Luke's Dog Georgia and Her Benign Growth

If you've followed my dog blog, you've seen some conversation between myself and another dog owner Luke in the comments. Luke's dog Georgia also had Fibroadnexal Hamartoma and he found my blog while doing research. He has sent pictures and descriptions of Georgia's growths and surgery. They are posted here with his permission. Thanks Luke for sharing your story and pictures!

Here is Georgia before (as you can see, 3 distinct lumps, with a 4th smaller one that you can't really see...the most concerning was above left eye and is really what forced my hand on getting the surgery with slowly but surely encroaching on her eye):

Here's right after surgery about to head home (for that big one above her left eye, they actually had to cut a flap of skin beneath her left ear and shift it over to the top of her head so the skin on her forehead wouldn't stretch too much and affect her ability to close her eye):

And here's right after we got home from surgery:

Here's 10 days after surgery, right after getting her stitches removed.

About 1-2 weeks later:

And now you can barely notice it!

Sorry again for taking so long...I definitely wanted to share though, because I know how I appreciated your blog.  It's always a bit scary putting your dog through any surgery, especially 1 where they're making so many incisions and placing so many stitches, so knowing that somebody else has been through it successfully helps a lot.  Not to mention, I didn't know what the heck those lumps were!  But all is well that ends well...growths are benign cysts...healing went better than expected...and insurance covered about 75% of expenses.

Daisy's Wound Is Improving & Spectacular Vomiting

Daisy's wound is looking better. This is from Wednesday. The vet that did the surgery saw us as we were leaving and checked out Daisy's wound. He is pleased with how it looks:

And this is from today:

Daisy did the most spectacular vomiting today that I've ever seen. I had to clean about 4 square feet of carpet! She's toward the end of three weeks on the antibiotic. The vet said to discontinue it and if the vomiting continues to bring her in for an anti-nausea shot. And she gets to eat chicken and rice, which she loves...

Daisy's Wound With Most Of The Stitches Gone

I think she still has a couple of stitches in place. They might be the ones that are supposed to dissolve. Here's how it looked today. The vet says that red is good healthy tissue...

Changing her bandage and cleaning the wound is quite the production. And Daisy is such a good girl!

Daisy's Laser Therapy

Daisy has 3 appointments this week and 3 appointments next week for laser therapy. Today, when the tech removed her bandage, a suture came away with the bandage. The wound looks like hamburger to me, but the tech said it looks good. One of the vets looked at it today and agrees that it looks good. I'd hate to see what "bad" looks like. Her regular vet and the vet that did the surgery were both off today. Here's what it looked like today:

Daisy is wearing an e-collar. Today, I caught her twisted up like a pretzel licking her foot. I told her to stop and she started doing it again a minute later. Now what? Anyone have any ideas?

Daisy's Gnarly Wound

This is what Daisy's wound looked like last night when I changed her bandage. It pretty much looked like this during our visit at the vet. Kinda gnarly, but she's on antibiotics now.

Good News For Daisy! and Melanie Paul And Her Therapy Dogs

Daisy had her follow-up today for the vet to check her wound. I thought it was starting to look infected when I checked it last night and the vet agreed. She's on an antibiotic now. The good news is that the lab results came back and it's not cancer! Thank God! Daisy is going to get laser therapy 3 times a week for 2 weeks, then the vet will evaluate the wound again. The vet that checked it today was the same one that did the surgery. He said that it looks better than he thought it would.

On a side note, I met Melanie Paul today at the vet. She had her Sheltie Molly with her. Melanie's Shelties are therapy dogs. Very cool! You can Google them. I'd love to do therapy dogs, but I don't think any of my girls would be suitable.

Daisy's Stitches

I got a good look at Daisy's stitches last night. The vet had to make an "H" incision to try to close the wound. He did pretty good. There's just a small area in the middle where the skin didn't meet. I'm keeping it bandaged and we are going to the vet on Saturday so they can check the wound.

Daisy's Surgery, Sky's Blood Test Results

Daisy's surgery went well today. The vet feels like he got it all. I should have the lab report in a week or so. I'm going to unwrap it tonight to make sure it's looking ok. I'll post a pic tomorrow. For now, she's resting in her pen.

Sky's latest blood test has come back. Everything looks good and she is continuing to take the Kinavet for chemotherapy.

Daisy Mae Has A Growth

So now Daisy has a gnarly growth on her back right leg. It didn't seem to be bothering her, so I waited a few weeks to see if it would go away on its own. But it didn't. So we went to the vet and she was on antibiotics for a couple of weeks, which didn't do anything. So she is scheduled to have surgery tomorrow to remove it and we'll send it to the lab to see what it is...

Howl-O-Ween

I can't believe I forgot to post my girl's holloween picture. Better late than never!

Sky           Daisy           Shannon

Sky: Possibly Another Tumor

I believe Sky has another tumor on her front right paw. There was blood so I swabbed it with some antiseptic. Here's what it looks like:

I think it's a tumor. But I don't know how it got bloody. She's been in an E-collar for several days now. I think she is going to have to live the rest of her life wearing it. Thank God she doesn't mind wearing it. I'm so scared that she will chew a tumor and have it release histamines and make her miserable and I'll have to put her down. Anyway, the fact that this spot is bloody and she's not itchy makes me wonder if it is a tumor... For now, I'm keeping an eye on it. Once it dried off, the fur went back to normal and you can't even tell there's anything there.

Shelties Playing

I had my phone with me at the right moment today. The Shelties had a little impromptu play session today. They are so much fun! Check out the Shelties Playing video (0:38) -- Shannon is laying down and Sky is standing up:

Sky: A New Tumor

It was very upsetting to find another tumor on Sky Saturday night. It's right next to the pad of her back left foot.

She was at the end of her sixth week on chemotherapy when I found it. So, I guess the Kinavet did slow down the growth of another tumor. But I was hoping it would prevent her from getting any more tumors. She had her last two-week blood draw today. Now it will go to once a month. The vet looked at it and agreed it's not surgical due to its location. They could remove it, but they wouldn't get it all. That would just make it release histamines and cause her to be itchy and miserable. I'm noodling if I should try to put some kind of covering on that foot so she can't chew it and so it doesn't accidentally get injured. If you mess with these tumors, they release a lot of histamines. It's got a little bit of crusties on the edge, but I'm not even picking them off. I don't want to do anything to make her start scratching like she was before. It was horrible. She scratched until she bled... She was all better once the tumor was removed. But with this one, we need to make sure it doesn't make her itch because surgery isn't an option. The vet said the Kinavet could still shrink this tumor. So, let's pray for that. On the good side, the Metronadizole fixed her loose poop situation.

Sky's Tummy Troubles

I fed sky some regular kibble because I was worried about her nutrition after having been on the chicken and rice for over a week. That turned her loose poop into diarrhea... I was out in the yard with her at 3:00AM. So, we went to the vet this morning and she was prescribed metronidazole. That should set her right!

My normal vet wasn't working today, so I asked for the vet that she's said had experience with the Kinavet. He said that since Sky had been doing well that this bout of issues is probably not because of the Kinavet and she should be able to continue on it. He wasn't worried at all about the vomiting since it had been a couple of weeks without recurrence. We discussed how long Sky would need to remain on it and he was unsure. There just aren't any studies yet to determine how long a dog should stay on this new medication. He said he had a previous patient that was getting tumors every 4 months. So they gave the dog Kinavet for 4 months, then stopped. The dog didn't get a recurrence while taking it nor in the 4 months since. But it's still a guess. And Sky got three tumors in as many weeks, a completely different scenario. He said that if taking it for 6 months prevents a recurrence, and you can afford to continue it after that, why not just stay on it for life. I'd appreciate hearing from anyone else that has insight and experience with Kinavet. Just leave a comment...

Sky's Blood Work & Sleeping Arrangements

Sky's blood work came back good today. She can continue to take the chemotherapy Kinavet. She will get another blood draw in two weeks, and if that comes back good, then she will go to once a month.

When Sky first had surgery, I didn't want to put her in a crate. She is usually in a crate overnight and when I'm not home. But I didn't want her to rub the stitches or staples against the sides of a crate. So, I set up a kennel in the bedroom. Shannon wanted to be in there too, which I let her do overnight. It turns out, she really likes to stretch out. That's Sky up against the side of the kennel. She is in a e-collar when I'm not watching her. She still has a tumor in front of her ear. If she scratches it, it will release histamines and make her itch. I don't want her scratching until she bleeds again. They have plenty of room, but this is how they end up every night.

Sky: Update & Expenses To Date

Here's an update on expenses in the treatment of Sky's Mast Cell Tumors:

I'll get her results tomorrow from her blood test. She's had some vomiting and loose poop. She's been on chicken and rice since Friday evening. I didn't get to see the vet today, they just took her to the back to draw her blood. So, I'll bring it up tomorrow when they call with the results.

Sky: How is she doing?

Sky continues to do pretty well. She vomited on 9/11 & 9/15 and had a loose poop on 9/18. She would vomit every now and then anyway, so I'm thinking she's ok. I put her on chicken and rice (which is a treat) to help firm up her poop. She will have her next blood draw on Tuesday, 9/22, to make sure she is still doing ok on the chemotherapy (Kinavet).

Sky Update: Vomit

Sky vomited a little bit last night -- on the carpet. Ugh! This is the first time she has vomited since starting the chemotherapy with Kinavet... I got all the dogs away from it, put on some gloves and cleaned it up. But I'm not really sure how to make sure the spot isn't toxic. I've got a stool straddling the spot and I've sent an email to the manufacturer asking them. Am I going too far worrying about this stuff? I know this isn't the last time she will vomit. She tends to get an acid tummy. She gets famotidine twice a day, but she still gets sick every now and then...

Sky Has Another Tumor, But She's Still A Happy Girl

Sky has a small tumor in front of her ear. I'm not advocating for surgery since the chemotherapy (Kinavet) is supposed to shrink tumors and can even make them disappear. (I found this several days ago but didn't think to get a picture and post it sooner.)

She is a happy girl! She is the most engaging Sheltie I've ever met. She is all about the eye contact and is in your face!

Sky Update: Blood Test Results, Healing Shoulder Wound, Worrisome Limp, and Daisy With A Dog Food Bag

Sky's blood test came back good, nothing to worry about. She can continue on Kinavet. The incision site on her right shoulder where a tumor was removed is looking better each day.

9/5

9/6

9/7

She has been limping all day. She's favoring her right front leg and was licking that foot this morning. If she's not doing better by tomorrow, it will be another trip to the vet...

Here's a picture of Daisy being a funny girl today. She's my Belgian Malinois mix. I always throw the empty dog food bag on the floor because my other Sheltie Shannon loves to lick the inside of the bag. Well, Daisy finally figured out (after all these years) what Shannon was doing...

Sky's Staples Are Removed

I took Sky to the vet today to get her staples removed and to get her first blood draw. She has been doing really well. She is full of energy and so far there haven't been any side effects from the Kinavet. I left her there after the staples were removed so that she could have a bath. Isn't she pretty! And she feels good and she smells good! She doesn't seem to be bothering any of the incision sites, so I'm taking off the e-collar when I'm able to watch her. If I'm in my chair, she only wants to be in my lap or at my feet (total Momma's girl) so it's easy to keep an eye on her.

Here's some pictures I took after the 53 staples were removed. Isn't there a saying about the good, the bad, and the ugly. Her leg looks pretty good. Some scabs though make it 'the ugly'...

Her side looks fantastic. 'The good'

 

Her shoulder looks horrible. This is 'the bad'. The technician started removing the staples and the wound started opening up. So I had the technician stop and asked her to get the vet to look at it. (Just a note for the record here. I had expected to see my normal vet today, but she was out for some reason and a different vet took care of us.) The vet came in and said sometimes with staples a wound will roll in. And removing the staples allows it to roll open. At this point, fur is growing in there and it's better to leave it open. I don't get it. I think it looks horrible. I don't understand how fur can be growing in the part that was inside the wound. But the vet assured me that it would look great in no time... I'll post some more pictures as this wound heals.
 

I'll also post again when the results of the blood work come in. Tonight she will get the last two pills of the first bottle of Kinavet, completing 2 weeks of chemo... I have another bottle here before I will need to get a refill, but that will wait until after the lab results come in, in case she needs to stop taking it.

Sky's Expenses (so far) and Possible Toxicity of Kinavet-CA1

I found my statement from Sky's first surgery to remove 2 tumors. Here's a break-down of expenses so far. I'll continue to update as things progress.

 

She has an appointment Friday to get her staples removed and to get her first blood draw. The chemotherapy (Kinavet) can cause 6 different syndromes that can kill her. So she will get blood drawn every two weeks to make sure she's doing ok. These are the possible syndromes:

• Renal Toxicities and Protein Loss Syndrome
• Non-Regenerative Anemia and Hemolytic Anemia
• Neutropenia
• Hepatic Toxicity
• Gastrointestinal Toxicity
• Other (Severe Weight Loss)

She continues to do well. I took off her t-shirt while she was on my lap this morning so I could brush her. She enjoyed the attention but was happy when I was done. She's such a good girl, she helped me put the t-shirt and e-collar back on when we were done...

Sky On Chemotherapy

Sky is tolerating the Kinavet really well. She hasn't had any vomiting or diarrhea. And she is full of energy! So far, so good...

Sky's Mast Cell Tumors: Diagnosis, Surgery, and Chemotherapy with Kinavet-CA1

Sky was diagnosed with Mast Cell Tumors on 8/14.

In July, I found a lump on Sky's rear left leg. It looked like a marble was just under her skin. The hair had come off of it and it had a moist brown crust. It was flesh colored and felt like it was soft and mushy. I'd never seen anything like it. This is on the outside of her left leg, near her knee.

So I took her to the vet on 7/15. Sky had chewed on it in the mean time, so it looked a little scabby in places when we went to the vet. I thought her allergies were acting up, she was scratching and chewing like crazy. (I've since found out that Mast Cell Tumors release histamines, which were making her itchy all over.) So she got the e-collar at that point. But she still scratched until she bled. The vet tried to get a fine needle aspirate, but couldn't get anything out of it. So she prescribed an antibiotic for 10 days, which did nothing. So we scheduled surgery for 8/10 to remove it. The night before her surgery, I found another lump on her right side where her waist dips in. My vet calls that her flank. This growth was smaller (no picture). The vet removed both and sent the one from her leg to the lab to be analyzed. Her leg wound got six stitches.

Her flank got five stitches.

The lab results came in on 8/14 (shown with my highlights for emphasis):

Microscopic Interpretation (Biopsy)

Cutaneous mast cell tumor, Patnaik grade 2 (low mitotic index), ulcerated and severely inflamed

Two tier histologic grading = low grade

Mitotic index = one (total mitotic figures counted in ten equivalent 400x high power fields).

Margins = this mast cell tumor forms a loosely circumscribed, base heavy nodule within the dermis and subcutis, 11 x 8 mm; it appears to be completely excised, closest approach to deep central margin is 1.0 mm, and the nearest lateral margin is approximately 2.0 mm.

Comments:

This inflamed mast cell tumor is classified as a grade 2 or intermediate grade tumor based upon the Patnaik grading system (1=low grade, 2=intermediate grade, 3=high grade).

Also, utilizing the recently proposed two tier histologic grading system for canine cutaneous mast cell tumors, this would be categorized as LOW grade mast cell tumor (see Vet Pathol Jan 2011: 48(1):147-155). Median survival time for high grade MCTs on this system was less than 4 months, while the median survival time for low grade tumors was not reached after 2 years of follow-up.

Histological grading may be the most important prognostic indicator overall but other clinical factors specific to each patient need to be considered as well. Negative prognostic factors include signs of systemic illness; rapid growth of tumor; and recurrent growth. Wide surgical excision with 2-3 cm lateral margins and 1 fascial plane is the standard recommendation for removal of MCTs. However, tumor recurrence and/or metastases were not observed with lateral margins of 10 mm and deep margins of 4 mm in one recent study (JAVMA 2011, 239,11:1464-1469).

Furthermore, it has recently been shown to that mitotic index is an important prognostic indicator, regardless of the grade (see Vet Pathol 2007 May 44 (3):335-41). For grade 2 mast cell neoplasms with mitotic index greater than five, median survival was five months, whereas tumors with mitotic index less than or equal to five, the median survival with longer than 70 months. This mast cell neoplasm has a low mitotic index, suggesting more favorable prognosis.

Assessment of these factors will dictate if any additional diagnostic tests may be required and will determine which therapeutic option (further surgery, radiation, chemotherapy) is best suited for your patient.

Approximately 15% of dogs will demonstrate multiple cutaneous mast cell tumors, either concurrently or sequentially. Though the current WHO staging of canine cutaneous mast cell tumors considers multicentricity a negative prognostic indicator, other studies have failed to demonstrate a difference in outcome for patients with multiple tumors (see JAVMA 2006;228:91-95).

 
 OK. So, Mast Cell Tumors are bad news, but it could be worse... The lab results give me reason to hope. There is a contradiction. It states that "negative prognostic factors include... recurrent growth." But then in states that "...studies have failed to demonstrate a difference in outcome for patients with multiple tumors."


We were supposed to return to the vet 10 days after surgery (8/19) to have the stitches removed. But I found another tumor on the night of 8/17 on her right shoulder. This one is even smaller than the other two. I wouldn't have found it if I hadn't been looking. It did have the same moist brown crust as the one on her leg, so I was pretty sure it was also a Mast Cell Tumor.

On 8/18, I arranged for another surgery on 8/19, instead of just going in for removal of the stitches. The vet would cut out the tumor and remove the stitches from the first two tumors while she was under anesthetic. Good thing for the anesthesia... The area where Mast Cell Tumors are removed often don't heal very quickly and sure enough, the wounds hadn't healed. So the vet stapled all three wounds with an abundance of staples. Leg:

Side (she jumped out of the car before I could lift her down, causing a little bit of bleeding. She's a Houdini. If she sees an inch of daylight, she's going for it!):

Shoulder:

 I count more than 50 staples... Poor girl. The e-collar is to keep her from chewing her leg and side. The t-shirt is to keep her from scratching her shoulder. (She's in a size 4T thrift store $1 t-shirt...) There's a shaved spot on her front right leg where she had an IV during the surgery. She is still just as cute and as happy as can be!

Sky's t-shirt is a rainbow smiley face with hearts and peace signs. She's so fashionable!

I have decided to give her Chemotherapy. I have always said that I'd never do Chemotherapy for a dog. But she can't live with these tumors since they cause her to scratch until she bleeds. And I don't want to keep subjecting her to surgery. So, the way I see it, my choices are Chemotherapy, or put her down. So, I'm going with the Chemotherapy, especially since the lab results show that she could have a good outcome and the chemotherapy looks so promising. Kinavet is a fairly new drug which inhibits the thing that causes the tumors. It can shrink and get rid of these tumors. Check out Oz's story. My vet had to order the Kinavet. I just picked it up on 8/21 and gave her the first dose with her dinner.

I'm supposed to give her two pills once a day. The pills are coated, but there's still a warning to wash with soap and water after handling the pills. And if I need to clean up her feces, urine, or vomit, I have to wear gloves (I guess since there's no protection from the pill coating once it's been ingested.) One month of pills is $138. She has to have blood work done every two weeks. There are a bunch of life-threatening adverse reactions that could result from this therapy, so she will need to be closely monitored. The vet said she could be on this drug for 6 months to lifetime. Sky is only 10 years old, she could have many more good years left in her...

I'm not sure what the cost is at this point. I'm missing a receipt for the first surgery. I know how much that was, but I also had her teeth cleaned while she was under and her nails clipped. So I don't want to include those expenses... I'll post when I find that receipt...

I'm optimistic at this point. The lab analysis points to a good outcome. We just need her to tolerate it well (no vomiting or diarrhea) and none of those life-threatening adverse reactions. So far she seems fine after her first dose last night. I'd love to hear from anyone who has experience with these tumors or this drug. You can leave a comment even if you don't have an account. It would just be from 'anonymous' but you can put whatever name you want as a signature in your comment...