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14 July 2017 - 4:45 pm
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First of all, thank you for adding me, and secondly, it seems that a toe amputation is much less daunting than what many of you have to face, but I am still worried.

Orlando is an 11 yo GSD mix who has had Cushing's Disease for 3 years, treated with Vetoryl. He is doing okay....not great, but okay. About a month ago I noticed a black spot on his toe on the front left paw and went to the vet. Biopsy confirmed melanoma with a low mitotic rate, less than 1%, and no vascular invasion. The lab does not stage, but did bleach which more or less reconfirmed a low mitotic rate. Because my first Cushing's dog died, about 15 years ago, during cancer surgery (and not with my current vet or hospital), my vet told me to take Orlando to one of the specialized surgery oncology groups. We have consulted with the oncologist and surgeon and they have mapped out a treatment plan involving toe amputation (third toe) and the use of the melanoma vaccine Oncept. I will not do radiation as it calls for anesthesia and that is probably what killed my other dog; no one really seemed to want to administer repeated anesthesia to Orlando and therefore did not push for radiation. They are giving him median survival rate of 1 year with surgery and Oncept.

Everything else has been kicked around as well....if they get clean margins could he skip the Oncept, if they get dirty margins should he just be made comfortable or should we proceed with the immunotherapy? Lymph nodes have not been aspirated but throracic views have shown clear lungs.

I do have concerns...not just the anesthesia, but also the fact that Orlando is not resilient to anything medical, mostly from a psychological point of view. Biopsy was done with a local as I did not allow anesthesia to be administered in a regular veterinary office. The center where he will go in LA at least has all the bells and whistles to help him if something starts to go wrong.

What complications can arise from a toe amputation which may not be forseen by me or not explained by the doctors? Has anyone used Oncept?  Thanks so much for listening.

The Rainbow Bridge

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14 July 2017 - 9:29 pm
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Hey there, welcome! We're glad you joined us and of course you're worried, no matter how much limb or toe is being taken it's still a big deal to us. We totally understand what you're going through.

So first, what clinic in L.A. Are you working with? We're familiar with a few there. I ask because if they are the clinics I'm thinking of, you really don't need to worry about the anesthesia protocols, the clinics I know in L.A. Are following the latest protocols.

I think that your treatment options really depend on how good of a margin they can get around the tumor. My suggestion is to take this one step at a time and then make a decision. You're smart for doing your research now though so you're not overwhelmed.

In my experience dogs who undergo toe amputation do just fine afterword.I've known two personally and they were back to their old antics in no time.

It's better to hop on three legs than to limp on four.™
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14 July 2017 - 10:49 pm
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Yep, DITTO Jerry and more DITTO Jerry!! Anytime a precious pet has a challenge, it is indeed worrisome and itnis a big deal!! You are crazy in @oce with Orlandr and you want to make the best possible decision for him! We all understand that!!

Having some connection issues so will be back later. Just wanted ro quickly say welcome and you are DEFINITELY in the right place for support and knowledge and understanding!!

Lots of hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

Schofield, WI
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15 July 2017 - 7:02 am
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Welcome!  My son owned our Max who had bone cancer.  His friend owns Duke who is Max's father.  About the same time we were going through the amp for Max's bone cancer Duke his father was having a toe amp done.  Sorry I do not know what type of cancer was on Dukes toe.  But Duke is thriving almost two years out from his toe amp.  In fact he got a GSD brother in December which he has no problem keeping up with.  You've done your homework and seem to have a good handle on what's best for Orlando going forward.  I hear you on the psychological end of the vet visits.  Our Max got so stressed out by vet visits that we promised him after he finished his chemo after amp no more poking and prodding.  We lost Max short of five months after amp but it does my heart good to know his father Duke is still going strong almost two years out from his toe amp.  It's like we still have a part of Max with us.  Good luck on your journey and I hope your Orlando can do as well as Duke has done.  

Minneapolis, MN
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15 July 2017 - 7:10 am
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Hi - I am so sorry for this unwelcome news for your dear Orlando.  And having had a 10.5 year old large breed dog who suddenly presented with a suspicious toe issue, I completely relate to your hesitations and worries.

Pofi was a Malamute sled dog mix with some amount of Saluki or Greyhound in the mix.  And I think the toe at issue was the exact same toe as for Orlando.  Disclaimer in advance, in the end, Pofi's toe was not where he had cancer. His cancer was a hidden peripheral nerve sheath tumor in the brachial plexus and the aggravated toe (which had a benign mass in it that probably was a little irritating, but had become a focal point for him to try to address the pain radiating from that nerve sheath tumor) was just a symptom.  We did not know that at the time, though, and after weeks of treating for a topical infection that he had created by licking and beating that, he suddenly was limping again and in clear pain. Measurements revealed that the toe was larger than the others and fine needle aspiration did not rule out neoplasia.  

So we amputated and because there was the fear it was cancer and he wanted clean margins, our surgeon took the whole toe - which on a sighthoundy foot was 6 centimeters in length.  Pofi had nearly died with a reversible, injectable anesthesia a few years earlier, so they were super cautious on the GA and put him under as lightly as they dared. 

Pofi recovered well from the surgery - when his foot was wrapped he really seemed very comfortable bearing weight on it.  Because it was a "middle" toe rather than an outer toe, there is a bit less stability in the foot.  It is a weight bearing toe.  And because it really was not the issue, the atrophy in his leg muscles, originally thought to be related to the fact he was not fully bearing weight on the limb, did not really improve.  Unfortunately, it was nearly a year an multiple consults later that we found the cause of his issues.

But...in the interim, despite the foot being a bit "floppier", he went back to running and playing quite normally. The intermittent limp had nothing to do with the toe or the toe amputation, but they were red herrings.

You might find that he would benefit from wrapping the foot with some vet wrap post amp on longer walks.  I think there are possibilities for therapeutic braces, too.  

I don't know if my tale above has helped at all, but my feeling is you could give Orlando quality time and remove what is likely a source of some pain and to me, that was worth the risk.  And please know, even though it is not a leg, it is still an amp and major surgery and significant for you and for Orlando, so don't think that we view it as minor.  

Let me know if you have any questions or want to see any photos (I have just a few pre and post amp).

Lisa, Minneapolis

On October 27, 2016, nearly 6 months after amputation, and 18 months since his cancer likely started, we lost Pofi to a recurrence of Soft Tissue Sarcoma in his spine quite suddenly.  His Daddy and I miss him terribly along with his canine sister, Mia, and two feline siblings, Lucia and Cliff.

Blog: Pofi, Peripheral Nerve Sheath Tumor Amputation

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15 July 2017 - 3:59 pm
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Thank you all so much for your kind replies. Certainly you have all been there and understand where I am with this.  First of all, the surgeon will be Dr. Huber at Animal Specialty Group on Colorado Blvd. in Los Angeles.  The oncologist was Dr. Ohashi at the same place.  It is encouraging to hear that your dogs have survived amputations and gone on to thrive afterwards.  With Orlando, they are not sure if the melanoma is in the nail bed or not as it is just too close to see where it might have advanced and since they will take the whole toe as well.  

I would be very interested to see photos of the procedure done on Pofi.

My first GSD, a purebred although a rescue, developed degenerative myelopathy. Of course there is no surgery for that and he lost the use of his entire back end a few months after diagnosis but we coped for two years with a cart and various slings, including bladder and bowel management as the disease advanced, so I do have some experience with what some of you have gone through with mobility-challenged dogs.  

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14 August 2017 - 5:58 pm
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I just wanted to give you an update....Orlando had his toe amputated on July 20 and has had all the bandages, splints, etc. removed now. He had a little bit of a rocky time with the fentanyl patch, which had to be removed early, and with the tramadol, but has been weaned off of it. The surgery went completely smoothly and because he is a calm boy, he did not need to wear a cone. The bandaging that they did was not even easily removed by me with tools when I was instructed to remove the patch and I appreciated that. No sloppy bandages falling off or coming unraveled.  The initial biopsy showed no advanced cancer in the toe and the resections were also clear. However, the melanoma was in the nail bed and the oncologists feel that we need to consider the Oncept vaccine.  At first, it sounded as if we were done, but I know that the possibility of stray cells is there. I am inclined to go ahead with the vaccine over the next couple of weeks, especially since I can find no report of serious side effects.  

Livermore, CA
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14 August 2017 - 7:38 pm
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Hello and a belated welcome to you and Orlando.

I'm glad to read that everything went well with the surgery!

My Tripug Maggie was diagnosed with oral melanoma a few years after her amputation (the amp was due to mast cell cancer and completely unrelated to the melanoma).  I did do some research at the time and found only good things about Oncept which is also called the Melanoma Vaccine.  Due to lots of factors including her overall health I did not have the melanoma tumor removed and so we did not try the Melanoma Vaccine.

I hope it works well for Orlando.

Karen and the Spirit Pug Girls

Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.

1999 to 2010

 

              Maggie's Story                  Amputation and Chemo

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2 September 2017 - 1:12 pm
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Orlando received his first injection of Oncept today, so I am hoping for the best. So far he is acting normally, no apparent reaction to it.  As it turns out, it is not immunosuppressive, so he is not able to get a rabies waiver from the oncologist under LA county guidelines.  They do not recommend giving the rabies vaccine while the Oncept is being actively used...for about 2 months. I plan to just lay low on the whole thing....

Virginia
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3 September 2017 - 8:18 pm
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ORLANDO!!   YOU ARE QUITE THE ROCK 4DTAR SWEET BOY!!!

Glad everything is continuing to run smoothly for you.  Let's keep it that way, okay?

A d yes, "laying low" sounds like a good plan!  Orlando doesn't need anything compromising his health anymore

PICTURES!!!  WE NEED PICS OF MR ADORABLE! 🙂

Hugs

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!.

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

The Rainbow Bridge

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4 September 2017 - 12:24 pm
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Hooorrraaay for Orlando! I'm glad to hear he's doing well after the Oncept. You are in GREAT care at Animal Specialty Group, I've heard good things about Dr. Huber and the staff there. Awesome!

As for the rabies vaccine. Well, yeah, I'm with you on that.

Good job!

P.S. Please consider starting a new topic in Treatment and Recovery so it will be easier to track Orlando's progress beyond the diagnosis stage. Thanks!

It's better to hop on three legs than to limp on four.™
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Support the Tripawds Foundation!

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7 September 2017 - 9:54 am
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Hi, I'm really late to the discussion....,my Dobe, Nitro, also had a toe amputated when he was 2 or 3 years old (back leg). When I worried he wouldn't be able to get around good, my vet said "these guys do great on 3 LEGS, having one less toe won't slow him down a bit". Little did I know that years later he would lose a leg to osteosarcoma. He lived over 3 years on 3 legs! Hope your pup continues to do well.
Paula and Warrior Angel Nitro

Nitro 11 1/2  yr old Doberman; right front amp June 2014. Had 6 doses carboplatin, followed by metronomic therapy. Rocked it on 3 legs for over 3 years! My Warrior beat cancer, but couldn't beat old age. He crossed the Bridge peacefully on July 25, 2017, with dignity and on his terms.  Follow his blog entitled "Doberman's journey"

http://nitro.tr.....27_2_1.jpg

"Be good, mama loves you".....run free my beautiful Warrior

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8 September 2017 - 7:27 pm
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Thanks for all the good thoughts. I will continue to try to post a better picture of him. I have been very happy with the quality of care at ASG and with their efficiency as well. For a place that is usually very crowded, including emergencies, they run on schedule and are very accessible by phone. O is getting along just fine with one less toe and is not impeded in any way by the amputation and I hope that the Oncept does what it is supposed to do. I will move the discussion over to the other forum as it progresses.

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