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Pofi: Peripheral Nerve Sheath Tumor Amputation Pofi's long strange trip to becoming a Tripawd dog

September 24, 2016

A bit of a bump, or lump, in the road

Filed under: Uncategorized — Tags: , , , , — hester @ 3:36 pm

More than four months post amputation and into his 12th year now (# 12 Gotchaversary coming up in November), Pofi continues to do well and be spirited and happy far, far more days than not.  Back on August 1, we had a second post op onco cat scan of lungs and surgical site and all was well.  Lymph nodes unchanged or maybe smaller than at first (we also had FNA cytology of a node at that first appointment and there was nothing concerning), no lung mets and surgical site looking clear as well.  While we were discussing the results and how he was doing in general, the oncologist noted a prominent callused mass on Pofi’s forearm of the remaining front leg.  They took a photo and asked about it and I said it had been there for 6 years, not really grown in the last 5  and been determined to be benign.  They also measured it (a perfectly round 2.25cm diameter) and said we should watch it.

As if those words were heard and understood, by Pofi or that damn lump, it started to seem to bother him in the last few weeks.  And it seemed to get a bit more prominent. It is hard to say which came first – the worrying and licking at it or the greater dimension came first, but despite our efforts, he managed to remove a lot of the callus and ulcerate it.  Still, I was determined we could calm it down, get past this (he was also licking clean some other spots around the wrist – this lump is above that carpus) and he frankly, has always done this to his poor wrists and feet every once in a while.  Always seemed like a seasonal irritation.  But on this past Sunday, at the dog park, he also got it pretty gloriously wet in some mucky lake edge water.  I tried to gently clean it up and redress it to keep him from licking, but by Monday evening, he was suddenly seeming to be very unsettled, very uncomfortable and perhaps a little painful (there were a few little squeaks to indicate this).  It was a rough night – and I considered bringing him in to the U of MN for an emergency look over and consulted with them on the phone, but had given him 2 Tramadol by then and he was calming down and relaxing.  About 6 hours later, 2 more Tramadol and 1 Carprofen seemed to have near immediate effect when he was restless again and in the end we got good sleep.

Wet, dirty and happy - at the Airport Dog Park

Wet, dirty and happy – at the Airport Dog Park

Morning and he acted as if nothing had happened.  But I got a suddenly open slot on the onco schedule for the afternoon and in we went.  Our onco was not available, so another from the staff boned up on his case before we arrived and we had a thorough recheck.  He showed no real sign of pain anywhere at all except when that now mean looking ulcerated mass was poked or prodded and even that was not seemed perfectly reasonable to all of us.  All of the other fatty lipomas he has were once again palpated and measured and nothing seemed changed or troublesome there.  Pofi, in fact, handled it all like a champ.  And the offending lump is still the exact same diameter, but does seem to have more depth to it.  But also sort of inflamed looking.  So he asked, would we or had we ever considered removing it?  YES.  Would I consider removing it now so we could relieve the irritation and worry of infection on his much needed leg?  YES!  And would I like to talk to a surgeon for a quick consult right now if one could be located?  YESSSS!!!

In case there is any wonder why we would consider removal of this thing from his remaining front leg, I present the culprit in all its miserable glory.

In case there is any wonder why we would consider removal of this thing from his remaining front leg, I present the culprit in all its miserable glory.

Happily, a surgeon was located and despite his protestations, Dr. E was able to really get a good feel of it.  We all talked about why it might be bothering him – could be seasonal allergy (other spots on leg also licked clean), it could be he knocked or scratched it first, it could be his only front leg is now sometimes a little painful, especially the fallen, hyper extended carpus, or, of course, it could no longer be benign.  The very good news was that he felt it was not deep at all – only in the skin – and he could remove it quickly and likely even close it without issue despite how little skin there is on the skinny part of a skinny dog’s leg.  Tension relieving incisions MIGHT be necessary, but thought he might be able to do without.

Also discussed – had we ever considered a brace to support that fallen carpus?  Well, yes, before he was a Tripawd this was discussed.  And why had we not pursued? That damn lump, that’s why!  And so if we removed this and get pathology on it, not only would he be more comfortable and we would know if there was some sort of spread (or different cancer), but he could be measured for and get fitted with a custom carpal support brace from Therapaws (or another option).  Honestly, despite the fact this will be the 9th GA for this dog in just over one year, this was a no brainer and when he said he could do it on Friday, I immediately agreed.  I don’t want to manage and worry about this lump any longer.  If it is cancer, it needs to be removed.  If it isn’t cancer, it needs to be removed.  Fine needle aspiration was done and nothing ugly showed in that, but this is not, of course, definitive.

We discussed his current meds regime and onco and surgeon agree we will have to suspend the Palladia while the surgical incision heals, as the way Palladia works could impede healing.  So that is a week to 10 days, but absolutely worth the risk as our use of it is out of an abundance of caution as we see no definitive proof (yet) of recurrence or further metastasis.  So his chest and heart were also listened to and blood drawn for the pre-surgical work up; nothing remarkable and nearly every value is good and none are concerning.  Yet again, after being taken from me for the blood draw, Pofi the three legged wonder hound pulled a perfectly normal sized doctor down the hall like they were ski-jouring to get back to his Mommy; Dr. E laughed and said, “He’s pulling me off my feet!”

We returned home to enjoy the next few days with dinners or rotisserie chicken and kibble, birthday treats (his just past and Mia’s is actually today) and presents.  You can see, despite no pain meds since wee hours of Tuesday morning, he is feeling just fine.  But the lump, while being lightly bandaged afresh daily, is still just ugly.

And because we were in a fine mood, we thought we’d try some selfies:

We are not good at selfies...

We are not good at selfies…

 

...But we laugh about how bad we are at them!

…But we laugh about how bad we are at them!

Cut to Friday morning and after barely sleeping, I am up at 5:15 to be ready to drop him for surgery by 6:30 and then go straight to the office where I have a long and busy day ahead of me culminating with a 2 hour presentation on soon to be launched process and tool changes to the people impacted (think herding cats).   And had signed up to volunteer for a cook-a-thon later (and really can’t back out) and pick up a friend at the airport at midnight to bring her to her hotel.  Pofi is DELIGHTED to be going solo with Mommy in the car until he quickly susses out our direction.  And I get the pleasure of leaving my dog with them, listening to his SHRIEKING echoing off the high ceilings in the expansive hospital lobby.

Surgery went well and was short.  Dr. E had no problems closing the wound.  Po, the champ, came out of anesthesia uneventfully.  He ate dinner very well – was just tiny bit whiny on ride home and at home, but I think it more his dissatisfaction with the mega bandaging than any pain.  To be certain he could sleep, I do give him some Tramadol, but we don’t need to repeat it later.  He woke up pretty bouncy this morning and is being completely chill while Daddy sands the floors in our living room; remarkable in itself as air compressors and other power tools send him round the bend.  In 7 to 10 days, we’ll have the pathology.  Hope, of course, for it to be benign, still.  Or low grade STS at worst.  Appreciate all the good vibes you can lob our way on that count and for healing to proceed without incident.  But we are so, so happy to have it gone.

Post lumpectomy, Mia keeps a watchful eye over her brother. As my husband said, it is easy to overlook the fact this is very hard on her, too. Especially on the days where she ends up home alone with only cats for company. And he is really her only canine friend. Sweet girl.

Post lumpectomy, Mia keeps a watchful eye over her brother. As my husband said, it is easy to overlook the fact this is very hard on her, too. Especially on the days where she ends up home alone with only cats for company. And he is really her only canine friend. Sweet girl.

 

This morning - feeling brighter and completely unworried about the floor sander!

This morning – feeling brighter and completely unworried about the floor sander!

 

June 6, 2016

A new scan, but no real news

Filed under: Uncategorized — Tags: , , , — hester @ 8:27 pm

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!

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