Today was amputation day. My household got up at 6am (a few hours earlier than we are used to) in order to get Millie to U of I by 7:00. Poor Mil was sleepy. We had a quick "poop walk" & Millie put herself back to bed. She sprawled across the pillows & gave me a look like, "Mom. Seriously. The light?"
Evan & I showed up at U of I just before 7:00. We were clearly the first clients of the day, which is nice considering Mil isn't a big fan of other dogs. Our student & resident came out to greet us and also answer any last minute questions we had. They apologized to us and said we could no longer wait with Millie up front. An emergency had come in, so Millie's surgery had been bumped from #1 to #2. They expected to start sometime after 10:30am. I held it together & kissed my girl one more time. The surgeon said that I should expect a call when Millie was intubated & again when extubated. She wouldn't call during surgery unless something went wrong.
Just a few minutes after noon, our student called to say Millie had been intubated. They were about to give her an epidural & start prepping her leg for surgery. An hour later my phone rang. Helllllllo panic. It was the surgeon. Hellllllllllllllllllllo panic! She started the conversation by saying, "Hi Katie. This is Dr. ____. We found a nodule .....(insert longest pause in history).......on Millie's back. We think it's a cyst. Would you like it removed?" ARE YOU KIDDING ME?! A cyst?! For the love of all that is good and holy - my heart was in my throat. My response, "No, leave it. It's been there for as long as I can remember, it's been aspirated before -- and yes it is a cyst. How is surgery going?" They hadn't started yet. One HOUR later. What the hell was taking so long? Thank goodness I have a few "insiders" at the U of I. Friends checked on Millie throughout the surgery & texted updates. Just after 4:30 our student called again. Millie was extubated. She was recovering well & already trying to stand (though they were not allowing this). The surgery had gone well & exactly as they had expected. Phew.
Around 6:30pm the surgeon called with another update, but basically nothing new to report. Millie was resting comfortably. She had plenty of pain meds on board & was still recovering well. She was scheduled to go outside (attempt) at 8pm and 2am. They would also try to feed her at 8pm.
Tomorrow morning they will re-run bloodwork & see how she is doing on three legs. At that point they will decide how the day will play out. Will she need to stay another night? Will she need physical therapy? Can she go home?
I can finally relax a little, although I don't think I'll be at ease until she is back home. Shugs is loving the extra space on the bed, but we all miss Millie. I've seen this phrase listed over and over again during the past week - "Dogs are born with three legs and a spare." My Mil just got rid of that nasty spare. Good riddance.
(photo credit: Geoffrey Tischman)
Tuesday, January 31, 2012
Monday, January 30, 2012
Surgical Consult with U of I
This morning we had Millie's surgical consult with U of I. Evan & I rode together with Mil & my mom met us at the clinic. Mil was pumped to see my mom, practically exploding with joy! She was uneasy when we got inside, but was pretty pleased that some of her most favorite people were there. We were called back fairly quickly by Millie's 4th year vet student. A technician student from a local college was on her soft tissue?/osteo?/surgical? rotation, so she would be shadowing the appointment. Believe it or not, this tech student was the same assistant who helped assist with Millie's unofficial diagnostic x-rays at our regular vet. What a small world.
The 4th year student did a physical exam & took down notes about Millie's history and medications. I immediately liked her, which is a good thing, since she'll basically be taking care of Mil while she stays at U of I. The poor girl weighs all of 98lbs, so Mil might give her a run for the money. Speaking of weight, Mil is down to 137. That is the smallest she's been in her adult life! This is fantastic news & will hopefully help her learn to be a three legged dog even faster. Anyway...the 4th year student relayed everything to our resident...who then relayed it to the staff surgeon. All of them came back into the room to explain exactly what would happen, what kind of complications I could see, etc. They fear that because Millie is still weight bearing on all four limbs she will have a harder time learning to balance on three - maybe even needing physical therapy. They mentioned that she has a touch of arthritis in her right rear (which I knew) and just a hair of arthritis in her right elbow (surprise to me). Almost all of this information was what I expected. The one thing that threw me off was where they would amputate the leg. All along I had expected a full amputation (taking it from the hip), but they wanted to do a partial amputation - leaving part of her femur. I expressed concern about this method, as every other person providing an opinion had suggested taking the whole leg. I think I would have been more comfortable about the whole change in plans had my concerns been taken seriously. They were almost dismissed. "We prefer to do it this way" was all I heard. NO! This is my dog, my baby girl, and I need to know why. The second time around they tried to address my questions, and did a decent job of explaining themselves. When the resident and staff surgeon left I still was not 100% comfortable with how this was being handled, but figured I could re-think it & run it by Donna later. The 4th year and I chatted about Millie's normal routine, how often she would walk her, when I could come visit (at the very earliest it will be Wednesday late afternoon!! -- seems like forever), etc. She seemed to really like Millie, and I really like her. So, at the very least, I knew I would feel good about Millie's post op care. Our student would also be in observing the surgery, and promised to call as soon as Millie was anesthetized and again when she was extubated. She also told me that I could stay with Millie tomorrow morning until the absolute last minute before her surgery. Thank goodness. We ended the consult with a visit from the oncology resident that we had a consultation with last Thursday. I have a much better feel for him now and am pleased he took the time to answer any last minute questions I had about chemo.
Mil ended the day by coming to work with me (getting lots of snuggles, treats & well wishes) and another short walk around the neighborhood. I was able to order her special harness as well. The gentleman I spoke to was fantastic & offered to put it in the mail today, so that I could have it by Wednesday. Donna called and talked me off the ledge regarding amputation site. I swear I couldn't do this without her.
I can't even believe her surgery is tomorrow. Forget that, it is less than 12 hours away. I will not vomit. I will not vomit. I will not cry. I will not cry. Tonight is going to be a long night.
The 4th year student did a physical exam & took down notes about Millie's history and medications. I immediately liked her, which is a good thing, since she'll basically be taking care of Mil while she stays at U of I. The poor girl weighs all of 98lbs, so Mil might give her a run for the money. Speaking of weight, Mil is down to 137. That is the smallest she's been in her adult life! This is fantastic news & will hopefully help her learn to be a three legged dog even faster. Anyway...the 4th year student relayed everything to our resident...who then relayed it to the staff surgeon. All of them came back into the room to explain exactly what would happen, what kind of complications I could see, etc. They fear that because Millie is still weight bearing on all four limbs she will have a harder time learning to balance on three - maybe even needing physical therapy. They mentioned that she has a touch of arthritis in her right rear (which I knew) and just a hair of arthritis in her right elbow (surprise to me). Almost all of this information was what I expected. The one thing that threw me off was where they would amputate the leg. All along I had expected a full amputation (taking it from the hip), but they wanted to do a partial amputation - leaving part of her femur. I expressed concern about this method, as every other person providing an opinion had suggested taking the whole leg. I think I would have been more comfortable about the whole change in plans had my concerns been taken seriously. They were almost dismissed. "We prefer to do it this way" was all I heard. NO! This is my dog, my baby girl, and I need to know why. The second time around they tried to address my questions, and did a decent job of explaining themselves. When the resident and staff surgeon left I still was not 100% comfortable with how this was being handled, but figured I could re-think it & run it by Donna later. The 4th year and I chatted about Millie's normal routine, how often she would walk her, when I could come visit (at the very earliest it will be Wednesday late afternoon!! -- seems like forever), etc. She seemed to really like Millie, and I really like her. So, at the very least, I knew I would feel good about Millie's post op care. Our student would also be in observing the surgery, and promised to call as soon as Millie was anesthetized and again when she was extubated. She also told me that I could stay with Millie tomorrow morning until the absolute last minute before her surgery. Thank goodness. We ended the consult with a visit from the oncology resident that we had a consultation with last Thursday. I have a much better feel for him now and am pleased he took the time to answer any last minute questions I had about chemo.
Mil ended the day by coming to work with me (getting lots of snuggles, treats & well wishes) and another short walk around the neighborhood. I was able to order her special harness as well. The gentleman I spoke to was fantastic & offered to put it in the mail today, so that I could have it by Wednesday. Donna called and talked me off the ledge regarding amputation site. I swear I couldn't do this without her.
I can't even believe her surgery is tomorrow. Forget that, it is less than 12 hours away. I will not vomit. I will not vomit. I will not cry. I will not cry. Tonight is going to be a long night.
Sunday, January 29, 2012
Four Legged Sunday Funday
I've tried to make the most of this weekend for Millie. We've put it more cuddle minutes than you can imagine, gone on several short walks, and both dogs got a bath today. I had planned the bath, but it was quite necessary following Millie's hunt & kill of a stray black plastic bag this afternoon - including a full slip and slide in the mud just before the death pounce.
Believe it or not, bath time is one of Millie's favorite things (see video).
I've washed her favorite toys, collar, and bed as well - after all, a clean dog should have clean things. We've spooned on the couch & watched re-runs of Curb Your Enthusiasm (with a few breaks to bark at squirrels outside). As Evan has said a few times, Millie thinks cancer is pretty amazing.
Saturday, January 28, 2012
Bone Biopsy Results
Well, it is official. Millie has cancer.
The results came in to VCA Aurora at 7:51am this morning. Sometime later that morning, they faxed them to Donna. She called me to pass along the results (which is incredibly, incredibly nice of her considering I won't get a call from VCA until Monday -- when oncology staff come back to work). The complete diagnosis is: Chrondroblastic Osteosarcoma, Low Grade Malignancy. Prognosis: Guarded.
As awful as it is to hear the results, it is what I was preparing for. The little, itty, bitty present is that it is a a low grade malignancy. So, as terrible as osteosarcoma is, at the very least she has the better end of this cancer. I'm hoping that amputation & chemo can kick that low grade malignancy's ass.
So, the plan is still the same. I will bring the biopsy results with me to U of I on Monday when we have the surgical consultation. My understanding is that they will do a physical exam & talk to me about exactly what they are planning to do. I expect I'll hear advice on how to take care of her once she's home, what to expect in general, pain management, etc. Her surgery will then be scheduled for the next day. I'll be able to bring her home on Monday, but she'll need to be very early Tuesday morning. I've already been told that she'll have to stay at least one night (maybe more -- all depending on how her surgery goes). The good news is that I should be able to come visit.
I've been thinking about how to best help Millie adjust to three legs. I found a lovely website (tripawds.com) with a lot of useful tips. One thing I worry about is how she'll balance when she squats to go to the bathroom. I also worry about her getting in and out of the car & getting out of the crate after surgery. I suspect that she'll get better and stronger with time, but I worry about her immediately following surgery. A harness on Tripawds looked like it might do the trick. It's called the Get-A-Grip harness from AST (pictured below). I called the company today, but haven't heard back. I'd really like to have it here before she comes home, though I doubt that will happen.
The results came in to VCA Aurora at 7:51am this morning. Sometime later that morning, they faxed them to Donna. She called me to pass along the results (which is incredibly, incredibly nice of her considering I won't get a call from VCA until Monday -- when oncology staff come back to work). The complete diagnosis is: Chrondroblastic Osteosarcoma, Low Grade Malignancy. Prognosis: Guarded.
As awful as it is to hear the results, it is what I was preparing for. The little, itty, bitty present is that it is a a low grade malignancy. So, as terrible as osteosarcoma is, at the very least she has the better end of this cancer. I'm hoping that amputation & chemo can kick that low grade malignancy's ass.
So, the plan is still the same. I will bring the biopsy results with me to U of I on Monday when we have the surgical consultation. My understanding is that they will do a physical exam & talk to me about exactly what they are planning to do. I expect I'll hear advice on how to take care of her once she's home, what to expect in general, pain management, etc. Her surgery will then be scheduled for the next day. I'll be able to bring her home on Monday, but she'll need to be very early Tuesday morning. I've already been told that she'll have to stay at least one night (maybe more -- all depending on how her surgery goes). The good news is that I should be able to come visit.
I've been thinking about how to best help Millie adjust to three legs. I found a lovely website (tripawds.com) with a lot of useful tips. One thing I worry about is how she'll balance when she squats to go to the bathroom. I also worry about her getting in and out of the car & getting out of the crate after surgery. I suspect that she'll get better and stronger with time, but I worry about her immediately following surgery. A harness on Tripawds looked like it might do the trick. It's called the Get-A-Grip harness from AST (pictured below). I called the company today, but haven't heard back. I'd really like to have it here before she comes home, though I doubt that will happen.
I plan on lowering my bed this weekend as well. I'll take it down off of the frame so that it is easier to get her into bed for post surgical snuggles.
Millie continues to act normal. She is taking several pain meds, so I'm sure that plays a very large role in how well she is doing. She was very stoic following her TPLOs though, so I wonder about how she really feels. Sugar's stomach upset has gone away too. Therefore, we spent a good portion of the day enjoying life as much as possible. I took each dog on a walk (though not too long so that Millie wasn't sore), and we even had a bit of a dance party (okay, it's me dancing & singing to the animals, but they seem to enjoy it & dance with me). I am trying to make this weekend as fun as I can for her. We want to celebrate life on four legs before we get rid of that nasty tumor.
Millie has also gotten in a fair bit of barking at the neighbors. I'm fine with that. Honestly, this dog can do anything she wants for the rest of her life.
Thursday, January 26, 2012
Consultation with the University of Illinois
This video was taken yesterday (1/25/12). Look at this adorable, nerdy girl. Ugh, I love her!
Today marks our second oncology consultation - this time with the University of Illinois. Millie & I picked up Donna and Evan, then made our way to vet med for an appointment at 11am. The waiting room was decently full, but this time is was mostly pet owners without their pets. There was an elderly man with a cat & a woman in her 50's with a very handsome Pit Bull. The Pitty was beyond thrilled to be there & was quite vocal & determined to come say hello to the Kate Moss of Mastiffs (referring to Mil's sassy new figure at 140lbs). We had to move twice to avoid Millie showing the Pit Bull just how much she didn't care for him. Mil was nervous, but seemed pleased to have me, Donna & Evan there. We've become "Team Millie."
After a short wait, we were introduced to our oncology intern. He was a nice guy, but I wasn't over the moon excited about him. Evan reminds me that it is hard for medical professionals to remember all the details about every one of their patients, and also understand how each person prefers to receive information. However, when he asked about her TPLOs & said, "Oh she had them in her knees and her hips?"...I was unimpressed. To his credit, he seemed to be much more knowledgeable about oncology (as he should as an oncology intern). He was pleased she already had a biopsy & talked to us about what we hoped to get out of today while he examined her. Mil was great during her exam, and even snuck in a few kisses. We decided we would do chest x-rays, CBC/Chemistry & a urinalysis. If each of those were clear then we would discuss the possibility of amputation & chemo afterwards...though I couldn't help myself from asking some questions right away. We left Mil & were told to return around 3:00pm so that we could go over the results of the diagnostics. Donna left to meet a friend for lunch & Evan and I stopped for a bite at Subway. It's hard not to only talk about Millie, so as it has been for the last several days, we continued to talk about Millie.
When I returned home, I discovered that poor Sugar had an accident. She's been having stomach issues off and on (besides her normal, super sensitive stomach) for the past few weeks/months. I called her vet & asked if they would have time to see her. We scheduled her appointment for 4:00pm.
Just before 3:00pm, the doctor called to let me know the good news. Millie's x-rays were clear! We had been told this was likely the case, but nevertheless this is GREAT news! Her bloodwork (minus her creatinine being up just a hair -- 1.7 & high end of their normal is 1.5) and urinalysis were both normal. Minus her leg issue, this girl was given a clean bill of health!
We picked up Mil & set up a surgical consultation for next Monday, 1/30/12, at 10:00am. Hopefully we'll have the biopsy results by then. If so, her amputation surgery could be as early as 1/31/12 -- providing her biopsy shows osteosarcoma. Her chemo treatments (1 treatment every 3 weeks for a total of 5 sessions) would start the day they remove her sutures.
Sugar's appointment went well. Her bloodwork is normal too, which is always nice to hear considering she'll be 13 soon. Her vet suspects anxiety induced GI issues (she's always been an anxious girl), or increase in stomach sensitivity as she ages. She's on FortiFlora, eating Purina EN with chicken & rice mixed in, and taking anti-diarrheal meds. Let me tell you -- this girl LOVES her some chicken & rice.
Millie seems to be doing just fine. She has some minor swelling at the biopsy site, but in all honesty I've been letting her do whatever she wants (see video above). In some respects it makes this process easier, but it can also make it more difficult. If it is osteosarcoma, it will be difficult to take her in for an amputation when it looks like she is doing so well. On the same token, I know this is what will give her the best chance at a longer life. So far I've been comfortable in every decision I've made. I hope that it will always be that way, and that I won't ever second guess myself.
Now for some adorable Millie (& Shugs) photos....
Oh so ladylike
This is a favorite activity for both girls...staring out the window waiting for the next killer (or child, or postman, or...a leaf blows by), so they can loose their minds barking. Good work girls. Good work. Also, take note just how lazy Mil is. She is sinking into the couch, spread eagle with her upper body pressed into the couch & head resting on top. I'm actually jealous of her perfect form.
Tuesday, January 24, 2012
Consultation with VCA Aurora
One consultation down, and one to go. We (me, Millie, Donna - my veterinarian friend & Evan) started the 3 hour drive to Aurora this morning at around 8:30am. The way up was spent mostly talking about what options we expected to be presented, sharing advice passed on to us from other friends in the veterinary field, discussing other research, and what I hoped to gain from today. Donna & I had only briefly spoken about Millie's unofficial diagnosis when I called her crying & asking her to accompany me to the consultations. So, in all honestly, the drive up to Aurora seemed to go pretty quickly.
We arrived early, but because they were overbooked, they could not see us until our scheduled appointment. I had time to take Millie on a walk (I was instantly annoyed by a woman who let her 15ish pound terrier mix off leash & come "say hello" (yes, she said this) AFTER I had told her Millie doesn't do well with other dogs -- so we narrowly avoided a mishap in the parking lot. Mind you this woman did the same thing to a Jack Russel & the two dogs got into a fight. Awesome.), let the humans take a potty break, fill out paperwork & drive us to a local Mexican restaurant for some lunch.
We arrived back at the clinic just before 1:00pm. The waiting room was large, but was also decently full. There were at least 6 dogs in the room, all situated a comfortable distance from one another. As I sat down with Mil I could feel myself becoming emotional. Donna picked up on this right away & was very supportive. Something about waiting to be called back made everything feel more real. I was waiting to hear what Millie's options were...her actual options, rather than what we had been guessing about after internet research. Also, when you look around at the dogs & the faces in the clinic, it is hard not to feel the sadness around you. Since this is a specialty clinic, you know that each patient is there for a real, possibly life-threatening issue. The pet owners disposition seemed to vary based on what their pet's issues were. You could tell that the old Lab with the shaved face & front leg had been in for multiple visits. It showed on his face & the owner's face. Ugh, talk about being able to feel sadness. I don't ever want Millie to feel that way.
At 1:00pm we were taken into a somewhat comfy room (basically an exam room, but with couches) & were greeted by our doctor who is a board certified oncologist. She sat down, took a breath, and started talking...and talking...and talking. I'm not certain she took a breath for 10 minutes. No kidding. I did not like her. I felt like she was giving me the basics on the disease, and nothing more. It felt like she was reading me a script. Millie was not a patient, she was simply a name filled in the blank that was her afternoon routine. She offered to calculate estimates for each of the options & I agreed. I just wanted her out of the room. After I expressed my displeasure, Donna & Evan talked me down some. Both reminded me that they were overbooked, and that the doctor would have more time to chat when she came back into the room. Thankfully, they were right. The veterinarian came back into the room just the way I had hoped our consultation would go - she was well informed, confident, but very willing to talk about what each option meant for Millie.
Palliative care (pain management until the cancer either causes a pathological fracture, or cancer overtakes the body) with the possibility of adding bone growth medication and/or radiation would be anywhere from $2,640 - $3,300. In my mind this was the least aggressive treatment, and not something I was interested in. This course of treatment would give Millie roughly 2-4, maybe 5ish months. I just didn't think it was giving her good quality of life for the little amount of time they guessed she'd be here. Plus, I want & hope that she is one of the 10% of dogs that beat the odds.
Amputation was the next option. Amputation alone they thought would give her 6ish months. The idea behind amputation is to remove the major source of discomfort (aka the tumor in her tibia). Sure, amputation is not a walk in the park (no pun intended), but the thought is to exchange some uncomfortable days/weeks for months of relatively pain free time. Amputation alone would cost anywhere from $3,361 - $4,201. The oncologist thought that Millie would do quite well with a rear limb amputation. Her right knee and hip look great, and since it is a rear leg, she should have fewer problems than if it was a front leg (since the front legs support about 60% of the body, and the rear take the remaining 40%). We also briefly discussed what type of amputation to do -- mid thigh or dislocating the hip & taking all of the leg. I didn't decide on which would be best, but I guess, as morbid as it sounds, nice that there is an option?
Chemotherapy in combination with amputation would, in theory, give her the most amount of time, and at least the chance to beat osteosarcoma. While I remain realistic about her odds, I'm also staying hopeful. Aurora would recommend six treatments of carboplatin. They would amputate first, then start chemotherapy. She would have three treatments -- one treatment every 3 weeks -- and then repeat staging procedures (radiographs, ultrasounds, etc). If her radiographs were clear, they would finish with the last three chemo treatments. Staging aside, chemo would cost roughly $4,320 - $5,406. The combination of amputation & chemo would give her closer to 6-12 months, but fingers (& toes crossed) she'd have much, much longer!
The oncologist also let us know that Millie could qualify for some of the partially funded studies that U of I was doing. After an initial period of somewhat excitement, we found out (through Donna's research) that she would only likely be eligible for one of the three studies. That one study was not what I was interested in as it was more along the lines of palliative care. We, did, however find out that U of I's costs should be lower than Aurora's estimate. I do not have an estimate in hand though, so who knows if that will change come Thursday.
Before leaving Aurora, we decided to have a bone biopsy done. That morning, I had decided that I probably would not get a biopsy (cost, would it be painful to Millie?, etc). Our oncologist strongly urged that we do a biopsy. She stated that if Millie had walked in without having had a TPLO she would feel like we were almost certainly looking at cancer. However, since she had a metal implant, there was a chance that the boney changes were due to a bacterial or fungal infection. She said that doing a biopsy would not make the cancer spread any faster than it already was, and we would be able to have an official diagnosis one way or another. We weighed the option of doing the biopsy today or waiting to do it at U of I. Since the sample has to decalcify, it would take the same amount of time to be read from either clinic. The appointment with U of I was not for another day and a half, and if it is cancer, every little bit of extra time you have is important. So, in an effort to make an official diagnosis & truly determine the course of treatment, I elected to do a biopsy. I decided against chest x-rays simply because we did not need them done that day. I'm not sure if it makes sense to have them done at U of I on Thursday, or if we wait until we get the biopsy results back. I need to make a note to ask Donna....
Millie's biopsy went without a hitch. They sedated her & gave her pain meds before taking a...or I guess two biopsies. One sample was from the "spongy" bone, and the other was closer to her TPLO plate. She has a small incision with one tiny suture. Millie walked out of the clinic the same way she walked in, without a limp. She seemed to be thirsty, and a little gassy...but honestly, that's Millie!
I think I ultimately agreed to have the biopsy because I wanted to know, one way or another, what Millie and I were up against. The doctor said they should have the results as early as Friday, and as late as Monday. So, fingers crossed we hear good news.
The doctor gave me a prescription for yet another pain medication, Amantadine, and told me that I could double the dose of Gabapentin if needed.
The ride home seemed to take forever. My emotional roller coaster was over *kinda*, and again all I had to do was hurry up and wait. What an emotionally draining day. I dropped off Donna & Evan, picked up a quick meal at Subway, filled Millie's prescription & came home. It was 7:30. Millie and I both ate & I called my mom to update her. The cats promptly got into a fight - kudos for awesome timing... My mom agreed to keep Sugar for tonight so Millie & I could relax & unwind from the day instead of drive to St. Joseph to pick up Shugs. Plus, lets be honest, Shugs loves herself some Nana time.
Evan asked me on our way home if I felt better after today's consultation. The short answer is no. I don't think I will ever feel better about a cancer diagnosis. What I do feel is better prepared. At the very least I have options in front of me and a diagnostic test pending. Millie clearly is still under the impression that cancer is awesome. She has been getting showered with special treatment, extra treats, and more cuddle time than one dog could ever ask for. This is how I intend to keep it.
Piper, on the other hand, could care less...
We arrived early, but because they were overbooked, they could not see us until our scheduled appointment. I had time to take Millie on a walk (I was instantly annoyed by a woman who let her 15ish pound terrier mix off leash & come "say hello" (yes, she said this) AFTER I had told her Millie doesn't do well with other dogs -- so we narrowly avoided a mishap in the parking lot. Mind you this woman did the same thing to a Jack Russel & the two dogs got into a fight. Awesome.), let the humans take a potty break, fill out paperwork & drive us to a local Mexican restaurant for some lunch.
We arrived back at the clinic just before 1:00pm. The waiting room was large, but was also decently full. There were at least 6 dogs in the room, all situated a comfortable distance from one another. As I sat down with Mil I could feel myself becoming emotional. Donna picked up on this right away & was very supportive. Something about waiting to be called back made everything feel more real. I was waiting to hear what Millie's options were...her actual options, rather than what we had been guessing about after internet research. Also, when you look around at the dogs & the faces in the clinic, it is hard not to feel the sadness around you. Since this is a specialty clinic, you know that each patient is there for a real, possibly life-threatening issue. The pet owners disposition seemed to vary based on what their pet's issues were. You could tell that the old Lab with the shaved face & front leg had been in for multiple visits. It showed on his face & the owner's face. Ugh, talk about being able to feel sadness. I don't ever want Millie to feel that way.
At 1:00pm we were taken into a somewhat comfy room (basically an exam room, but with couches) & were greeted by our doctor who is a board certified oncologist. She sat down, took a breath, and started talking...and talking...and talking. I'm not certain she took a breath for 10 minutes. No kidding. I did not like her. I felt like she was giving me the basics on the disease, and nothing more. It felt like she was reading me a script. Millie was not a patient, she was simply a name filled in the blank that was her afternoon routine. She offered to calculate estimates for each of the options & I agreed. I just wanted her out of the room. After I expressed my displeasure, Donna & Evan talked me down some. Both reminded me that they were overbooked, and that the doctor would have more time to chat when she came back into the room. Thankfully, they were right. The veterinarian came back into the room just the way I had hoped our consultation would go - she was well informed, confident, but very willing to talk about what each option meant for Millie.
Palliative care (pain management until the cancer either causes a pathological fracture, or cancer overtakes the body) with the possibility of adding bone growth medication and/or radiation would be anywhere from $2,640 - $3,300. In my mind this was the least aggressive treatment, and not something I was interested in. This course of treatment would give Millie roughly 2-4, maybe 5ish months. I just didn't think it was giving her good quality of life for the little amount of time they guessed she'd be here. Plus, I want & hope that she is one of the 10% of dogs that beat the odds.
Amputation was the next option. Amputation alone they thought would give her 6ish months. The idea behind amputation is to remove the major source of discomfort (aka the tumor in her tibia). Sure, amputation is not a walk in the park (no pun intended), but the thought is to exchange some uncomfortable days/weeks for months of relatively pain free time. Amputation alone would cost anywhere from $3,361 - $4,201. The oncologist thought that Millie would do quite well with a rear limb amputation. Her right knee and hip look great, and since it is a rear leg, she should have fewer problems than if it was a front leg (since the front legs support about 60% of the body, and the rear take the remaining 40%). We also briefly discussed what type of amputation to do -- mid thigh or dislocating the hip & taking all of the leg. I didn't decide on which would be best, but I guess, as morbid as it sounds, nice that there is an option?
Chemotherapy in combination with amputation would, in theory, give her the most amount of time, and at least the chance to beat osteosarcoma. While I remain realistic about her odds, I'm also staying hopeful. Aurora would recommend six treatments of carboplatin. They would amputate first, then start chemotherapy. She would have three treatments -- one treatment every 3 weeks -- and then repeat staging procedures (radiographs, ultrasounds, etc). If her radiographs were clear, they would finish with the last three chemo treatments. Staging aside, chemo would cost roughly $4,320 - $5,406. The combination of amputation & chemo would give her closer to 6-12 months, but fingers (& toes crossed) she'd have much, much longer!
The oncologist also let us know that Millie could qualify for some of the partially funded studies that U of I was doing. After an initial period of somewhat excitement, we found out (through Donna's research) that she would only likely be eligible for one of the three studies. That one study was not what I was interested in as it was more along the lines of palliative care. We, did, however find out that U of I's costs should be lower than Aurora's estimate. I do not have an estimate in hand though, so who knows if that will change come Thursday.
Before leaving Aurora, we decided to have a bone biopsy done. That morning, I had decided that I probably would not get a biopsy (cost, would it be painful to Millie?, etc). Our oncologist strongly urged that we do a biopsy. She stated that if Millie had walked in without having had a TPLO she would feel like we were almost certainly looking at cancer. However, since she had a metal implant, there was a chance that the boney changes were due to a bacterial or fungal infection. She said that doing a biopsy would not make the cancer spread any faster than it already was, and we would be able to have an official diagnosis one way or another. We weighed the option of doing the biopsy today or waiting to do it at U of I. Since the sample has to decalcify, it would take the same amount of time to be read from either clinic. The appointment with U of I was not for another day and a half, and if it is cancer, every little bit of extra time you have is important. So, in an effort to make an official diagnosis & truly determine the course of treatment, I elected to do a biopsy. I decided against chest x-rays simply because we did not need them done that day. I'm not sure if it makes sense to have them done at U of I on Thursday, or if we wait until we get the biopsy results back. I need to make a note to ask Donna....
Millie's biopsy went without a hitch. They sedated her & gave her pain meds before taking a...or I guess two biopsies. One sample was from the "spongy" bone, and the other was closer to her TPLO plate. She has a small incision with one tiny suture. Millie walked out of the clinic the same way she walked in, without a limp. She seemed to be thirsty, and a little gassy...but honestly, that's Millie!
I think I ultimately agreed to have the biopsy because I wanted to know, one way or another, what Millie and I were up against. The doctor said they should have the results as early as Friday, and as late as Monday. So, fingers crossed we hear good news.
The doctor gave me a prescription for yet another pain medication, Amantadine, and told me that I could double the dose of Gabapentin if needed.
The ride home seemed to take forever. My emotional roller coaster was over *kinda*, and again all I had to do was hurry up and wait. What an emotionally draining day. I dropped off Donna & Evan, picked up a quick meal at Subway, filled Millie's prescription & came home. It was 7:30. Millie and I both ate & I called my mom to update her. The cats promptly got into a fight - kudos for awesome timing... My mom agreed to keep Sugar for tonight so Millie & I could relax & unwind from the day instead of drive to St. Joseph to pick up Shugs. Plus, lets be honest, Shugs loves herself some Nana time.
Evan asked me on our way home if I felt better after today's consultation. The short answer is no. I don't think I will ever feel better about a cancer diagnosis. What I do feel is better prepared. At the very least I have options in front of me and a diagnostic test pending. Millie clearly is still under the impression that cancer is awesome. She has been getting showered with special treatment, extra treats, and more cuddle time than one dog could ever ask for. This is how I intend to keep it.
Look at that bottom lip! (Yes, she's wearing a shamrock bandanna -- for good luck, of course!)
Piper, on the other hand, could care less...
Check out that yawn!
Sunday, January 22, 2012
Unofficial Diagnosis
I am a day late in starting this blog, but honestly I didn't do much more than cry, cuddle Millie & talk on the phone yesterday. At her 10:20 appointment yesterday morning, Millie was unofficially diagnosed with osteosarcoma, or bone cancer. I say unofficially because she has not had a bone biopsy yet, and at this point her doctor is using his gut & her x-rays to say that he suspects she has osteosarcoma.
I knew, just knew that Millie's radiographs would come back as suspicious for osteosarcoma. Since I adopted Millie in 2007, my two biggest medical fears with her were bone cancer and bloat...and here I am faced with one of the two...the less desirable of the two...
On 1/19/12 I returned home from a very hectic day at work. We had a new corporate client come in & my afternoon was taken over by meetings. I didn't have time to run home to walk Sugar & Millie. A friend & I had planned to meet up for dinner & drinks after work, so she happily followed me back to my apartment to walk the girls before heading out together. We walked in, and Sugar was immediately at our feet, and supremely sorry. She had an upset stomach, and couldn't hold it. As I cleaned up her diarrhea Millie happily wagged her tail in her crate. My friend took Sugar for a walk & I let Millie out of the crate to leash her up. Millie emerged from the crate with a slight limp. As she danced around waiting for the leash to be hooked up, she seemed to lose any sign of a limp. I brushed it off as nothing, assuming her leg had fallen asleep due to the way she had been laying, and out we went. I mentioned it to my friend, though, but more of as a, "my day couldn't get any worse after cleaning up diarrhea, and now my other dog is limping..." kind of thought. Later that evening I returned home & Millie was still using all four feet just fine.
I had the next day, a Friday, off. I had just returned home from a work conference, so this day off was in place of one of my travel days. I had missed the girlies while away, not to mention a few TV shows, so I planned to do nothing but cuddle the creatures & catch up on TV. We had a glorious day of nothing. Later in the evening my boyfriend, Evan, came over, and I noticed Millie limping again after greeting him. It was in that moment that I knew. Something just felt off. I hoped that I was wrong, and that it was just some unknown arthritis triggered from her TPLO & the recent cold weather, but I knew. I had Evan hold her so that I could palpate both back legs & could feel that her left knee was slightly bigger than the right. I had him walk Millie up and down the hall while I stared at her back legs. I called a friend who was working at the emergency clinic (since it was around 11pm at this time), to see how much an exam & radiographs would be. She gave me prices, and said that as long as Millie was okay, I could probably wait until tomorrow & go to her regular vet. She was right, Millie was fine. I was impatient, but I had to keep my budget in mind. I decided to wait until the next morning to take her in.
At most, I slept an hour. I had my alarm set for 8am to call the clinic, but there was no need for an alarm. I watched the minutes tick by. At 8:01, I called the clinic & they fit me in at 10:20. My veterinarian is amazing, and performed both of Millie's TPLO surgeries (one in the end of 2007 & the other in the beginning of 2008). He knew Millie's joints & history, and I was confident that he could give me an answer. During her physical exam we laughed & made small talk. He initially suspected what I was longing to hear - flare up of arthritis in her knee with the sudden cold weather change. He told me that he had another suspicion, but didn't even want to say it out loud because he knew I already had it on my mind - osteosarcoma. A Mastiff we both know, about Millie's age, was recently diagnosed with osteosarcoma, and he knows me well enough to know that is what I was worried about. We both decided that radiographs were in order. Millie was lead away & I knew she was going to be a bit of a troublemaker in x-ray. She hates being on her back, and I have helped hold her for radiographs when I worked in this same vet clinic a few years ago. They were gone for 10 or so minutes & an assistant returned Millie to the room while the veterinarian went to do an annual exam on a patient in the other room. I felt sick to my stomach. If it was nothing, I knew he would have come in, told me so, and we would have joked about me overreacting. Instead, he was attending to the other patient. I suspect that he knew I would have a million questions after giving me the news. When he finally entered the room, he apologized about the wait & said he was worried. Her radiographs looked like she had osteosarcoma in her left tibia & maybe fibula -- right where her TPLO plate is.
1/21/12 - Millie's left knee (suspected osteosarcoma)
1/21/12 - Millie's right knee
He advised that I go to the University of Illinois Vet Med for an oncology consultation. We briefly discussed options (palliative care, radiation, amputation, chemo - or a combination of some of those). He helped me answer my immediate questions & assured me that he would give her good pain medication that we could start right away. He gave us Tramadol & Gabapentin. I held it together as best I could, but found it difficult to do so with so many emotions & questions running though my mind. I have a million times convinced myself that my animals have some horrible injury/illness/disease/etc, and have always been happily surprised to find out they were okay. Today was different. Today I was proven right. My dog has cancer. My dog. Evan took Millie to the car while I paid the bill & waited for her x-rays.
Evan drove home while I called my parents & brothers to share the news. My next call was to an incredible friend who is also a veterinarian. I asked her to come with me to Millie's oncology consultation. She graciously agreed to do so. A few calls later & that was all I could do. I needed cuddle time with Millie. Her pain meds had made her pretty tired, so she was quite happy to cuddle. One of the cats had so nicely peed on the bed, so I was left standing in my room, staring at a pee spot & crying. Evan stripped the bed, gathered extra blankets & helped Millie on to the bed (she can get up just fine, but now I was worried about her jumping). While he started laundry, picked up the apartment & washed dishes, I cuddled Millie & cried. I know she can sense my attitude, and I want to keep her spirits up, but I needed some time to just be sad. Millie has always been an excellent cuddle partner, and she lived up to her very best performance.
My veterinarian friend called in yet another pain med for Millie, and after picking up her Rimadyl, I went home to start my research. Saturday evening was spent scouring the internet for anything and everything that could be useful. Evan & I looked up everything from cancer basics to prosthetics to doggie wheelchairs. I wanted to be as prepared as I can be. I scheduled two oncology consultations -- one for VCA Aurora on 1/24 (just because I had heard good things about them) and one for the University of Illinois on 1/26. My hope is that I will feel better about where we stand after having two consultations. The last thing I want to do is make a poor decision for her treatment. Two has to be better than one, right? The more information, the better I will *hopefully* feel about any decision.
I have been told that our first step is diagnosis via a bone biopsy & chest radiographs. Though, they hope Millie's chest is clear of any obvious metastasis, if it is there, her treatment plan will be dramatically different. In something close to 90% of dogs, the cancer has micro-metastasized elsewhere in the body, which is why they usually recommend chemotherapy with this type of cancer. Another treatment? to strongly consider is amputation of the affected limb. Her veterinarian says that her right knee and hip look great, so he suspects she'd do just fine with three legs.
At this point I am trying not to drive myself crazy by over thinking things, but to also trying to become well informed. My CareCredit available balance has been increased (thank GOD for CareCredit), I've been approved for some time off of work for her appointments, and my veterinarian friend has agreed to accompany me to both oncology appointments (how wonderful is she, right?!). Millie seems to be feeling well, and really, that is the most important thing. The best advice I've been given at this point, has been to remember to listen to what Millie is telling me. Right now she is telling me it is time to pee & go to bed.
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