Soft Tissue Sarcoma

Hi Everyone, mum wants to take over to talk some "serious" stuff. So I apologize ahead of time if you get bored. I have SOOOO many happy posts that she said she would help me post but never did, and now everytime we post, its something "serious"... SIGH! We will try to get those happy posts in too in the near future!

Now, I'll leave you with a happy picture before I hand the blog over to mum!

TA-DAHHHH!!!!



From Sunshade's mum:

Hello friends, thank you for all the support on the blog, the chat box, personal e-mails, text msgs, as well as on Facebook. All your prayers and words of encouragement mean so much to me during this difficult time. Sunshade is my very special girl, so THANK YOU all SO MUCH!

Most of you know, I left for an 18 day vacation on Friday, October 22nd. On Wednesday October 20th, I clipped Sunshade in the morning, then took her to her rehab pool for a swim. It wasn't until that evening, did I find the lump. I thought I had left more hair on one side of the body than the other. To clip her, I would have needed to run the clipper over the area of the lump for a short cut. Jacqueline, the pool therapist usually runs her hands all over Sunshade's body, giving her massages during swim breaks. She didn't notice the lump. The lump practically appeared in a mere of hours.

I, naturally, was umm.. freaking out and considered canceling the trip all together. The next day, Thursday October 21st, I took Sunshade in to see her vet, Janice. Based on my description of how fast the lump appeared, Janice felt it was probably a bug bite. To the best of our knowledge, malignant tumours don't usually appear overnight. Still, we had a Fine Needle Aspiration (FNA) done just to be sure. I left for my trip the following day telling myself the lump would resolve itself, even though I now must admit, my gut feeling told me otherwise.

Our flight was from Seattle to Ft. Lauderdale, so we took the shuttle bus down to Seattle. On my way there, I got a call from Sue, another vet at the clinic. Sunshade's regular vet (Janice) had left the same day as me for a week long holistic vet conference, so Sunshade's file was passed onto Sue. Sue told me the result from the FNA showed "spindle cells". Since she had not seen Sunshade's lump, she felt spindle cells were consistent with a probable bug bite, which was what was written in Sunshade's file. So Sue assured me it was ok for me to continue my trip. She said even if I were to come home, we still would not be doing anything for 10-14 days to wait and see if the "bug bite" resolved.

I had two sets of friends looking after Sunshade. One couple that worked during the day but stayed at my house over night. The second couple that was able to spend time with Sunshade during the day. It was important for Sunshade's care takers to be people she knew well given her aloof personality toward strangers. Sunshade knew those friends well so she responded beautifully to them (as in bossing them around). I had informed my friends of Sunshade's lump and asked them to keep an eye on it for me and if there was any change to take her to the vet immediately and call me.

The first week that I was away, my friend Raul, took a half day off work to take Sunshade in to the vet. Since I had asked him to keep an eye on the lump, he wanted to know how he would know if there were changes. So he took her in to see Sue (Janice still away) where she taught him how to measure the lump. Raul, bless his heart, measured Sunshade's lump religiously everyday, couple times a day.... LOL.

Things were good for a week and a half. I received daily Sunshade reports from my friends. Few examples of Sunshade report:

Hihi
I am at ur place. Took Sunshade out for a walk earlier. She's doing fine and Raul is taking care of her needs... I played the hide and seek game and in the middle of it, she humped her horsie twice!!! Does that mean happy or frustration?

LOL. I got Sunshade really psyched with egg whites. Since she didn't want to walk earlier, we just let her stay in... she napped.. and then I went downstairs to give her one eggwhite - made her work for it, hid it in her "bone-shaped" drawers.. and also prepped another eggwhite. She got quite psyched and since I wouldn't give it to her, she kept barking. I thought we'd go to starbucks to get coffee and an oat bar, so Sunshade barked all the way to starbucks while I had the bowl of eggwhites, lol. I don't think I've seen her this psyched, ever! So gave her half on the way to and the other half on the way back! Starbucks sold out of Oatbar today, but I think it's okay, she's pretty happy hanging out on the lawn (with towel) right now.

Hey Sunshade Mama....

Your daughter is constantly hungry..... I know it has to do with cushings... so I have kept giving her peas.. What else do you do to keep her entertained???

We took her out on Saturday and Sunday afternoon for walks around Jericho, we took different walks since I remember you saying she doesn't like walking the same routes. Sunshade loves the beach and big green field filled with fall leaves! I'm glad that I was here cause Raul said she doesn't pee/poo when she's so fixated on the "enticements"... but while at the beach, Sunshade had no problem walking since I can tell she was really happy! I think dogs are choosey like humans... if we're happy, we don't need to be told what to do, we just do it self-willingly.

In the case of Miss Sunshade, she seemed happier when we take her out by car to somewhere instead of "walking" around the neighbourhood, cause today, Raul drove the car to work so I could only take her around your place for walk walk... We took the route around 6th Ave and then she just wouldn't cross the street with me to go on for another block. She wouldn't budge and just wanted to go home. So after we got home and I didn't give her any treats, I said, Sunshade, do we walk to get oat bar? Let's go get oat bar okay?? I don't know if she understood me (I don't think she did) but she followed me to the door and we were on our way to Starbucks! She got lots attention from the passerbys too. People thought she's very well trained, cute, wondering what type of dog she is, etc. Even your neighbour (an old lady) recognized her, but Sunshade didn't even say hello, just walked passed her! :P

Sunshade looked good yesterday, I took her to Ambleside Park/Beach and got her some treats (she got herself some and wouldn't let go of that one so I had to buy it - it was a twirlly dental flossy thing, I kept the wrapper in case you want to know what she had.) and the other treat is the freshwater trout biscuit cause they were a bin of fresh biscuits!!!

About 5 days before the end of my 18 day trip, I got two separate messages from Raul and Cindy (day time care taker), both telling me that they thought the lump was bigger. Cindy made an appointment and took Sunshade in the next day while I contemplated coming back home a few days earlier than planned. Janice was back by then and she felt the lump itself was the same size, but there was some amorphous tissue around it that made the entire lump seem bigger. She decided to do another FNA which would take another day or so to get the result back. At that point I decided to just stay until the end of the planned trip (2 more days) instead of paying $500+ (new ticket + penalty) to be back home a day earlier and on a day that Janice didn't work anyway.

The second FNA came back showing the same thing - spindle cells, which did not fit the profile of a bug bite anymore given the time frame. I came home on Tuesday, November 9th, took Sunshade in Wednesday, November 10th to have the lump biopsied. Sunshade only required local anesthetic in the area of the lump since it was fairly small. Miss Sunshade stood and ATE the entire time. She finished two bags of chicken jerky by the time the jelly bean sized mass was taken her and she was sewn up.

The jelly bean mass along with an adjacent fat tissue were sent for biopsy. Two days later, the pathology report came back and ultimately shattered my world. That was on Friday, November 12th.

Click here to read Sunshade's pathology report

Diagnose: Grade 1 Soft Tissue Sarcoma - an easy to understand read here on diagnosis, treatment, prognosis.

My heart girl had cancer......... how would I live without her??

That was all I could think of in the days followed. My mind was filled with all kinds of sad/negative thoughts. At one point I believe, even Sunshade didn't want to be close to me with all my negative energy.

Thankfully, I was lucky enough to have my bf, my friends from home as well as all over the world to offer support and words of encouragement. They reminded me to stay positive, and pointed out all the positive things that I failed to see in my state of despair.

Positive things being, Sunshade isn't in pain, she doesn't even know or feel it at all. It is a Grade 1 tumour, the lowest grade you can get. It is a type of tumour that has a low metastatic rate, as well as low recurrence following excision/clean margin.

In Janice's words - if you're going to get cancer, this is the type you want.

Pipa, a receptionist at the clinic told me about her beloved Weimeraner, Pluto, who was diagnosed with Mast Cell Tumour (a more aggressive type of malignant tumour with higher metastatic rate) when he was 10. He had tumour removal surgery with clean margin and lived cancer free for the next 6 years and passed away at an ripe old age of 16 (from old age).

I became calmer, more hopeful, and stopped thinking about losing Sunshade.... just in time for her clean margin surgery that was scheduled for Wednesday, November 17th. The day before her surgery, we followed our tradition of having Sunshade on IV at home for 24 hours pre and post surgery to keep those kidneys of hers extra hydrated.

Tuesday, November 16th, 2010

She was hooked up to IV, in an x-pen,


But that didn't stop her from smiling,


November 16th happened to be my birthday, so Derek cooked me a 4 lb lobster knowing how much I loved seafood (except fish)!


He also prepared Chinese hot pot where you add raw ingredients to boiling soup and cook as you eat,


Since Sunshade had always been a very involved member during meal time, today wasn't going to be any different. We worked around her limitations of being on IV inside an x-pen....LOL.. Yes I'm a little crazy, Derek not so much, but he's learned to live with the crazies. He came up with the whole meal set up for tonight LOL...


Sunshade usually gets a bowl of frozen veggies that get fed to her periodically while we're eating. She wasn't too thrilled about her bowl of frozen green beans.


She waited patiently for our food in the beginning,


Then pulled out her usual begging antics. A two syllable bark,


Or a PAW-Please!


I shared some of my lobster with her,



Dinner was excellent! Sunshade thought so too! Thank you Ninja Spy (don't ask LOL)!

When I came back from the trip, there was a big package waiting for me. It was from Maggie and Mitch and their wonderful mom Sue. Since me, Sunshade, Jaffa all have November birthdays, Sue had a present for each and everyone of us. This was mine, a Steiff Airedale! I had always wanted one but never got around to getting one!


The scarf the Steiff Airedale is wearing is handmade by Sue. The little Airedale face on there was made by, I believe, Miss Maggie's hair. The scarf is very special to us, you will find out why later.


Thank you Sue, you somehow always know what I love (Mini Sunshade was from Sue too!)! We are so lucky to have you & the pups as friends. Sunshade and Jaffa will get to open their B-Day presents from Maggie and Mitch when we celebrate next week.

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Derek and I took shifts during the night to watch Sunshade and the IV. It got a little clogged just before midnight and never really ran the normal flow despite numerous of flushes. Possibly a slight kink in the catheter as I was told later.

Wednesday, November 17th - Clean Margin Surgery Day

Sunshade wasn't scheduled to go in until 10:30 am, but since we had been having trouble with the IV overnight, I decided to take her in as soon as the clinic opened at 9am. She was put on the IV pump to continue fluids until it was time for surgery.


I put Sunshade's lucky bandanna on. It's actually a newly acquired name for the bandanna. This was Sunshade's 8th B-Day, "handmade" present from Sue. Sunshade wore it back in April when she underwent the stem cell procedure. The entire procedure was a success so I thought I would continue the tradition.

See the similarity in Sunshade's scarf and the Steiff Airedale scarf??


Being prepped for the surgery. The little square patch in the middle of the big shaved patch was the 2 cm incision that we used for the biopsy last week. Like I had mentioned before, it was done under local anesthetic and the actual tumour itself came out from there. However, the incision today was going to be 3 cm by 3 cm wide margin from the initial incision site. The whole piece of skin and everything else under it would all be taken out.


I stayed with Sunshade throughout the surgery like I'd always done. Janice took the 3 cm by 3 cm piece out, but said all the tissue looked like normal tissue. Since I felt there were some amorphous tissue that went beyond the 3 cm margin, I asked Janice to take out more from under the skin while leaving the skin on top in tact.

Don't know why, but Sunshade had the little lump that was the tumour and then swelling around it that would go up and down from day to day. The swelling was another reason why it was thought to be a bug bite in the beginning. According to Janice and people I've talked to, this type of tumour doesn't usually have swelling to go with it. Maybe Sunshade's tissue had a reaction to the tumour? The extracted tissue were sent for pathology. Hopefully we had achieved clean margins.


Groggy girrrl waking up from anesthetic,


Fully awake!! Sunshade has a tendency to fight the isoflorane gas (anesthetic) by not breathing it in. So she's usually under lightly and wakes up easily.


One more scar to add to Sunshade's collection. A 6 inch long scar from having an oval piece of skin removed. Sunshade didn't seem to be bothered by the scar at all, she didn't even looked at it.


As soon as Sunshade was able to swallow properly, we left the clinic at around 2 pm, just before the rush hour started.

Derek saw Sunshade's scar when we came home and he turned a little white. He right away went to our dehydrator and grabbed a bunch of chicken jerky to give to Sunshade. I think he was a bit shocked at how big the scar was and felt bad for her.

Sunshade of course was just thinking - GREAT! FREEBIES!! - as she patiently awaited her butler to deliver them.


Sunshade had to be in the x-pen again for another day of IV fluids......

Just as I was feeling more hopeful about the whole thing, I was yet hit with another possible condition to worry about. Prior to putting Sunshade under anesthesia for surgery, Janice was feeling Sunshade's lymph nodes around her jaw area. They were enlarged. I think it worried Janice some as she did not say much about it but went to take two fine needle aspirations to send for pathology. Janice usually checks all of Sunshade's lymph nodes everytime she sees her. The last time Janice saw Sunshade was a week ago when we went for biopsy. The lymphs were fine back then.

I knew Airedales were one of the breeds that were more predisposed to Lymphoma (aggressive cancer of the lymph nodes), so all night long, I was just worrying and praying that we would not be dealing with two cancers at once.

Thursday, November 18th, 2010 - 1 Day Post Surgery

The morning started by me receiving a delightful e-mail from Janice. You may have to click on the picture to enlarge it to read,


However, I could not get myself to stop worrying about the enlarged lymph nodes.

Finally, I received a call at 3 pm from Jen, the vet tech. She told me Janice told her to give me a "big smile". Those enlarged lymph nodes were actually overactive salivary glands. The FNA showed normal salivary gland cells. YAY!!!!!

WHEWWWWWWWWW!!

Not sure why they're overactive, but I won't worry about that right now.

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Sunshade finally finished her IV therapy this evening. She assumed her regular sleeping spot as soon as she was let out of the x-pen.


She was a lot happier then. We had been taking turns sleeping downstairs on the sofa bed for the last few nights, so the bed was all plush and comfy for the girl.



So far, she hadn't even looked at her incision. The spot where the IV catheter was in was bothering her more. She had been licking at it ever since the catheter came out so I'd been putting Zicofax - Unscented baby diaper rash cream on her.


Friday, November 19th, 2010 - 2 Days Post Surgery

Received yet another more creative e-mail from Janice. Sunshade was now known as the "SQAD"... LOL,


We hadn't taken Sunshade out for walks due to her needing to be on IV, and of course, the fresh incision. This morning, Derek decided to walk Sunshade out to get lunch. He asked me to put a clean shirt on her so her wound didn't get infected. He didn't want to use Sunshade's raincoat because it hadn't been washed. It was very cute seeing him so concerned. I think he was still quite shaken up by the size of that wound.

So I got Sunshade one of my tank tops that was snug. It read, LIVE HARD FAST AND FREE!


Derek said absolutely NOT. He was not going to walk her if she dressed like that. According to him, he would be "misunderstood".

HUH? Why? He had no problem walking Sunshade in her pink harness, pink leash, and the beaded collar. Said something about "biker girl".....


He insisted on putting Sunshade's rain coat on top of the biker girl outfit. It was a sunny day, albeit a bit cold.


Off they went!

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I had been doing laundry, but hadn't been folding them......


After the nap, Sunshade resumed her daily ritual,



I don't think the incision was bothering her too much at 2 days post op... LOL!

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Our post-op care for the incision was to rinse it under lukewarm water twice a day to prevent scabbing. According to Jen our vet tech, once it scabs up, dogs tend to want to scratch at the wound.

We had been rinsing since the first night we came home from surgery. Sunshade had been so good, so brave throughout the whole process. Never a complaint from her, true to her trusting, stoic personality. I'm sure its got to hurt somewhat....


She follows me into the bathroom everytime I ask her to and waits for her reward,


My daily work out!!


A little bit unsure about what's to come.....


But a little bit of food goes a long way nowadays!!!



Sunshade has always been a stoic girl. I realized that when I accidentally cut her ears flaps (into two flaps...) while trying to un-glue her ears at 3 months of age. Even as a pup, she never yelped nor struggled from pain. I only found out I had cut her big time when I saw blood everywhere.... Sometimes I do wish she would make more of a fuss so she wouldn't have to hold so much in if you know what I mean.

Anyway, here's the rinsing process. She was very talkative as usual about her treats! The stain you see on the gauze pad is not from her wound, it is actually honey. I will write more about it below.

Incision all cleaned up, looking beautiful at only 2 days post-op!


The night before Sunshade's surgery, I was up until about 5 am watching the IV. I chatted with a long time blog friend in Singapore almost the entire night. Sweet Anne, who had recently lost her heart girl, Snowball, was able to put aside her own heartbreak and help me stay positive (Thank you thank you thank you!!!). She had looked up Sunshade's specific type of cancer - Soft Tissue Sarcoma, and came across a blog documenting a dog named Cider and her success in beating this beast.

Cider was a Collie mix that was dx with Grade 2 Soft Tissue Sarcoma on her elbow when she was 8 years old. To make a long story short, the owners chose de-bulking surgery for Cider instead of amputation. They were fully aware of the fact that the surgery would NOT be able to get clean margins given the location of the tumour (around a joint). They also opted NOT to do any follow up chemo or radiation and just worked on improving Cider's immune system. The hope was that Cider's immune system would be able to kill off the rest of the cancer cells or at least keep them at bay. Cider is now almost 2 years since the de-bulking surgery without any recurrence. This gave me tons of hope and further emphasized on the low recurrence, slow metastatic rate for this type of tumour.

Cider's Blog - Beating Canine Cancer (if you have a chance, maybe you can drop by and congratulate them for beating the cancer!!)

In the blog, I saw Cider had a gaping wound from her incision splitting open (a leg has a lot less skin to work with than on the body). The wound was getting worse until the owners started to apply Manuka Honey on it twice a day (you can see pictures of the healing process on Cider's blog). After going through the entire blog, I decided to contacted Cider's owner privately regarding the use of Manuka Honey. Karen, so graciously e-mailed me back a detailed step by step instruction for application as well as words of encouragement.

On the day of Sunshade's surgery, I went to pick up some Manuka Honey with the highest natural UMF (the higher the UMF, the stronger than antibacterial effect).


I have been applying a thin layer of Manuka Honey onto a gauze pad twice a day,


And sticking it to the scar evertime after a rinse.


I wasn't sure if it hurt because Sunshade never complained.... But I was told by a friend who had a raging staph infection on his calf that "it hurts like a b*tch!" (I quote). He had a 6 cm diameter hole on his calf that was getting progressively worse over a 3 week period despite efforts by the doctor. I told him about Manuka Honey's antiviral/bacterial & healing effects and suggested him try it. Two days after he started using it, he saw tissue growth!!

Sunshade wants to let everyone know that you can EAT Manuka Honey too to help with stomach issues!! She doesn't have stomach problem, but I have been giving her two tablespoons a day to help with her immunity.


Few links on Manuka Honey:

• Natural Healing with Manuka Honey
• Effective Staph Infection Treatment
• Manuka Honey Eradicates MRSA

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Why did Sunshade get cancer prematurely?

That was a question I had been asking myself a lot. Yes, 11 years is premature to me.

The cancer diagnosis came as quite a shock to me (and Janice too) because Sunshade had been on a great diet, proper supplements, and no vaccination prior to this. However, when I thought about it, I realized I really shouldn't be surprised. Most of you know that Sunshade has been battling Cushings disease (unsuccessfully) for quite some time now. The uncontrolled Cushings had gotten progressively worse and none of the herbs/supplements we had her on did anything. One of the major side effects from untreated Cushings is a severely weakened immune system. Prior to the Cushing's dx, Sunshade had never had an infection, only needed antibiotics a couple of times following surgeries. Since her Cushings, she has been having recurring UTI's and has become resistant to a couple of commonly used antibiotics.

As we all know, cancer doesn't happen unless the immune system is weakened where the natural killer cells in the body don't recognize cells that need destroying and those bad cells proliferate out of control. I asked Janice on Wednesday before the surgery if she thought the reason we were dealing with cancer now was because of the Cushings. She gave me a definitive YES.

We had hoped to be able to avoid drugs commonly used to treat this disease due to their potentially deadly side effects. However, seeing how Sunshade's overall condition had deteriorated over the last 6 months, Janice and I had decided that we would pick a drug and start her on it once I come back from the trip. Unfortunately... a little too late. I came back to the ugly C, and it now takes priority.

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Lastly, there is an extremely knowledgeable, helpful yahoo group specially for dog owners battling cancer with their fur-kids. If you are dealing with the ugly C, I strongly recommend you join the group.

• Yahoo Canine Cancer Forum

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Thank you again everyone for your support, you have no idea how much it has helped me. I would also like to say a special thanks to Sunshade's team of wonderful vets & tech for being so AWESOME to my girl. We couldn't have asked for better friends/vets/vet tech.

We still don't have the pathology report back yet from the clean margin surgery. I am hoping for good news so we can move on to treat her Cushings disease. Please continue to keep Sunshade in your thoughts. She is my life!

Ear scratches to all your fur babies for me,
Sunshade's mum


Update:

• Pathology Report
• Consult with the Oncologist