February 19th 2008 10:15 am
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Ellie is only three and on December 7th we heard one of the scariest words imaginable "cancer". In late September my husband and I thought we noticed Ellie possibly favoring a back leg. It was only when she was full out sprinting and we weren't entirely sure which leg was even causing a problem. The slight gate change was so small, we questioned whether or not we were just paranoid or if it was really happening. She was due for her first chiropractic appointment that week so we decided to mention it (she's mildly displastic and the chiropractic is a way to help make sure she has less problems as the years go on).
Our vet had us take Ellie out back to watch her run when we mentioned this slight change we had noticed. He thought he saw it too, but couldn't pinpoint which leg was to blame. He did a very thorough, all over touch exam (not easy with a dog that is 130 lbs.) and found a very small, lump on her back left ankle. This thing was so small and it moved so much that is was hard for any of us to find even after we knew it was there. We were sent home to keep an eye on it for a month. I guess it moved and felt like a lypoma (sp?) which is just a normal, fatty tissue growth that can occur, especially in high stress areas like on a leg joint.
At the beginning of November we took her back in. The lump was definitely more formed and easier to find. You still had to squeeze on the muscles to really feel it, but it had changed consistency. The vet decided we needed to get an ultrasound done on this thing, but no one seemed to think that it was anything more than a lypoma. One week later, that's what the ultrasound revealed. They thought it really looked like a lypoma, but a blood vessel was feeding into it and that was causing the rapid growth. My husband and I debated for a while about what to do. He didn't want to cut into a healthy dog and put her under anesthesia just to remove fatty tissue. I didn't want to keep this growing thing inside of my dog. In the end, the vet recommended surgery since it was growing so fast and causing a change in her gate (again, only when she was full out sprinting).
December 7th was surgery day. My husband got sent out of town last minute for work and I got a phone call from the vet at around 11:00. This scared the crap out of me. Ellie was in surgery. And this was the vet, not a tech. She said, "This doesn't look good." Basically, after cutting into her leg, what looked like a mass was more of an octupus like growth with tendrils wrapping around nerves and tendons. This is not something a lypoma does. This is something soft tissue sarcomas do. She gave me the option of trying to remove what she could which could possibly cause tendon damage which would paralyze the leg, or she could biopsy the tissue and we could send it off for a concrete diagnosis. Of course I said lets biopsy it. The leg seemed to be perfectly healthy and I didn't want to damage it. But man was that a long day. I cried and cried and I had to take a friend with me to the vet to pick Ellie up because I was so zoned out I was afraid I might not hear everything I needed to hear. This was a good thing because she seemed way more drugged than I had ever seen her and I don't think I would have been able to get her in the car or the house by myself.
It was a painful two week wait on the biopsy results. The local lab could only isolate that it was cancerous in nature, but they couldn't figure out what type. There were various options and some were really severe. Our vet tried to prepare us for the possibility of amputation. We looked into prosthetics and wheelchairs, but we really didn't want to have to do this. Removing her back leg would more than likely lead to a hip replacement on her other leg within a year due to the added stress on an already mildly displastic hip. Right before Christmas we got word that it was a 1-2 Grade Periferal Nerve Sheith Sarcoma. There are no vet oncologists in Utah, so our vet recommended Colorado State University. We wanted to make sure we were comfortable with her care, so we checked out a few other treatment centers too. Luckily, we are originally from Colorado and we have family there, so this wasn't as hard on us as it could have been. We scheduled Ellie two appointments with two specialists while we were home for the holidays.
Dr. Dernell at CSU was the first vet we met with and he gave of us several options. One, we could just do radiation at the site, but this type of treatment usually guarantees that the tumor will return in 1-2 years (and when they return they are usually more aggressive). Two, we could do surgery to debulk the tumor and then follow up with radiation. This has an 85% effectiveness. The final option was to amputate. This is 100% effective, but we felt very extreme for her age and her hip situation. Dr. Dernell agreed and felt that for Ellie, the surgery with radiation was the best option. They did an xray of her leg and chest to make sure that the tumor hadn't spread to the bone and that nothing else was going on. Everything on that end was good. He recommended surgery as soon as possible and tentativley put Ellie on the schedule for a Friday surgery (we saw him Wednesday).
The other vet we saw only gave us two options: radiation or amputation. She didn't feel comfortable doing a surgery on a tumor she knew she couldn't get clean margins on. We discussed this and we just didn't feel comfortable putting her through radiation knowing the tumor would come back or taking her leg. So we called Dr. Dernell and scheduled the surgery. He was so great about answering our millions of questions and being patient. We really felt good about the choice.
So Ellie had her surgery and we discovered that even this well seasoned surgeon was shocked at just how much of a mess this tumor was. He explained it like opening a bag of spaghetti, it just went everywhere once you broke through the surrounding tissue. They were able to get what they thought was about 90% of the growth and they sent off the tissue to be re-biopsied. We took Ellie home for what was supposed to be a two week healing period. Radiation would start when our vet gave the all clear. It would be 18 days of treatment with anesthesia every day and weekends off.
Ellie didn't heal normally after this second surgery. She kept getting a seroma (internal fluid build up) when we took her pressure bandage off. This happens when the body is trying to fill dead space from tissue removal and since it was on a joint, I guess they are harder to heal. After four weeks of dealing with this, we were sent back to CSU. Dr. Dernell said radiation needed to optimally start within four weeks of the surgery to be effective. We would just have to deal with the seroma as we went. We were also told during this four week period that her tumor had been rediagnosed to a synovial cell sarcoma from the new biopsy. This is a much more rare form of cancer that is associated with the joint capsule. There is no breed or age predisposition.
This time around at CSU, we met new people. Dr. Greenberg would be helping Dr. Dernell on the oncology end and Dr. LaRue was going to be our radiation oncologiost. Since we were at a teaching facility, we would also have a new student every two weeks making sure Ellie was taken everywhere she needed to be and had everything she needed. This turned out to be a really good thing because these specialists get soooooo busy, you rarely get the chance to just sit down and talk. The students are your eyes and ears. We also met Dr. Robinson who was going to be Ellie's accupuncturist. I had read that this can really help with the side effects so we wanted her on board. So team Ellie went in to get reviewed on Monday, January 28. Radiation started Tuesday. The scheduled end date was February 21.
Something you should know about Ellie is that she never has done anything the easy way. If there is a 1% chance of something, she's that 1%. And she's always had sensitive skin. She had a follicular inflammation that got really bad one year and required surgery (99.9% of the time these aren't an issue) and she reacted to her internal sutures when she got spayed as a puppy. Her skin is very transparent and her hair is super soft (apparently this is a sign of skin sensitivities in dogs). So, on top of the seroma, a week into Ellie's radiation she reacted to her internal sutures from her surgery. That's right, they just started popping through the skin. And she also started showing symptoms from her radiation that most dogs don't get until weeks after their treatment is finished. So now, we are dealing with severe radiation burns, a seroma, and a suture reaction. Things got so bad last Wednesday that I said enough. I told the faculty we were taking a long weekend. Ellie wasn't doing well, physically or emotionally. I was really worried about causing more harm than good.
So, we took a break. It seemed to really help. Thursday and Friday were all about keeping her comfortable and finding the right dose of pain meds. Saturday and Sunday were all about being a dog and having fun. By Monday, she was a whole different animal. Now, the oncologists didn't agree with this break, the radiation oncologist and the accupuncturist were all for it. And I believed it was the right thing to do. If there is anything that I have learned from all of this, it is to trust your gut. You know your animal. Not every dog fits every protocol. Doctors by nature like to follow their protocols because they have numbers and statistics that give concreteness to their treatments. But we as pet owners know when our animals have had enough.
I should have listened to my gut from the get go. I was highly concerned about my dog favoring a leg, having a lump of any kind on her body, and proceeding with treatment when my heart was telling me to stop. Now I feel better. I really hope we get through these last few okay so that we can start the healing process. Am I sure we did the right thing? I don't know. I see the pain she is in every day and I can't help but wonder. She is our baby girl, truly our kid. We did what we felt was right at the time based on everything we read and were told. But I don't think I could ever put her through this again. I'm not sure what route we would go if it ever came back. But know this, Trust Your Gut.
If something about your animal doesn't feel right, say something. We always felt like the neurotic pet owners who were always calling the vet and hacing problems. We know now that we'd rather be too careful than not not careful enough. There's too much at stake. 50% of dogs will get cancer in their lifetime. The numbers are less with cats, but still pretty high. And it's not just older dogs. Ellie is three. Quite a few of the dogs I've seen at CSU are just as young. There's a wide range of breeds and ages. Cancer does not discriminate.
Please feel free to write if you have any questions. I want to help as many people as I can through our experience. We did switch Ellie to a raw diet and added various supplements to help fight this thing. Everything I read said that protein basically starves tumors and carbs help feed them. I should mention that her tumor is now just being classified as a soft tissue sarcoma. Dr. Dernell didn't feel that it visually associated enough with the joint to be synovial cell.
When her treatments are done we will be able to take her home and go through the long healing process from the radiation side effects. There are no tests to see if we completely killed her cancer. We just have to watch her and be on the lookout for anything suspicious. Just another situation in our lives where we will have to Trust our Gut!
I do want to thank Dr. Israelson and Dr. Hillegass (our vets) for finding the tumor in the first place and making sure we had the best care available. It's important to have a vet you feel comfortable with and trust.