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Marley's prognosis 4-6 months
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Forum Posts: 104
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17 February 2009 - 7:50 pm
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Hi everyone, 

I spoke with the oncologist today. Marley's cancer was found to be histiocytic sarcoma. With chemo she'll have 4-6 months. They'll alternate CCNU and Cytoxin every 3 weeks. Normally they would just do CCNU, but it can affect the liver (6% can result in liver failure!) so they'll alternate with Cytoxin. The 6% is scary, esp with her liver issues, but otherwise… I guess everything is about defying the odds here. 

He did say the prognosis is better with the amputation, but there's a 99% chance it's in the lymph node he says based on the ultrasound report (though aspirate did not catch it). Not sure what that means. I did find this online: This form of histiocytic sarcoma, which is often encountered on the extremities, has the best prognosis if treated early by surgical excision or by amputation of a limb. When spread to distant sites beyond the local lymph node occurs, the disease is then termed disseminated histiocytic sarcoma; this is more likely to occur unnoticed when primary lesions occur in cryptic sites (eg spleen, lung, and bone marrow). 

So if it's in the local lymph node, maybe ok? gosh I am just grasping for straws here looking for hope that we'll get more time…

What I don't understand, is how to start counting down the 4-6 months? From the date she first started limping? from surgery date? 

Gosh, all of this is so hard. To get through the amputation with such success and then to face the inevitable future… I guess we just need to keep remembering that she's no longer in pain and we can enjoy her TODAY. and for some time to come, hopefully longer than they say! 

Thanks for listening, 

Holly, Kevin and Marley 

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17 February 2009 - 8:07 pm
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Hi,

 Just focus on the positive. I'm sure Dr Pam can clarify the medical terms. Remember nothing is written in stone as far as how much time any one dog has remaining. Don't let the prognoses scare you… Sound like your doing all you can and that's the best you can do for Marley. There is no count down, just live it up and do things with Marley that she enjoys. All she knows is love and she has no concept of time, that's for us humans.

Keep us posted..

Kim & Buster

Kim & Angel Buster

"Until one has loved an animal, a part of one's soul remains unawakened."
–Anatole France

My heart lives at Rainbow Bridge
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17 February 2009 - 9:28 pm
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I agree with Kim.  There is no countdown there is only today and you must make the most of today to make Marley happy and to keep your sanity.  Each day is a special blessing.  You've been given that day to enjoy your companion.  Those of us fighting the big C have to remember that just like humans, the dr's cannot know for certain how much time any patient really has.

Hugs to you and Marley.  Live it up!

Shanna & Spirit Trouble ~ Trouble gained her wings 3/16/2011, a 27 1/2 month cancer survivor, tail wagging. RIP sweetheart, you are my heart and soul.  Run free at Rainbow Bridge.
The November Five - Spirits Max, Cherry, Tika, Trouble & Nova. 11/2008 - 3/2013 An era ends as Queen Nova crossed the Bridge.

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17 February 2009 - 9:32 pm
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Hi guys..Im sorry about Marleys prognosis, but if there is one thing I know, its that these dogs do amazing things. Dont count, just live…for the moment and for Marley. The rest will just happen. Enjoy the time you have with her and make the best of a situation you cant control.

Best wishes to all of you. We will keep the Labby prayers coming!

Paula and Max

Paula and Spirit Max

Edmonton
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18 February 2009 - 12:49 am
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Holly & Kevin, I agree with everyone and well said.  Prognosis is all statistical data.  Focus on the “now”.  If you keep thinking of the 4-to-6-month window, you already set the timeframe yourselves!

Recently I have read Traveling Light: Releasing the Burdens You Were Never Intended to Bear by Max Lucado.  The chapter “The Burden of Fear”, in which Max told about his friend who used to remind himself of the golf course to overcome his fear of crowds…

“When you are hitting your ball out of the rough, and you are surrounded by trees, what do you do?”

“I look for an opening.”

“You don't stare at the trees?”

“Of course not.  I find an opening and focus on hitting the ball through it.”

I thought that analogy was right on the money.   When I am putting out on this green, I don't think of which club to use on the next tee.  One shot at a time.  Remember only the good hits. 

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18 February 2009 - 7:36 am
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Holly, Kevin and Marley – I'm sorry…I'm waiting for Cooper's biopsy results to come back and this is one of the possible diagnoses. I'm trying not to think about it. I agree with everyone else, focus on today because it's all any of us really have for sure. Dogs know this, they so live for the moment. Marley isn't thinking about tomorrow, let her guide you.

Rottie hugs to you and yours.

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18 February 2009 - 12:04 pm
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Thank you so much everyone! 

I lay awake last night… couldn't get the “6%” out of my head. Can't stop thinking that I'm going to give her this drug that could kill her before the cancer does! Does anyone know if many of the chemo drugs have this risk of liver failure? I'm waiting to hear back from my vet to get her opinion. My concern is that the oncologist said CCNU has only a 40% response rate. I'm not sure what the prognosis would be if we chose not to do chemo… I'm always hanging up the phone with a vet or the oncologist and kicking myself for missing a question.. 

Pam, I would love to hear your thoughts on this! 

Carina, I'll keep my fingers crossed that you get better news about Cooper! 

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18 February 2009 - 12:47 pm
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Hey there Marley – everyone had such great advice and thoughts…I couldn't agree more with the one day at a time…we only have today and that no one ever knows for certain how much time any of us have. The 4-6 months is a guide from the doctors and probably also a worse case scenario. So when you get scared, think of Jerry and his prognosis (4 months) and then his reality (almost 2 years). Love, prayer and a positive attitude can do wonders for all of us…and for our fur babies. I try and focus on those three things when I get fearful of the inevitable…it works.

We love you guys and are saying lots of prayers as you go through this decision on chemo phase…

Mom and Zeus

Heather and Spirit Zeus - Our life changing journey…from the earth to the heavens…one day at a time…always together


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18 February 2009 - 1:30 pm
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Marley,

Did they take the lymph node out during surgery?  I know that the needle aspirate was inconclusive so usually they will do a lymph node biopsy or take it out during surgery.  The liver biopsy should have caught disseminated disease so it is probably still localized to the bone and possibly lymph node.

I have used CCNU several times with mixed results.  It is very myelosuppressive so the most common side effect is a low white count or platelet count.  I have seen dogs get an elevated ALT (liver enzyme) and then need to stop the drug. I have also seen dogs need IV antibiotics or even die from this drug but that is rare. Cytoxan is fairly benign and usually only affects the bone marrow or bladder.

I would talk to your oncologist and follow their advice. It is always hard to know which dogs will react badly to the chemo.  It is possible that the treatment is worse than the disease so you will have to make a decision.  I was afraid that the Metacam that Tazzie is taking as part of her metronomic chemo protocol would hurt her liver but so far her tests have been normal.  Hopefully Marley will be able to tolerate the CCNU.

Pam and Tazzie

Linden, MI
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18 February 2009 - 2:31 pm
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Like Zeus and Heather said, remember Jerry's original prognosis was 4 months and he lived for 2 years! All we can do is just make the most of each day.

Sending lots and love and prayers your way….

Sue and Nova

Dane Mom Sue at nova.tripawds.com and Mom to Beautiful Great Dane Queen Nova, a Blind Tripawd, who kicked cancer's butt from 11/08-03/13. The Queen is Spirit Nova now, but her legacy lives on here at Tripawds!

The Rainbow Bridge



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18 February 2009 - 3:14 pm
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Holly, Kevin and Marley,

Everyone's advice here is so right on. We are truly sorry that the outlook isn't as pawsitive as we want it to be, but try to remember that a prognosis is just an educated guess based on statistics. Every dog is so different, we all handle this cancer thing in our own ways. Prognoses are often off.

There's a lot of information going through your brain right now, I know it's overwhelming, but there is definitely one thing you can do that will help Marley so much, right now; remember that we dogs don't keep track of days, or months or just time in general, only humans do. Embrace each day as a gift, and enjoy every minute of it. None of us, human or dog, know how much time we have left, and that is the inveitable future. This cancer thing is a hard reminder of that, but it can also be a blessing in that it makes us aware of how little we really have control over and how important living in the moment really is.

Gosh, I hope this helps somewhat. Hang in there. We are here for you.

It's better to hop on three legs than to limp on four.™
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Forum Posts: 104
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18 February 2009 - 3:54 pm
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tazziedog said:

Marley,

Did they take the lymph node out during surgery?  I know that the needle aspirate was inconclusive so usually they will do a lymph node biopsy or take it out during surgery.  The liver biopsy should have caught disseminated disease so it is probably still localized to the bone and possibly lymph node.

I have used CCNU several times with mixed results.  It is very myelosuppressive so the most common side effect is a low white count or platelet count.  I have seen dogs get an elevated ALT (liver enzyme) and then need to stop the drug. I have also seen dogs need IV antibiotics or even die from this drug but that is rare. Cytoxan is fairly benign and usually only affects the bone marrow or bladder.

I would talk to your oncologist and follow their advice. It is always hard to know which dogs will react badly to the chemo.  It is possible that the treatment is worse than the disease so you will have to make a decision.  I was afraid that the Metacam that Tazzie is taking as part of her metronomic chemo protocol would hurt her liver but so far her tests have been normal.  Hopefully Marley will be able to tolerate the CCNU.

Pam and Tazzie


They could not take the lymph node out during surgery – it is deep within her abdomen so it would require a separate surgery. The oncologist said that 1/3 of dogs would die from the surgery of taking it out. (He does not seem to have any positive news for me!) So what are your thoughts on the 6% of dogs having liver failure from CCNU? does that sound right to you? he seemed to say that they could have a response just to ONE treatment and the liver would fail and nothing could be done. I definitely need to talk to him again. 

Also, when it's in the bone AND lymph node, is it still “localized” meaning not that bad? We did read some things online that seemed to say it wasn't so bad. Or when it gets to a lymph node is it likely to spread somewhere else quickly? Sounds like the oncologist thinks that is the case. He just seems to not have anything positive to say to me… wondering if he's just a pessimist?? I simply have to find hope that things will be better… it's the only way I can get through this! 

thanks so much for your help! I'm also waiting for my vet to call me back to get her opinion… 

Holly, Kevin and Marley

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18 February 2009 - 3:58 pm
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Thanks everyone, I agree – I have to optimistic that we'll have more time. My issue is making this decision on chemo! After making that heart wrenching decision on whether to amputate, now we're faced with another one!!! 

Northern Indiana
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18 February 2009 - 5:36 pm
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Hey there, 4-6 months, 6 %, 99% chance…..those are all just numbers you know. They are to help us prepare, but we already know what we are facing. I am glad our dogs can't hear those limitations. Hang in there and love your Marley one day at a time.

Sending you love & licks, Gineej & Paris

Grateful for every moment we had with Paris…..no regrets!

Honoring her life by opening our hearts & home to Addy!


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18 February 2009 - 7:37 pm
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Marley,

They are probably talking about the sublumbar lymph node which is up against the spine, and that is not something I would remove!  I thought it was the inguinal lymph node which was enlarged and that is in the groin.

I think that 6% of dogs having liver issues with CCNU is pretty accurate. I sadly just had to euthanize a Sheltie that was having CCNU treatment from a local oncologist for a tumor in his mouth.  The tumor went into remission but the CCNU permantly damaged his bone marrow after just 2 doses and his ALT was over 500.  This dog could not make any more platelets (his count was almost zero) and he started spontaneously bleeding. His bloodwork was all normal prior to starting the meds.  I am not trying to scare you or sway your decision this is just an example.  I have also given dogs 8 or more doses without incident.  This drug is just a little more unpredictable than carboplatin which is much safer.  Unfortunately carboplatin wil not work for a histiocytic sarcoma.

See what the oncologist recommends and also talk to your regular vet. I would also ask what the best case scenario is if no chemo is given at all.

Pam and Tazzie

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