For those of you who are crazy lucky enough to share your life with a German Shorthaired Pointer, I’m sure you are quite familiar with the “oh sh*t” feeling when a veterinarian tells you that you have to somehow do the impossible….restrict your GSP’s activity. Even at 10 years old Lager does NOT act his age. He’s still got that insane-in-the-membrane-never-ending-crazy-high GSP energy. Along with praying that somehow we are miraculously teleported to the “all clear from restrictions” date our veterinarian gives us, my usual go-to for a restricted activity period is stuffed West Paw brand Topl or Qwizl, lickimats, puzzle toys, and snuffle mats. In Lager’s case, however, we could not do any of that due to his simultaneous recovery from his rostral mandibulectomy. Lager’s jaw and chest surgery were on October 31st. He was due to get his chest sutures out on November 11th. However, when his body bandage was removed, there were signs of an infection. Restricted activity and suture removal date was then extended to November 17th while Lager completed a round of antibiotics. Once the bandage was off, Lager began to try and lick the area, so he continued to wear a Suitical Recovery Suit until his chest could be reevaluated. At his appointment on November 17th, the surgical team at Blue Pearl decided that the chest sutures could be removed, Lager’s jaw was healed enough that we could remove the E-collar, AND Lager could have all restrictions lifted …giving some MAJOR thanks for this!
Once home, even with the sutures having been removed, Lager began to lick the area, making the healing incisions redden. We still have him wearing the Suitical Recovery Suit until this area is fully healed in order to try to avoid an infection, giving him a break from wearing it only when we can watch him closely.
Lager does not need to have a follow-up appointment with Dr. Jennings (Dentistry Team) or the Surgical Team in the future unless a problem arises. However, there was a nodule observed on his adrenal gland during his abdominal ultrasound. It was suggested that we may consider reevaluating the suspected growth in 3-4 months, so I will be discussing this with Lager’s medical team to determine if they believe that repeating the ultrasound would be appropriate for him.
“We often take for granted the very things that most deserve our gratitude.”
~ Cynthia Ozick
Eight dogs, sixteen feedings per day, and each meal was prepared and presented to our dogs without realizing I should be grateful for the whole process….not only for being blessed with the food itself, but for the fact that all of our dogs could eat on their own. I never thought about how I should be grateful for that…it’s just something dogs do, right?! I took for granted that I put food in front of our dogs, and voilà…They ate it…UNTIL…Brian and I were hand-feeding Lager after his surgery. It was then that I realized I needed to take a step back and direct more focus on being grateful for the daily routines that are in fact blessings as well.
Lager had been doing wonderfully with being hand-fed “meatballs,” (made from a mixture of his regular kibble ground to a fine powder using a food processor wet food, pure pumpkin purée, and grizzly salmon oil) however, he was having a difficult time learning how to pick up food without us having to place it in his mouth. We tried meatballs in a bowl, meatballs on a flat dish, dry kibble that had been put through the food processor, soaked kibble, regular kibble…you name it, Lager had not been able to pick up any of the food. However, Lager’s never give up attitude paid off…It is with an extremely grateful heart that I share the progress Lager had during breakfast on November 20th: Lager was able to pick up meatballs and eat it all by himself! The meatball still needs to placed on a flat dish at an elevated angle, but picking up the meatball on his own is a huge accomplishment! We are so proud of Lager and his motivation to improvise, adapt, and overcome!
Lager has also been doing a phenomenal job picking up soft stuffed toys! He has been enjoying all the toys that he received as gifts!
No One Fights Alone
I added some oral cancer awareness bling to Lager’s collar this week! Canine Acanthomatous Ameloblastoma (CAA) luckily is not known to metastasize if clean margins are achieved during surgery (which was the case for Lager). Even though we are celebrating what we hope and pray is the end of Lager’s CAA Journey, he will still have some challenges to face as he continues to adapt to doing daily activities differently with his mouth. We want to be sure to continue to bring awareness to this type of canine cancer, and do our best to support other families that one day may find themselves on this same journey with their pup.
We have many reasons this year to give thanks with a grateful heart. This week, in addition to the more obvious “bigger things,” I will be focussed on recognizing and mindfully appreciating the smaller blessings in our daily life as well.
May this Thanksgiving be filled with peace, love and happiness for you and your family.
Now that the pathology report from both the chest masses as well as the jaw sample has returned, we have a new diagnosis, but still much to be thankful for!
pathology result: follicular cysts
Follicular cysts are large bumps, or nodules, on a dog’s skin that originate in the hair follicle. The hair follicle becomes dilated and fills with a dark brown substance that looks similar to a blackhead. These cysts are prone to becoming infected. Lager’s follicular cysts should not grow back now that they have been removed.
The mass originally deemed Oral Papillary Squamous Cell Carcinoma was reevaluated as Canine Acanthomatous Ameloblastoma (CAA)
The tumor diagnosis can sometimes change as a better sample is acquired during the removal of the “heart” of the mass. This type of tumor has “layers” and the superficial part of the mass is made up of similar squamous-type cells which often produces an inaccurate diagnosis. During Lager’s first surgery, only the superficial part of the mass could be removed and sampled.
About Canine Acanthomatous Ameloblastoma (CAA)
Acanthomatous Ameloblastoma is a locally aggressive tumor that originates from the epithelial cells of the dog’s jaw. Acanthomatous Ameloblastoma forms a large red mass on the gums. Beneath the visible portion of the mass, there is usually considerable bone destruction. These tumors have not been documented to spread to other areas of the body. As Lager’s tumor was removed with clean margins, it is not expected that there should be any recurrence. Without treatment, this type of tumor will continue to grow and destroy the jaw bone, becoming life-threatening for the dog.
Dr. Jennings said that Lager looks great! Dr. Jennings is pleased with the surgery site and healing process. Any remaining oral sutures will fall out and/or dissolve on their own over the coming few weeks. During today’s appointment Dr. Jennings answered all of my questions in detail. The following was covered in today’s appointment:
We have observed some teeth chattering. Dr. Jennings said this should subside as the mouth continues to heal
Lager may begin return to a normal diet. Over the next week, we will work on transitioning from wet food meatballs to soaked kibble to regular kibble as we monitor Lager’s progress in re-learning how to eat on his own.
We can begin brushing Lager’s teeth immediately. Dr. Jennings also recommended that we continue to use products to help reduce plaque and tartar. We currently use a water additive called Vetradent, which is included in products that have earned the VOHC Accepted Seal , so we will continue to use this.
Lager is cleared to compete in dock diving once we start up again in the Spring, and is cleared to train and condition throughout the fall and winter once his jaw and chest is completely healed!
As long as no issues arise, Lager does not need to have further follow-up visits with Dr. Jennings. Dr. Jennings recommends that we have Dr. Campbell monitor Lager’s oral health at his regular check-ups. If we happen to notice any bad breath or dental buildup/inflammation of the gums, Dr. Jennings instructed me to have Lager evaluated by Dr. Campbell or himself.
Lager can begin to have soft toys within the next week. We experimented today during the appointment with an Extreme Vertical/Speed Retrieve bumper. Upon sight of the bumper, Lager grabbed it up! After dropping the bumper on the floor, in less than 30 seconds Lager had learned to pick it up on his own! He is truly amazing and an inspiration! There was some minimal dilute blood on the bumper which Dr. Jennings said was normal at this point. In about 5-7 days when Lager is closer to being completely healed, we will try giving him some soft stuffie toys.
Dr. Michael Jennings and his nurse, Ashley McCullough, provided outstanding care and surgical excellence for Lager. Confidence in a medical team and their abilities was imperative to us. Beyond the medical aspect, Dr. Jennings and Ashley displayed such care and compassion not only for Lager, but also for me as I broke down in tears (at every single appointment)! They not only patiently answered my notebook full (literally) of questions, but also took the time to explain everything in detail. I will never forget the personal touch and willingness they spent making sure I felt comfortable with all of the information being presented to me, and comforting me during a terrifying time to ensure me that Lager was going to pull through this procedure just fine. Dr. Jennings and Ashley’s love and passion for animals is remarkable, and shines bright for all to see. We are blessed to have been lucky enough for Lager to have this the dedicated, thoughtful, and compassionate surgical team.
Chest Suture Removal
November 11, 2022
The Surgical staff at Blue Pearl was also wonderful! Their attention to detail on Lager’s chest surgery and kindness towards me was beyond appreciated. Today Michael Pawenski evaluated Lager’s chest incisions. After removal of Lager’s cross-your-heart bandage, Dr. Pawenski noted that the incision is healing well, but there are two small areas of dehiscence and a small amount of discharge that may be due to an early surgical site infection. As a result, the sutures cannot be removed, and Lager will be required to take antibiotics. This also means that his activity restrictions will still need to be in place. The bandage was not reapplied but Lager will have to wear a tee-shirt or Suitical Recovery Suit to prevent rubbing or scratching of the incision. Lager will return to Blue Pearl on Thursday November 17th for an exam with the Surgical Team, and and hopefully suture removal.
We Don’t Know Them All, But We Owe Them All
Lager’s check-up fell on Veterans Day 2022. Blue Pearl Hospital is located on Veterans Highway with a Veterans Memorial 0.2 mile down the road from the hospital parking lot exit. with Lager being a Veteran himself, I knew we had to stop at the memorial. It was raining pretty steadily, but we stopped anyway, and I’m so glad we did. Lager got a break from his cone and was able to take a small, slow walk around the beautiful memorial.
With respect, honor, and gratitude, Cello’s Corner would like to thank all who have served and continue to serve our country. Your bravery and the sacrifices you have made to protect our freedom will never be forgotten. Thank you to all veterans – you are our heroes!
Things That Make You Go MMM…
…A vanilla McDonalds milkshake! Lager had a few licks of the milkshake as a treat on his way home.
Keep on Keepin’ On
Over the next week, we will continue Lager’s restricted routine while working on transitioning his diet back to his regular kibble. I will post another update after Lager’s appointment on November 17th. Thank you ALL for your continued prayers, positive thoughts and good vibes for Lager and for your support for Lager’s PAWrents!
Lager was first anesthetized for an oral exam and dental X-rays. These radiographs confirmed the mass centered on his left lower canine tooth had invaded the underlying bone along the back of canine tooth root. Dr. Jennings called us at that point to inform us of the degree of bone invasion. He recommended removal of the front of Lager’s lower jaw at the level of the left 3rd premolar and right lower 2nd premolar in order to hopefully obtain clean margins of normal tissue along with the oral tumor. Dr. Jennings informed us that this also means Lager’s mandibular symphysis (where jaw meets in “V”) will no longer be connected. We agreed to the new plan in hopes to get clean margins for Lager.
Lager received both systemic pain medication and local nerve blocks to help control any discomfort associated with his procedure. His rostral mandibulectomy was performed, and the sample was submitted for histopathology to confirm the tumor type and clean margins. Dr. Jennings explained that it’s rare, but in some cases he has seen the cancer evolve into a different type/stage, so the biopsy will confirm the tumor type and also will dictate if Lager would need further treatment after he heals from his surgery. Dr. Jennings noted that the biopsy results may take a couple of weeks to come back. Lager’s remaining teeth were also scaled and polished.
Lager also had two dermal sternal masses removed. Those of you who know Lager well and have enjoyed his enthusiasm up close/ in person know that he has had a problem spot on his chest since we adopted him that had to be expressed on a weekly basis. Although it was not easy to manage at times, the problem spot was deemed not to be concerning. However, recently the area had gotten bigger and changed in appearance so it was decided that it would be best to have this removed and biopsied while Lager was undergoing his oral surgery. The two masses on his chest were also removed and submitted for histopathology to confirm the tissue type. The surgery sites were closed with absorbable sutures and he was wrapped in a cross-your-heart chest bandage. The biopsy results for this sample should return in about a week.
Dr. Jennings called after surgery was completed and told us that Lager did well during the surgeries and had recovered smoothly. Lager had to be hospitalized overnight so that pain, anti-inflammatory and antibiotic medications could be monitored and managed. Although we knew it was best for Lager to stay the night, we missed him dearly and called every couple of hours to check on him. The staff assured us that Lager was recovering well and in good spirits.
November 1, 2022
We called to check on Lager first thing in the morning and the staff said that he did well overnight. He ate from someone’s hand and was able to lap-up water. Dr. Jennings called around 12pm and thoroughly reviewed Lager’s recovery plan and confirmed that Lager was doing well enough to come home. The drive to Blue Pearl is about an hour, so my parents drove me to the hospital to pick up Lager so that Brian could monitor Porter and Jägermeister while working from home.
Much anxiety had built up with preparing to see Lager post-surgery. Upon arrival to Blue Pearl, my mother and I were escorted to an exam room to wait for Lager to be brought out. Although I was extremely upset at first sight, Dr. Jennings entered the room with Lager happily prancing by his side. Lager’s eyes were bright and alert, his tail was wagging, and he gave me a heartfelt greeting. My heart and mind were so relieved – but this didn’t stop the tears from flowing – what an absolutely amazingly resilient soldier this warrior is! He was in such great spirits!
Dr. Jennings was amazing… I mean REALLY AMAZING…he was so patient, compassionate, and kind. He took the time to explain everything and also to offer support and reassurance that everything was going to be alright and he could already tell that Lager was going to be back to doing everything he loves to do in no time at all.
Believe it or not, it was difficult for me to even get non-blurry pictures on the way home because Lager did not sit down the entire time! He barked the whole way home and actively looked out the window for the duration of the ride. Pictures below to show Lager’s new lower jaw length:
Although alarming in appearance, the large pinkish-red “bubble” you see under Lager’s tongue in the photos below is normal after a surgery like this and should go away on its own in 5-7 days:
Photos below are the best shots I have so far of Lager’s new “chin.”
“Dogs Are a Miracle With Paws” ~ Susan Ariel Rainbow Kennedy
I always say that as humans we have so much to learn from dogs. I am in awe at Lager’s resilience and ability to adapt. As you can see from the photos above, Lager’s tongue was hanging out of his mouth during our car ride home. Dr. Jennings informed us that Lager’s tongue will most likely be hanging out of his mouth for quite some time and that Lager may…or may not… adapt to holding his tongue differently so that it stays inside. Well, by the time our one hour drive home ended, Lager had already learned how to hold his tongue inside of his mouth! When we arrived home, he was able to drink water and was extremely motivated for food.
Lager has not even skipped a beat. He’s happy, alert, and prancing around the house – handsome as ever! Dogs truly are amazing, aren’t they? They don’t look in the mirror or focus on their appearance, and they don’t care what others think either. Dogs remind us to focus on the important parts of others – HEART and SOUL… not physical characteristics or imperfections. They teach us that you shine from WITHIN and that imperfection can impact the world in a positive way….to use your difference to make a difference. Dogs adapt, overcome, and continue to enjoy their journey despite the obstacles that may develop in their path. They don’t worry about challenges – they conquer them. Lager is living proof of this. In my eyes, Lager is an inspiration. I am grateful for the lessons he has taught me, and for the experience he has shared with me. His journey will equip me with the ability to pay it forward when someone else is faced with seeing their dog through the same operation.
Lager has to be hand fed soft food until he heals completely and adapts to eating / drinking with his shorter lower jaw. On November 1st, his first night home, I used a blender to make his kibble into a powder and mixed in some wet food and water to make it “meatball” consistency. I made little meatballs and although I was proud of how well the prep went, I’m not going to lie … our first attempt at properly delivering the “meatballs” to Lager’s mouth was quite a messy situation! The morning of November 2nd, I did a better job of creating the meatballs, and Brian figured out that it was easier to “deliver” the meatballs to Lager while standing behind him and using gravity to help Lager get the meatball in his mouth.
We very much appreciate the continued support, prayers, and positivity sent to our family! The overwhelming outpour of post comments, private messages, and kind gestures have filled our hearts with hope, love and courage during a very emotional time. We appreciate ALL of you beyond what words can express.
Below is a picture of the beautiful Belle…Her wonderful Mama posted this adorable photo in support of our boy:
The pack’s amazing Aunt Jackie sent a care package that arrived on Halloween day… some really cool Halloween dog toys, and an awesome mug displaying Lord Byron’s quote, “The poor dog, in life the firmest friend, the first to welcome, foremost to defend” and featuring her dog, Freya (who we refer to as Whiskey’s sista-from-anotha-mista)! I certainly will need extra caffeine and will get good use of this mug… and once things settle, the dogs will enjoy these toys !
A good friend who I met while her pug, Axl and our girl, Margarita, were battling cancer simultaneously, sent Lager some pre-surgery treats and a Comfy Cone for his recovery!
Lager will have his chest site and bandage changed on Saturday November 5th as long as the bandage holds up. If we see anything seeping through the bandage, or if the bandage is failing, we will have to bring him in sooner. He will then see Dr. Jennings on November 11th for a re-check of his jaw.
Lager is an extraordinary pup with an astonishing background. (It’s sometimes hard to believe that our boy was assigned to keep the U.S. Embassy in Baghdad safe)! His bravery and resilience is inspiring. By the time he was 3 years old, he had already traveled to more countries and states than most people visit in a lifetime. Despite his disciplined working career before we met him, Lager quickly adjusted to civilian life and showered us with much love and affection. Beyond his serious working mode, Lager also has an extremely goofy and jubilant side. His pure, genuine passion for life is contagious. He gets excited about anything and everything. The smallest of things makes him literally jump for joy…so much so that I often joke that he is the real-life Tigger. He has taught us to be happy and thankful for everything – big and small – and to remain positive and joyful through whatever life throws our way. His love of life fuels him to do everything with 250% effort and enthusiasm. He’s “got heart” like no other…and I know in my heart that Lager will face this new challenge and overcome any obstacle that may attempt to stand in his way of continuing to enjoy life to the utmost degree. If heroes are measured by the strength of their heart, Lager is definitely a Superhero in my eyes.
10/10/22: Lymph Node Cytology and Radiograph Results
Lager’s oncologist, Dr. Olivier Campbell, called the morning of October 10th with a positive report! The cytology results of Lager’s mandibular nodes showed that the lymph nodes were reactive and no tumor cells were observed, which is great news! In addition, the radiologist’s final interpretation of Lager’s radiographs showed nothing significant! The next step is to meet with the dentistry specialist to plan surgery. Dr. Olivier Campbell asked how Lager was doing. I laughed and said, “He’s just as crazy as ever. You would never for one second know that he has cancer, and he reminds me everyday that mindset is everything.”
Thank you to everyone who shared with me that they signed up for the Chase Away K9 Cancer 5K to walk for Lager. We did this 5k in two parts and I was lucky enough to be able to meet up in person with some friends and their pups to complete this 5K!
Chase Away 5K: Part 1
On October 10, 2022 we met friend and fellow Pointer Rescue, Organization volunteer Jen along with her foster pups Vera & Virgil …and our friend Heather with her pups Kayla and Ellie from Team Salty Paws at Amico Island Park in Delran, NJ. We also were walking for our Pointer pal, Virgil, who is battling hemangiosarcoma.
Prior to Lager’s appointment, I wrote down questions in order to prepare my self for the consultation:
Is your anesthesiologist board certified?
Can you explain how the operation is performed?
What are the risks and possible complications for this operation?
Will Lager need special diet after his operation?
When does Lager need stop eating and drinking leading up to the surgery?
What medication will Lager be sent home with after surgery?
Could you tell me about your experience with this operation?
How can I contact you if I have more questions?
What can I expect during Lager’s recovery?
What restrictions will Lager have after surgery?
How do most dogs who have to have a partial mandibulectomy usually recover?
Will Lager’s life and lifestyle change after this procedure? Will he still be able to dock dive?
Are there things I can do to prepare myself, my home and/or Lager for this procedure?
On October 13, 2022 I met with Dr. Michael Jennings at Blue Pearl Pet Hospital to discuss Lager’s surgery. Dr. Jennings was so kind and explained in detail the surgery Lager will need. Dr. Jennings shared that unfortunately, Lager does need a partial mandibulectomy which will most likely include removing the portion of the lower jaw that incorporates the 2 canine teeth and incisors. I immediately broke out into tears upon hearing this, and Dr. Jennings was beyond compassionate and reassuring. Dr. Jennings said that the location of this tumor combined with being oral papillary squamous cell carcinoma (a sub-category [lesser version] of squamous cell carcinoma) is actually best case scenario in the big picture.
The diagram below shows the projected approximate portion of Lager’s jaw (below the red line) that will be removed during his surgery:
Lager’s surgery will be an attempt to remove the mass along with a margin of normal tissue and bone. The degree of removal is based upon Lager’s anesthetized oral exam and dental x-rays. In Lager’s case, Dr. Jennings suspects it would include the front of his lower jaw, hopefully keeping the back of his mandibular symphysis (chin). Once removed, the resected portion will be reevaluated to both confirm the tumor type and to check the edges for evidence of tumor cells. If clean margins are achieved, the papillary squamous cell carcinoma will not likely recur and Lager should be cured. However, if when reevaluated the tumor is determined to be squamous cell carcinoma (not the papillary subtype), Lager may require follow up chemotherapy or radiation therapy if the tumor characteristics indicate more aggressive behavior.
Dr. Jennings shared that after oral surgery, dogs generally do well, and although there will be a learning curve of how to place the tongue, and pick up food/objects, dogs adapt quickly and efficiently and continue a high quality of life. Pain is controlled prior to and following surgery, and most dogs return to eating and acting normally without any significant issues. Dr. Jennings is confident that with Lager’s drive, that he will adapt and likely will be able to compete in dock diving next season as well.
Quite Frankly the Best Boy Ever
Lager was such a good boy at his surgery consult, so we stopped at Philadelphia Pretzel Company for a pretzel dog. Lager enjoyed a few bites as a reward before returning home.
10/14/22: Partial Mandibulectomy Surgery Scheduled
We received confirmation on October 14, 2022 that Lager’s surgery is scheduled for October 31, 2022. Lager will not be allowed to eat hard food or put objects in his mouth for up to a month after treatment, depending on his recovery. There is a possibility that he may initially struggle to eat food and will most likely have to be hand-fed. He may also have difficulty drinking water, and positioning his tongue normally for the first few days following surgery. In the next two weeks leading up to his surgery, Brian and I will be doing our best to prepare our hearts and our home for the temporary changes and challenges that Lager may face. We believe it is important to appropriately equip ourselves in all aspects in order to have the strength to project positivity and confidence for Lager to absorb, and to preserve a sense of normalcy for him. Any prayers, positive thoughts, and good vibes will be greatly appreciated this Halloween and the few weeks following.
The Rainbow in Our Clouds
The continued support, prayers, and positivity that friends and family near and far continue to shower over our family has undoubtedly kept us all in good spirits and brightened our cloudy days… we can’t thank you all enough. We are also beyond grateful for the private messages, comments on posts, and heartfelt gifts.
Lager’s Cousin James made Lager a card and he listened intently as James read it aloud to him.
Team Salty Paws gifted us with oral cancer awareness decals for our vehicles!
Keeping calm is not my strong suit. Hearing the “C” word when our veterinarian confirmed Lager’s cancer diagnosis weighed heavy on my mind, but the uncertainty of what would follow was even more difficult for me to handle. Securing a consultation appointment with the oncologist of our choice was the easy part. Waiting for that day to arrive, however, was torture. Time could not pass quickly enough to reach that date and get more information. To help keep anxiety and fear in check, I focussed my efforts on preparing for the first appointment:
When scheduling the oncology appointment I asked the following questions:
What will be covered during a consultation appointment?
Do I need to bring anything with me to the appointment?
What’s the best method of transferring notes and pathology results to you from Lager’s primary veterinarian?
Does Lager need to fast for this appointment?
There is no cancellation list for the doctor we chose, so I called on a daily basis, joking with the front desk staff that they would get to know me more than they’d like! The staff was understanding and my persistence paid off…I was able to catch two cancellations and move Lager’s appointment up twice during the torturous waiting period.
I educated myself on the basics of Lager’s diagnosis, making sure to remind myself that each case is different and to be mindful that I don’t let what I read completely freak me out while waiting for Lager’s appointment with the oncologist. Researching enlightened me on oral papillary squamous cell carcinoma, treatment options, and presented new terminology that I needed to familiarize myself with prior to the consultation.
When I’m nervous, I do listen, but nothing (and I mean nothing) will sink in. I knew discussing Lager’s diagnoses, tests, prognosis, possible surgery, etc would be upsetting …making it difficult for me to process the information at that time, and to correctly relay the important details to Brian. If I can’t precisely remember and process the information the oncologist is delivering, it will be near impossible for me to take the steps needed to get the best care for Lager.
I prefer to write my notes rather than type them.
As an old-school retired teacher, I am a firm believer that despite modern technology, whenever possible – handwritten notes enable you to remember and comprehend the information more efficiently.
Eye contact is important to me – especially post-Covid when one or both people may be wearing a mask. Personally, it is easier for me to maintain eye contact with someone while writing on paper versus typing on my phone.
I’m the Queen of Typos (as I’m sure most of you already know from my prior posts – and most likely this one!) .. I’m not the best speller to say the least, but I can decipher my handwritten misspellings much easier than the “creative” auto-correct choices my phone or iPad makes for me
No worry about getting a low battery alert on my phone…there will be plenty more to worry about, so taking one issue off my list is a win!
Although some people I know have recorded their consultations, I am not comfortable with doing so
List of questions specific to Lager’s diagnosis
What stage and subtype is Lager’s oral papillary squamous cell carcinoma?
What is the typical percentage of chance this type of cancer has metastasize? What additional tests (if any) will be performed to rule out the spreading of this cancer to other areas?
What are the treatment options you recommend and how does Lager’s stage/subtype impact his options?
What are the potential downsides, including common side effects that I can likely expect, as well as rare but more serious complications?
When would he begin treatment?
What is the cost of the treatments? Follow up appointments?
What is the prognosis with the different treatment options?
What is the recovery time of treatment/surgery?What oral surgeon do you recommend to perform any surgery needed to remove the mass and any other areas that it may have invaded?
Is Lager currently in pain?
Is he allowed to have soft toys before and after his surgery?
What supplements, dietary changes, lifestyle changes, etc can I do to further support Lager
Will Lager have any short or long term restrictions before/during/after surgery and/or treatment?
Should I cease all vaccinations for Lager at this time?
If I have further questions what is the best email address or phone number to call to clarify points or to further discuss information presented in this appointment?
Show support for Lager
I ordered an oral cancer awareness ribbon paracord bracelet (created by Ford’s Cord & More)
Oncology Consultation Appointment
October 4, 2022
Lager sported his oral cancer awareness bandana (highlighted later in this post) and I put on the hat that Margarita wore when we went to her oncology consultation.
Arriving to Lager’s appointment…
Being a good boy in the waiting area…Lager wore his cancer awareness collar, oral cancer awareness bandana, and oral cancer awareness charm for his consultation (all gifted to him and highlighted later in this post)
Lager’s oncologist is Dr. Olivier Campbell (coincidently the same last name as our primary veterinarian, but no relation). Dr. Olivier Campbell was so patient and kind – he took time to answer all my questions and explain everything (he even drew pictures to provide a visual and help me to better understand). Here is what I learned at the consultation:
Lager’s cancer is a subtype (called papillary) of oral squamous cell carcinoma (this is good!). There are no particular “stages” with this type of cancer.
Oral squamous cell carcinoma is locally invasive and potentially locally destructive with a very low potential for metastasis – this is considered a low-grade malignancy.
This tumor type tends to invade the adjacent tissues, including the underlying bone in approximately 77% of cases. They can also occasionally metastasize to the regional lymph nodes and to the lungs. Tumors of the mandible (lower jaw) generally have a better prognosis than maxillary tumors (upper jaw).
Oral papillary squamous cell carcinoma has a lower chance of metastasizing, but it is still possible
if it does metastasize, it will tend to travel to the lymph nodes, lungs, and stomach. Ultrasound, x-ray, and aspirate sample will rule this out.
Surgery is the first line of defense against this type of cancer.
Surgeries of the jaw are usually well tolerated in dogs.
If a tumor is incompletely excised, radiation therapy can be considered to try to kill the remaining tumor cells in the area.
With local treatments, the reported median survival times range from 9 months to 3 years.
Lager’s prognosis cannot yet be determined until all tests are completed and mass removal is completed
Although Lager is is not displaying any symptoms, he is most likely having some level of discomfort, so playing with toys are not recommended at this time
While waiting for his surgery, if Lager begins to display signs of discomfort, there are oral pain medications, non-steroidal anti-inflammatory drugs and injectable medications to help with bone pain.
With this type of cancer, there are no supplements / dietary changes to add that have been proven effective as supportive additives.
Vaccines should be ceased at this time but can be resumed once Lager is recovered from his surgery.
Once surgery is complete, the oral surgeon will help us determine any restrictions moving forward
Tests completed at this visit:
Cytology (mandibular nodes)
This test provides an answer in 80% of cases approximatively. Results are pending and should be obtained in 7-10 days.
No evidence of radiovisible metastasis, but the radiologist will review Lager’s radiographs to ensure that no significant change is present. An update will be provided at the same time as the cytology.
Abdominal and Cervical Ultrasound:
Ultrasound of the cervical region reveals no enlarged lymph nodes and the mandibular salivary glands and thyroid/parathyroid regions are normal. There is no evidence of metastatic disease within the abdomen or at the cervical region.
Liver: No significant abnormalities.
Spleen: Prominent in size with normal in echotexture.
Kidneys: No significant abnormalities.
Adrenal Glands: There is a 0.7 x 0.9 cm, hyperechoic nodule at the cranial pole of the left adrenal gland most consistent with nodular hyperplasia. The remainder of the adrenal tissue is normal. A developing primary adrenal tumor is considered less likely. This may revisited in 2-3 months if symptoms arise, or if suggested by our veterinarian.
Urinary Bladder: No significant abnormalities.
Stomach: There is a large volume of echogenic ingesta within the lumen
Intestines: There is echogenic ingesta multifocally throughout the lumen.
Colon: No significant abnormalities.
Pancreas: No significant abnormalities.
Peritoneum: No significant abnormalities.
Mesentery: No significant abnormalities.
Lymph Nodes: No significant abnormalities.
Prostate Gland: No significant abnormalities
Visit SummaryNotes from Dr. Olivier Campbell: Lager is an adorable dog. Unfortunately, he was recently diagnosed with an oral squamous cell carcinoma. In Lager’s case, the tumor subtype was most consistent with a papillary squamous cell carcinoma, which is thought to be potentially even less aggressive than other oral squamous cell carcinomas. On today’s visit, we discussed that we could characterize Lager’s health condition and the extent of his tumor with thoracic radiographs, cytology of the mandibular nodes +/- abdominal ultrasound, neck ultrasound to assess the retropharyngeal nodes. No evidence of spread of his tumor was observed upon imaging and the results of the cytology of the nodes are pending. The next step to consider to fight his disease would be to meet with a dentistry specialist to plan the surgical removal of the tumor +/- the lymph nodes if the tumor is detected in them. At home, please continue to monitor Lager as usual and contact a veterinarian if his condition deteriorates.
DockDogs World Championship
From 2015 to 2017 I was blessed to be Lager’s teammate in Dock Diving. It was a privilege to share the dock with him. We competed at the World Championship in 2015, 2016, and 2017. Right before the 2018 season began, Limoncello was diagnosed with Dilated Cardiomyopathy, and was not able to compete. I thought it would be best for Brian to take over as Lager’s handler since Limoncello’s diagnosis left Brian without a dock partner. Brian and Lager had a great run together before Lager had developed some insecurity on the dock beginning in 2019. Although they tried to work through it, Lager continued to hesitate on the dock. After we had Lager medically examined to be sure there were no underlying issues, we decided that change may be a good thing, and we once again switched back to me being Lager’s handler this year…I hadn’t realized just how much I had missed my teammate! Lager and I had an exciting season as we got back into the groove of competing together. Lager’s insecurity disappeared, and he earned himself an invitation in every discipline in which he competed!
In Lager’s best interest, we unfortunately will not be making the trip to Iowa this year. Although we are extremely disappointed that we won’t be competing at the World Championship with our dogs and that we will not see our friends, this is the best choice for our family, and most importantly, for Lager. We wish all competitors and DockDogs staff a safe trip, and are sending good vibes and positive energy your way. Don’t forget to soak in every single moment with your pups (and peeps!!) when you are there. Best of luck to all competitors… it’s your dog’s time to shine! Team Liver Killers will be looking for updates on social media and cheering you all on from New Jersey! We look forward to sharing the dock with you and your pups in 2023.
I Get By With a littleA LOT Of Help From My Friends
Saying “thank you” is not sufficient to capture my gratitude for all of you. In fact, there really are no words that can fully express my appreciation for the overwhelming outpouring of love, prayers, positive vibes, phone calls, post comments, text messages, private messages on social media, and generous gifts. You all have provided support and strength as we embark on a new Journey through uncharted territory…and somehow the these acts of kindness always seem to arrive at just the right time. Brian and I both want you to know that you all have lifted our mood, enhanced our hope, and comforted our hearts. I will forever remember this compassion and thoughtfulness, and vow to to do my absolute best to pay it forward.
Beautiful card that included a heartfelt written letter as well
These Superhero capes were gifted to Lager to provide him superpowers on his Journey. The red cape pictured on the left is new. The blue cape pictured on the right belonged to a friend’s dog. My friend explained that she was not only purchasing a new superhero cape for Lager, but also passing along the cape of her beloved dog who has been blessed with an extremely long life…and that she wanted to share that with Lager in hopes that the cape would grace him with many more years beyond his Journey.
An amazing friend commissioned Ratjr Theos ( Portrait One ) to create this stunning digital painting of Lager.
A box of gifts arrived for the whole pack! The whole family feels the stress during difficult times – we are so appreciative that the rest of our pack is being supported as well! This is the first time I have ever seen a Limoncello (LimonSMELLo) dog toy!
Eat Like a King
After a 5 hour day of being the bestest boy during all of his testing, Lager undoubtedly deserved a reward. We stopped at Burger King on the way home and Lager enjoyed a couple of fries and a few pieces of a plain cheeseburger.
Waiting With Hope
…And now we remain hopeful as wait for a scheduled surgery date, the final cytology results, and confirmation on the x-rays and ultrasounds. Overall Lager’s oncology visit was full of positives, and we are beyond grateful for that!
For those of you who may have just recently joined our pack’s adventure, Lager was a Contracted Working Dog (CWD) and served our country as an explosives detection canine. His war zone name was Nayt, and he spent 18 months in Iraq, checking cars for explosives at the the US Embassy in Baghdad. He was one of the lucky ones to have had his privately contracted company pay to fly him back to the United a states after his tour ended, as many working dogs are not as fortunate. Upon Lager’s return to the U.S., we adopted him (read his full adoption story HERE). Lager has been enjoying his civilian life with us for the last 7 years with us with his favorite pastimes being swimming & dock diving. However, Lager has recently found himself back in a war zone of a different kind. On September 16th, he was diagnosed with oral papillary squamous cell carcinoma.
Discovery of Lager’s Mass
September 6, 2022
After a phenomenal performance at a World Championship dock diving qualifier, earning better scores as a 10 year old than the 1 and 3 year olds in his division and placing 2nd overall in Warrior Iron Dog, we were riding home in our camper on Tuesday, September 6, 2022 when I discovered the mass. Lager showed absolutely no signs of being in pain or not feeling well before, during, or after the competition. Lager does not appreciate having his mouth examined. Although I brush his teeth, it’s more of a “shove the toothbrush in and brush what I can” kind of thing, and I never get a good look in his mouth. While he was sleeping with his head on my lap on the way home in the camper, his bottom jowls were hanging in a way that enabled me to catch a glimpse of something abnormal. My heart sunk as my eyes focused on a mass located just behind his left lower canine. The growth was mostly covered by all those “extra bird dog bottom lips.” However, had I been able to do regular mouth checks and pulled those lips away from the canine, this mass could have been discovered much sooner. Please consider this a reminder to check your dogs regularly. Checking your dog’s oral health as a part of a routine cancer check is extremely important. If your dog isn’t a fan of you brushing their teeth or inspecting their mouth, get a friend or family member to help you, seek advice on training techniques that condition your dog to allow his/her mouth to be fully scrutinized, or ask your veterinarian to to an oral check at your dog’s routine visits.
Initial Primary Veterinarian Visit
September 7, 2022
I called our primary veterinarian, Dr. Helen Campbell at Old York Veterinary Hospital, from our RV immediately after I discovered the mass. She fit us into her busy schedule on Wednesday, September 7th. She was immediately concerned with what she saw and squeezed him into her surgery day that Friday, September 9th. She explained that most times oral masses such as this grow very deep, often invading the teeth and/or bone, and that getting clean margins during the surgery that Friday may not be possible. Dr. Campbell further shared that often times dogs will have to see an oral surgeon to remove the rest of the affected area whether the mass is malignant or benign. Dr. Campbell is one of the most brilliant, patient and kind people I know, and her staff is beyond amazing. Dr. Campbell and her staff not only provide the best care for our fur-kids, they are gentle and understanding with the humans in our pack. I ask a million questions, conjure up every “what-if” scenario, constantly ask Dr. Campbell to spell-out medical terms that I’m trying to write down in my notepad, and can’t pronounce a single medical term correctly…this woman is a SAINT. I am so grateful for everyone at Old York for not only keeping our 4-legged kids healthy, but also for for putting up with my high-strung personality (Dr. Campbell kindly calls me “motivated”…lol).
September 9, 2022
On September 9th Lager had the visible part of his oral mass removed by Dr. Campbell at Old York Veterinary Hospital so that it could be sent for biopsy in order to give us better direction on what we are dealing with. Lager made it through the surgery without any issues. However, Dr. Campbell did have to attack this mass as aggressively as possible, creating a gingival flap and cauterizing the area …so Lager’s healing period may be extensive.
Pathology Report – Not The News We Were Hoping For
September 16, 2022
On September 16th, we spoke to our primary veterinarian, Dr. Campbell who delivered the news we feared the most…Lager’s mass is malignant. The pathology report proved that the mass was oral papillary squamous cell carcinoma, and that surgical margins were incompletely excised (that part we were prepared for).
Oral papillary squamous cell carcinomas are locally invasive and potentially locally destructive with a moderate to high possibility for recurrence due to incomplete excisions. Masses may range from being entirely noninvasive to showing invasive growth, including bone intrusion. They do, however, have a very low potential to metastasize. X-rays were taken during Lager’s surgery with Dr. Helen Campbell. In viewing the radiographs, Dr. Campbell is hopeful that the mass did not invade the bone. There is, however, a questionable area that will be further explored by an oncologist and/or oral surgeon. If the mass did invade the bone, Lager may be required to have teeth removed and/or a partial mandibulectomy.
Initial Plan of Attack
It was a Friday when we learned of Lager’s diagnosis…which was probably a good thing considering I needed a few days to get my head straight. I spent that weekend on a rollercoaster of feelings: Disbelief, sadness, anger, guilt, numbness. Guilt consumed me. I blamed myself for not finding this mass sooner…for not finding a way to get a look in Lager’s mouth…for not seeking help. It took some deep reflection for me to remember that I am no good to Lager when I am wrapped up in myself. I looked back on my past blog entries when I was faced with a cancer diagnosis (not once, but twice) with our beloved Margarita to help me remember that my firstpriority is not finding the right treatment for Lager – but rather dealing with my emotions in order to clear my mind and be able to focus energy where it is needed…on Lager. I also knew I had to adjust my mindset and find the strength to be hopeful and positive. Living with Margarita’s cancer diagnosis – watching her go through chemo and then beat Lymphoma and maintain remission – only to lose her to hepatocellular carcinoma forced me to change my mindset altogether. Through it all, Margarita lived each day in-the-moment and enjoyed each second. She wasn’t worried about dying – she was focused on living. Even while she was sick, she encouraged others and spread positivity – and is still doing so in spirit to this day. As humans, when we hear that cancer diagnosis, we tend to start mourning our dogs who are still very much living. We have a lot to learn from dogs – live in the moment and enjoy the NOW. Lager has no idea he has cancer – he’s as happy and bouncy as always … and if anyone picks up on human emotion efficiently, it’s a dog (I swear they have super powers!) I am Lager’s guardian – it is imperative for me to maintain optimistic and in good spirits (no matter how difficult it may be) in order to preserve Lager’s emotional well being during his journey.
The next step was scheduling a consultation with the oncologist. I have secured an appointment and have begun to create my list of questions in preparation for the consultation. When we meet with the oncologist, he will advise us at that time on what direction is recommended for Lager.
Effective immediately: Get moving! Although Lager is an active 10 year old in general, I have been slacking lately in the “taking each dog for a daily walk” department. Studies have shown that exercise is beneficial for cancer patients – both human and canine. Exercise can enhance your mood, reduce anxiety, improve sleep, and boost energy… all of which is much needed for both Lager and myself at this point to ensure we are mentally and physically fit for his journey. Lager and I will be starting a daily walk regimen and may even choose to start doing virtual 5K’s for charity again. There is always strength in numbers… join Lager’s Legion…we’d love your company walking with us either in person or virtually!
United We Stand
We are almost certain at this point that we will not attend the DockDogs World Championship. We are a team…we play together, we stay together, and we fight together. No dog left behind…If Lager has to sit-out, we all sit-out. It is uncertain at this time if Lager is still in any discomfort – or if he will be at the time of the competition. These masses typically cause discomfort, yet Lager showed no signs of pain while competing, chomping down on bumpers and toys with enthusiasm during his last competition before the mass was discovered. Lager will do ANYthing you ask of him, which makes it near impossible to observe if he is in pain. We still need to be careful and make sure Lager isn’t aggravating his surgical area, as it is still in the healing process, and we won’t know if that area will be fully healed by the time he would be at the World Championship. Until Lager is further evaluated by an oncologist and we have more answers, we won’t feel comfortable with Lager participating in competition or traveling 1,039 miles away from his medical team. We look forward to the World Championship every year – we work all season toward the goal of getting all dogs qualified…so we will be greatly disappointed if we miss the World Championship and miss the opportunity to see competitors – extended family – that we haven’t seen since last year or even before Covid… but Lager’s health takes precedence.
Guardian Angels Up Above Please Protect the Ones We Love
September 17, 2022 The night following Lager’s diagnosis, Brian and I went to dinner with my sister, Casey, and my 9 yr old nephew, James. On the way to dinner Casey asked how Lager was doing (we had not told James anything at this point). James asked what we were talking about and Brian gave him the gist of the story, which made James sad. We forgot to make reservations so when we arrived to the busy restaurant we had a short wait. As we stood waiting for our table, Casey spotted a penny on the floor and pointed it out to James. I said to James “Pick it up!… You know what they say – ‘pennies from Heaven’…Someone is sending us a message!” James picked up the penny and without looking at it, put it in his pocket. Later at the dinner table, James bet me the penny on something. I won, and James turned the penny over to me. My eyes immediately filled with tears. The year on the penny was 2016 … the year we met Penelope…who we called PENNY… and adopted as Margarita!! Sweet Reet was letting us know that she’s going to be alongside Lager through his journey!
A good friend sent me this book when Rita had passed away:
Once a Soldier, Always a Soldier
Hey Cancer, you picked a battle with the wrong dog. Lager was a soldier in Iraq …He is known as Captain America in the DockDogs community…And he has an army of amazing people (if you are reading this, that’s YOU!) behind him…so I hate to break it to ya, “big C, ” but you better be ready for the fight of your life.