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post #26 of 126 (permalink) Old 11-24-2018, 11:56 AM
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Thank you Mel !
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post #27 of 126 (permalink) Old 11-25-2018, 05:43 AM
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These are tough dogs for sure..recently my friends dog Brutus had two issues come on at about the same time.......first...cough...then went into congestive heart failure...tons of fluid in the lungs etc....they drained ...got him stable and on meds for the condition....he made it.....then has to deal with the front right leg.....diagnosed with bone cancer.....they opted to amputate.....the amputation was 2 weeks ago..on a Tuesday....
Surgery Tuesday.....came home next day 2 in the afternoon...by 4 pm same day ....used a sling to get him outside to pee.....by Friday.....72 hours after surgery he was laying on the incision site......attempting to stand on his own.....although still assisted with a sling......by Sunday 5 days post op....then came the big poo......from this point on he has excelled.....the owner initially questioned himself ...but now Brutus has mastered balance with 1 front leg....and will get the stitches out in 2 days. Brutus is 7 years ....but he also had DCM against him......I was amazed that he tolerated the anesthesia like he did.....still amazed every time I go to visit him.......Brutus is pain free now with that right front leg gone.....playful as ever......as far as his heart ...still on the daily meds for that ......with plans for a few chemo treatments.
After the surgery his owner stayed with him 24 hours for a week straight ....so He would not mess with the surgical site or attempt to do to much that might pop stitches. The owner also made sure he layed carpet all over his slick floors so post op his dog would not be on slippery surfaces. I know you might have to make other decisions ...but today I wanted to share my friends experience so you would know once they get past the initial surgery Brutus did not seem to care about his leg being gone....He just adapted and is more active than ever!
Hang in there sounds like you have some great doctors to helping you....stay in touch .......we will keep praying for you and your pup.

Hoss

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post #28 of 126 (permalink) Old 11-25-2018, 06:26 AM
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So very sorry. Thoughts and prayers are with you.


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post #29 of 126 (permalink) Old 11-25-2018, 12:53 PM
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Wow, Lady Di, what a story. It must be the season, I have been so weepy lately and a story like that brings the tears again.

"Lots of people talk to animals...Not very many listen, though...That's the problem. " ~ The Tao of Pooh
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post #30 of 126 (permalink) Old 11-25-2018, 01:32 PM
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Quote:
Originally Posted by Cressrb View Post
Wow, Lady Di, what a story. It must be the season, I have been so weepy lately and a story like that brings the tears again.
Tough stuff to deal with for sure....

Hoss
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post #31 of 126 (permalink) Old 11-25-2018, 02:10 PM
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Sorry to hear about Huck's prognosis. I know you will make right decision for him.

This short video clip might make you feel a little better about the amputation option.
It's Spock & Eva meeting "The Crazy Doberman Lady" at HADR Doberfest in 2015 with three of her adopted Dobes, two with limbs missing.
They adapt so well, our Dobes do....



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Poke Everything.
It's New? Bark At It.
Moves? Chase It.
Doesn't Move? Smell It.
Liquid? Spill and Dribble It.
Treat or Food? Wolf It Down.
Not Food? Chew It Slowly, Be Quiet & Hide From Human.
A Toy? Shred & Destroy It.
Stuffed? De-Stuff It.
Bites You Back? Wrestle It!
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post #32 of 126 (permalink) Old 11-26-2018, 04:54 AM Thread Starter
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Below is the copy and paste of an email I just received from the surgeon at University of MN.

Please help. Opinions needed and welcomed. I’m trying to cypher through this and all I’m seeing is no matter which cancer, it has spread at least to the lungs, highly aggressive, a palliative amputation, or am I reading this wrong?
I’ve never been so confused about medicine as I am now. I feel like it’s all filled in with unnecessary minutiae and I just need bottom line. Not to mention amputation of the “forelimb” is disconcerting since it’s his hindlimb.

I can’t, for the life of me understand why their isn’t a suggestion of having him PTS if it has spread instead of palliative driven amputation for therapeutic removal of the pain. He would be spending his last few months trying to recover from the amputation and suffering from the metastasized area. Which at least in the Hemangiosarcoma, death usually occurs from rupturing at the primary tumor sight that’s usually in the right heart, lungs, liver or spleen and associated with catastrophic hemorrhaging.

So we couldn’t do the things that he loved like swimming, running, UFC bouts with Calamity and Moonshine. By the time he heals enough to be active he’ll most likely be near death or dead.

What do I do first?

Sorry it’s so discombobulated, in both format and form. My head is gonna explode!



Patient:
HUCKLEBERRY CANINE
DOBERMAN PINSCHER RED AND TAN
MALE NEUTERED
Case # 6541412
41.7 kg
DOB APR 20, 2012
Discharging DVM: Dr Chris Thomson Instructions By: Dr Chris Thomson
Attending DVM: Dr Chris Thomson Tech:
Thank you for your recent visit to the University of Minnesota, Veterinary Medical Center, below is a summary of the visit. Huckleberry was presented to the Surgery Service for evaluation of a pathologic fracture of the distal right tibia.

RELATED HISTORY: Huckleberry presented to the UMN VMC ER Service on 11/15/2018, for evaluation of lameness of the right hindlimb. Upon physical exam, Huckleberry has marked swelling around his right hock. ER Radiographs (x-rays) of Huckleberry's right hindlimb showed a comminuted oblique pathological fracture in the distal right tibia.

PREVIOUS DIAGNOSTICS, TREATMENT, MEDICATIONS
Codeine Sulfate 30mg tablets: Give 2 tablets by mouth every 8 hours for pain.
Deracoxib 100mg tablets: Give 1 and 1/4th tablet by mouth once daily for 4 days. Last dose given Sunday pm.

PHYSICAL EXAM FINDINGS:
Pulse: 90 Resp: 20 Mucous membranes: pink Capillary refill time:<2s Wt: 41.7 kg BCS 5/9
On physical exam, Huckleberry is bright, alert and responsive. His eyes, nose and ears are clear and free of debris. He appeared to be euhydrated. Peripheral lymph nodes palpated small, soft, symmetrical and freely moveable. Cardiac auscultation was unremarkable with no murmurs or arrhythmias appreciated. Femoral pulses were strong and synchronous. Normal bronchovesicular sounds were heard on lung auscultation, with no audible crackles or wheezes. Abdominal palpation was unremarkable with no masses, organomegaly, fluid waves, or pain appreciated. He was partial to non-weight bearing in the right hindlimb from distal tibia fracture with pain on direct palpation; custom fiberglass splint still in place.

TESTS:
Fine needle aspirate (FNA): A small needle was used to obtain cells from Huckleberry’s fracture site. The collected cells were reviewed under a microscope.

RESULTS: Based on the atypical cells present on the slides, there is concern for an aggressive ‘sarcoma’ tumor. However the slides were of low cellularity with only a handful of cell clusters providing a diagnosis. Additional stains were performed but unable to further differentiate the type of sarcoma. A surgical biopsy is needed for a confirmatory diagnosis.
Thoracic Radiographs: This is an x-ray of the chest that allows us to evaluate the heart, lungs, and other
Print Date: 11/26/18 Page 1
structures within the thoracic cavity.

RESULTS: Two pulmonary soft tissue nodules were noted; differentials include early metastatic disease or superimposition of normal structures such as end-on vessels

ASSESSMENT: Based on the findings of the right tibia limb radiographs, cytology, and thoracic radiographs, Huckleberry likely has a malignant type of tumor called a sarcoma. Possible differentials include hemangiosarcoma, histiocytic sarcoma, or osteosarcoma. Unfortunately, these types of cancer are highly aggressive and have a high rate of metastasis (i.e. spread to other organs). Confirmation of which type of tumor can be made with a surgical biopsy of the fracture site to further assess the cell morphology.
Due to the aggressive nature of these cancers, the primary recommended form of treatment is amputation of the limb. This treatment would be palliative (removal of the source of pain), aid in achieving a diagnosis (surgical biopsy), and would be considered local control of the tumor if there is no evidence of metastasis (spread) elsewhere in the body. For all three tumor options, adjunctive chemotherapy is highly recommended as these particular tumors are responsive to various forms of chemotherapy. Unfortunately, many dogs will have metastasis at the initial presentation, whether detectable or not. At this visit we screened for metastasis in the thoracic cavity with chest radiographs, which is the most common area of metastasis for these particular sarcomas. There were two small nodules in the lungs that are concerning for early spread of this cancer. However, it is possible that these could be normal structures such as end on vessels.
Prior to moving forward with forelimb amputation, additional staging could be considered. This includes an abdominal ultrasound (roughly $550, to assess for spread of cancer to the liver, spleen, or other abdominal organs, a common finding for hemangiosarcoma or histiocytic sarcoma), a bone scan ($900, to assess for possible additional bone metastasis, which can occur in up to 10% of osteosarcoma cases), or a combined thorax and abdominal CT scan ($1200, to further define any potential lung metastasis or spread to abdominal organs, beneficial for all three differentials). If interested, these tests should be performed prior to surgery; if evidence of metastasis is observed elsewhere in the body, it would highly effect Huckleberry’s prognosis but not necessarily his next treatment recommendation (forelimb amputation). If you would like to discuss the advantages and disadvantages of the various staging options, please let me know and we can discuss by phone.
At this time, Huckleberry is scheduled for a right forelimb amputation with Drs. Callie Blackford and Betty Kramek on December 5th. Drop off instructions are listed below.
Thank you for entrusting us with Huckleberry’s care. He was a pleasure to work with. If you have any questions or concerns regarding Huckleberry’s progress at home, please do not hesitate to call us at (612) 626-8387 or email the surgery service at [email protected].
Attending Clinician:
Chris Thomson, DVM
Small Animal Surgery Resident [email protected]
Surgery Chief of Service:
Shiori Arai, DVM, PhD, DACVS-SA
Hailey Erickson
Senior Veterinary Student


Even when broke, he’s still broke.







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post #33 of 126 (permalink) Old 11-26-2018, 08:16 AM
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PHYSICAL EXAM FINDINGS:
Pulse: 90 Resp: 20 Mucous membranes: pink Capillary refill time:<2s Wt: 41.7 kg BCS 5/9
On physical exam, Huckleberry is bright, alert and responsive. His eyes, nose and ears are clear and free of debris. He appeared to be euhydrated. Peripheral lymph nodes palpated small, soft, symmetrical and freely moveable. Cardiac auscultation was unremarkable with no murmurs or arrhythmias appreciated. Femoral pulses were strong and synchronous. Normal bronchovesicular sounds were heard on lung auscultation, with no audible crackles or wheezes. Abdominal palpation was unremarkable with no masses, organomegaly, fluid waves, or pain appreciated. He was partial to non-weight bearing in the right hindlimb from distal tibia fracture with pain on direct palpation; custom fiberglass splint still in place.


To me - That sounds like a very good news ! I would have thought that if Huck's cancer had spread - something would have shown up .

RESULTS: Based on the atypical cells present on the slides, there is concern for an aggressive ‘sarcoma’ tumor. However the slides were of low cellularity with only a handful of cell clusters providing a diagnosis. Additional stains were performed but unable to further differentiate the type of sarcoma. A surgical biopsy is needed for a confirmatory diagnosis.

This concerning to me - they don't know what it is . I would ask if there is anything else that could cause the appearance of a lesion - yes - I may be grasping for straws here

ESULTS: Two pulmonary soft tissue nodules were noted; differentials include early metastatic disease or superimposition of normal structures such as end-on vessels


Oh boy ! It could be early metastatic OR Normal structures ! --- Or Normal structures ???


My thinking here - There is not enough results for me to make a decision of this magnitude - and I relies we may not always get them - yet - I am really questioning results here - I would ask about the surgery biopsy - pro's versus con's - recovery time - anything and everything --

There is always the chance they are wrong - That is what I'm praying for !

But --- If they are right - reread your post above -- you answered your question as about what to do -

Thoughts and prayers - by the tons for you and Huck

Doc
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post #34 of 126 (permalink) Old 11-26-2018, 09:42 AM
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From the report:
There were two small nodules in the lungs that are concerning for early spread of this cancer. However, it is possible that these could be normal structures such as end on vessels.Prior to moving forward with forelimb amputation, additional staging could be considered. This includes an abdominal ultrasound (roughly $550, to assess for spread of cancer to the liver, spleen, or other abdominal organs, a common finding for hemangiosarcoma or histiocytic sarcoma), a bone scan ($900, to assess for possible additional bone metastasis, which can occur in up to 10% of osteosarcoma cases), or a combined thorax and abdominal CT scan ($1200, to further define any potential lung metastasis or spread to abdominal organs, beneficial for all three differentials). If interested, these tests should be performed prior to surgery; if evidence of metastasis is observed elsewhere in the body, it would highly effect Huckleberry’s prognosis but not necessarily his next treatment recommendation (forelimb amputation). If you would like to discuss the advantages and disadvantages of the various staging options, please let me know and we can discuss by phone.


From Lady Di:
Since they are not sure about the nodules in the lungs .....
If it were me I would consider the additional staging ....in advance of the amputation.........combined study thorax/abdominal study $1200.
Also call and discuss with them over the phone ..they extended the invitation ...get them to put this in terms you can clearly understand........still praying for you and your pup.....what a sweetie.........also always ask your physician first about this suggest recording the telephone call.......just ask your physician for permission first ..its a courtesy thing in an MD's world....
I did this when I dealt with my dog Hoss.....he had an MRI done......having the physician phone call recorded was so useful to me........we forget so much when dealing with something like this over the phone ........being able to go back to your recording is a great help when having to make such decisions or pass information to others ........put one phone on speaker phone .......use another phone on video to record the phone call .......video will pick up the telephone conversation......
Oh....feeling so much for you and yours today..............I work for surgeons........when they get clinically stressed during a surgery this is what they say to do ..........keep focus........keep the main thing, the main thing........so one step at a time.........here we go.....Has the cancer definately spread ? Additional staging could help answer that question for you .
I understand that it's so hard to think straight when your fighting for your own pup......

Hoss

Last edited by LadyDi; 11-26-2018 at 09:54 AM.
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post #35 of 126 (permalink) Old 11-26-2018, 10:08 AM
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All you can do is to do your best to make a decision out of love for Huck, which I know you will do. There's no wrong answer when you do that, and you're working with no "right" answers...this is a crappy situation and it isn't as if one answer is "right" and one is "wrong." Any decision that you make knowing your dog, with his best interests in mind is the right one.
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post #36 of 126 (permalink) Old 11-26-2018, 11:20 AM
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I'm so sorry to hear about Huckleberry. I have been watching you/him on hear for years, I also had a red Huckleberry.
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post #37 of 126 (permalink) Old 11-26-2018, 02:13 PM
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Oh no, I'm so sorry to hear. Prayers and hugs for you and Huck

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post #38 of 126 (permalink) Old 11-28-2018, 10:14 AM Thread Starter
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We saw his regular vet on Monday. She’s reviewed all the tests and is pretty sure that he has metastasized to the lungs. She feels that at this point we do what testing that we need to make us feel comfortable to basically make an end of life decision.

Based on her experience, she would be very hesitant to amputate and/or chemo. Her straightforwardness was very beneficial.

So what are next step is to do the scans on Monday, based on those immediate results they will also redo the needle biopsy in hopes they get a better sample and can type and stage. After his procedure, since his case is so complicated, there will be a group meeting with his oncologist, the chief of surgery, us, and our regular vet will be on speaker phone.

If the type is the histiocytic sarcoma is hereditary and would like to let his BYB siblings aware.

Thank you to everyone that has responded with kindness and positive thoughts.


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post #39 of 126 (permalink) Old 11-28-2018, 10:20 AM
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Thank you for keeping us attuned to his diagnosis. Heartbreaking news.

"Lots of people talk to animals...Not very many listen, though...That's the problem. " ~ The Tao of Pooh
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post #40 of 126 (permalink) Old 11-28-2018, 10:51 AM
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Oh dear. The preliminary information doesn't sound very positive. About your question why the vet didn't suggest euthanasia as well as the various alternatives. From what vets I've know over the years have told me it's ethically inappropriate to suggest to a client that euthanasia should be considered immediately.

I have had vets suggest euthanasia for pets of mine--but they were doctors I'd known for years and they were well aware of my feeling about keeping any one of my pets too long because I couldn't bear to see them go. Every one will have different opinions about this and I have a good many friends who have kept a dog or cat much longer than I would have--nursing them along through continually deteriorating quality of life.

So most vets will do what the one who saw Huckleberry did--present the options and the fact that they don't have a definite diagnosis yet and let you make a more informed decision.

That fracture would play a heavy role in a decision I made given the circumstances--mostly because the things that cause a pathological fracture are never good news and usually indicated that there is very serious bad stuff going on.

I can only tell you that in your position I would not do a palliative amputation in this case. But I know that you will be realistic and give your boy his best chance--and what ever decision you come to will be in Huckleberry's best interest.

Such hard decisions--I wouldn't wish them on anyone. Good luck to you and Huckleberry.
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post #41 of 126 (permalink) Old 11-28-2018, 11:16 AM Thread Starter
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Oh dear. The preliminary information doesn't sound very positive. About your question why the vet didn't suggest euthanasia as well as the various alternatives. From what vets I've know over the years have told me it's ethically inappropriate to suggest to a client that euthanasia should be considered immediately.

I have had vets suggest euthanasia for pets of mine--but they were doctors I'd known for years and they were well aware of my feeling about keeping any one of my pets too long because I couldn't bear to see them go. Every one will have different opinions about this and I have a good many friends who have kept a dog or cat much longer than I would have--nursing them along through continually deteriorating quality of life.

So most vets will do what the one who saw Huckleberry did--present the options and the fact that they don't have a definite diagnosis yet and let you make a more informed decision.

That fracture would play a heavy role in a decision I made given the circumstances--mostly because the things that cause a pathological fracture are never good news and usually indicated that there is very serious bad stuff going on.

I can only tell you that in your position I would not do a palliative amputation in this case. But I know that you will be realistic and give your boy his best chance--and what ever decision you come to will be in Huckleberry's best interest.

Such hard decisions--I wouldn't wish them on anyone. Good luck to you and Huckleberry.


Thank you. We agree about the palliative amputation.


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post #42 of 126 (permalink) Old 11-28-2018, 11:16 AM Thread Starter
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Thank you for keeping us attuned to his diagnosis. Heartbreaking news.


Thank you for listening


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post #43 of 126 (permalink) Old 11-28-2018, 11:26 AM
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We saw his regular vet on Monday. She’s reviewed all the tests and is pretty sure that he has metastasized to the lungs. She feels that at this point we do what testing that we need to make us feel comfortable to basically make an end of life decision.

Based on her experience, she would be very hesitant to amputate and/or chemo. Her straightforwardness was very beneficial.

So what are next step is to do the scans on Monday, based on those immediate results they will also redo the needle biopsy in hopes they get a better sample and can type and stage. After his procedure, since his case is so complicated, there will be a group meeting with his oncologist, the chief of surgery, us, and our regular vet will be on speaker phone.

If the type is the histiocytic sarcoma is hereditary and would like to let his BYB siblings aware.

Thank you to everyone that has responded with kindness and positive thoughts.


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Quote:
Originally Posted by dobebug View Post
Oh dear. The preliminary information doesn't sound very positive. About your question why the vet didn't suggest euthanasia as well as the various alternatives. From what vets I've know over the years have told me it's ethically inappropriate to suggest to a client that euthanasia should be considered immediately.

I have had vets suggest euthanasia for pets of mine--but they were doctors I'd known for years and they were well aware of my feeling about keeping any one of my pets too long because I couldn't bear to see them go. Every one will have different opinions about this and I have a good many friends who have kept a dog or cat much longer than I would have--nursing them along through continually deteriorating quality of life.

So most vets will do what the one who saw Huckleberry did--present the options and the fact that they don't have a definite diagnosis yet and let you make a more informed decision.

That fracture would play a heavy role in a decision I made given the circumstances--mostly because the things that cause a pathological fracture are never good news and usually indicated that there is very serious bad stuff going on.

I can only tell you that in your position I would not do a palliative amputation in this case. But I know that you will be realistic and give your boy his best chance--and what ever decision you come to will be in Huckleberry's best interest.

Such hard decisions--I wouldn't wish them on anyone. Good luck to you and Huckleberry.
Gosh, this is so hard to hear. I just want to give you a hug. I have to say I agree with dobebug, as hard as that is for me, because you know how much I love Huck. I'm here for you, whatever you need. Lots of love your way.


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post #44 of 126 (permalink) Old 11-28-2018, 12:10 PM
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I'm so sorry to read this - I will be honest here - I was hoping in my heart so much they may have missed something And that can happen - Maybe Doc here was being the glass is half full to much after reading your above post . It sounds like you and MC know each other and even though I have not meet MC - I can say that you have a great friend to lean on + all of us on here -


Thoughts and prayers to you all


Doc
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post #45 of 126 (permalink) Old 11-28-2018, 12:49 PM Thread Starter
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I'm so sorry to read this - I will be honest here - I was hoping in my heart so much they may have missed something And that can happen - Maybe Doc here was being the glass is half full to much after reading your above post . It sounds like you and MC know each other and even though I have not meet MC - I can say that you have a great friend to lean on + all of us on here -





Thoughts and prayers to you all





Doc


Yes, she is a great friend and her support is well cherished.


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post #46 of 126 (permalink) Old 11-28-2018, 01:04 PM Thread Starter
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Gosh, this is so hard to hear. I just want to give you a hug. I have to say I agree with dobebug, as hard as that is for me, because you know how much I love Huck. I'm here for you, whatever you need. Lots of love your way.


Yeah, I hate that his last days are without me. But I’ll be home on Monday morning prior to his appointment.

As well as the obvious of losing him, my immediate future plans consisted so much of him in my plans like moving, land with a creek, travel trailer etc...so I’m even more lost on what to do, or more free on what to do and that overwhelms me with more guilt, if that makes sense.

Anyways, I’ll call when I get home.


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post #47 of 126 (permalink) Old 11-28-2018, 01:22 PM
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Yeah, I hate that his last days are without me. But I’ll be home on Monday morning prior to his appointment.

As well as the obvious of losing him, my immediate future plans consisted so much of him in my plans like moving, land with a creek, travel trailer etc...so I’m even more lost on what to do, or more free on what to do and that overwhelms me with more guilt, if that makes sense.

Anyways, I’ll call when I get home.


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I'm really heartbroken for you.


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post #48 of 126 (permalink) Old 11-28-2018, 01:55 PM
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I'm so sorry--I'll be thinking of you and yours today.
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post #49 of 126 (permalink) Old 12-06-2018, 04:08 PM Thread Starter
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Huck had his ultrasound and scans on Monday. Based on those results and his activity level -bounding around like a banshee- we have decided to go with the amputation tomorrow morning (12-7), and chemo.
The Surgical Oncologist feels he has a good quality of life outlook for at least a year. Hoping I can take him camping and swimming this spring. He’ll probably need a life jacket. Please continue with the positive thoughts.

We are thinking he needs an Incredible Huck coat!




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post #50 of 126 (permalink) Old 12-06-2018, 05:40 PM
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Sending lots of love and good thoughts your way. You will be in my thoughts tomorrow - keep us posted.
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