Thursday, February 19, 2009
Sarcoma: A Zoey Update
the doggie oncologist at the emergency vet service we have been using did a biopsy under anesthetic just before they did some imaging studies of Zoey's tumor and lungs.
The CT scan was recommended because the surgeon was not sure from the X-rays whether or not the tumor has twisted around nerves, or involved the ribs or infiltrated the chest wall.
So yesterday morning, we all sat on the floor of a small exam room at the animal hospital, the surgeon, the doggie oncologist, the original vet who had examined Zoey three weeks ago, the oncology/imaging tech, the Engineering Geek and me, with Zoey dozing half-on, half-off my lap.
The best outcome would be if the tumor was a (benign) lipoma, they said. But unfortunately, Zoey's tumor was not acting like one. It was growing fast, having doubled in size since the first exam, and it was growing in stair-step fashion, like a malignant tumor does: growing like mad until it outgrows the blood supply, then stabilizing while more capillaries are made, then growing like mad again. The problem of knowing what the tumor is, the surgeon opined, was secondary to knowing whether or not it was resectable (surgically removable). The oncology guy wanted to do a biopsy under anesthesia, should we consent to imaging.
The issue was this. We wanted the tumor removed, but we didn't want to put Zoey through it if ribs were involved, or if there were any complicating factors.
I can't imagine consenting to the removal of several ribs from an old dog.
And if the tumor was malignant--well, that would bring a new set of considerations.
I also did not want to wait on another biopsy. We needed to get some information.
Yesterday afternoon, the surgeon called. The oncologist had examined the cells himself. He was pretty certain that the previous inconclusive results were due to muscle that was over the tumor. And he identified the tumor as a hemangiosarcoma, an agressive cancer that is often not discovered or identified until it has metastasized. Although this cancer is found more often in canines than in any other species, it is still relatively rare, accounting for 7% of malignant tumors in dogs. It is known as the silent cancer, because the tumors are often not noticable until onset of very rapid growth. In Zoey's case, it has not metastasized, but the CT scan showed that two or three ribs are likely involved. If surgery is done, and if the tumor is resectable with wide, clean margins, then the chances of recurrence are 40% within 6 months to a year. However, I just read that there is some promising research involving tyrosine kinase inhibitors as part of chemotherapy. But that is rather academic in Zoey's case, unfortunately, because first we have to know if the tumor is resectable.
The surgeon e-mailed the CT images to a board certified vetinary radiologist for a second opinion, but as I said above, her own impression of the images is not promising. We are waiting for word from the radiologist, which is likely to come tomorrow.
Realistically, though, I believe we are looking at a maximum of two months survival with no treatment except palliative care.
Right now, Zoey is home, with three different medications to help with the pain. And it has been helping. She ate twice today, and has shown periods of curiousity and liveliness that have been missing altogether in the past two weeks. However, I am noticing bouts of panting, and she is sleeping a great deal as the tumor robs her of her energy. And her mobility is severely compromised by the location of the tumor under her front left leg. I know that as time goes on, there will be more bad days and fewer good ones, until Zoey's number of days is fulfilled.
We are preparing ourselves to say good-bye to our dear Zoey. Today, when I took Lily to our local vet for her shots, I spoke with her about what would happen when the time comes to put her down. They will do it at the local clinic, in an old house under a cottonwood near Tijeras Creek. We will bury Zoey's ashes here, at home, in her beloved mountains.
Zoey has been my dog from the moment the neighbor girl brought her over, saying that she had been abandoned at a pet adoption. She has followed me around the house and supervised my outdoor work. She has slept at my feet or next to my side of the bed for the past nine years. When the time comes, there is going to be an awful hole in my world, and in the family.
I have cleared my schedule of all but the most essential tasks, so that I can spend as much time as possible with Zoey hobbling at my side, or sleeping nearby while I write.
So once again, we wait. Bowing to the inevitable circle of life, we count every precious moment we have left with her as a blessing.
As the Boychick said, through racking sobs last night, "When you get a dog, you know this day will come. But knowing it doesn't make it any easier."