Neka's Cancer/Life Journey

My girls name is Neka, she is a large breed mix/ridgeback/Shepard/ hound…and whatever else God gave her. She is currently 10 months post op amputation with OAS. Above pic is july 14-2014

I want to share our journey in hopes that it may help others with their research and journey.

Bare with me this will be a long story because I am detail oriented and will share my thought process in every step I took and decision I made for her.

Our journey started in November of 2013, Neka is 10yrs old, when one day I palpated a small lump on her Right front leg above the wrist area. (I was a Massage therapist for 15 yrs so i tend to poke at everything as well as a rehabilitation professional, so anatomy is my expertise)
I called my vet of many years the same day, as most would think this was drastic since the lump was not visible at all and Neka was not lame nor did she have any symptoms. I urged the vet to see her the same day as I was determined not to let something go unaddressed since only 3 days prior I lost my cat of 12 yrs due mis-diagnosis of diabetes from a local emergency vet. So with my determination in hand and my tears still flowing from my kitty; I took her to my local primary care vet.

He is not fully convinced it was, what my worst nightmare was, a bone mass on her leg. But I know what I felt on the leg, I only hoped maybe, just maybe it was a old fracture or calcium deposit, but inside of me I feared the worst and unknown. After some convincing(because she was asymptomatic=no symptoms) he decided to xray, at that moment I walked back into the room and saw her rads on the screen and could distinctly see the mass. It was about 1.5-2cm round at the radius wrist. My heart sunk tears welted in my eyes, I was nauseated. The one thing he told me, which helped me just get a grip is, “just remember she doesn’t know whats going on and look at her shes fine right now, but I need to refer you out to a specialist”. The words were simple yet, so helpful, If I start loosing it, she(Neka) will know, I had to keep it together(easier said than done)
My journey and research begins.
I immediately took her to Vet specialty center,(awesome, awesome place, great doctors and techs.. i mean amazing..kinda a Mayo clinic for pets) I had prior experience with them. She had a prior TPLO 3 yrs ago on her Left rear knee and had a vulvoplasty only 3 months prior. From my research If it was osteosarcoma it is very fast moving and time is of the utmost essence..
After speaking with the surgeon , I had a slight gleam of hope that maybe just maybe is was a fungal infection which can mimic an OS mass, and he suggested a biopsy. Most people say that no they are a distinct visual on the xray, but he mentioned hes seen some not follow status post, and though fungal infections are rare, He asked me “could i live with an amputation if all she needed was antibiotics” Clearly my answer was no. Alot of what I read also stated that a if its suspect OA then the biopsy is an unnecessary procedure with risk of fracture however in my situation, she was a dog that went to the horse stables with me and often played in the mudd, creeks and ponds, perfect breeding ground for this type of infection. So I yet again , hold on to a little hope. I never prayed so hard for a “positive” test result.. Positive would mean fungal..
The biopsy came back negative, negative for fungal, my heart yet again felt destroyed.
We discuss the amputation. Working with dogs and horses my whole life and tech-ing in a vet clinic as a youngin, I know dogs can survive vivaciously and strong on 3 legs, but with her history of her  Left TPLO and continued occasional Knee discomfort, I was concerned about if she could manage as most dogs would on the 3 legs. If it weren’t for that knee, I would have said chop it off and lets move on to recovery. The surgeon did not feel it would be an issue for her, but i began my research about partial amputation with a prosthetic, since she was so active and had some arthritic in knees( after-all I’m a rehab therapist)
The surgeon helped talk me through it and looked deeper to see if he could get clean margins(he felt he “should” be able to) and leave enough leg for the prosthetic attachment and talked to a prosthetic maker orthopets out of colorado. I also continued my research, calling various universities and spoke with orthopets myself.
What it came down to is… what am i trying to accomplish?… If I put her through this surgery and I expel the funds for this.. what is it I need to happen?, i need to know that we removed “all” of  the cancer without it spreading and reducing a chance of having to cut more leg off and to ultimately save her life and give her a fighting chance to the best of my ability. Since no on had ever done a partial amputation with this type of cancer and my fear of doing it spreading based on the aggressive nature of OS, potentially needing to take more leg in a second surgery, I felt the risk was too great and with minimal research on a partial in relation to this cancer, the safest choice was full amputation.
The surgery was scheduled ASAP, Dec 10 2013. The time span between finding the mass and surgery had to do with waiting for biopsy results which took about a week. but all said and done it was very fast from first day of confirmation to amputation. As stated, time is of the essence. Same day of surgery, we did full chest xrays and abdominal Ultrasound to verify nothing had spread as this could have changed our fate.

A hiccup 3 days before the procedure:

So approx 3 days before her scheduled surgery date, her whole neck swelled up and I felt a very swollen mass in her neck. It felt like a lymph node but it was close to her salivary gland. I though oh my gosh, its spreading so fast, if it hit the lymph nodes then surgery would not be an option to put her through. I spoke with the vet on the phone, and we felt we could wait til day of surgery and he would look at it.  Of course the massive swelling and fluid retention went down but the nodule was still very large, approx just shy of golf ball size, on the opposite side of her Right leg which had the confirmed mass.  So day of surgery, the surgeon aspirated the nodule and would you believe the U of I head of Lab was up visiting their clinic and he was able to take a direct look at the sample. NOT CANCER.. yes…whew!!! thank God.. it did not spread, would you believe it was an infection of unknown origin not even related to the cancer at all or anything for that matter, she could have picked it up from anywhere. Antibiotics injection during surgery and she was good to go. Of course at the same time, we did chest xray and abdominal ultrasound to confirm no spread of the OA. She was cleared and ready for surgery.  So my adivise, hang in there for all the crazy little things that pop up, and find a great vet/surgeon who is willing to give you as many details and updates as you need to be comfortable. After all these are our babies.

My trouper came home next day on Dec 11. One of my worst fears was if she would be able to get up ok because of her back knee TPLO surgery she had 3 yrs prior and that she began to get arthritis in.. but she squashed that fear the 2nd night home, she jumped up in middle of night to get up and get a drink of water.
To step back, she is a dog that I never had to crate, which did make this challenging because they need to rest, but she always slept in bed with me, yup all 80 lbs of her. So a crate now would have given her more anxiety. Well when she had her knee surgery 3 yrs prior I temporarily took my bed apart and put the mattress on the floor, worked perfect. So I yet again, took my bed apart and mattress was on the floor. She stayed calm and just wanted to be next to me anyway.
I bought a bunch of area rugs to line my slippery wood floors as to prevent any slipping. Being that she was a large breed i also used the harness alot to not stress the other legs, Imaging a person using crutches, your arms and one leg get over worked, we stop when that happens, our pups, their instinct is to keep going. So our intervention is helpful in preservation of the remaining legs and joints until endurance and tolerance is build up.
Her stitches came out Christmas Eve.

Chemotherapy:

Within 2 weeks of stitches removal I decided to start IV chemo a combination of carboplatin and doxirubicin alternating every 3 weeks, she was able to do max dosage, I think it was 8 dosages each so a total of 16 doses. Since osteosarcoma is so aggressive and can often spread microscopically I felt without chemo, I chopped her leg off for nothing. Dogs don’t have the same reactions as people and after discussing with multiple clinics they are able to control and nausea and diarrhea with a couple of pills. We were fortunate she had none of those side effects at all what so ever. But from my understanding even if they have some side effects they can give the dog a break and resume when they feel better.

Hiccup with chemo:

Yup another “oh my gosh” moment. About 1 month into chemo the right side of her faced swelled massively and you could see a nodule above her molar on upper jaw(maxilla). I take her back into oncologist, my fear is that the cancer spread to her jaw, not supper common but possible. The oncologist said it could even me a 2nd primary site or a secondary site. He didn’t think it was a tooth abscess because her WBC count was normal and no fever and no pain. The only way to confirm is to aspirate it, he aspirated it and the longest couple days of my life yet again her fate rest in the balance. It came back as sarcoma with malignant tendencies. Oh my gosh my heart sunk, how do I address this, we re-xrayed her chest and it was still clear. The oncologist stated that because we don’t know exactly what type of cancer it is at this point we are all ready doing chemo for the OA that as long as the “mass” stays stable we need to treat what we know is life threatening. But oh my heart, to think it spread to her face. I continued my research on mass removals, radiation, universities trials. I also reconsulted with my surgeon, he felt it would be easily removal based on what he felt, but it ultimately it would be based on what the CT scan would show how invasive the mass was. I asked for xrays but they said because of the make up of the skull the peaks and valleys of the bone structure it wouldnt give good images. I wondered if a dental xray would show any better but the surgeon and oncologist both said a CT scan would be better and then from there we could determine how to address the mass, whether a surgery candidate or radiation. But ultimately we had to finish all her chemo sessions first to give the rest of her a good fighting chance.

I decided to have the  head CT scan done at the U of I, mostly for cost(about $400) and that they would go down to her lungs for only $100 more. Plus if I decided to do the face surgery I was looking at around $5k and if radiation around $2-3k. So I wanted to save where I could.

CT Results:

the face CT.. NEGATIVE.. oh my gosh.. yay!!.. what?? how??  it was an abscessed tooth.. because of all the inflammation in the tooth, sometimes aspirate can come back as false positives, no way to know unless we actually biopsied but we didn’t want to do that because we would have had to stop the chemo for healing and with the face if were biopsying it then at that point we should just remove it.  the odds are that the chemo lowered her immune system and an old like a 10 yr old chipped tooth just flared up and caused it to abscess. Everyone asked me about that tooth, but because it was such an old chip and it was a really healthy tooth still plus with the aspirate results, no one would have guessed. whew!!!

However……when they went down to the lungs… there were approx 4 very small lung mets approx 1-1.5mm each…. my heart sunk, and so did the staff at the U of I, she looked and was doing so good. How can I get such great news about her face and yet such bad news at the same time. aaaahhhh… Too small to show on xray and too small to cause her any problems. She did have a very slight like allergy cough, which now the cough could be related even though they seem to think they are too small for that. The million dollar question was, were those masses always there or just pop up? Well never know. The way to keep track of them now, is to xray periodically no need to keep doing CT’s. We know they are their and if they start showing up on xray then we know they grew. uuuggg… heart sunk again.. but pushed myself for getting a grip.. plus it was a 3 hr drive home just the two of us. That’s alot of time to think.. actually too much time to think.. but remembering what my old vet said..”remember she doesn’t know what she has” I snapped myself out of it.

The U of I was offering a trial that was going on that she fit right into, but, I was a bit apprehensive because it was first phase and no baseline data on the drug. It was a hard decision, if I don’t do it and it works, I passed up a great opportunity, but if she has horrible side effects then I just lost time and put her through alot. I think if the trial was a 2nd phase or more base line data I would have gone for it. but i decided to go with the most commonly used med Palladia. Since her mets were so small and she was in great health, her outcome was promising.

IV chemo doxi and carbo:                                                                                                            Rare no stress side effect:

She did, however, have a very rare side effect that it took me pulling teeth to get any oncologist to admit to, within about 8 hrs of the chemo she had some leaky urine. At first they tried to pitch to me that she was an older female and started to become incontinent and I could use this medication proin(lots of side effects).. Im like wait, so she never had an accident or leaked in her life and suddenly shes incontinent.. Im not buying it.. then after kinda arguing this assessment.. someone admits… ” well very rarely have we seen some bladder irritation and it can lax the sphincters”..hmmm.. interesting.. and they say within a couple days it will resolve itself.. .yup it did.. within 3 days it fully 100% subsided… in the meantime.. I bought some doggie bloomers and put a microfiber washcloth inside for better absorption and it worked perfect, no mess, no stress!!!
Aside from that.. she stayed healthy and took it like a champ.
But tip.. is ask for ALL side effects a good way to ask is what side effects… then ok.. and what unusual side effects have you seen, or what is the most rare side effect… I feel alot of vets dont want to scare people with information, which I understand, but i was the kind of person that wants to know the worst the best the odd and the ugly, then give me statistics, then give me scenarios.

We had toothed pulled within 2 weeks and 2 weeks to heal. After all time is of the essence again because of those pesky lung mets.

Palladia:

Her dose was 90mg M F W.  We did blood work at 2 weeks just regular CBC, all was normal. She did seem a bit stiff on the palladia, but probably because she already had the underlying arthritic in knees, nothing debilitating just something I noticed. Well at about her 3 week mark, I noticed one morning she ate her food really slow.. hmmm thats not like her, she ate it but it was slow, and she seemed a bit more tired than normal that day (wed). Fri was when her next dose was due and she was still a bit off, so I withheld the dose. By Sunday she didn’t want to eat and seemed really lethargic and did vomit 1x. That monday I called vet and made appointment for wed. But when I came home monday she was really, really lethargic, personality still ok but really out of it. Nope thats it, I called vet and got her in next morning. We ran a full chem panel (September 16th)and found her liver enzymes were off the charts, it seems as though she falls into a small % that just doesn’t handle the palladia.. UUG.. that was our fighting chance for stunting the lung mets. All her other work up was normal except for the liver….We put her on a bland diet, which she still wouldn’t eat, and the next day I researched about the liver.. aaahhh.. more research.. I found some good supplements to boost liver recovery, denamarin and denosyl… Denamarin has milk thistle in it where denosyl i believe does not. From what I read denamarin seems to be a bit stronger via hitting the liver from all sides.  The oncologist recommended trying scrambled egg and egg french toast..no butter, because of the extra grease/fat for the liver is not good.  I stubbornly did not try it at first, I cooked her everything under the sun. Chicken (grilled and boiled) hamburger, turkey burger, cottage cheese, yogurt, rice, regular cheese, home made chicken broth (store bought has onion powder in it which is toxic to dogs) Plus of course the digestive prescription canned food the vet gave me.. but nope my girl wouldn’t touch any of it.. so I tried the scrambled egg with french toast (no butter bad for the liver).. Of course she ate it..LOL.. but only picked and it and took ALOT of coaxing.. oh and princess didn’t want it reheated I had to make it fresh each time…Now its been a week. but still only eating eggs, I called vet and he felt that if shes not better we need to recheck her levels.  I brought her bak in on September 20th and her ALk levels came way down(234) they were higher than the machine could read. her ALT level was still pretty high but did drop a few points at 370. The oncologist said that she should be feeling better by now since its been a week and a half since shes been off the palladia and usually when you stop it for about a week they are at least feeling better, well her mood and lethargy resolved but she just still didn’t want to eat. So for fear of the cancer spreading or something else going on he wanted to retake her  chest xrays and check her abdomen with ultrasound. ( oh I  also forgot to mention, she began leaking urine on the 16th about 5 days into not feeling well.They had no answer for that one)

Xray–still Negative except a small area of suspicion but only suspicious because we already know there tiny mets via prior CT scan, but nothing causing her illness.

Ultrasound-negative.. liver looks fine.. kidneys look fine…no mets noted…yes…ok.. were good….whew…

so from here he said at this point if all shell eat is eggs to go ahead and let her eat scrambled eggs. he also gave me some prescription A/D to stimulate her nose and appetite. My stubborn little girl only picked at it. a few more days passed and she only picked at the eggs, I resorted to force feeding the I/d prescription diet and she would pick at the A/D. and she would eat bread. About another 2 weeks past and we were headed back in to have blood recheck, its now October 3rd. I did get her to eat a couple cups of her old single protein diet (Signature)the night before heading back to the vet. I had her on that because of her allergies but went back to the Orejin once she had cancer because of the higher protein and fat content which is good for cancer patients.

Oct 3rd liver enzymes recheck.. ALK down to 97 ALT down to 172, they are still a bit higher than normal limits but have come down alot. The question is why is she still just picking at food. The oncologist really at this point didnt know why and consulted with a GP he though maybe check for Addisons disease (adrenal disorder) I though that was reaching but, im not the vet and at this point whats another $100 to eliminate something that could be treatable. RESULTS–negative……Ill be dog gone, she went home that night and scarfed up dinner..lol.. and has been eating normal ever since.. She did need some coaxing, I think mostly because, I kept bringing her all these foods and had been force feeding. So I do feel that messes with their heads a bit from conditioning so any food put in front of them they look at you like OMG now what…lol… but after making it exciting she got back to her normal chow down.

WHATS NEXT::

Researching if I have any other options for trying to stunt these lung mets. I fear my options are limited and if so, will her liver be more prone to having issues? Are there proven other treatments options out there? Not to just do something for my human satisfaction but actually treatment with clinical results. Also getting a holistic vet, my plan was to get one earlier, but I had all these other decisions and things I had to conquer. But its way past due, even if people dont want to do herbs etc.. just supplements, such as I used cranberry to help with the liver, since I read its a great liver detox and I already used it in the past for UTI’s and for basic kidney health. Also when I started back on the cranberry when she started leaking, ironically it stopped within that night… coincidence?? Ill never know.. !!!

So I still have a lot of work to do.

Some say.. How.. why go through all of this?… This is the way I see it. Neka did not ask me to bring her into my home, I did. That makes me responsible for her in every aspect. If she had mets all over her body, then it would be my job to make her comfortable until her time. Just like its my job to give her the means in any way I can within my ability for her and the rest is up to her to fight. Did I spend alot of money on her.. YES… ALOT… sitting on my chase card ( thank you chase promo 0%)…lol), am I well off?.. Nope not in the slightest. Im a single adult student who gave up alot, and would do it again. But this is a “Life” God gave her to me, i owe it to her to give her a fighting chance. I don’t want there to be a day that I look back and think, “Only if I….” Or “I should have…”

Keep an eye on my blog, Ill share my steps, trials, tribulations

and successes.