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Travis Ray and the Soft Tissue Sarcoma (Noooooo not my baby boy!!)
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17 May 2017 - 7:20 pm
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OK, so a little back story first. A couple months ago I noticed a lump on Travis’ right elbow. It was about 1 inch in diameter, squishy and did not seem to be attached. This was right after we had him into the vet for an anal gland infection so, suffering from vet fatigue, we thought oh, its just a lipoma, and went on with our lives. A month or so later it had changed, it was not any larger but seemed more apparent and had grown harder to the touch. Time to go back to the vet! 

One fine needle aspirate later, the suspicion was that it was a soft tissue sarcoma (STS). So we headed off to UC Davis for an oncology consult. There was no question of doing a biopsy (pretty much just as invasive as full removal), we just went straight to getting that thing off our sweet boy! Pre-op xrays were clear (yay!) and a pre-op abdominal ultrasound was clear (triple-quadruple yay!) (we did this bc his physical exam showed he had an enlarged spleen, which I did not know is relatively common in GSDs). Given where the tumor was they warned us to expect dirty margins. Travis rocked his surgery and recovery, he is strong and doing really well, and so here we are, trying to decide what the next step is. 

At our oncology follow up we learned that TR’s tumor was a grade 2, likely fibrosarcoma. We were hoping for grade 1, which most of these tumors are, but hey, I am just thankful its not a grade 3. So, its intermediate grade with “close” or “narrow” margins (which means they got it all…..maybe…the margins are only 1mm). Davis presented us with a couple options (cost is a factor but we would bankrupt ourselves if we thought it was the only way, I’m including cost for informational purposes but bear in mind these are costs at a teaching hospital). Quotes are from our post-op oncology visit summary.

1. “The most aggressive and most studied option is to perform definitive radiation therapy, which is daily radiation doses Monday through Friday for 3-4 weeks. We expect with this option to achieve local disease control in 95% of patients at 1 year, 85% at 3 years, and 75% at 5 years (these are studies for dogs with incompletely excised tumors – meaning there are cancer cells left behind). Therefore, there is a chance that Travis Ray could do even better with a narrowly excised mass. The cost of definitive radiation therapy is approximately $6200-6500.” 

At UC Davis the radiation protocol for STS is 16 treatments over 4 weeks, five days/wk, and the dog must be sedated during each treatment. We live about 1.5 hrs (with no traffic) from Davis. Travis stresses really bad when he goes to the vet. They say dogs tolerate radiation and chemo better than we do but this seems really brutal, even for a dog that is otherwise fit. We are really not considering this option because TR’s tumor was not grade 3 and we think it would be awfully hard on him (not to mention Ralph–it would basically be a full time job for him to take Travis up there every day). If the tumor was a grade 3 we would definitely consider this option though. 

2. “The least aggressive option is to monitor the site for recurrence without any additional adjuvant treatment. If/ when recurrence occurs, then we could treat with another marginal surgery. Expected recurrence rates without any additional treatment fall somewhere between 10-40+%. It is difficult to predict if Travis Ray’s tumor will recur, as technically his surgery was complete, but with the cancer cells so close to the edge, it is concerning that there may still be some cells left behind.”  

A grade 2 STS, especially when located where TR’s is, apparently has a relatively low rate of metastasis (yay!). Chances of recurrence with no follow up are higher than we would like though. While his margins were clean they are so narrow (1mm vs the 3cm margins that would pretty much guarantee no recurrence) there could still be cancer cells around the surgery site. If it did recur we could potentially do another surgery, as long as we caught it early when it was still small. I emailed TR’s surgeon and she said they typically remove the scar tissue from the original surgery as well as the new mass so that could be difficult given there is not much excess skin left at his elbow. 

3. “A “middle of the road” option to try and address the microscopic disease left behind is a treatment utilizing chemotherapy infusions in and around the scar. These would be performed under heavy sedation to ensure we keep Travis Ray as comfortable as possible and minimize exposure to the team doing the infusions. This has not been officially published but was presented as an option a veterinary cancer conference. The median survival time reported with this treatment (meaning 50% of patients do better and 50% do worse) was >1,000 days. There was a recurrence in 27% of patients but this was significantly less than the reported recurrence rate in patients that had surgery alone. Again, these were dogs with incompletely resected tumors with a much higher risk of recurrence than those with narrowly resected tumors like Travis Ray. With this option, we would plan to do chemotherapy infusions around the scar once weekly for 6 total doses. However, the schedule may have to be flexible and allow for dose delays to possibly every 2 or 3 weeks if there are any local reactions or irritation. The most common reported side effects included mild skin toxicity that required dose delays. With systemic chemotherapy (when injected into a vein), we expect ~15-20% of our patients to experience side effects, which includes bone marrow suppression (reduced white blood cells or platelets) and GI toxicity (vomiting, diarrhea, inappetence). While these could also be possibilities with the regional chemotherapy infusion, I imagine they would occur less commonly compared to systemic administration. We would still plan to send you home with anti-nausea and anti-diarrheal medications, as well as check blood work at the one week mark before giving another infusion. The charges for each visit would be ~$400-600.”

We are looking hard at this option right now. I need to see if I can find a copy of the presentation on this treatment. There are no published studies yet but apparently the results are promising. Davis has only tried it with one dog (!) but they said she is doing well so far. The drug is called 5-fluorouracil (5-FU). It is tempting to try this but I would sure like some more info! 

4. “Another option is “metronomic” chemotherapy, which is low dose, oral chemotherapy given at home every day. There are some studies which show that this may slow down or delay recurrence rates for incompletely resected soft tissue sarcomas. The cost of this medication would be approximately $150-200 per month, and Travis would need recheck bloodwork monthly which is approximately $200-300.”

Metronomics is the other option we are seriously considering right now. Cost is comparable to that of the injected chemo option but would last much longer. It is my understanding that you do metronomics as long as the dog will tolerate. Is that correct? So if we went with this option would we really need to continue it the rest of Travis’ life? 

So thats kinda where we are at right now. All input welcome!!!! I have been a part of the Tripawd Nation for going on 10 years, give or take a few, but have not been dealing with cancer with any of my current dogs until now (my heartdog Rosa died of hemangiosarcoma in 2005). I am so grateful to be able to turn to you guys for your experience and support! 

xoxo,

Martha, Travis Ray, and the Oaktown Pack

P.S. heartheartTravis Ray would love it if you visited his blog for HIS perspective on this whole thing!heartheart

Minneapolis, MN
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17 May 2017 - 8:21 pm
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Just going to let you know I will be back tomorrow with a bit of STS hard won wisdom / observations for you when I am not so tired.  Till then, lots of love to Travis Ray.

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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17 May 2017 - 8:33 pm
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Ditto Lisa and Pofi! Also, do they not offer SRT at UC Davis? As few as 5 radiation sessions with each shorter than the day before. Stats are in line with traditional radiation if not slightly better? And, yep, have been reading about injectable chemo for humans as being one of the newest treatments: interesting to hear UC Davis willing to try. But ditto Lisa and Pofi! We on the East Coast are getting zonked:)

Virginia




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17 May 2017 - 8:53 pm
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Oh my dear Martha. Such a bummer!! This stupid disease is so horrid.

You, Ralph and all the Oaktown Pack are such an important part of the foundation of the Tripawd Universe! You have offered support, information, humor and love to soooo many over the years. I know I’ve certainly been on the receiving end of your graciousness.

I’m so glad you are reaching out to your family now and let us try and give back!

I imagine Karen and Lisa will be able to give you some insight, even if their journeys weren’t exactly the same.

You’ve posted some INVALUABLE information for everyone, regardless what “type” of this crap disease they may be dealing with.

For whatever it’s worth, you are doing a STELLAR job….a BRILLIANT job…of checking out all your options!! And you’ve put Travis Ray first in every part of each equation. You are clearly focusing d on his quality, who he is, how he handle carrides, Vet trips, etc.

I really can’t offer any insight. I would agree though that the first option is completely off the table.

Obviously, the metronomic therapy is the least invasive and tolerated very well. Would they be using Cytoxan? Just has a “discussion” under Rob and Bruno’s thread where Leukeran was used instead. Vruno had a history of cystitis right after his amputation and that could be a “side effect” of Cytoxan.

You may recall the thread that Katy started on Jackson. If I recall, he had been on Metronomic therapy for…hmmm….maybe as much as a year???? Anyway, in that thread their was a discussion avout how long you could do metronomic and how long before it would lose it’s effectiveness. It was quite interesting. I, of course, have not put in the right words to find that particular thread on the search thing!

Okay, gonna go hop over to Travis Ray’s vlog who, I’m sure could care less about all of this stuff!!

He does care about his watermelon eating festivities though! Isn’t it time…almost?? With video??

Lots and lots of love and extra hugs! Rosie will guide you to the eight decision for TRheart

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!

Orange County, CA
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17 May 2017 - 9:17 pm
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Awwww, Travis Ray, what the heck?!?!?!  Stupid fibrosarcoma!!  Look, I know a couple things about the Oaktown Pack, and one of those things is that the OP is full of tough hombres!  (And chickas, too!)   I know you can handle this buddy!  Especially with the help of lots and lots of Flying Dutchmans to strengthen you through the fight!  We’re all rooting for you down here in the OC buddy!  Hang in there and kick some ass!!!  

Diane, John, Linda & Bernie bin Laden

Virginia




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17 May 2017 - 9:53 pm
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Look at that Travis Ray!!! You brought Linda and Bernie bin Laden out of hiding!!! OMD!!! Are you a special boy or what!!!

Maybe…….just maybe…..Bernie bin Laden would consider posting one of those crazy pictures of himself to cheer your humans up!!! There are a lot of new people here who have not at the privilege of LOL at some of his great pictures! 🙂

We’ll be watching………

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!

Los Angeles, CA
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18 May 2017 - 9:18 am
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Oh Travis Ray!!!! I am so sad to hear there … but I know you’ve got the best pawrents a dog could ask for who will speak for you! You are one lucky dog to get a flying dutchman though (Jasper Lily was eyeing that photo with her big eyes)… We will keep you in our thoughts and send lots and lots of positive energy your way!!! 

HUGS!!! And cuddles and snuggles from little JL! 

Alison with Spirit Shelby in her heart (and little Jasper too) 

Shelby Lynne; Jack Russell/Shiba Inu mix. Proud member of the April Angels of 2014.

October 15, 2000 to April 8, 2014

Our story: Broke rear leg in June 2013 - non-conclusive results for cancer so leg was plated and pinned. Enlarged spleen in September 2013 and had it removed and was diagnosed with Hemangiosarcoma and started chemotherapy. Became a Tripawd January 8th, 2014 and definitive Hemangiosarcoma diagnosis. Three major surgeries in 7 months and Shelby took them all like a champ only to lose her battle to cancer in her brain. We had 8 amazing extra months together and no regrets. #shelbystrong #loveofmylife

The Rainbow Bridge



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18 May 2017 - 10:57 am
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Thanks for posting here Martha. I’ll tell everyone what I told you the other day…

There are no right or wrong choices. Whatever you decide will be made with love and care for TR’s quality of life, and that’s the best decision ever. Chemo is a crap shoot. It gives you better odds of beating a cancer but it doesn’t guarantee anything. Nobody can.

It is my understanding that you do metronomics as long as the dog will tolerate. Is that correct?

Correct. We’ve seen some dogs go a few years on it.

You mentioned investigating holistic remedies. You may want to look further into Maggie Moo’s story, she did the natural medicine route for her STS and it worked out really, really well. I know her auntie Gina Snow treated Maggie and would be happy to talk to you, along with Tracy, Maggie’s mom.

It really bites that you’re dealing with this. But like Maximutt says, the OP conquers ALL!

It's better to hop on three legs than to limp on four.™
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Schofield, WI
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18 May 2017 - 12:27 pm
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I know many here have firsthand knowledge of that cancer and you should get some good input.  You know Travis Ray your Mom & Dad will make their best decision for you based on many factors including your FOV (fear of Vet).  Whichever way they go it will be right for you and to get you back to your “beautiful life” which you richly deserve.  Don’t forget to play the “poor me” card for extra watermelon and steak treats either.  Hugs to the whole Oaktown pack!  

Linda & Spirit Mighty Max

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22 May 2017 - 8:23 pm
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Thanks everypawdy, for your ideas and support! It means the world to me heartheartheart

Lisa, we would love to hear your ‘bit of STS hard won wisdom / observations’ whenever you have time. I read all the forum posts you started as well as Pofi’s blog. What a sweet and beautiful boy he was, and dawg, he had the best ears ever!!!!! 

Charliebear, yes I asked about sterotactic radiation therapy at Davis. It is not what they are recommending. It is my understanding that SRT only works for smaller tumors? Like 1 cm or so in size? Travis’ tumor was 3 cm so the follow up radiation needs to cover that whole area and then some. I think SRT is more targeted than that and used specifically to go after tumors. We would basically be doing radiation to kill any stray cancer cells that might still be in the same area as the tumor.

Sally, yes they are talking cytoxan (not my favorite drug, I was on it for more than a year at much higher dosing!). Actually I am more worried about the NSAIDs that go along with it. None of my dogs have tolerated NSAIDs well, and believe me, we have been through nearly every one! Thanks for remembering Jackson’s thread on metronomics . I will see if I can find it, his banner was up when I logged insmiley 

Rene, thanks for the reminder there are no guarantees and for mention Maggie’s success on alternative therapies. I will go take a look at Tracey’s posts. 

Diane, Alison, and Linda thanks for the kind words and support! 

I have found some more info on 5-FU, the injectable chemo but can’t access it so have some emails out to people that might be able to provide me with the info. A paper was published on the pilot study for using this drug to treat K9 STS (they had a grand total of 6 dogs!). And there is a cancer center in AZ that has just concluded a 6 year study!! But they have not published yet, so I am contacting them to see if they can give me any results. 

So thats where we are. Travis is being his normal self and begging me for more flying dutchmans. Unfortunately we are gonna have to cut him off soon as he has gained back the weight he lost going through the two surgeries! Can’t wait for my sprained ankles to heal up so we can go walking in the redwoods again!! 

Will post more soon. 

xoxo,

Martha, Travis Ray, and the OP

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22 May 2017 - 8:30 pm
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As I was writing my last post an email from Dr. Nancy Kay came in discussing herbal supplements for cancer! Some of these I am familiar with from Tripawds and others I have never heard of. You can link to her blog post above if you are interested.

Virginia




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22 May 2017 - 9:22 pm
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You are doing your research and you are obviously open to any option that makes sense for you AND Travis Ray.

And thanknyou for takinv the time to share your findings.

I think you can see from all the responses, you and the Oaktown Pack are quite well loved. 🙂 And you know how good that makes you feel, right? That’s how good Travis Ray feels because he knows he is loved by you 🙂

I’m gonna go check out the link you posted. I think that’s a good “sign” that Dr Kay’s email came at the time it did! 🙂

And true to form, Travis Ray is blissfully unaware of any stress you may be feeling. He’s just having a blast BEING DOG! 🙂 🙂

Love to you and the Oaktown Pack….And an extra treat for Travis Ray! Low -cal ice cream perhaps? And sending extra healing energy to you znd your owweee!!

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!

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24 May 2017 - 6:29 pm
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OK …. My research felt like it was starting to go round in circles so I stopped, Ralph and I both looked at what I had, and we decided to go with the 5-FU treatments over metronomics for the following main reasons:

1. We liked the idea that, if successful, this would be a one time deal versus metronomics , which would be required for the rest of his life (providing he tolerated it well). With two 12 yr old dogs and Austin, who we fondly call “our very own trainwreck” and is always seemingly in need of vet services, it doesnt seem prudent to take on a guaranteed $4000ish vet bill annually on top of whatever else might come up with the pack in the next few years. Of course we are hoping for nothing major, knock on wood, but we do not, unfortunately, have a money tree in the backyard so do need to consider this!).  

2. While the 5-FU only treats micro mets locally, in the original tumor area, and metronomics is systemic so potentially deals with distant micro mets as well, the rate of local recurrence is significantly higher than metastases for a Grade 2 STS. 

3. This treatment cost is similar to the low end annual cost for metronomics we were given by UC Davis, even accounting for the fact that we could probably get drugs a little cheaper online and would be a one time cost vs an expected three+ years of metronomics

4. We can always start metronomics later if we need to eg. if the STS recurs or mets show up somewhere else, right? 

I was able to get a copy of the 5-FU pilot study and it does indeed look very promising! Just wish they had more than 6 dogs worth of data! Yesterday I emailed Dr. Kelly at the Veterinary Cancer Care center in Santa Fe NM to see if she would be willing to discuss the study results with me. Hope to hear back soon and if I do I will post what I find out here. One of the oncology residents at UC Davis told me there was a 27% recurrence rate with this treatment but without knowing what grade tumors the dogs had, how complete the margins were, or what the length of time to recurrence was in each case, this number does not mean much. Hopefully I will hear back from Dr. Kelly before we take Travis in next Wednesday for his first treatment. 

In the meantime, I am carefully going over Travis’ scar every day so I can imprint on my mind what it feels like now, right after surgery. It is pretty lumpy because the fat pad on the tip of his elbow ended up under the scar when they closed the incision up so I am terrified I won’t know if there is a recurrence! I almost feel like keeping his elbow shaved because it would be easier to catch a recurrence when its smallbig-grin

More soon!

xoxo,

Martha, Travis Ray, and the Oaktown Pack

The Rainbow Bridge



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24 May 2017 - 7:09 pm
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I LOVE that idea. Yeah, it was a pretty small study but knowing Dr. Kelly, she’s on to something. As I mentioned on the phone, Dr. Kelly was Jerry’s oncologist who first turned us on to metronomics , way back in 2006 before most onco vets were even considering it. She was also one of the first to do a Leukeran metronomics study to find alternatives to cytoxan, which causes UTIs in some dogs. This is one forward-thinking vet and we love that you’ll be helping to move this treatment forward if it indeed works.

We are looking forward to hearing more about how it goes, and plan on making sure this treatment is featured more prominently here. Ready to write some guest blog posts about TR’s experience? 😉  Haha, first things first., TR is #1 and then we’ll talk about those posts.

Keep us posted!

It's better to hop on three legs than to limp on four.™
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Virginia




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24 May 2017 - 7:56 pm
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Oh Marthat! Do younhear it? Shhhh….listen!! Yeah, now you can hear it!! It’s the standing ovation with a lot of clapping and yelling WAA-HOOOO!! YAY! You have done an OUTSTANDING job of going forward with a treatment plan with lots of promise and seemingly no stress for Travis Ray!!!

And you AND Travis Ray are doing an incredible job of shsring this valuable information and how you got to the conclusion you jave. I can only imagine how your head must jave been spinning trying to grasp everything and applynit to whatr best for Travis Ray!

You know this, but it never hurts to ssy it again. Every decision made out of love for Travis Ray will ALWAYS be the right decision!

Onward and upward! And the other soundnyou are hearing? Non-stop cheering for Travis Ray surrounded by positive energy!!! This boy is gonna make history!!! 🙂 🙂

Lots of love!

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

PS…..Teri (Isa) is from New Mexico and coming to the Va Pawty. We’ll ask her if she has any connection to Cr Kelly and crew.

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!

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