What Daisy Loves...Redux

Oh, Skunky Brewster, how I do loathe thee. While sweet Daisy dearly loves to bark at your black-and-white striped self as you strut by on the other side of the fence, all the rest of the unfortunate residents of our house wish you would just go away. Your essence and aroma last for days, inhabiting every last crevice of our poor noses and home...reminding us constantly of your blithe unconcern with the plight of your foes.

Snoopy and I are going to resort to peeing around the entrance of your den, thanks to the advice of our outdoorsy friend Hound Dog. (Both his advice and his name are SO not a joke) Well, maybe we'll just bottle some and pour it instead. Please understand that these words are serving notice of your imminent eviction, though we swear no harm will come to you.

Don't go away mad, just please please PLEASE go away!

What Daisy Loves...

Thanks to our friend Amy, we are here today to discuss some of the things most precious and dear to Daisy the Black Dog's heart.

The first is probably the most important, and that is a good ball wedged between her jaws. She likes to bark while she has it there, and she wishes everyone could experience how it feels. It's like a pony head toss/sneeze/bark combination that vibrates all through your body. It feels great!

Sometimes this works up a thirst, which requires a cold Frosty Paw to cool her pipes. She's especially relieved that they now come in edible cups so Shiva's Mom doesn't have to chase her around the yard anymore screaming "DON'T EAT THAT CUP DAISY...DROP IT...NONONO!!!!!"

She also likes people to admire her broad, flat back and what a good sitter she is, and she also likes folks to see her "scuttle" on her butt for them. This is a combination of sitting, scooting and begging to be petted for being such a good girl.

Her favorite nickname is "Daisy Dirtnose." She got this from Mr. Man thanks to her love of digging up canna lily roots in their garden. The first time she did this, her parents had something called a "heart attack" until they found out they weren't bad for the Black Dog's tummy. She already knew this, but they were just making sure. She'll post again when she thinks of more.

Obsessive Licking, Hot Spots and Cancer: Is There a Connection?

While the Red Dog Blog began as a way to keep friends and family apprised of our dog's progress in her courageous battle with cancer, it has evolved into a small but vibrant community where we can share a mixture of fun and facts with the dog lovers in our lives. Through our experiences with cancer, we have learned much - both about ourselves and the disease itself - and we want to share some of this with those of you who are interested.

(We also plan to implement some of the suggestions shared in response to our recent "Curious" post. Special thanks to both Amy & LiveWorkDream for the awesome feedback!)

Today, we'll talk about what we consider to be a potential "canary in the coal mine" indicator for the disease itself. Although little has been said about obsessive licking and hot spots being possible warning signs that your dog might have cancer, much discussion has centered on the facts that these behaviors can indicate anxiety, discomfort and pain. In our experience, all may have validity.

One potential mitigating factor is that Golden Retrievers can lick obsessively as a breed characteristic; what we are discussing, however, is not so easily explained. That the behavior can be expressed in any breed or mix gives credence to the belief that the behavior is not idiopathic, but rather has causation. In addition, veterinary scientists have documented many instances where underlying conditions were present prior to the behavior. This also suggests causation.

In our cases, all instances involved Shiva (Golden Retriever), Katy (Golden Retriever) or Snoopy (Basset/ACD mix). All have obsessively licked, thereby creating "hot spots" on multiple occasions for both physiological and psychological reasons, although both Retrievers also have obsessively licked surfaces such as furniture fabric and carpet. Ideally, both causes could be identified, although explaining the motivations and psyche of a dog tends to stray into the realm of speculation. In these instances, all we can do is hypothesize the most probable cause or causes of the behavior.

For that reason, as well as our hypothesis that cancer may be one potential underlying cause of the behavior, we will focus on instances having likely physiological causes. Although Shiva initially presented the behavior sporadically at a fairly young age (which we attributed to psychological motives), it was not until a recent instance that a definitive physiological condition could be linked to it.

Prior to receiving her diagnosis of osteosarcoma in 2009 - and prior to any limping behavior - Shiva began obsessively licking the anterior (front) side of her lower rear leg (metatarsus segment). Over the course of a week or two, she developed a classic hot spot. Unsure of her motivation, we sprayed an anti-itch agent on the area to discourage her from continuing.

Given her history with psychological stressors, we knew it could get much worse without intervention. In this case, she refrained for a short while, turned her attention to licking her dog bed and then resumed licking her leg with diminished regard for the distasteful agent. Within another week, she began very subtle, intermittent limping while continuing to obsessively lick her rear leg. This behavior increased in frequency and severity with some rapidity, which triggered a trip to the veterinarian.

The rest of the journey of surgery and recovery can be viewed here. After the removal of her right front leg and its subsequent healing, the licking behavior vanished. Please note that the limb affected by cancer and the one she licked were not the same.

As many of you know, a few weeks ago I discovered a mass between the toes of her remaining front leg. What you don't know, however, is that a couple weeks prior to this discovery she began obsessively licking the same spot on her rear leg as in the previous instance. She also licked the fabric on our couch into a soggy mess on multiple occasions. Since the removal of the new mass (which also proved to be cancer - melanoma this time), the behavior once more stopped. Again, the affected limb and the limb she licked were not the same.

In both instances, the intensity of the licking behavior and subsequent hot spots were indicators of something being amiss elsewhere in her body. For this very important reason, we suggest casting a wide net when searching for possible causes if your dog presents and persists with this behavior. While the cause may be in the limb being licked (cuts, sprains, foreign objects in paw etc.), in our experience it just as likely is not.

In Katy's case, her licking behavior has been less consistent, as well as more focused on fabric surfaces. The one exception is immediately prior to her recent diagnosis of hemangiosarcoma. In hindsight, there was a marked increase of obsessive licking and general unease which likely indicated her internal discomfort. Since the removal of her spleen, very little licking behavior has been evident.

With Snoopy, we were fortunate that neither instance pointed to cancer. The first example of obsessive licking indicated a soft tissue sprain in a rear leg. Unlike Shiva, he focused his attention on the pads of a front foot. After treatment, the behavior stopped. The second episode actually involved the same foot being licked, but the source of discomfort was a different spot than he was licking. Upon closer inspection, we discovered he had split his dewclaw down to the quick and was suffering acute pain from the injury. Sedation and careful trimming by our vet - followed by pain meds - solved that dilemma, as well as his licking behavior.

The bottom line for us is to never forget to take a whole-body approach when investigating persistent symptoms in your dog. Things are not always as they appear.

Our hope here is to foster discussion - and ultimately research - on this subject, so that those of us unfortunate enough to face cancer in our beloved dogs can have every opportunity of successfully fighting it. In most cases, the window for effective intervention is small, so time is of the essence. Perhaps obsessive licking behavior is one more diagnostic advantage we can use to tip the balance in favor of our canine friends.

Please share this entry with dog lovers everywhere, and add your own experiences and opinions to the comments below.

Curious

The Red Dog is curious. She wants to know what special ingredients she needs to add to this blog to gain more comments and more followers. While she adores - and frankly expects - the adulation and attention showered on her by her loyal followers, she wants her experiences and knowledge to be of help to others who have to walk her shoes. Please let her know what your suggestions are, as she is never too old to learn. Thanks, and WOOF!

Hemangiosarcoma (Is NOT Your Friend)

While every bit the wallflower compared to her life-of-the-party friend Shiva, Katy chose not to take a backseat to her in her choice of cancer. The Red Dog's presentation of osteosarcoma all those months ago left us reeling, but nothing prepared us for the "gift" dear, sweet Kate gave to us in December. As I mentioned in a previous post, hemangiosarcoma is the real bad boy member of the canine sarcoma family. My description of the blood-borne beast bears repeating:

"these tumors usually start on the spleen, though they can also originate on the liver, heart and lungs, and they grow quite quickly and like to involve as much of your dog's vascular network as possible. German Shepherd Dogs and Golden Retrievers have the dubious distinction of being the most common victims of this variety, although it can strike any dog at any age."

This stuff is nasty and extremely aggressive. Once diagnosed, choices are limited to immediate surgery (if the tumor's operable) or an all-too short wait for the inevitable end. If it's on the skin (dermal or subcutaneous), that's better. If it's on the spleen, not so good. If it's on the heart, that's bad. In any case, the odds aren't great. The worst aspect of it, however, is the insidious and stealthy nature of its approach.

The first obvious sign dog owners often see of the internal varieties (splenic, heart-based or other) is when their dog collapses from weakness due to blood loss caused by the rupture and subsequent hemorrhage of the mass. Due to their vascular nature, the tumors grow quickly and then burst with devastating results. Many of these dogs die, while a lucky few (like Katy) get better (temporarily) over time. This can provide us a diagnostic window in which the scope and operable/inoperable nature of the cancer can be determined.

The good news (hey, we take it where we find it) is that the surgical removal of a cancerous spleen prior to visible spread to other areas of the body can buy a few to several months of survival...possibly more with chemotherapy.

In the case of heart-based tumors, evidence of cancer elsewhere at the time of discovery is very common. Removal of the mass is also more difficult thanks to its proximity to the heart and its lining. This is a tough diagnosis, but it still may be worth the effort. Surgery and potential chemotherapy should be considered. Take the same approach with tumors found on other organs as well. Listen to your vet, then get a second opinion or have a consult with a surgeon.

As one veterinarian said to us during this trying time: "Why wouldn't you prevent your dog from bleeding to death if you knew you could?"

In hindsight, there were subtle signs that something with Katy was amiss. It began with a gradual reduction in stamina on her walks. We chalked that up to her advancing age (now 12) and arthritic hips, but it was there nonetheless. She also had a harder time standing up, which we also attributed to the aforementioned factors of age and arthritis. Another was an occasional hacking cough, like she was trying to clear something lodged deeply in her throat. In fact, on the night of the tumor's rupture, we were awakened by that cough and actual vomiting.

Finally, she presented obsessive licking behavior. Although not discussed as such by veterinary medical experts, we have seen this occur in multiple dogs with undiagnosed (at that time) cases of cancer. Both Katy and Shiva did just that in the weeks leading up to their diagnoses, and Shiva repeated the behavior with her recent melanoma. We'll give this subject a more in-depth analysis soon.

One other tell-tale sign seen after a rupture is pale or white gum color due to concentration of blood at the hemorrhage site. We were unaware of this symptom, so we did not see it until Dr. Brandi examined her that morning.

After assessing symptoms, veterinarians use a combination of blood work, x-rays and ultrasound screenings to get a better picture of your dog's interior. If the cancer is limited to an operable area, a quick surgical decision should be made. Definitive diagnosis via biopsy is not an option due to the risk of tumor rupture. It must be removed.

After removal, the tumor should be sent for pathology testing. If you're really, REALLY lucky, you'll find out your dog had a benign hemangioma and is cancer-free. Luckily, removing it saved your dog's life, because they rupture just like their malignant cousins. If, on the other hand, it's malignant, be grateful you likely have purchased some more quality time with your dog. Recovery takes 2-4 weeks, after which you should have as much fun as possible while watching for a return of the signs mentioned above.

In summary, don't dismiss the potential symptoms of hemangiosarcoma, especially if your dog presents more than one. It's better to rule-out something like this by spending a little money on diagnostics than to have your dog suddenly die for no apparent reason. We were some of the lucky ones, and we hope what we've shared helps those unlucky enough to face this deadly disease.

Enjoy each extra day for the gift that it is, and never forget that your dogs (most of them, anyway) would do the same for you!

What a Relief/Oh, Happy Day (Reprise)

Yesterday Shiva and Katy visited with a man they have mixed and complicated feelings toward: their surgeon Dr. Mitch. This stems from all the mixed messages they receive at his clinic...a place full of sharp and pointy objects, kind and loving staff and wonderful people who remove your legs and internal organs. They really want to love him, but they're scared to commit. Fortunately for them, this was only a follow-up visit to have Katy's staples removed and Shiva's incision checked. Both, of course, received clean bills of health and now are allowed to return to taking short walks.

This they did this morning, and our house is once again quiet and contented. We expect Shiva to be back to her irrepressible and irascible self soon, and gentle Katy gets to return to a new normal at her own leisurely pace. Thanks for everyone's thoughts, prayers and good wishes, and we'll keep you updated with their progress. Extra special thanks to Dr. Mitch and his entire staff for the awesome and expert care...we've experienced firsthand the love all of you put into your work!

Also, expect to see more posts sharing all that we've learned about canine cancer and post-surgical care, and please feel free to share your stories, comments and questions. Thank you!!

Melanoma, Red Dog Style

Well, the pathology results are in: the tumor removed from Shiva's foot was melanoma. While anything malignant is a drag, this news from Dr. Mitch isn't all bad. For one thing, a skin melanoma such as hers is slow to metastasize and often won't recur in the case of successful removal. Another positive was this particular tumor's low mitotic index. In layperson's terms, this means the cells of the tumor were reproducing (and thus the tumor was growing) quite slowly. If that wasn't good news enough, x-rays of her foot/leg area, chest and abdomen show no signs of either its spread or the return of the bad stuff. For this, we are ever so grateful.

Now, education time! Melanoma generally occurs on the skin (often on the foot) or in and around the mouth. Here are a couple photos of it on Shiva. In the one where she's chewing the bone, it is almost completely obscured by the fur on top of her foot. (It's probably a good idea to click it to enlarge.) In fact, this photo was taken a couple days prior to the tumor's discovery.





The photo with the dime (taken after its discovery and a trim of the obscuring fur) shows both the size and scale of the tumor and its classic dark pigmentation.











While prognoses for melanomas that involve the toes or the mouth are not as good as for those of the skin, most can be treated surgically if caught early. This means making a habit of performing regular checks of your dog's skin and mouth, paying special attention to the areas between the toes, in and around the nail beds and both the lips and the throat.

As the pictures here attest, long haired breeds need special attention because their fur easily can hide those nasty suckers. It's time to get hands-on, people! Click here for expert information and several helpful photos.

Pre- and post-surgical photos of the tumor can be found here, although they are not recommended for the squeamish.

Remember one thing: early detection is critical if you hope to achieve a positive outcome in your dog's fight against canine cancer. Shiva the Red Dog (and now her BFF Katy) is living testament that miracles can and do happen, and statistics are nothing more than numbers waiting to be disproved.

Comments, questions and suggestions are all welcome here, so join in the fun!

Daisy & Snoopy Love Snow!

Lest you think we ignore the other members of our substantial pack due to either the Red Dog's general magnificence or our ubiquitous and ongoing relationship with canine cancer, please behold evidence to the contrary: a video taken this morning of Daisy and Snoopy exulting in their discovery of our backyard buried under a carpet of freshly fallen snow.

Evidence of Recovery in the Midwinter Sun

First off, thanks to everyone for the resounding words of support for us and our pups...we needed it...thank you! Secondly, we wanted to post an update of Shiva and Katy in today's beautiful sunshine (in contrast to last night's freak snowstorm) showing you how well they're doing.

Because of Dr. Mitch's strict instructions to keep Shiva off her foot as much as possible and from his staff to keep the foot clean and dry, we've been challenged to overcome the muck that currently passes for our front yard. We tried really hard to follow the staff's suggestion to put a baggie over her foot, but that makes it impossible for her to walk due to its slick nature, the icy snow-covered ground and her reliance on the foot for balance and traction.

After several hilariously painful attempts at creating and attaching ACE bandage/plastic baggie/double sock/duct tape hybrid boots last night and this morning, we decided to cut the crap and get serious about this stuff. Our solution? A visit to the Ruff Wear section at our local Mast General Store. The result? The purchase of these bad boys:


Although we only needed one, we bought the set of four so she could wear three and keep a spare. Shiva wasn't consulted and was none too sure about having boots on all three of her feet simultaneously, but she was agreeable to wearing one on her all-important front foot. Of course, now she wants to wear it in the house!

Enjoy the sunshine and pawsitive vibes...we sure did. Special big woofs to Ruff Wear...you guys are the greatest!

What We Did on Our Christmas Break

What have we been doing, you may inquire, that could be so important as to keep us from blogging our little butts off during this Holiday season? Well, we thought you'd never ask!

Let's start at the beginning, shall we?

During the night-time hours of December 13th, we were awakened by the sound of our sweet Kate throwing up. After checking on her (she seemed fine) and cleaning up what appeared to be "normal" vomit, we went back to sleep. The next morning, we found she was so week in her rear legs that she was unable to stand. We immediately gave all the other pets a quick pee break and raced her to our vet. Upon examining Katy, Dr. Brandi discovered her gums to be pale and her abdomen to be somewhat swollen. She recommended bloodwork and x-rays, to which we readily agreed. After waiting for what seemed like hours, even thought it was no more than 10 minutes, we were greeted by a grim-faced vet delivering bad and scary news:

"I suspect Katy has hemangiosarcoma, and a tumor has ruptured in her abdomen."

Well, shoot. First we had Shiva the Red Dog introduce us to the world of osteosarcoma, and now Katy was sharing with us an even lovelier member of the sarcoma family. It's like this: these tumors usually start on the spleen, though they can also originate on the liver, heart and lungs, and they grow quite quickly and like to involve as much of your dog's vascular network as possible. German Shepherd Dogs and Golden Retrievers have the dubious distinction of being the most common victims of this variety, although it can strike any dog at any age.

Dr. Brandi also performed an ultrasound due to the free blood in Katy's abdomen occluding the x-rays. The two views showed an ugly, if murky, picture. From the looks of it, she had a softball sized mass on her spleen as well as possible liver involvement. Because of this apparent metastasizing of the cancer, she was a poor candidate for surgery. She was also 12 and had a grade 3 heart murmur. This was bad. We did learn, however, that dogs have the ability to auto-transfuse their blood, and if her tumor stopped bleeding, this neat trick could prolong her survival. In fact, some dogs have been known to survive this situation several times before succumbing to the cancer. And really, what choice did we have?

Dr. Brandi encouraged us to get a second opinion, as the only way to confirm a diagnosis of hemangiosarcoma was through biopsy or removal, and she told us to keep Katy quiet and still in the meantime. To complicate matters further, she informed us that it was possible the tumors were benign hemangiomas that also would cause her to bleed to death but could be cured by removal. We began Healing Touch treatments on her as soon as my mom arrived in town, and we put her on Shiva's anticancer regimen of K-9 Immunity and Artemisinin. While unsure if this protocol would work for her, we were assured by several veterinarians familiar with it that it wouldn't hurt. We also added fish oil and prayer...lots and lots of prayer. Add in Christmas preparations along with a full roster of pet sitting, and you can imagine the fun in our house! Here's a pic of my mom working her voodoo Healing Touch magic on our girl (the shaved belly is from the ultrasound):

After encouragement from Dr. Pam (uber vet from California we met on tripawds.com) and our dear friend and shelter medicine/spay-neuter goddess Dr. Becky, we decided to schedule a consult with Shiva's surgeon Dr. Mitch for right after Christmas. If Katy was still with us, just maybe something could be done.

The following week, Daisy - Katy's daughter - began limping much in the way Shiva did almost two years ago...and on the same leg. We now had a potential disaster on our hands, as our immediate fear was osteosarcoma and amputation. To say that the ride to our vet's office was tense would be doing a disservice to the word. We were freaking out! Dr. Brandi performed a very thorough exam, and shot x-rays of the offending appendage. Fortunately for us, they came back clear, and she received a diagnosis of soft tissue damage (a sprain). She was placed on house arrest, and we're glad to say she seems to be doing better.

A few days later we piled Katy once more into the Element and headed west to see Dr. Mitch. We crossed our fingers that the improvement in attitude and appetite Katy showed over the previous week indicated stabilization of her condition. Dr. Mitch shot x-rays, and Dr. Brian provided his usual brilliant ultrasound work. The results were dramatically different from those of just a little more than a week prior. All the free blood was gone, and the only tumor evident was on her spleen. Just to give you some perspective on the size of this sucker, take a look at her x-ray (I circled the tumor):


Dr. Mitch informed us that since her tumor appeared to be localized to her spleen, we had a window of opportunity for removal. Although Katy presented higher risks due to her age and the presence of a heart murmur, he felt good about her chances. After some deliberation and prayer on the part of Shiva's Mom and myself, we decided to set surgery for the following Monday...three weeks to the day from discovery of her condition. Dr. Mitch also told us that Dr. Robert Paddleford, the man who literally wrote the book on small animal anesthesia, was going to be in the clinic that Monday consulting with him on another case, and would we like to see if he was willing to run anesthesia for Katy? Having heard this man spoken of in reverential tones by many vets over the years, I was ecstatic at the possibility, and I asked him to make it happen!

Then Christmas, ah Christmas. When everyone loses their minds, when your pet sitting schedule explodes, when your mother takes over your entire kitchen - including the oven - with a massive turkey, and you and your wife (Shiva's Mom) have to go to a neighbor's house to cook all the side dishes in their oven, and when poor Shiva's Mom is felled by the nastiest of intestinal viruses on Christmas night. Yeah, Christmas. Enough said.

Katy lived through it (and so did we), and on the morning of the 27th we took her to the clinic for possible surgery. If x-rays of her heart and lungs showed no signs of cancer, Katy was going to be under the care of an all-star team of veterinary professionals. If anyone could pull her through, it would be them.

Once the x-rays showed "all clear," things got moving. Dr. Mitch happily allowed my mom to perform pre- and post-operative Healing Touch treatments on Katy, and he remarked that it sure seemed to work with Shiva when Brenda Rasch treated her all those months ago. He called her a "record-breaking, fast-healing osteo surviving Golden," and that's enough for us. Dr. Paddleford proved to be sincere, sympathetic and kind, and his expertise - and hugs - were greatly appreciated. A little less than 90 minutes later, it was over. Look at what they found (sorry of you're squeamish):

















The one on the left is the alien beast emerging from our sweet girl's abdomen, and the one on the right is after it's been "killed" and placed on a tray. The flat parts are spleen, the big dude is tumor. The little bumps are tumor nodules spreading into other parts of the spleen. Isn't science fun?

One thing we're good at in our house is managing post-op recovery...we've elevated it to an art form. Since we needed to keep Katy still and quiet for two weeks, that's good. Her first 36 hours were spent in the clinic, and then it was time to come home. Here are her first pictures after returning home. The omnipresent red camera hog makes her appearance, as you knew she would. We hope you like her snazzy t-shirt and "I can't chew on my stitches" collar:


































So, where were we? Oh yes...Katy's recovery. It's going well, but an interesting thing happened along the way since her surgery. Last Friday, I found this between the toes of Shiva's remaining front foot:


What could it possibly be? Why, another tumor of course! So...back to Dr. Brandi's clinic we went, where Sarah aspirated it (Dr. Brandi was gone at the time) and we discovered the meaning of the term "vascular." We then took the results to Dr. Becky, who spent considerable time over her New Year's weekend researching different types of interdigital masses. Because of the blood in the slide, diagnosis wasn't possible. The two things she told us were: 1. it might be benign, but 2. it needs to come off asap. On Monday we took the slide and the Red Dog to Dr. Brandi, who concurred with Dr. Becky. On Tuesday (today), we took her to - you guessed it - Dr. Mitch for a consult and possible removal. He agreed with our other vets, took x-rays of her foot and chest to make sure nothing had spread and recommended removal within the next week or two.

Due to our recent experience, we decided not to wait, and Dr. Mitch agreed that the mass could be removed immediately. Thanks to Shiva's stupendous disposition, he even was willing to lightly sedate her and remove it using local anesthetic only, rather than subject her to the rigors and risks of general anesthesia. Here is what it looked like before removal:


Twenty minutes later, take a look at the result of the efforts of Dr. Mitch and his AWESOME staff (another squeamish alert...sorry):


Less than half-an-hour after that, the Red Dog walked out of the clinic under her own power...with a little help from her Ruff Wear harness (yay!). Right now she's asleep at my feet. In a few days, we'll know what it was. Until then, thank you to all the vets, to all our family and friends who care about these ridiculous dogs of ours and to my mom for her tireless work during her "vacation." And finally, a special thank you to Jesus for inspiring us to pray. The Miracle Maker, indeed.