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Post Amputation Subcutaneous Tumors, Sub-q Mets
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Winnipeg
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15 October 2009 - 4:14 pm
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Hi Pam

I don't have a pressing question, but thought you might be able to provide some insight pertaining to Tazzie's strange mets (when you have time). In back-searching archives, I see how much you have contributed for a long time now. I hope you realize how very much we all appreciate your assistance.

Tazzie is now 3 months post-amp, and 5 weeks post subq met, 3 weeks since it was removed. I just felt that area (near right hip) and can feel a small lump growing in or near the same spot, blast. I guess the vet did not want to cut out too much of the muscle. On the bright side, that leg had tremored the week before the lump was removed and is not doing that now, so I am glad the big mass is gone, even if it returns in a few more weeks time.

Otherwise, I think he is doing very well and his blood work has improved. Liver enzymes and RBC are normal and even the Creatinine is coming down (then again, he is virtually on dialysis with the vegie water I give him throughout the day to avoid a bladder infection from the Cyoxan).

You mentioned a St Bernard from your clinic that had sub-q tumors (and lung mets I believe) and lived for several months. Did they do any sort of treatment during that time? That is really the only specific question I have today. With this sort of thing, should I just expect things to show up anywhere on his body: subq or abdominally?

Tazzie has been on metronomics for 1 week now, but I understand it takes about 8 weeks for the drugs to really kick into gear. (He is dosed at 25 mg Cytoxan per day, 30 mg Actos, metacam; my vet did talk to a very well-qualified oncologist (Maximutt's) before dosing this high and adding the Actos). I intend to start Artemisinin sometime this week, hopefully this weekend.

I want to take things one day at a time (I got into that mind space for a while there, before the blasted met changed everything). We are scheduling things at work for the Jan to April term, so I am kind of trying to peer into the crystal ball. 

Susan & T2


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15 October 2009 - 8:06 pm
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The St Bernard I mentioned did not have any chemo or supplements of any sort.  His tumor was quite advanced on his rear leg.  The owners had originally declined amputation due to his size but after 4 months the tumor had grown to the size of cantaloupe on the poor dog's ankle and he was walking 3 legged.  I convinced them to try amputation and he then lived another 8 months. He had at least 25 nodules over his body but never seemed painful from them.  The owners were unable to afford chest xrays every 3 months but he started coughing 6 months after amputation and then we found the lung mets (his lungs were clear prior to surgery).  I believe he was given prednisone until it became too hard for him to breathe.

On a more positive note one of the other vets at my clinic just saw a Rottweiler that had his leg amputated by one of our surgeons 4 YEARS ago and diagnosed with OSA on biopsy.  This dog also did not have any chemo, NSAIDS, supplements, or even a special diet.  His cancer has just now recurred in his jawbone but his lung rads are clear and he still hops along just fine.  His biopsy report said that the cancer was highly malignant but obviously he has exceeded all expectations.  Sometimes the cancer just does what it does, no matter how hard we try to prevent it.  So for your Tazzie I would keep my eye out for other nodules, xray lungs every 3 months or so, and most importantly be on the lookout for limping or bony swelling in another leg since that is also a common spot for mets.

Pam

The Rainbow Bridge



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15 October 2009 - 8:56 pm
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OMG Pam, really? FOUR YEARS????? Holy moly! If you ever run into that Rottie hero, make sure he comes here to share his story. What an INSPIRATION!!!

It's better to hop on three legs than to limp on four.™
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Winnipeg
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16 October 2009 - 8:07 pm
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Tazzie got the stitches out today (it was slow to heal due to earlier chemo). There is a new little subQ lump, like a large pea, ~1 cm, just above the site where the lump was removed three weeks ago. It seems so close to the surface, but to remove it would of course require anesthetic and a new batch of stitches for a couple of weeks. We can't keep putting him under the knife and maintain quality of life. My vet was also suspicious that something was growing at the site where the tumor was removed. Did that Saint B have any lumps that seemed to grow into the muscle?

My main concern is that it will grow into the muscle and compromise mobility on the hind right (the leg was quivering a bit before the last surgery and I noticed it quivering a bit the last two days when he was lying down).

I am kind of wondering what the point is of looking for new nodes, if we can't really do anything about them. Just to be alert in case one seems particularly problematic? Or is there something we can do?

Sure hope the metronomics and Artemisinin will slow things down. In any case, if we are doing all we can do, I will try to relax and enjoy things. Kind of lost that frame of mind the last month.

Susan & T2


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16 October 2009 - 9:04 pm
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I would not keep removing nodules surgically.  You can note the size and location of any new lumps and then monitor them to see if metronomics or artemisinin shrinks them or at least keeps them the same size.  Yes, these often grow deep into the muscle and sometimes do sit near a nerve which may cause involuntary tremors.  I do not think that they are usually painful unless they grow large enough to stretch the skin or muscle.

Pam

Oregon
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9 November 2009 - 10:28 pm
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Well… I thought of all the places to post this and thought the best place was to let Tazzie know he is not the only one with Sub Q mets. Apparently Shilo was jealous of those lumps and wanted some of her own…. smiley13 We got the confirmation today from our local vet. So now it is what now. I called the oncologist, Shilo is scheduled for her 3 chemo on Wednesday. He wants to continue the chemo stating that the Carbo will help keep it from going into the lungs… I don’t know… We told him no to the surgery (thank you Tazzie2 – I felt led that way as well), it is all about quality. The lumps don’t bother her so we will leave them be. I am just kinda at a loss as to the best way to go.. I have mushrooms coming and we have been doing the low carb no grain diet.

She is better then Friday, sf-smilethank goodness. But she still seems a little weak and appitite is decreased…

Advise would be great, I am thinking metronomics . Although I don’t think the oncologist we go to puts much hope in these things.

Shilo diagnosed with osteosarcoma 9/4/2009, amputation 9/9/2009. ShiloAnne lost her battle 11/23/2009 where she regained her fourth leg and is patiently waiting for her parents to join her. We will always love you baby girl.

Winnipeg
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9 November 2009 - 11:49 pm
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Hi Shilo

I don't get how these rare bumps are becoming so common. My oncologist said she hasn't had any for over 5 years and now has two patients (including Tazzie) with them.

Anyway, my gut was saying what your oncologist suggested – use chemo to reduce chance of lung mets and also to keep the size of the subQ down. But my oncologist and vet (well, oncologist from location where we were in the summer) thought there was no point in using the same chemo drug. If any chemo, she suggested changing to a different one such as mytoxatrone (sp?).

I have no great insight into what would be best but here is where I am leaning with our situation or questions I have:

(1) If we did the surgery right after I found the lump, rather than 2&1/2 weeks later when it was twice the size, would we have gotten rid of it? Probably not, but maybe it would not have gotten into the blood vessels and muscle at that time. This is not a big deal surgery, although they do want the usual restrictions about not runny like a mad crazy dog for two weeks, which is a drag when life is short.

(2) It seems as though it was growing more slowly when Tazzie was on the high dose chemo. I can't say for sure. I think these things grow exponentially (double in size one week, then again the next, making it look much larger after a few weeks). I do not think the metronomics is helping much at this stage. I think it takes about 8 weeks for the metronomics to really make itself known. We are at week 5 of metronomics now. Given the current size of the lump, that probably won't help us much now.

(3) It is growing very quickly now. A friend has been here for three days and sees it much bigger than when he arrived. So do I. Will it break through the skin or enter the bone? I don't know, but I can't imagine it stopping its growth. Given the rate of growth, I am guessing the current lumpy area on his right hind will be the thing that gets him, not lung mets. And maybe the surgery aggravated the area and led to more growth. Of course, I have no answers (so sorry!!!).

(4) I had a phone message from my vet today, relaying another idea from a different oncologist. He said we could add mytoxatrone to the mix, as long as we lay off the metronomics drugs for a few days before and after the mytroxatrone (I think it was 3 days before and 7 days after, but can check if you want that specific information). At this point, I might be having to think about palliative care and avoid doing anything that would set Tazzie back even for a few days. So I don't think I'd will go that route in our case (but I will find out more about it). I think Tazzie would be under the weather for a few days if he had high dose chemo, due to the blood cell suppression.

Is your oncologist going to check for nodes in the lungs or abdomen now? Did he suggest removing the subQ lump surgically? I don't think all lumps grow as quickly as Tazzie's, although I guess you are also a newbie tripawd who got lumps, darnabit.

I realize I have opened more questions and resolved none. Maybe in the light of a new day I can offer a better opinion. I know it feels better to have something underway than nothing, that's for sure. I hope you can get a new treatment plan in place quicker than we did, or continue with the original plan.

General question that I'll ask my vet: do such tumors ever stop growing? The way it is growing on Tazzie, it is hard to picture it doing that.

Well, let's all try to get a good night's rest and see how it looks tomorrow,

Susan and Tazzie 2

p.s. Toto previously sent me a reference for a study that from Colorado State that found that low-dose chemo (metronomics ) was more effective in extending life for hemangiosarcoma dogs. That is a different type of cancer but their mets sound surprisingly similar to mine. Obviously a big drawing card for metronomics is the lack of side effects.


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10 November 2009 - 6:28 pm
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So sorry to hear about Shilo's lumps!  I would tend to agree with Susan's oncologist that the current chemo drug is not working so if Shilo has not had it yet I would first try Adriamycin (doxorubricin).  You could also try mitoxantrone or metronomics .  It might be worth waiting until the vet chat with the oncologist next weekend (Nov 21st?).  What does your general vet think?  Continuing the carboplatin may help with lung mets but it is clearly not doing anything for the SQ mets and there may be mets starting in other places that you can not see.

I agree that you should focus on quality over quantity, and if Shilo is still feeling poorly then IV chemo may not be ideal.  Maybe those mushrooms will make her feel better.

Pam

Winnipeg
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10 November 2009 - 6:33 pm
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Pam

Both Shilo and I had the subQ lumps show up pretty soon after amputation (I think less than 8 weeks in both cases, maybe more like 6). At least in our case, I am thinking that the met was very likely present, but just not large enough to feel. So it might have been growing slowly while on high-dose chemo (I'm not sure that my oncologist was right to say the original chemo drug did not work). My vet never x-rayed those areas and we never did an abdominal ultrasound before surgery (to check the spleen where there are two nodes). Any opinion on this?

Tazzie 2


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10 November 2009 - 6:41 pm
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Susan,

It is hard to say, since all of our dogs probably have cancer cells somewhere else at the time of amputation.  It is more likely that the primary tumor (the leg) was removed so then the secondary sites are able to grow faster.  Carboplatin does a great job penetrating the lungs but is not so great at penetrating other sites (especially bone) so I would change to another drug anyway.  In my opinion lung mets aren't as bad as other locations because they can be somewhat controlled with other drugs/chemo protocols.

Pam

Winnipeg
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10 November 2009 - 6:54 pm
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Interesting. I did not know that some drugs are better at penetrating certain locations. Great info for Shilo.

Given the size of Tazzie's hind right lumps, I think there is probably no point in adding Mitoxatrone to the mix at this point. It just sounds as though it would result in down-time that we can't really afford to have at this stage (by the way, he is rebounding from his overexertion on the weekend, thank goodness – I was worried I had really blown it). Do you agree or do you think it might be worth exploring the hybrid metronomics x high dose mytoxatone protocol an oncologist mentioned as a possibility?

Susan & T2

Oregon
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10 November 2009 - 7:02 pm
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Well just an update here… The oncologist seems to agree with you all as well. We are stopping the carboplatin and not sure what we are going to do at this point. She is going in tomorrow to have X-rays & a ultrasound, we need to find out why she is feeling ill. I don’t think that it is because of the sub-q mets. He said even with the tests it is possible we won’t find out and in that case I maybe giving her something for the nausea here on out. She is on Cerenia now but, she is still not eating and she was visually nauseated just from the smell of food. She is drinking well and keeping liquids down, so we are all at a bit of a loss. All her CBC stuff came back normal as well. Right now we are saying no to any chemo drugs until she feels a bit back to herself, thank goodness her oncologist agrees.

He mentioned some drug that started with a Gar? – he said it can cause the white count to plummet, but can have an affect on the tumors. I will mention the Adriamycin or mitoxantrone(thanks Pam). I did mention to him metronomics and he said that there has been some proof that it has helped those who are not showing mets yet, but since she is he didn’t feel it would be very effective. He did say that we could do whatever we wanted to though, it was just his feeling on it.

Good news is she is getting around well, alert and responsive to those around her. She seems to be breathing well, no tempature, and no tenderness anywhere. You can just tell she doesn’t feel good. I am hoping that we can address and help her with that cause it is sad to see her not feeling well.

I hope to get the mushrooms in this week and hopefully they will make a difference as they have for others.. (paws crossed). I will keep you updated as well Susan, maybe between the 2 of us we can get somewhere..smiley2

PS – In regards to when her lumps showed up, I would say within a week after her stitches were removed, so maybe 3 weeks after amp. I feel bad now, but I had thought it was due to the surgery. The last thing I thought was a met. It wasn’t until the second showed up that I became concerned, and that happened just this last week.

Shilo diagnosed with osteosarcoma 9/4/2009, amputation 9/9/2009. ShiloAnne lost her battle 11/23/2009 where she regained her fourth leg and is patiently waiting for her parents to join her. We will always love you baby girl.

Winnipeg
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11 November 2009 - 9:09 am
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Hi Shilo

I was mulling this lumpy business over last night. I view you as a little sister, having brought you from the blog to the forum world and now finding ourselves together in this mess! I bet you wish you stayed in the care-free blog world now!

Tazzie's lumps seemed to be growing slower when we were on regular chemo, although it is hard to say that for sure. IF we were back in the early stages of a lump and IF my dog tolerated high-dose chemo really well, I'd probably opt for a different high-dose chemo drug. Tazzie was okay with chemo, but not great. He was lethargic for a few days about a week after Adriamycin, had the hair loss and a few things that you just don't want to see once you know there are mets. It is different when you are pre-met and figuring out how much 'good time' he might get for the 'bad time'. Now we just want the 'good time'.

I think most oncologists agree with yours about the metronomics . The effects of metronomics are more well-documented before mets than after. But metronomics (love the phrase: 'mets for the mets') did seem to be more effective than high-dose chemo with that hemangiosarcoma study, by which I mean they gave the dogs an extra 60 days in which they felt good (the study involved dogs with a fairly advanced stage of a really aggressive cancer). Given we can easily see and feel our dogs' lumps, I think we might be asking a bit much of the metronomics . On the other hand, they don't seem to affect the dog in a bad way.

For high-dose chemo, Tazzie was originally on Adriamycin (doxyrubin) and carbo, which is why we would have switched to the other drug (mitoxatrone). Since you have not used Adryiamycin, that is a possibility for you. A few dogs on this site (very few) have used the other one you mentioned (the “G” one). Anyway, if you want to find out more about how Tazzie reacted to Adriamycin or anything else we can help with, we can PM.

I sure hope you find out why Shilo is not feeling well. I am concerned about that. Tazzie was feeling really good when I first found the met lump.

Susan

I'll ask Jerry the Wizard to move this thread out of the “ask the vet” column to the “treatment and recovery” so Pam doesn't think she is being bombarded with questions. I was going to PM you, but just in case there is another subQ dog coming along after us, I thought we might as well keep the basic discussion here.


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11 November 2009 - 9:12 am
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Susan, I would not add mitoxantrone if this was my dog.  I would continue with the metronomics and artemisinin .

Shilo, it is hard to formulate a plan for you until they know why you are getting nauseous. I hope that the Cerenia helps.  Have they tried Carafate yet?

Pam

Oregon
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11 November 2009 - 12:10 pm
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Susan – I actually was just thinking about the fact that you were the one you brought my blog into the forum and was the first to give the support I needed at the time for Shilo. I don’t wish I stayed in the blog free world because with Tazzie’s story at least I kinda new was I was up against, and it sheltered the major blow when I get to have it tested. I think I took a better attitude as ok, change of plan now what.. I am thankful to have a the support, I have no doubt I will be using the PM’s, thank you!!

Pam – Her nausea is sooo weird, she hasn’t eaten anything in over 24 hours now. I dropped her at the vet this morning and they are going to do a chem panel, CBC, x-rays, and ultrasound. My gut says this is something different. She is drinking well, and as long as she lays down a bit after drinking she keeps everything in. But if she gets up she will spit up some clear mucus stuff?? I have given ther Cerenia but, it doesn’t seem to be helping. Hopefully I will be getting an answer soon!! They talked about sending me home with a naseau medicine that is injected? It maybe Carafate I am not sure. I just know the Cerenia is not doing the trick..

Shilo diagnosed with osteosarcoma 9/4/2009, amputation 9/9/2009. ShiloAnne lost her battle 11/23/2009 where she regained her fourth leg and is patiently waiting for her parents to join her. We will always love you baby girl.

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