  It would be a hardship, not just financially, but a difficult treatment for my loving homebody of a hound to be dropped off every weekday for 18 to 22 radiation sessions.  He will hate it.  But it could give us so much more time.  First things first, though.  We want to know if the metastasis was only regional or if it is also “remote”.  If possible, tomorrow’s imaging will also give the radiation oncologist what she would like to see in terms of mapping the interior scar from surgery to plan radiation treatment, but he will be positioned for a good look at another lymph node in the chest and the lungs (which were clear per x-ray one month ago).  If mets are in either place, it has traveled via the bloodstream and it is a whole new ball game.  We are currently on Metronomic Chemotherapy, which he is tolerating well, and were considering radiation, but I would take that treatment off the table if we have lung mets.  He will not spend these summer days in the hospital chasing a future that is cast in complete doubt by presence of cancer in the lungs.

But right now, I just want this day, with a happy, tail wagging, bouncy Tripawd and perfect weather to last forever.  Not a moment of regret on the amputation, except I wish it had happened sooner.

About a month after his last visit to the dog park, Pofi returns as a Tripawd

About a month after his last visit to the dog park, Pofi returns as a Tripawd

Today we will go to the Airport Dog Park as we have nearly every weekend for years.  We went back for his first visit in a month or so on May 21 and he had a wonderful time.

We went yesterday and all who met him were delighted with his smile and his attitude.  Most could not believe he had only had the amputation a month earlier.  The leg was so painful in those final weeks, he had stopped using it altogether and, though he works much harder with three legs than four good legs, he is much happier and more energetic now that he doesn’t have to cart that thing around with him.

He beams – and he thinks he is king of the world again.  He picked out a giant English Mastiff for some sport right away yesterday and even put his right front leg up on the Mastiff’s back!  I thank that dog and his owners for their patient indulgence, but it made me so happy to see him being so sassy.

This is a sign of how good he is feeling, how pain free he is.  Other signs are my shoes and clothing being absconded with from my walk in closet and ending up on a dog bed.  And the attempts at counter surfing and begging to lick my cereal bowl in the mornings.

I just want this to last forever.  Can’t it?

2016-05-19 19.39.49

Another sign of how well he feels – hoping for a taste of Daddy’s beer, 5-19-16