Nerve Sheath Tumor

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PofiMia
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Nerve Sheath Tumor

Postby PofiMia » Mon Apr 18, 2016 9:43 pm

Cannot believe I am writing this. Had an appointment on Friday at U of MN Vet hospital with head of rehab - another consult. The two therapists who have worked on him thought they might have more luck loosening the very tight tendons, especially the carpus, if they could sedate him and use ultra sound to heat the tissues while stretching. Assessment was supposed to be for that.

But after examining him, the doctor said, A. she doesn't think they can stretch the tendons in the carpus enough, and B. she thinks his lameness is not related to toe tumor, toe amputation, second back foot growth and lumpectomy, and then wrist growth and lumpectomy. All of this having started on May 1 of last year, she thinks the muscle atrophy of his tricep cannot simply be attributed to him being only partly weight bearing from May through November and from November to now, not weight bearing at all. She believes he likely has a nerve sheath tumor affecting the triceps. And that we need to do an MRI and if confirmed, take his leg.

I felt like I had been hit in the gut with a baseball bat. I've been numb since then. Convinced she was nuts. Didn't understand how much trauma this has been and how long. And tonight he seems like he is in real pain. As if to tell me I am wrong, she is right and we are just spectacularly unlucky to keep having smaller things pop up in the same leg and hide the big bad from sight. How is it possible for three completely unrelated growths pop up and take his leg from us one piece at a time.

I cannot stop weeping right now.

Any experience or knowledge of nerve sheath tumors and treatment appreciated.
Last edited by PofiMia on Tue Apr 19, 2016 5:21 am, edited 1 time in total.

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Re: Nerve Sheath Tumor

Postby whiteboxerboy » Tue Apr 19, 2016 5:20 am

Oh Lisa, I'm so sorry. This is shocking news for sure. Sending all good thoughts to you guys.
Sorry I don't have anything helpful to offer.

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Re: Nerve Sheath Tumor

Postby SherriA » Tue Apr 19, 2016 9:37 am

Oh LM, I have nothing helpful to offer, but you know that Pofi is being surrounded by love and support from afar. He's such a special boy with such a huge fan club. I'm holding both of you in my thoughts.
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Re: Nerve Sheath Tumor

Postby Sabine » Tue Apr 19, 2016 11:03 am

I'm so very sorry :( What a punch in the gut. :(
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Re: Nerve Sheath Tumor

Postby Calypso » Tue Apr 19, 2016 2:54 pm

Lisa Marie, I am so sorry. The experience I have with a nerve sheath tumor is in a human child (in his cervical spine) and that surgery to remove it was difficult and ineffective.

This is the question people asked me when I was looking at an MRI for Havana's spinal issue - would knowing with an MRI change the treatment plan? In her case it didn't, so I was able to put that money toward rehab. It's hard to think of Pofi without one of his long, beautiful legs, but if the vet is fairly confident amputation is the only, or best, way to go, he will adjust. I know front legs are harder, but I know a 90 lb golden/berner mix who is going on 4 years as a tripod (rear leg amputated) and he's just fine, even with all that weight.

My heart and thoughts are with you guys.

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Re: Nerve Sheath Tumor

Postby Kathleen » Tue Apr 19, 2016 3:03 pm

Oh wow. I'm so sorry he is still really hurting and I hope you are able to get to the bottom of it.

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Re: Nerve Sheath Tumor

Postby UpwardDog » Tue Apr 19, 2016 4:07 pm

I am so so sorry to hear this and I'm confused. It seems impossible to believe that so many lumps in one limb could be unrelated. Or is she thinking they are? Does anyone have an explanation for why these lumps/tumors are occurring? In the meantime, can they give him some gabapentin if it's nerve pain? It made a huge difference for Ben's.

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Re: Nerve Sheath Tumor

Postby JudyL » Tue Apr 19, 2016 4:52 pm

I'm sorry, LM, and I have no experience here either. I'm sending comforting thoughts to you all.

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Re: Nerve Sheath Tumor

Postby Amanda » Tue Apr 19, 2016 9:26 pm

I'm so sorry about this, LM. It is devastating and I just really hope the doctor is wrong.

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Re: Nerve Sheath Tumor

Postby connie » Wed Apr 20, 2016 5:25 am

A lot depends on whether the n/s tumor is benign or malignant, I understand.

When my Banjo came into rescue, he had an immense tumor on his back and he underwent surgery to remove it; it was a benign nerve-sheath tumor. Banjo had a lot of other health issues too, and neuro conditions that were probably the effect of having lived with that tumor a long time. Nevertheless, he came to me as a senior Sheltie and he had a couple of excellent years -- lots of activity, complete enjoyment of life -- before he passed on.

https://www.vetstream.com/canis/Content ... e/dis02547

I am sorry, this is an awful thing to hear and I know what it feels like to get such a diagnosis. I hope you have the best possible outcome in whatever treatment you choose for Pofi. If you need a support protocol, which as you know was so amazingly effective for Sander, Roger is still working with Marina's protocols at the Natural Rearing website.

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Re: Nerve Sheath Tumor

Postby PofiMia » Wed Apr 20, 2016 7:54 am

Thanks, all. I really do find it hard to believe this would be the third impactful (and most seriously impactful) lump/growth in the same limb. My original consult was with U of MN was because my vet wondered if he was missing something to connect the first two. They were very different - the first was a benign tumor in the toe and the second a sebaceous cyst/infectious property. Could have been a small foreign body that started that. He was partial weight bearing on the leg till the cyst on the wrist.

Heather, yes, he is on gabapentin since Friday. In fact, he is on three modalities for pain - Tramadol, Carprofen and Gabapentin. We had a good weekend, but he did water treadmill on Friday, dog park Sat and Sunday and starting Monday seemed to be really feeling it. He was perkier yesterday and indicated he wanted to go for a walk, but literally stopped at my next door neighbor's house to sample some tender grass leaves and did not want to resume. He is also just very flat. No real enthusiasm except for the really big stuff (going in the car to go to dog park). He doesn't respond like Pofi to being talked to and hearing his name. Through all these trials, he usually comes back to the dog who begs and tries to eat off your plate and countersurfs and presents you with toys. Right now he just lies on a dog bed all day. Doesn't come when the treat jar is opened. Eats treats offered with enthusiasm. Could this be the meds rather than pain? Possibly.

The U of MN doctor thinks a nerve sheath tumor in the brachial plexus that is impacting the triceps. Per my doctor and one other vet friend, there is a lot of nerves jumbled together in this area. The diagnostic indicator is pushing upward in that space between leg and chest (armpit) firmly to see if there is a pain reaction. There really was not one on right side, but was some on left. Trying to get in to one of my two vets for them to repeat test tomorrow or Friday after he is a bit rested from the activity burst this weekend. Because there is a lot of tissue in that area and this complex jumble of nerves, when the tumor is located here, they usually want to remove the leg. Also because nerve sheath tumors are usually not metastatic, but do seem to recur locally when removed. Depending on what MRI showed, there is a possibility of trying to remove just the tumor. And a much smaller possibility they could consider radiation on it instead. If we were lucky and MRI shows nothing sinister, we would talk about surgery to help the carpus - could not restore it fully, but may be able to make it more functional for him.

In the end, I realized when talking to my own doctor yesterday that it is actually luckier if there is a nerve sheath tumor that it be located in his "bad" leg rather than one of the remaining three good ones. And he is managing on three legs right now and as our Dr. P pointed out, that long beautiful, but disused leg at the moment is adding weight and stress on his good legs. He does okay on three legs right now, but would likely do better with less weight.

I still feel just sick. I cannot believe this is happening. But I need for him to be my joyful, funny dog again. I can't leave him in pain.

Thanks for the links, Connie.

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Re: Nerve Sheath Tumor

Postby MaisyPancakes » Wed Apr 20, 2016 9:07 am

I'm so sorry, LM, but I, too, would wait to go all-in emotionally on the U vet's pre-imaging assessment. If he's only been on Gabapentin for less than a week, he could very well be getting used to it. I was told that it takes a *few weeks* for it to kick in and for the dog's pain signals get sorted out (you're basically changing the way his body responds to pain, which isn't as fast-acting as, say, NSAIDs)—and lethargy is definitely one of the side-effects. Especially if you're also doing Tramadol, it can be quite flattening, I think. Are you replacing the Tramadol w/Gabapentin over time, or is he meant to stay on both + the NSAID? (I'm just asking out of curiosity.)

Also, I've slowly learned to remember that, at least for MP, she may take a little longer to recover from an exertion, and progressively so, as she gets older (and that she keeps getting older at a faster rate than I am ready to process!)—I'd get super elated from a great park trip, and forget that she may be a little draggy afterward and become devastated when she's a little wobbly at home (she's always gimpier when not excited/ecstatic). Kind of rambling, but it's been a little of a rollercoaster for me, and every few weeks I end up a sliver short of despair, even though nothing has really changed and she is doing as well as she can.

If you'd want a second opinion, I love and trust our rehab vet in Burnsville with all my heart. No matter how busy she is, Dr. T has *always* been there for us, whether it was the holidays or the weekend or the middle of the night or she was out of the country at a conference, and even if it weren't entirely about her gimpiness. She's one of the only people in the world with some kind of special certifications/degrees (sorry for the lack of specificity; I just know that it was plenty bad-ass for me ;) ), and is beyond kind and thorough.

Hang in there, LM! <3

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Re: Nerve Sheath Tumor

Postby Jen » Wed Apr 20, 2016 9:25 am

I'm so sorry to hear this. I have nothing useful to add but I'm thinking of you and Pofi. :(

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Re: Nerve Sheath Tumor

Postby JudyL » Wed Apr 20, 2016 11:04 am

The flatness could be from the meds, and I wonder if that will get some better for Pofi as his body gets used to the effect, especially the Tramadol being a narcotic. I've heard that dogs on narcotics long-term get used to them and may even crave the next dose, much like a human addict.

I may be seeing some of that with Cinnabon. She is on a very low dose of hydrocodone to interrupt the body-to-brain cough signal, not enough for pain, and she is slightly out of it on that medicine. I try to time the dosing so that she is less drugged around mealtimes, otherwise I do see the lethargy and disinterest. Other of her meds can also cause inappetence, but sometimes she simply slightly stoned and when she comes out of her funk will want to eat 4 meals a day like I've been starving her.

Charting out Cinnabon's many meds has been a necessity with the added benefit of helping me to see a pattern of when she is feeling her best and may want to eat or be more interested in activities.

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Re: Nerve Sheath Tumor

Postby PofiMia » Wed Apr 20, 2016 11:52 am

He has been on Tramadol a while now - varying the dosage and frequency to need. It really was necessary to use when his liver was in crisis from the gallbladder mucocele. He had greater frequency after the last surgery for several days, but that has tapered off (both amount and frequency) and now that Gabapentin and Carprofen were added back in, I am giving him 1 50 mgTramadol twice a day. The triple modality is deliberate for now. I did give him one extra Tramadol Monday night when he seemed unable to get comfortable and sleep and he really did settle down and have a better night after that.

I forgot to add that also on Friday, my vet called with our repeated hepatic blood panel from the prior night and all his liver values are "perfect" still, so that liver did bounce right back and there is no sign at this point the mucocele has returned.

He did seem "flat" last week prior to the rehab consult, but he had again had big weekend - dog park twice and a walk on that Monday. I do think, Nana, he does take longer to bounce back from exertion and the meds are adding another layer to it.

Judy, I need to chart all of this too!

Appointment with one of my vets tomorrow AM - will go before giving him his meds so we can gauge better.

Nana, you and others do think highly of the Burnsville rehab. I will consider, but I had purchased 12 sessions of rehab with U of MN and am also already in for 3 consult fees. I have to think through the value of another. I also have a recommendation from a vet on the Blue Pearl neuro specialist and they will also have MRI, but I would have to be referred to them and there would be a consult fee as well. Oi. Still, I am going to call and ask their pricing.

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Re: Nerve Sheath Tumor

Postby PofiMia » Wed Apr 20, 2016 12:01 pm

Ha. Pofi seems to be too big for the MRI that Blue Pearl has in Eden Prairie. U of MN is probably only game in town. And the price was significantly lower, so that is a plus, I guess. The volume of patients they see may mean they can actually offer a lower price. I know MRI equipment is a huge investment and has big maintenance costs.

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Re: Nerve Sheath Tumor

Postby MaisyPancakes » Wed Apr 20, 2016 12:25 pm

I hear ya about the cost, etc., LM. This shit is expensive!!! :( Just FYI, I do know that while my both my regular vet and my rehab vet *love* BP, they both recommended the U for neuro. Neither are huge fans of the U, so tend to refer most specialist stuff to BP, but for neuro, they said that the U is better equipped (their MRI isn't big enough, I believe). I considered going to see one but haven't, since I was told that they tend to just give you inactionable information, at least for a dog MP's age...so it'd be for "information for the sake of knowing" kind of thing. (We explored all kinds of possibilities and their treatments including surgery, adn none were much different from our current protocol, in our case.) :/

Yay for the bloodwork. :) <3

ETA: Oops, I didn't see your comment about the little MRI machine. Ha! :)

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Re: Nerve Sheath Tumor

Postby PofiMia » Thu Apr 21, 2016 8:09 am

Update - we saw our vet today and there was a pretty clear and consistent pain reaction to pressure under the left armpit. He concurs with the U doctor's suspicion. He also believes the U is the best place for the surgery - considers it more specialist territory.

Now we have to hope a lung x-ray and the MRI don't reveal any other bad stuff. Metastases is rare for this type of tumor.

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Re: Nerve Sheath Tumor

Postby MaisyPancakes » Thu Apr 21, 2016 9:42 am

:( So sorry, LM. :( So, next step is to MRI for visual confirmation, then removal in whatever appropriate form? Thinking of you guys. Let me know if there's anything I can do. xoxo

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Re: Nerve Sheath Tumor

Postby UpwardDog » Fri Apr 22, 2016 10:31 am

My thoughts were articulated by others already. I'm thinking of you and keeping all the crossables crossed for the best possible outcomes with smallest possible bills.

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Re: Nerve Sheath Tumor

Postby PofiMia » Fri Apr 22, 2016 5:06 pm

A positive update as Pofi really seems to have made strides in terms of handling the meds. He is much brighter and more interactive today. Even engaged in a little fence posturing.

Have been having good email exchanges with Dr. Lafond who will be lead clinician on the team. She is patiently and thoroughly answering all my questions. Chest X-ray and MRI will happen within next two weeks. If an amputation happens it will be May 16. Have had some frank chats with two local Greyhound friends who have had osteo amputations for their dogs. They have been honest and Frank, which I need. The first few days post amputation are generally pretty tough. Jen from MN Greyhound rescue has an unsparingly detailed blog on it. I recommend it for anyone facing this.

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Re: Nerve Sheath Tumor

Postby PofiMia » Tue Apr 26, 2016 12:48 pm

And now feeling down in the dumps again. He is just so, so flat. So depressed. I keep telling myself it is the meds.

Chest x-ray and potential MRI next Friday the 6th. Which is what I wanted, but now seems interminably forever away. I did not want to have MRI and chest x-ray before we got photos taken, but I am having trouble scheduling that and am afraid the dog in photos won't even resemble my happy, funny, beautiful dog. This sucks so very, very much.

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Re: Nerve Sheath Tumor

Postby MaisyPancakes » Tue Apr 26, 2016 1:35 pm

Oh LM, I'm so sorry you're feeling crummy. It is a rollercoaster indeed—I am really easy to push down the hill of misery and despair on a bad (usually hormonal!) day. It *is* a crappy, cloudy, dark,wet, cold day here—MP is extra owie today. I'm thinkin' that Pofi agrees it's a dumb day, too. Was he much better until today?

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Re: Nerve Sheath Tumor

Postby PofiMia » Tue Apr 26, 2016 2:31 pm

He was just quite excited when I was getting ready to take Mia in for a grooming. And he insisted on coming. And went into PetSmart and the grooming salon to drop her off. But then I took him into the store and he pretty much wanted to lay down right away. Same on Sunday at the dog park - super excited to go and we walked in 100 feet or so and he wanted to lay down. On April 10 he was really energetic a the park - roaming running. Then on the 15th we had the assessment and got potential diagnosis and started meds. He's been depressed and lethargic since. My brain tells me it is all the meds, but my inner demon says it is the tumor/cancer and it is much worse than we think. I think the pain meds are doing a good job of controlling his pain, but he is a zombie. Zombie Po. He only rallies to the surface for short bursts...

Sorry you are on the roller coaster, too, Nana.

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Re: Nerve Sheath Tumor

Postby MaisyPancakes » Tue Apr 26, 2016 3:01 pm

LM, AFAIK, gabapentin really does take 2+ weeks (sometimes a month) to reroute how his brain receives pain signals, but the lethargy/mental dullness/wobbliness is supposed to happen much sooner. If he's eager until he tries and then quickly gets bummed, it does sound like it could be pain—but not to worry, because it is consistent with how gabapentin is supposed to work. I do recall my rehab vet specifically warning me that MP may seem out of it or more subdued than usual, and that was supposed to be a more immediate effect—even if the pain management part doesn't happen until later (so, basically, don't be surprised if she seems down, but is still owie). Also, do I recall your mentioning in the past that Po isn't very stoic about pain? :) Some dogs can plow through a whole lot of shit with stoicism (MP!) and some dogs are more self-restricting and can't take much discomfort without letting you know. It's good that he's not out running around and hurting himself if he needs rest. :)

Try not to start extra-worrying just yet, LM!!! xoxo!

ETA: Hope scheduling your photo sessions goes OK! Luckily, we have a lot more hours of great light afternoon-evening now. :D (Assuming outdoor shoot.)

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Re: Nerve Sheath Tumor

Postby SherriA » Tue Apr 26, 2016 3:24 pm

Oh, I'm sorry LM :( I hope he gets used to the meds and you can have your sweet boy's goofy personality back soon.
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LisaT_II
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Re: Nerve Sheath Tumor

Postby LisaT_II » Fri Apr 29, 2016 7:13 pm

I am really sorry to hear your news :(

I don't know if there is anything helpful in this thread, a GSD with a nerve sheath tumor.
http://www.germanshepherds.com/forum/ar ... ery-5.html
Max-n-Indy

Info regarding Ticks and Tick Diseases
http://tinyurl.com/3arfn6r

Forum for the GSD enthusiast!
germanshepherdhome.net/forum

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LisaT_II
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Re: Nerve Sheath Tumor

Postby LisaT_II » Fri Apr 29, 2016 7:27 pm

Max-n-Indy

Info regarding Ticks and Tick Diseases
http://tinyurl.com/3arfn6r

Forum for the GSD enthusiast!
germanshepherdhome.net/forum

UpwardDog
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Re: Nerve Sheath Tumor

Postby UpwardDog » Sat Apr 30, 2016 10:35 pm

Thinking of you guys.


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