Amira's battle with Synovial sarcoma

Amira’s Daddy and I had to send our Baby to the Rainbow Bridge Saturday March 12, 8 days after learning her cancer had metastized to her lungs and abdomen.  She left us with her head in my lap and looking into her Daddy’s eyes; oh how she adored him!  The past 68 hrs have been the worst of our lives as we struggle not to collapse from the unbearable pain in our hearts.  We said our final goodbyes this morning, sending along a box of her favorite food and treats along with her ball and one of her dozens of “babies”.

I have not updated this blog since Amira’s first chemo treatment in Oct as I was afraid to jinx things… After her first chemo, she did good with the following 5 treatments with little adverse reaction other than a bit of tiredness for a day or so after.  Her white blood cell count and liver function remained unaffected by the CCNU possibly because she was getting Denamarin daily.  She had physically adapted to being a Tripawd without much difficulty although our house became a mishmash of carpets, runners, yoga mats (it’s all hardwood floors) to keep her from slipping.  The few times she got excited when daddy or I came home and ran to meet us, she wiped out which made our hearts stop for fear of her hurting her remaining back leg!

Amira was fully back to her pre-cancer self by the beginning of November and we had a nice Holiday season together including a Christmas visit from Grandma.  She did so well in fact, that during her restaging on December 11, 2015, there was no sign of metastatic growth at all and her blood work all looked good.  You can imagine how ecstatic and grateful we were!  Still, I didn’t want to jinx it by sharing our good news here…

At her Feb 4,2016 follow up, her oncologist continued to be happy with Amira’s progress and she looked great!  Her  blood work was good, coat was glossy and almost all the fur had grown back over her amputation site.  Her appetite was good – actually too good as she had gained 3 kegs between her Dec and Jan doctor visits.  We were flying high although at this appt her oncologist said that with hystiocystic sarcoma, if it’s going to come back, it’s usually within 5 months.   Well,  she was unfortunately right…

During Amira’s March 4 restaging X-rays, a large mass (10cm) in her lung was clearly visible.  Ultrasounds showed inflammation in lymph nodes.  They did fine needle aspiratation of the lymph nodes and we waited for the pathology report.  We went back on Tuesday -exactly one week ago today- and the bad news was confirmed.  Oncologist said without treatment, it would be about a month and “she would go down fast”.  With treatment, 3-4 months with still good quality of life”.   Our world crumbled then… We opted to at least try the Palladia option but Amira could not start it until the diarrhea that had started after her appointment,  got resolved with Flagyl.  She started on Prednisone Tuesday as well and By Thursday evening, her poops had improved to being soft but formed so the plan was to start the Palladia on Friday.  She woke me up 3 times to go out through the night Thursday and didn’t want to go back in the house but Friday morning, she seemed fine.  She’d had a soft poop when she woke me to go out at 6:00 am so She just had her breakfast and proceeded to work on the big beef joint bone she’d started on the night before during the 2 hr drive from our house in LA to our vacation home in Rancho Mirage.

By about early afternoon, she started straining to poop And started having small dry chalky poops which usually happens when she has too much bone.  She’d also started to pant more than usual as well.  Didn’t think too much of it until mid afternoon when she went out frequently, strained and nothing came out…daddy and I ran a few errands until 4:30 and she didn’t appear to be in any discomfort;  was still giving me “those eyes” hoping I’d share some of my cheese with her at about 5:30.  Unbenownst to us until later, she’d actually pooped 2 more pieces of the dry chalky poop in the house while we were out ( she rarely had accidents in 5+ yrs).  I gave her her prednisone and first dose of Palladia sat 6:00.

By dinner time at 7:00, she took a few bites and walked away.  Alarm Bells but not panicked yet thinking it may be the Palladia side effect.  7:30 daddy hand fed her and she ate the rest of her dinner.  8:00 she threw it all up and thereafter asked to go out every 15-20 mins but still no poop and now she was grunting with effort. Around 10:00 i notice blood on her rump.  We thought maybe from the straining too hard and I proceeded to use the flashlight to watch as she was trying to poop.  Clear liquid was actually dripping out of her rectum and the blood was actually coming from her vulva (she’s spayed).  Now ofcourse we are in full panic mode and called her oncologist’s practice which is 24/7 ER but the ER docs were tied up with Emergencies.  The ER vet called back around 11:00 and thought the panting maybe from the Prednisone but because of the blood, recommended we go to the local 24 hr vet clinic.

We went and waited till after 2:00 during which time Amira actually only went out 1 time and seemed to be doing ok.  When the clinic vet finally saw her, even she said that Amira looked good and bright eyed and Abdominal palpitation yielded no response and was soft.  Vet thought bleeding may be due to a UTI and suggested X-ray of abdomen and a urine draw directly from bladder.  By now it’s almost 3:00 am and we had every intention of leaving to head back to LA first thing in the morning so that Amira could be seen by her oncologist at Animal Specialty Group, so we declined.  Got back to the house and went to sleep around 4:00 am.

Amira woke me at 4:30 and 5:00 to go out and still no poop.  She was up at 8:00, I took her out again and she strained for quite a few minutes then threw up mostly bile, twice.  We called ASG, explained the situation, got ready and got on the road to head back to LA.  Before we left, I did my “chicken test” with her and was optomistic since she not only did she eat the little pice I offered her, she gave me a kiss to get it!!!

While we were on our way, her oncologist called to confirm that although fully booked, she was worried too and told us to bring her in at 2:00.  We got back to LA by 12:00 and thought we better eat something while we waited to go. Amira was lying down as Daddy and I tried to eat and when I looked at her eyes, the fingers of fear started wrapping themselves around my heart  and she turned down scrambled eggs.  Did the chicken test again, and she took it!!  As I checked on her again around 12:30, I notice more blood but this time a  big clot as well.  By this point, we weren’t waiting and proceeded to get her out to the car.   I held her as She threw up again on the doorstep as she was trying to go back inside…we noticed though that she seemed to be better after she threw up!

1:00, we get to ASG which was miraculously quiet and calm (it’s usually a zoo on the weekends since it’s an ER) and her oncology team were all available for her.   Her tech took her temp which was normal.  She was looking much better and bright eyed again.  Good signs!!!  But she still needed to X-rays to see what was going on.  She went to the back with “uncle Lane” for the X-rays and we waited; not tooooo worried now with the good signs and knowing she was in good hands.

Our world collapsed at approximately 2:15 pm March 12/2016…X-rays showed she had poop in her intestines but a big tumor pretty much pressing her bowels from above and something around her uretha pressing from below.  There was no way for the formed waste to come out…her oncologist and amputation surgeon both perform a rectal exam and could feel the mass with their finger tip.  Nothing could be done medically to resolve the proble.  The End was here; there was no choices left.

we spent the next hour and a half with her telling her how much we loved her and how brave she’s been through all this.  I told her not to be scared and to find her doggie cousins when she got to Heaven and to wait for mommy and daddy to join her there.  Amira was very calm and almost dosing as we rubbed her.  Luckily she was not stressed by our crying and my tears dripping on her face…at approximately 3:45 pm, we lost our true Pack Leader and her crew of 2 became lost and unmoored… I’m pretty sure I helped hasten her demise by giving her that big bone that started clogging her up.  I AM SO STUPID!!!!!

These past 3 days for Amira’s daddy and I, have been the most painful of our lives.  By far Worse than even losing his mom and losing my dad. We feel like we can’t breath and just want to jump out of our own skin. The pain in our heart is searing; unbearable…Amira was our world, the 3 Muskateers!  I see her in my minds eye everywhere. I try to trick myself that she’s in the other room and visualize her chilling on her bed.  I hear her shaking herself as she gets up and the tapping of her three legged hop on the floor…I am dreading coming home to an empty and silent house.  Worse yet, being alone when my husband has to travel for work.

But yesterday, my clever Baby girl, let me know she was ok.  We have a deer family that live/visit our property for several years but I hadn’t seen them in many months.   Amira always sensed where they were, but they were beyond our sight lines.  As I got into my car yesterday morning and was about to leave, I looked up the slope beside our driveway and saw a deer standing there looking at me.  I watched her for a minute, then she turned and I watched her wagging her tail.  She went a bit farther into the bushes and was squatting to poop.  I didn’t think much of it at the time as my brain was foggy with grief, but when I told my husband about it later in the afternoon, it hit me!  It was Amira using that deer to tell me: ” mommy, I’m ok!  I can poop again!”  I should mention that the Chinese character in my name, includes the character for “deer”! some may say I’m crazy, but I know it was my Amira who came to see me.  That has brought me some comfort an i am holding on to that for dear life!

Her Daddy I know, was hoping for a similar experience but it didn’t happen.  Until this afternoon that is, when he somehow ended up with Amira’s poop on his shoe;  that has never happened in the 5.5 years she was with us and he was watching where he was stepping too!  You see, Daddy was the Poo Master; he was the one who she almost always went to if she needed to do business and the one to pick up her business! So it seems our Baby wanted to let daddy know too, that she can poop again!

This morning we went to the crematory to say our final goodbye to our baby girl.  now, I no longer pray for God to watch over Amira to keep her safe, healthy and cancer free. Instead I pray that He will stop this unbearable pain soon.

 

 

 

Amira had her first dose of Lomustine (CCNU) on Friday 10/9, the same day she got her staples out.  Up until that point, she had had a pretty rough recovery having had an adverse reaction to Tramdol but continuing to demonstrate signs of distress/anxiety/pain even after switching to the Gabapentin, especially at night.  She would pant/breath heavily for hours from the late evening to the very early morning hours.  She developed what we thought were seromas as there were two occasions where there was wetness around her incision which we though were spontaneous “bursting” of the seroma.    We though perhaps it was the seromas that was causing her discomfort and thus the panting.  Although she was eating, it certainly was not with much gusto and she refused some of her favorite things like apples.  There were a couple of brief moments where we though ‘our baby is coming back’, but they seemed to disappear as quickly as they came…However, after she got her staples removed (and the surgeon said she didn’t have a seroma…),  i stayed inside the clinic to wait for the results of her pre-chemo blood test while Amira and daddy waited in the back of the SUV in the parking lot.  When i looked out to check on them, i saw “my Amira” hanging with her daddy, looking sharp and alert, watching folks and their pets coming’ and going.  Folks stopped by to chat with daddy and Amira was Miss Friendly!  “Happy” doesn’t begin to describe how i felt seeing her being herself again!

We gave her the Lomustine along with the Cerenia and Denamarin Friday early evening as instructed by the Oncologist.  She had a pretty good night with only about a half hour of panting before she went to sleep!!!! Saturday was a great day for her – she actually responded to my call from the kitchen for her to have her dinner and even played a little tug of war with me!  We were so happy that ‘our baby is back!’  Unfortunately, Sunday (day 2 post chemo) was not so good…Amira didn’t finish her breakfast and didn’t even have any interest in a big ol beef rib bone with plenty of meat on it.  She seemed lethargic  and tired.  She wouldn’t eat her Honest Kitchen + chicken dinner but did eat straight up chicken breast and ground beef with nothing else mixed in.  The panting started at about 10:30 and lasted to about midnight, then she slept.  She’s continued to be like this now since Sunday and today, the panting/heavy breathing started in the late afternoon and has been on and off since.  She continues to refuse to eat anything other than plain chicken breast and ground beef (although luckily her love of Brie cheese remains since i wrap all the pills in it) and still doesn’t drink much.  I’ve been getting liquids into her by mixing it in with her food and every couple of hours coaxing her to drink chicken or beef stock (the water i cook the meat in) through her water bottle.  I keep hoping that even though she’s picky, her willingness to eat the chicken and ground beef is a good sign although i worry about her not getting enough nutrients…It seems like Amira just keeps drawig the short straw and falls into the ‘exception rather than the rule’ with her amputation recovery challenges and now, with the chemo side effects; she’s gotten a double whammy that’s for sure!

It continues to break our  hearts to see her like this.  I realized yesterday that i have not seen her wag her tail since before this whole nightmare started on 9/18… i have not seen her ‘happy’ except those brief few hours between getting her staples out and starting the chemo and even then, she was not the same Amira PC (Pre-Cancer).  People talk about how their dogs got their sparkle back after 2  weeks; we’re still waiting and hoping that Amira’s will return soon.   Sometimes i think i see just sadness in her eyes and i wonder if she’s trying to tell me something.  She’s been letting me hug and kiss her which she NEVER would have done before so i wonder more, ‘ is she trying to tell me something?’  I am having serious doubts as to whether we are doing the right thing since it seems we are only causing her more suffering.  Is it worth it to make her go through the chemo side effects every 3 weeks?  Assuming it takes her a week to get over the nausea and fatigue it causes, that means she gets to have 2 ‘good’ weeks before being subjected to another ‘hell week’…I told the oncologist we were going to make a liar of her when she said prognosis was 5 months even with the chemo.  I’ve read several studies re: use  of CCNU treatment on histiocystic sarcoma and one specifically re:  periarticular hystiocystic sarcoma, which had mean survival times of 18 to 36 months respectively, if used in conjunction with surgical recision/amputation.   I continue to pray that all her suffering will be worth it in the long run!  In the meantime, each day i battle the doubts that are in the back of my mind, the terror that the cancer has spread every time i hear her panting and her nose running and the overwhelming sadness that is like a cloud that envelops me.  I keep wondering “when will our lives return to ‘normal'” or will it ever????  We are scheduled to go to Europe for 3 weeks on Nov 10 but there is no way i can leave Amira for that long now.  We were thinking that if she’s doing well in the next 2-3 weeks then maybe we will go, but only for 2 weeks… now i don’t know what to do as i would hate myself for leaving her ‘if something happened’ while we were away…I wonder if i will ever feel at ease leaving her behind if we go away on vacation…i wonder if i’ll ever stop crying

Last Friday 9/18, Our 6 yr old girl Rottie went in for TPLO surgery for what was believed to be a blown crucial ligament in her rear left leg.  She’d started limping badly on Tuesday 8/11 all of a sudden and babying her front right leg.  I tried to check her pads and toes but she was having none of it!  She seemed to improve but then worsened again so we took her to the vet on Sunday.  As she was getting into the back of my SUV, her dad thought he heard/saw something fall out and found a little blob of plastic with sharp corners!  We thought “aha” but went to her regular vet anyways.  By the time we got there, she was walking fine and even let me fully check out her pads and toes!  Since she seemed fine now, we decided to go home  without seeing the vet.  Unfortunately, she started limping again later that week so we went back to the vet the following Sunday who did a physical exam and found nothing wrong.  We were scheduled to go out of town that week for 10 days so she suggested X-rays when we get back if she continued to limp.

we took Amira to her trainer Brigette for the 10 days we were out of town and when we got back, Brigette said that she’d been doing well but for the past 4 days, she’s been having issues with her BACK left leg and we should get X-rays done.  We were like “Huh, her back leg??”

anyhow, we scheduled for her regular vet to do the X-rays on Wednesday 9/9.  Radiologist reviewed and saw osteoarthritis throughout and some fluid in her rear right stifle but thankfully, no growths/masses.  Her vet palpitated and felt some swelling and suspected a torn CCL and referred us to an orthopedic surgeon.  We went for the consult 2 days later on 9/11 and yep, torn CCL!  We went ahead and scheduled the TPLO surgery for the following Friday 9/18.

During that week in between, Amira seemed fine; one would never know she was limping unless you knew to look carefully at her movement but by the next wednes/ Thursday, she seemed perfectly fine!  Her dad and I agonized over whether to proceed with the TPLO since she seemed fine ( and I could not replicate the “drawer movement”!) but ultimately decided to go forward after reading tons of articles saying that CCLs don’t repair themselves and will only further deteriorate without surgical treatment especially in big dogs like Rotties.  So I dropped her off Friday morning 9/18 for the TPLO surgery.

Later that afternoon, the surgeon called and told me that during the TPLO surgery, the membrane of her joint capsule was noted to be thickened and discolored. They proceeded with the TPLO and took a biopsy of the joint tissue for pathological testing.  I was obviously very worried and started praying HARD but we were so glad we went forward with the TPLO as otherwise, we would never have found the problem until it was probably too late.

We got the devasting news the next day that she tested positive for synovial sarcoma (soft tissue cancer).  By this time, I’d tried to learn as much as much as I could about abnormalities in canine “joint capsule” and had read about synovial  sarcoma and knew that prognosis could vary depending on what type it was.  I’d read one vet study that found a high incidence of histiocystic sarcoma in Rottweilers and that would NOT be good…. We asked the  surgeon what type of synovial sarcoma our baby Amira had and she said they wouldn’t know without having further histology stains but those would take 7-10 business days.  She said that regardless of the typing, recommended treatment would still be full leg amuputation.

Her daddy and I decided not to wait (or give that evil cancer even one extra second to have a chance to spread!) and scheduled her amputation surgery for Tuesday 9/22 with her primary orthopedic surgeon.

Although her previous X-rays taken when she was diagnosed with the torn CCL showed no thoracic or abdominal abnormalities, an ultrasound of her belly would be performed the next day (Sunday).  Needless to say, we were emotionally drained from a night of crying and worrying, so the wait to hear back seemed interminable!  We finally got the call with bad news – they found a nodule on her spleen.  They aspirated it and sent it off to pathology so another round of crying, begging God to spare her, and night of research re splenic masses ensued.   We decided to bring her home Sunday afternoon since her surgery was not going to be until Tuesday.

I have never prayed so hard for anything and it appears that God was listening because the next afternoon, we got the call that pathology found no cancerous cells and the nodule was “normal regenerative growth” ( whatever that means I don’t know cause I stopped listening at “no cancerous cells).

Of course they said that the cytology is not as definitive as a biopsy but we were not about to have her undergo abdominal surgery for a biopsy  after she’d just had the TPLO!  We are optimistic that the cytology result is indicative of NO metastasis which hopefully means the amputation with follow up chemo, will successfully eradicate and prevent any spread.  So, we breathed a sigh of relief, thanked God and prepared to take her in the next morning for her amputation.

The next day was one of the most difficult days I’ve ever been through waiting to hear how Amira did through the surgery. I’m sure God was tired of listening to my prayers all day along!  Her surgeon had warned me that they would probably be doing the procedure in the afternoon and that we may not hear from him until 6 or 7 pm.  As it turned out, it was actually 7:45 pm when the junior surgeon called and reported that everything went smoothly and Amira did well.  My sense of relief was indescribable!

Amira did well that night reportedly and had even been able to get up and walk with a belly sling!! we visited the next afternoon but knew that we had to set a positive emotional example but I was afraid that I would break down seeing her for the first time after the amputation.  Having read someone else’s brilliant suggestion to ask the techs to put a t shirt on a new Tripawded, I did exactly that and it definitely helped.  She seemed to be in good spirits and in less pain than she was on after the TPLO surgery only 4 days prior.  Our poor baby went through so much in such a short period of time…Doc said that if she did well again that night, she could come home the next day and she did!  She reportedly was up and moving and was eating (which she wouldn’t do after the TPLO) and “acting as if nothing was wrong!”   We sprung her outta there and brought her home yesterday early evening and our road to recovery and rehabilitation began.

within an hour of coming home, I was in a panic and tears again…as I was helping her arrange herself on her new $200 Big Barker bed, I accidentally grazed the stifle area of her remaining rear leg and she let out a scream!  My a baby is not a screamer, in fact before all this started, I’d never heard her cry out!  Of course our greatest fear is that there is something wrong with her “good” leg (i.e. Same thing as the amputated leg…) as she has already been through so much!    I can’t even bear to think about it…..still waiting for the follow up pathology reports which will probably be very telling…we pray that it’s synovial myxomas which rarely metastasis!

It was a very difficult night for all three of us as Amira was visibly in pain starting around 11:00 pm which was 3 hrs after her last dose of Tramadol.  She was non-stop heavy panting and wouldn’t sleep.  We don’t know whether it was due to incision pain, phantom pain or God forbid, her remaining hind leg.  We gave her another does of tramadol at 6 hrs vs 8 her but it took 45 mins to kick in and only seemed to help for about an hour before she stared panting again.  I slept on the floor with her to try to soothe her and I don’t know if it helped or not…

We got up at 7:30 and she went out and peed.  I feed her her breakfast by hand and she ate it all which was a great sign!  She’s been resting much more comfortably today so not sure what helped although I’m just glad she seems to be feeling better.  I’ve been taking her out to do her business using the Ruffwear Webmaster harness and it really helps  although we are trying to limit her even being on that back leg at all for now.   Talked to her surgeon today and he said there’s no way to know what is going on with that leg without examining it but we agreed to do it at her next appointment in 2 weeks for sutures to be removed.  In meantime, he told us to slightly increase her tramadol from 3 to 4 pills every 8 hrs and see if that helps.  We shall see tonight!  Fingers and toes crossed that she will rest easier tonight!

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