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Need help interpreting biopsy possible sarcoma

LilF

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JJ, my 14 y/o Shar Pei mix had a biopsy because I notice a mass in his thoracic region earlier in the week. Seemed to come on rather quickly. Surgery may not be the best option in my opinion because he has protein in his urine, has increased his urination (peed the bed again last night through the male wrap and pad). But would like an opinion about putting this biopsy in "english" as to what it is. It sounds like they don't know what it is and could be a hemangiosarcoma? Again, new territory for me to understand. I do know what a hemangiosarcoma is but seems the biopsy is not definitive on much. I am heartsick as to what to do for him. What can I do for incontinence? I thought CBD oil helps with such things like masses but I did not have great experience with Ellevet. It tasted terrible and didn't see benefit...almost seemed to make him more spacey. Has anyone an opinion of Charlottes Web or Medterra that I heard about from friends. Or one that has a track record with malignancies? JJ was getting laser, I think that should be discontinued since I thought not to do laser in dog with a mass. As an aside, with old dogs I was cautious about laser because, as in this case, you never know if a cancer is brewing. When I told the holistic vet she rolled her eyes at me. But think I was right to not have done it. I also feel that now a biopsy could have leaked out cancer cells and seeded in the body. I wasn't thinking and maybe should have done an ultrasound instead. I know I am jumping all around but that is where my head is at!! Thanks
 
Dear Lil,
As always, the best treatment is building up JJ's own natural resistance to cancer.
Do you have a copy of the biopsy that you could post?
Do you have blood (CBC, Chemistry) and urinalysis results?
Has JJ had a rectal recently to evaluate his prostate?
We need to know the actual situation to advise you on interpreting the results.
It is possible, but not likely, for cancer cells to be shed from a skin mass into the body. Usually an extremely fine needle is used, and care is taken to avoid blood vessels.
Cannabinoid oil has indeed been helpful with some malignancies / cancers. There are many companies, and it is important to get a full spectrum extract which is third party verified for quality and content. Some products taste better, too.
Dr. Chapman
 
@Dr. Sara Hi Dr. Sara. I attached JJ's biopsy, April bloodwork, Urinalysis (he had protein in his urine). I am updating the urine sample today. I asked the conventional vet to do a culture and sensitivity test since his urine has a distinct smell and he wet his bed again last night. Taking that in right now. Next week will see holistic vet and ask for a Vitamin D test to make sure that is optimal. Today I gave him some Standard Process Renal Support, doubled up his mushrooms, curcumin and he did accept it. I put it in my hand as the supps usually get kicked around in the bowl. His SDMA was a 10 in April. When I brought JJ in for the biopsy I saw the vet poke around the back end so will ask what he did when I drop off the urine sample now. I did ask the vet on the phone if it could be his prostate and he said no, so maybe that means he checked it. Will verify. Thanks for the reply ... sure helps to have support and information to make decisions. Thank You!
 
The cytology shows the type of changes that are usually seen in cancerous cells - differences in size, and some cells with two nuclei. This makes the pathologist suspect a sarcoma, and the conventional treatment is removal. Since these types of tumors are highly variable in their behaviour, they don't know if it is likely to spread or not.

JJ's kidney waste products and SDMA are normal, so it is less likely that the protein in the urine is due to kidney glomerulus damage. However, it doesn't tell us where the protein originates.
There are no blood cells or bacteria present, which points away from a bladder inflammation. That is why I would be interested to be sure that the prostate is normal: neutered males have a higher level of prostate cancer than intact males, intact males have more benign prostatic enlargement.
There are also some tumors that can cause increased protein in the urine.
JJ's elevated reticulocytes is a bit odd. These are young red blood cells, and when they increase it normally is in response to blood loss.
Sometimes protein can appear in the urine for no apparent reason, so I am glad you are having it checked again. A house trained 14 year old male dog will not start urinating in the house without a reason. Older spayed females may develop weakness of the urinary muscles, but that is rare in males.
Let us know what you discover.
Dr. Sara
 
Thanks for posting Lil, and I'm so sorry to hear about JJ's continued health journey. :(

Dr. Sara, thanks for your super amazing analysis of his results!

Great news Lil that his kidney tests are normal. As Dr. Sara said, the elevated reticulocytes are usually a response by the body to low blood count (like from blood loss) but his blood count is great.

It's possible that both the elevated reticulocytes and platelets indicate a non-specific inflammation. However, this is often a good sign, as it is a clue that JJ's body is doing its job (inflammation is how the body heals).

Yes, as Dr. Sara also mentions, your absolutes best action is to optimize JJ's natural healing ability.

One great way to do this is by using the Happiness Protocol. Especially Therapeutic Sniff Walks, snuffle mat, petting, playing, etc.

What does JJ love to do above all?

How's his BEAM (on a 1 to 10 scale with 10 being perfect)?
 
@Dr. Sara @Dr. Jeff You all have no idea how grateful I am for these explanations. Information helps me greatly to stay calm and maybe look deeper into some of the things you bring out. So I am thinking ahead on JJ's mass, possible sarcoma. To answer about his BEAM, lately he has been eating all his food enthusiastically and taking supplements. He is not walking much when I take him to the park and mostly stands, sniffs a little and wants to go back in the car. That's ok, he does seem to enjoy it but now it will be hot and this will impact him. He likes sleeping in the car (and the heat will now preclude this too) and being pet. He also enjoys being in the fence when it is not too hot. Last night, he was adorable , at dusk he was lying in the grass and even rolled over for me to pet him. He did not want to come in (I insisted because of coyotes) but he was getting some grounding just laying on the grass. He enjoys being out there after dinner and doesn't want to come in. So that is what he likes. On one phone consult Dr. Jeff mentioned to sit in the car with him and pet him. I DID and boy did he like that !!!! Great suggestion.
But my question is more sobering about diagnostics. JJ is old and very nervous. He moves slowly and the holistic vet even said when I had planned to do some rehab for his back and I would not be allowed to go into the place with him, (curbside service) she would not suggest it because he relies on me and is nervous. So if the differential with his mass is xrays and abdominal ultrasound to see if anything spread. I don't know if I should do it. They would have to give anesthesia for xrays. And then if those are clear, the mass could be removed. That all seems like a ton of bodily and mental stress. The conventional vet was not sure surgery would be advised as things could go wrong. But that is the differential and I would like thoughts on the diagnostics which would lead to whether surgery would be indicated. My last editiorial thought is I repeatedly told the holistic vet I did not like laser done on an old dog because we don't know if an old dog might have an undiagnosed cancer. People often think I am a worry wart but I feel this is another case where I should have followed my instincts. Thanks for your thoughts and opinions especially on the diagnostics moving forward. I am considering everything.
 
Dear Lil,
It is always hard to decide on the best choice for our Super Seniors, especially when they are feeling well and do not appear to be overly troubled by their lab work. I imagine his lack of control over his urine bothers him somewhat, though it seems like you are managing that quite well.

As I understand you, your concern is that the manipulations to JJ without his support system (you) would be quite traumatic. We want to treat JJ holistically to address his body, mind, and emotions. I will sometimes suggest a traumatic intervention when the potential benefit to the patient is great. I am not sure that we know if the benefit to JJ outweighs the traumatic experience.

I would want to know if JJ has an enlarged prostate. In neutered dogs that has a poor conventional prognosis, and would be another reason not to put him through the stress of definitively diagnosing and removing a skin mass.

I would try my best to address JJ's needs by supporting him overall. A dog's own immune system can bring a cancer under control, with skilled support from holistic prescribing. Many, many of my elderly patients with chronic disease improve dramatically when their people make little changes to help them be happier. You are already doing this with sniff walks, and finding things he likes to do. If JJ does not mind being wet down, another summer comfort measure can be wetting down his hairless tummy to help him feel cool outside - some dogs like their people to spritz them down with a spray bottle.

The potential risks of laser treatment are unclear; I use acupuncture myself, not laser. Like acupuncture, laser increases circulation, which is why neither procedure is done directly on a cancerous mass, as increasing circulation to a cancer could stimulate it to grow faster. Acupuncturists will still administer acupuncture distant from the cancerous tumor, and I have done this on many dogs to their benefit.

You are JJ's ombudsman, and you are doing well to consider all your options in light of what is best for the dear old fellow!
Keep us posted,
Dr. Sara
 
LiI, I think at this point I would be very aware of what constitutes "good days" for him, and maximize those times and moments, such as the car petting when doable. They honestly don't count the days; only silly humans do that. As much as possible, fill his days with good stuff; not only will you be making him happy, but also raising his BEAM with positive energy which could significantly improve his overall health, even without invasive treatments. At this point with him, there are not likely to be discrete problems which can be removed without inducing more general weakness. I'd keep him going, and as happily as you both can manage. Been there, done that - quality of life is everything, and they thank us for it.
 
@GinnyW Yes, Yes and Yes...... You say what I am feeling in my gut, inducing more general weakness or decline..... THANK YOU for saying this so succinctly .....I digress.... Now, my Gabby who has Protein Losing Enteropathy, is like a pup compared to him, yet the holistic vet said that it would be a long recovery if I opted to get a definitive diagnosis on her (gold standard) with an intestinal biopsy...and the risk for bleeding....now that was for a 14 year old that is still running around and seems more like 9.... I got as much info on her noninvasively and eliminated all the other causes....and feel very comfy with her knowing her diagnosis without the gold standard proof and treating her with diet and quality of life.---It is working for her........Back to JJ... he is a typical old man, moves slow, some cognitive issues, has protein in his urine and a few times over the last 6 weeks incontinent at night with spondylosis....So it seems like a slam dunk if an intestinal biopsy was ill advised for my pup like Gabby then xrays, ultrasound and surgery would be a deal breaker for my seemingly older than 14 guy. People tell me he seems older... BTW........Plus I think he would be so freaked out with the testing without me around . Even though his bloodwork was very very good.... I still think he has potential issues....with a surgery.... The conventional vet stated that as well. It seems like a long haul. He is eating great and taking supplements. With any old dog, do not want to interrupt the quality of life to trade for who knows how much longer for a dog already 14. Chasing a diagnosis is worthless if doing so precipitates the need for more diagnoses!!... Over the years after a number of dogs.... I have come to being ok to manage whatever is going on without having to put a name to whatever it is, watch and tweak the plan (and my mindset) as needed.... Basically, he just wants to be loved and feel close....that is all he EVER wanted (and to know he will be fed, rescued from a hoarding situation) Thanks for taking the time to give me food for thought!
 
I just wanted to post an update on JJ's sarcoma about a 2.5 cm.... I have been massaging coconut oil infused with frankensense oil twice a day now for several weeks. Have also ramped up his mushrooms, curcumin and oral boswellia. I feel the sarcoma is going away, very small now from what I can feel hope I am correct... can it be so? The sarcoma was exactly where the assisi loop generator/battery lies when I put the loop over his head to treat his neck. The sarcoma appeared suddenly within weeks after receiving a new loop. The new loop seemed sloppily put together and the loop not completely round. I should have followed my gut and not used it. I did measure the magnetic radiation I measured from the generator/battery and it was off the charts. It is my opinion that this caused his sarcoma. This was our 3rd loop in the past few years. I do not know what the normal radiation level is for the generator but it could not be "healing". So we are not using the loop anymore ever, not ever. I never saw any caution about putting the battery on the dog during treatment.
 
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