Jasmine's Cancer Story
The Lump Saga
Wednesday, April 26, 2006
Sigh. I know that OSA can and will rear its ugly head at a drop of a hat, we're not really prepared for this.
Jasmine has a 1 cm red mass on her right flank, below midline. I noticed it on her this morning and took her to our local vet, Dr. Thompson. She had a bath on Saturday, and I didn't feel it then, so it may be very recent. Dr. Thompson believes it is a mast cell tumor (looked that way to me) but couldn't recommend any course of treatment. We went through this with one of our other dogs a few years ago, so I know how much tissue is removed in order to get clean margins (Levi's tumor turned out to be a benign fibroma).
Dr. Thompson said we couldn't put her on prednisone because of the meds she's on. He wouldn't recommend surgery because she wouldn't heal well, because of the Cytoxan. He wasn't sure what to do because she does have metastasized bone cancer, and is living on borrowed time. He did recommend Benadryl, which we were going to start because her spring allergies are acting up. She isn't scratching at the lump, and it isn't ulcerated or bleeding. She's eating and drinking fine, and plays some, but her right foreleg arthritis is bugging her a bit.
I've emailed Jasmine's oncologist, Dr. Hillers, to get her take on things. We didn't do a needle aspirate or biopsy, because the histamine reaction could be severe. She isn't scheduled to go back to CSU until the end of June or the end of September, or if some problem crops up.
Here's Dr. Hillers response:
did dr. thompson aspirate the mass? ie. do we really even know it's a mast cell tumor? [answer, No]
if it is, i would consider removing it if starts bothering her. the low dose of cytoxan would not worry me, and i do not think her lung mets are so bad, that i would worry about anesthetic risk a lot more than usual. we've had other dogs on a lot stronger chemotherapy have their skin/mouth masses removed without any healing issues (depends on where the mass is located and how much tension will be present after surgery).
i would not start prednisone though, as i don't even like to do that for mast cell tumors, unless they're grade 3. go ahead and start the benedryl since she's taken that in the past.
but i think i would figure out for sure that it's a mast cell tumor and then go from there. but the cytoxan doesn't worry me. the lung mets concern me the most, but i don't think they're so horrible that i would NOT pursue surgery if the mass started bothering her.
Jasmine celebrating her 12th birthday by eating her Rocky
Mountain Chocolate Factory dog biscuit. August 31, 2005
I asked her if I should take Jasmine to CSU for tests, or do that here. I also asked her about the Tagamet. The saga continues.
Dr Hillers must be on her computer, 'cuz she got right back to me:
you could give her both--once we really know what it is.
i would probably just use a generic pepcid (famotidine) and a generic benedryl (diphenhydramine) if she really does have a mast cell tumor. the benedryl twice a day along with the pepcid. but even then... i think what would concern me more is if it changes or gets bigger. it could potentially be a low-grade mast cell tumor. the main thing we worry about with them is 1) grade 3 (aggressive) and 2) histamine release from the tumor if it becomes angry. so the benedryl doesn't necessarily always prevent a histamine release, but it helps decrease some of the effects if that would ever happen.
i don't think you need to bring her to CSU. just get it aspirated at dr. thompson's. that way you'll know for sure what it is. then, i guess, you could potentially keep an eye on it for a month. if it's pretty quiet, and it doesn't bother her, then.... we could monitor given her other disease. but if it starts changing/growing a lot, then we should get it off for sure. if she didn't have OSA, i'd say, let's do something NOW.
everything is about quality of life in animal oncology. so i don't want to dope her with benedryl if we don't need to, and we really may not need to.
So, I'm taking Jasmine in for the aspirate tomorrow morning. Unfortunately, Dr Thompson doesn't usually do them, so who knows what will happen. I've printed off Dr Hillers' responses and I'll give that to him tomorrow. sigh. She does get really dopey with Benadryl.
Thurssday, April 27, 2006
Well, Jasmine had the needle aspirate today and the vet found some mast cells but not gobs of mast cells he would expect with MCT. He found "big round cells" and "not much mitosis." I emailed Dr Hillers with that and she says it sounds like a histiocytoma, which, thankfully, is benign. The best website that I've found is at the University of Georgia http://www.vet.uga.edu/vpp/clerk/woods/index.htm and that is exactly how her nasty lump looks. The vet's office is sending the slides to CSU for a cytology review.
"Most histiocytomas regress spontaneously without treatment; however, surgical excision is usually curative. These neoplasms rarely metastasize and the prognosis for non-recurrence is excellent."
So, hopefully that is what it is, and we don't have to do anything. It should disappear as fast as it showed up, and she can continue being the wonder-mutt.
Friday, April 28, 2006
The results came back today from CSU about the histocytology. It is a neoplasia (no surprise), and it could be extraskeletal OSA or a plasmacytoma (related to MCT, lymphoma and histiocytoma). Either way, the pathologist suggested removal. I haven't contacted our oncologist, Dr Hillers, to see what she says. Our GP vet will remove it if we want. He has no strong opinion either way, and is as lost about what to do as we are. I asked him how big a margin he'd take, and he said 3 cm. There is a picture of it on her site now at http://www.wyomingweb.net/jasmine/images/JasmineLump_sm.jpg It is blurry, but the best I could get while holding the camera, ruler, and petting Jasmine to keep her down while Nixie licked my head. It is about 2 cm wide, and looks bigger than yesterday, but that could be because it is shaved around it.
My gut says remove it. Is that because I can see it, and how ugly it is? I can't see the similar things growing in her lungs, so I forget about them. It isn't bothering her, and neither are the lung mets. What to do?
Chewing a rawhide. February 19, 2006
Dr Hillers last email to me said "we could monitor given her other disease. but if it starts changing/growing a lot, then we should get it off for sure. if she didn't have OSA, i'd say, let's do something NOW." So, I think that is the wisest course of action right now, though it is hard. Da*n disease.
Saturday, April 30, 2006
Scott and I are both seriously leaning towards removal of said lump, but now it comes down to money. With trying to get him set up in his new job, a 4 hour drive away, and buy a house for him, so money is tight. We can probably do it, but I want an estimate from CSU before I take her down there. Starting in June, I can't take any vacation leave because of the BIG MOVE (we're relocating the state library to a temporary facility 3 miles from the Capitol area) for two months, so we need to do this in May, when I can take time off, and Scott is still in Wyoming.
Dr Hillers was going to contact the "surgeon of the week" about this and take a look at Jasmine's labs and get back to me.
Monday, May 1, 2006
Ok, I'm at the frustration stage of diagnosis. You know, that phase where you just want your dog all better, and can't wait for the surgeons and oncologists to poke and prod and test to say "yes, this really should be removed." I remember feeling like this when we were dinking around trying to get a handle on what was growing in her jaw back in August 2004 (yes, that long ago). Fibrosarcoma? Benign epilude? Melanoma? Turned out to be "a relatively high grade, osteosarcoma-like" mass, though the second biopsy came back fibrosarcoma. So, is it really OSA? Or is it FSA? Some combination? That's why it doesn't surprise me that this new lump could be *both* a skin met *and* a plasmacytoma. But, the surgeons want to make sure, before they take out too much or too little. I don't blame them, but don't give me the run-around. I played phone tag with an oncology nurse today, and I wasn't in the mood for that.
We have an appointment on Friday at 10:30 at CSU for consultation, I believe. Dr Hillers thinks the surgeons will look at it, look at the cytology and go "yep, we should remove it." So, we're planning on having it removed that day, but then we've been there done that before. Oh, and we have to bring a copy of the cytology, even though it was done at CSU.
Wish us luck and a skilled surgeon on Friday. Jasmine is finally getting that tummy tuck to go with her nose job!
Wednesday, May 3, 2006
I know this might interest some of you. We got a copy of Jasmine's cytology report from our local vet, so we can take it to CSU on Friday. For some reason, the pathology lab and the hospital aren't exactly connected, so they have a hard time linking things up, so Dr Hillers thought it best if we just brought a copy with us. So, without further ado, here it is:
Description: Cellular preparations. The cells consist of indivualized cells with basophilic cytoplasm and eccentric nuclei. There is moderate variation in nuclear size and frequent single nucleoli. Binucleation occurs occasionally. The cells occassionally have a sprinkling of fine azurophilic cytoplasmic granules. There is rare extracellular magenta matrix material. These cells have the appearance of both well-differentiated osteoblasts and plasmacytes seen in plasmacytomas.
Comment: Neoplasia, options include extraskeletal osteosarcoma of the mammary region and plasmacytoma. Removal and/or histology is indicated.
Checking out the snow. February 18, 2006
So, it does sound like plasmacytoma (benign) and a skin met. Which came first? Did the skin met cause the plasmacytoma? Is the extraskeletal OSA just hanging around everywhere, and it was only found here because of the erruption of the plasmacytoma? What does it mean that some granules are "blue loving" (did I interpret that right?). And what does the "magenta matrix material" mean? It looks and acts like a plasmacytoma (red, round, suddenly showed up), but I don't know how a skin met would look, feel or act. It hasn't appeared to have gotten any bigger, and it sure isn't bothering her.
After my rant to Dr Hillers about lab work and consultation, she said that the surgeons just want to confirm what it is before removing it. I can appreciate that. Because of the CT scan and second biopsy, Dr Dernell was able to save the right side of her jaw, so if they figure out what they are removing, maybe they won't have to take so much. I do wish she'd get a tummy tuck. She's a bit flabby there since she lost the extra weight. It hangs over her feet when she sits square.
Friday, May 5, 2006
Well, we didn't see Dr Withrow today, but Dr Bacon, who is equally capable, and had a nice accent to boot. He gave us three options--1) leave it alone, 2) remove it under full anesthesia, or 3) remove just the lump under a local with sedation. We opted for #3. It was starting to get a bit ulcerated, so it is good it was removed now.
Jasmine now has a 3" long incision and four stitches. Not much of a tummy tuck. They just removed the lump, no big margins or anything--what's the point she already has lung mets. I swear, it was the cheapest oncology appointment of her 20+ months of going to CSU. Yeah, not all the charges were in (like the lab), but still, it'll be cheaper than her regular check ups!
She is now flaked out on the couch, looking a bit dazed. Nixie keeps trying to cheer her up by playing, and Jasmine is having none of that.
We should get the pathology back on the lump early next week. She should get her stitches out in 10 - 15 days. She's a little less dopey now, but still sways a bit when she stands. She vomitted up icky green stuff earlier, so she got a cup of rice cooked in chicken broth for dinner. She gobbled it up. I've caught her licking at the sutures once. If it gets to be a problem, she's turning into the blue astronaut again!
Tuesday, May 9, 2006
I got a voice mail from Dr Bacon today, stating that Jasmine's mass was diagnosed as osteosarcoma as the needle biopsy had suggested. It seems most likely it was a metastasis rather than a new tumor. The margins were clean, so it shouldn't recur at that spot. There were no cells present suggestive of plasmacytoma.
She is doing well, and leaving the sutures alone. There is a bit of discoloration around it (bruising? razor burn?) but otherwise it looks great. She's decided to be little miss spoiled dog and wants canned food only, so we're obliging by giving her half canned and half kibble. The things we do for our dogs...
This pathology report does make me a bit sad because the cancer is slowly winning and eating her from the inside out, and now the outside in. However, I had to know, and I suspected that is what it was after the cytology came back. Frankly, I like the idea of a skin met much better than a new cancer like mast cell tumor. OSA is a beast I know, and I'd rather fight the beast I know than the one I don't. I keep thinking about that 24% 2-year survival rate for OSA in that part of a jaw, and I'm just amazed at how well she is doing. It took almost a year to metastasize to her lungs and 9 months to metastasize to her skin. I could look at it that the disease is starting to ramp up, or I could view it as how long the time is between stages. Who on BCD said you have to have hope, love and belief? It is so true.
She is a fighter, though, and will always be Dr Hillers' superstar and our wonder-mutt.
Tuesday, May 16, 2006
Jasmine had her sutures out today. Dr Thompson looked at her other new skin lumps, and we decided to not remove them. Or, at least until they got red and icky and ulcerated. She is in fine spirits, but her back right leg gives out on occasion.
Sunday, May 21, 2006
Jasmine's two new lumps are now larger, red and squishy, like the skin met she had removed two weeks ago. I'll call her local vet tomorrow to see if he is willing and able to remove them with a local anesthetic. I was really hoping they would stay small and pink and hard, but now with them getting ulcerated, they really need to go before she gets an infection. It has only been a week since she had the sutures out from the first skin met removal. *sigh*
Tuesday, May 23, 2006
I got my buttons today--five more "Cancer Sucks" and one each of "Leave me alone I'm LIVING", "What doesn't kill you makes you STRONGER!" and "Life is full of choices, CHOOSE HOPE!" I think I'll put a bandana on her on Thursday and she can wear the "Leave me alone I'm LIVING" button to her outpatient surgery.
I'll email Dr Hillers (if she is still around) or Dr Bacon and see about upping her doxy or adding the etoposide. I really can't take time off to take her to CSU right now, so if I can do a consult via email that would be great. It is all about quality of life right now, and I don't want to put her through a bunch of tests and procedures. She is still handling the cytoxan, which I am surprised about.
Scott is moving to Nebraska this weekend, so anything we have to do with Jasmine I'm going to have to do on my own. His last day at his job here is tomorrow, and he starts his new job next Wednesday. He was starting to second guess himself yesterday, but I know he will be much happier (and healthier!) at the new job than if he stayed here and stressed himself to death.
Thursday, May 25, 2006
I dropped Jasmine off at the vet this morning to have her two, no, wait, three lumps removed. She is wearing a bandana with the "Leave me alone, I'm living!" button on it. I told the tech to have the vet call me before he did anything, which he did, about a half hour ago. We discussed it long and hard, and decided to not remove those new lumps. She is at the point in this disease that we will just make her as comfortable and happy as possible. I really wish she would take the decision away from us, but she is too much of a tough old broad to give into the cancer. We're going pick her up at 11:30 when we take Levi-of- the-stinky-butt in for his anal gland check. Those are probably infected. If it isn't one, it's the other, or all three...
