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!
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