The Day I've Been Dreading

Since our last visit, the infection in Hudson's mouth has gotten much, much bigger.  I called and asked if I should bring him in last week, but the back up oncologist is only in on Thursdays.  I could have seen the internalist, but I won't lie, I wanted a board certified oncologist to look at it, rather than have someone else guess.

The cytology done last time came back negative, but Dr. Janson had also said that they couldn't find a lot of tissue to look at.  It was mostly blood when the needle was stuck in.  The mass has increased to four times its original size and Dr. Glawe, the back up oncologist, is fairly certain it's another metastatic osteosarcoma tumor. In addition to the increase in the mouth mass, we found two other new subcutaneous lesions during this visit.  While the Kinavet is doing it's job and decreasing the size of the shoulder mass, it isn't stopping new growth.

The mouth mass is painful for Hudson, so we have scheduled surgery on Monday, June 4th to have it removed by Dr. Stubbs.  This will be a debulking procedure to make him more comfortable, but will not remove all the affected tissue.

We could start Hudson on Leukeran, if desired.  It, like Kinavet, is not intended to treat Osteosarcoma tumors.  Both are intended for mast cell cancers.  The chance of efficacy is only 20%.  Palladia is also an option (and a mast cell chemo,) but side effects are 75% likely and include GI upset, urinary concerns and internal bleeding.  While we have been lucky with Hudson and he has experienced very few chemo side effects, I am not willing to put him through the side effects that could occur on Palladia.  We've already seen that his cancer is very adaptable.  No matter what chemo we put him on, the cancer is twisting itself to become immune to it.

 Hudson is like a garden.  The seeds of the weeds are already there.  For each one we pull, another pops up in a different location.  This is why we are choosing not to remove the subcutaneous lesions.  The fact that he has developed multiple masses since our last visit is very concerning.  While he is still feeling good at home and hasn't been sick, the rate at which he is developing new masses has led Dr. Glawe to expect his quality of life to begin to decline in the next few months.  She is estimating that he has 2 to 3 good months left.

Working from Home with My Kids

One of my favorite things about my job right now is my Work-From-Home-Fridays.  I sit at a table outside with my laptop while my babies sunbathe. J

 Hudson is channeling his inner bad-ass Dane by faking some cropped ears. J

Accupuncture

Porter has been diagnosed with three different spinal conditions in three different locations of his spine.  Dr. Landy didn't feel that pain meds were needed at this point, but suggested that Porter be brought in for accupunture to relieve some of the pins and needles discomfort that he is likely feeling.  Since Hudson has GOT to be sore as well from changing his gait, I decided to start bringing him as well.

Normally, Dr. Rob does his accupuncture while his patients rest comfortably on the couch, but my guys are too big for that.  That doesn't stop Porter from taking over the couch while we wait. :)

Acupuncture has helped Porter tremendously.  He experiences nervous tics in his face that have dropped off significantly since we began acupuncture.  Dr. Landry has been really pleased with his reaction and his gait has certainly improved.  We don't hear his nails dragging nearly as much when he walks and he doesn't slip as often on the wood floors either.

Hudson was very sensitive in his back end when we first brought him in.  That makes sense, since he has already been diagnosed with spondylosis.  One of my fears when proceeding with the amputation was that he would perhaps have difficulty hopping on one leg with his pre-existing condition.  Acupuncture has helped tremendously.  His reactivity to the needles is much less than the first visit.  He gets up easier now and we are seeing less slipping as well.  Dr. Rob is also treating for nausea and GI discomfort, so that eases my mind.  I've always been afraid that Hudson isn't feeling well, but doesn't show me.  (He only rarely will pass food by.)

Kinavet Follow Up

Hudson went in for a post Kinavet follow up today.  I had found two more masses since we last were in, so we had cytologies done for both.  There was a mass on his hip which was found to be a benign cyst.  There is a small infected looking mass in his mouth by his front bottom teeth.  That was determined to be a benign infection.  Good news for both of those.  (The mass is visible in the pic below on the lower left side of his mouth.

As usual when starting a new chemo, Hudson's white blood cell count fell lower than anticipated while on the Kinavet.  We are taking a one week break from his Kinavet treatment (and taking Cyclophosamide every day) before reintroducing it at a lower dosage.  Dr. Janson said that she has never treated a Dane that didn't have sensitive bone marrow when it comes to chemo. :)  He had been fairly lethargic on his Kinavet days, so I was anticipating his low white cell count.

This was Dr. Janson's last appointment with us prior to the birth of her baby, so she discussed next steps and provided contact info for her maternity back up, Dr. Phyllis Glawe from Deer Creek Animal Hospital.  We have an appointment set up to see her on May 31st.

Things NOT to Say to a Pet Parent Struggling with Cancer

• Your dog is really lucky you're willing to do that.  I think that this is intended as a compliment, of sorts.  However, it comes across with a silent "because I sure as hell wouldn't" attached.
• Why are you spending so much money on a dog?  This one particularly upsets me.  It's my money and I can spend it however I like.  If your child was sick, I would never question you spending money to save them, even if it was to prolong their life for a very limited time.  Hell, I don't care if you blow all your money on a convertible.  It's not my money and how you spend it doesn't affect me.
• How much time does he have left?  I think the intention here is good, but any time you remind me that my dog is dying, that's not helpful.  Even though Hudson is doing well and is happy, the end result of osteosarcoma is always in the back of my mind, I don't need any reminders.
• Isn't it cruel to put him through all that?  Making the decision to amputate and treat with chemo is extremely difficult.  You second guess yourself constantly.  You struggle with your choice every time even a hint of a side effect occurs.  The last thing you need to hear is someone implying that you are purposely hurting your pet.
• I would never treat my dog with chemotherapy, it's so hard on him.  This is almost the same as the "isn't it cruel" comment above, only this one punches you in the heart.  This is almost an accusational comment.  I felt like I was personally being attacked.  To make it even worse, we'd only just gotten out of the hell week after amputation when this comment was made.  I was already physically and emotionally exhausted, and this really hurt.  It doesn't matter that the person knew nothing about canine chemo and its side effects.  In fact, that makes it worse.  I was being judged for something that the person knew nothing about.
• How will you know when it's time to put him down?  There isn't a day that goes by that this isn't already on my mind.  Please don't ask me to make you a checklist.
• Oh...cancer....that's a death sentence.  I know that.  Trust me, that's the first thing I thought of when the vet gave me the diagnosis.  The last thing that someone fighting osteosarcoma needs to hear is the worst case scenario.