2/17/14 UPDATE (1:24pm PST) long post warning...

Today I spoke with Chloe's vet about options such as removing it and then biopsy it after and he recommended I consult a surgeon first.  Aside: I'm sad that I've moved from the Santa Cruz area since her vet hospital there was able to do everything in house, rather than have to get referrals for surgical procedures (truly is convenient!!).

Thursday 5pm (2/20) my mom will take Chloe to a referred surgeon to examine the tumor and give us an idea of whether she thinks a surgeon (like herself) would be able to excise it with enough wide margins and not leave an open wound.

Pros/Cons (things to discuss with Surgeon)

Straight to surgery: assume it is malignant (even low grade), attempt to get wide enough margins and be able to close it with enough skin. Biopsy it after and aspirate her nearest lymphnodes (while under) to see if it had spread (unlikely  with soft tissue malignancy). Pros = less visits to vet and best case scenario, its done in one swoop.  Cons = might not be able to get enough clean margins because it is on top of foot meaning she will have an open wound for weeks that requires multiple follow up visits in general and also has potential for getting infected.

Biopsy then maybe surgery: biopsy the tumor, find out if it is malignant, what grade and then undergo surgery with more information. If it turned out not malignant I could leave it or not require wide margins for excision.

Additional Previous and Current Tumor Info

The vet that did her amputation 3.5yrs ago told us it was spindle cell sarcoma, but her current vet from the same clinic said that the records say the specific spindle cell tumor type was "peripheral nerve sheath sarcoma".  My personal opinion is that it is highly likely the same type and that she must have a genetic predisposition for this type of tumor. Fortunately if this tumor is that same type and low grade again, if were to leave it, her life expectancy is 2 years. Downside is that this type can get grow to the point of being inoperable (right now it is small enough there is a chance) and potentially cause pain in that limb. Right now palpating it did not cause pain, nor does walking. Also, neither did her other tumor on her back leg, which was larger but too large to just excise.

 The vet said these types of tumors (he used a fancy word I dont remember) are unrelated, that she didn't have this potential cancerous tumor for the past 3.5yrs lurking from the previous.  They are independent occurrences.

My Thoughts

I'm going to see how the consultation goes, I'll phone in to be on speaker phone with my mom and Chloe at the surgeon's.  My hope is that they think it is possible to excise it with enough margins to be on the safe side under the assumption it is malignant and close without an open wound leftover.

If they do not think it is possible, I might consider getting it biopsied just to know how much time she would have left (based on type and grade). I'm just not sure I want to put the responsibility of caring for an open wound for weeks on my mom.  It is reminiscent of the reason why Rocket (Chloe's "sister" dog) passed. Rocket started out with an infected foot wart, that ended up getting some sort of super intense bacterial infection and even before it got the bacterial stuff, it was so difficult to manage 1. washing 2x/day 2. pills everyday 3. cone everyday (she sometimes got off) 4. vet visits every couple weeks and 5. Rocket not licking it every chance she got when the cone came off.  My mom did everything she could, but it was virulent and it got to the point where Rocket went downhill very fast and was in terrible pain. We had to let her go.  Granted Chloe's situation would be different and not due to another underlying condition, but I don't know how long in an ideal situation it would take for the wound to completely heal. 

If I went the biopsy only route and revealed it was the same type of cancer with a life expectancy of 2ish years, honestly that would be amazing. She is already 13 and still COMPLETELY healthy otherwise. That type of tumor is only locally invasive (just might cause pain and need meds later for that until its time to let her go). If it meant leaving the tumor and she live (healthily) to ~15, it would mean that not only did she thrive after an amputation at the age of 9.5yrs (which technically now has extended her life by 1.5yrs if life expectancy were ~2yrs in 2010) and live healthy, happy years with a second cancerous tumor, I would be absolutely blown away.  Even now with all we have gone through, she is still the most inspirational dog I've ever had, what a fighter! I love you my dear Chloe, I know you and my mom will take good care of each other until I find a different living situation where I can have you back by my side. And FYI Chloe (I told you this last night), but truly, my mom needs lots of your unconditional healing love with all she has gone through this past year. Please love her like you have loved me through grad school because she needs a wonderful spirit like you in her life right now.

Ok I'll post another update on Thursday after the appt. P.S. My mom is just awesome for supporting and helping me/chloe through this!

Yes I analyze things maybe a little too much..lol. But I'd rather have the most information possible to make the best informed decision, but at the same time still put the least amount of stress on my mom and Chloe.

Also, going to start Chloe on some K9 immunity ! Her vet said it wouldn't hurt to try, especially since she is in the early stages of diagnosis.  I think I remember reading our left rear amp buddy Maggie was on K9 immunity as one of her supplements as well (but also alot more since she saw a homeopathic type vet).

We shall see if we notice a difference for Chloe since she has a soft tissue sarcoma instead of osteosarcoma like many of the other pooches that use it. And yes I used the affiliate link, so you guys get a kick back 

And my grandma (mom's mom that bought a Tripawds bandana from you guys 3.5yrs ago) also offered to help out in any way regarding Chloe's care.  I'm really blessed to have a family that supports Chloe and I so much, I thank them everyday for being so willing to help us through this time. 

2/20/14 Update: Surgeon's Analysis of Tumor Removal

The vet surgeon outlined these options:

1. Maximum Tumor Removal with Open Wound: excise as much as possible with 1cm margins and leave open wound that would take ~2months to heal. Best option if no follow-up with radiation, since radiation cannot be performed on an open wound (anywhere from another 2.5-8 grand). Highly aggressive surgical approach.

2. Some Tumor Removal with Wound Closure: excise a large portion of the tumor with enough left over skin to close the wound. Best option for follow up radiation treatments.  Conservative surgical approach.

My mom said she is willing to manage the open wound if I chose that route and considering the extraordinary cost of radiation, I'd rather cut off as much as possible now and give her the best chance in that scenario.  Also, the vet surgeon had a cardiologist listen to Chloe's heart murmur and diagnosed it as a grade 4-5.  The vet surgeon said that they perform surgeries on dogs with that grade heart murmur all the time and it is just a matter of changing the procedure.  She did recommend having Chloe getting an echocardiogram in order to diagnose the cause to get a better idea of how to proceed during surgery.  Result of that test was that it was ok for surgery. Atrial valve leakage, need to watch for coughing etc like I outlined before. Cardiologist says she doesn't need meds for it either.

Chloe will be going in for surgery tomorrow and depending on her recovery might be able to go home tomorrow evening. Biopsy results will be available about 5 days after her surgery, so late next week.

Outcomes we can secretly/openly hope:

1. Biopsy reveals its benign.  

2. Biopsy reveals low grade tumor with prognosis of ~2yrs since it will likely grow back.

3. Biopsy reveals low grade tumor and all microscopic cells were removed during surgery (nothing grows back).