Well, our Lexie has always marched to a different drummer; no straightforward diagnosis for us. We're at her two-week ampuversary and had our onco visit today. 

According to the pathology report she did have an aggressive soft tissue sarcoma (STS) which affected the nerves, bone, and went all the way down to her feet -- and unfortunately it has spread to the lymph nodes as well. The mitotic index, for whatever that's worth, is 6.

The English portion* of the report cited extensive metastasis to the axillary and scapular lymph nodes, which isn't the best news -- especially combined with the presence of lung mets. Where it gets more frustrating is that her aggressive yet 'poorly differentiated spindle cell sarcoma' also has some characteristics of osteosarcoma, and could also be compatible with synovial cell sarcoma -- or even a grade 3 soft tissue sarcoma.

Bottom line is that our oncologist thinks that Cytoxan/metronomic therapy isn't strong enough and he recommends:

5 Doxyrubicin traditional chemo treatments as Option 1, every 2 weeks for 5 weeks. A few issues with that:

- Lexie hates needles (had allergy shots for years) and hates being inside the onco vet's office; she just shakes when she's there in the exam room and is highly anxious.

- Lexie also has Cushing's disease (an adrenal issue) and chronic but well-managed pancreatitis, so she already has to have regular bloodwork and other tests and her internal med vet discourages anti-anxiety meds since many will react to her Cushing's.

- I wonder about stress to her heart given age and the other medical issues she's had to deal with, and just the anxiety factor for her. 

I asked about Palladia as Option 2. That would involve 7 vet visits over 6 months, but Palladia is oral so no needles (except for usual blood draws and labs, etc.) He doesn't think that the Palladia results will be as good as with the Doxy, but he understands my concerns given her needle and anxiety issues. 

Another issue I'm concerned about: Arthritis. The surgeon said she did show some signs of arthritis pre-op, and at certain times of day it definitely seems more painful for her to get around than others. We're going to switch her from Rimadyl to Dermexx (I think...sp?). Anyone have arthritis supplements or med combos you'd recommend? One note: she can't have anything fatty like Omega 3s due to her pancreatitis; has to be low fat all the way. 

Wild card: Maybe I'm paranoid, but because she does seem more tender on her feet...think it's worth asking about Fosomax or Boniva just in case it turns out that she does have some unusual strain of osteo going on as well? Btw, she's on Gabapentin, Tramadol and Yunnan Baiyo post op (pre op too), and will continue those for a while longer.

Second opinion? I like our onco vet a lot, but now that we have pathology I wonder if it's worth getting another opinion from the other onco at her main practice where her I-med vet is for her Cushing's (the only reason I didn't go there before is because their onco vet was booked solid and the tumor was growing daily, so I took the first available I could find).   

On the good news front...

The lung mets aren't huge (yet); she seems happy much of the time; she loves the spring and and her naps in the sun. When she does feel energetic and her various meds have kicked in she has a fabulous hop/walk...and always wants to keep going. In spite of only being 2 weeks out from surgery she's wanted to climb stairs, jump on the couch, etc., which we're trying to discourage...but to me, all of that indicates that she has spunk and wants to hang out here with us longer.

Sorry for the long post, but I'm sure I'll get some great advice and insights from my Tripawds friends. I'll do some advanced forum searches on Palladia for lung mets and lymph node issues, of course, but any thoughts are welcome. 

Thanks to all!

P.S. Did anyone else skip Doxy or other traditional chemo because of needles and their dog's anxiety factor?

*The detailed science portion of the pathology report re. the lymph nodes: Two of the axillary nodes contain focal to diffuse infiltration by neoplasia (plus a lot of other detail...if anyone else had lymph node issues and is curious, I can share).