Decisions, decisions...and updates!

Today is Tuesday March 30, 2010. Three days ago was my birthday. March 27th meant a lot more to me this year than merely the celebration of aging another year...it marked the one month milestone since Heidi was diagnosed with her MCT. I almost can't believe that it has been a full month; in some ways it feels like a year...in other ways it feels like it only happened yesterday.

My last update talked about our oncology visit at NEVOG. I left there with a lot of information: thoughts on what to expect for the future and ideas on what to do in terms of further diagnostics and treatments. I have had about 2 weeks to digest all of that information. I've done more research online, and tapped my greatest resource yet: the amazingly informative and patient doctors at my practice. I've come up with the following:

Ive decided not to pursue radiation therapy with Heidi. The costs of it far outweigh any benefits I see. Here are some of the pro's and con's:
Pro's: the radiation will hopefully kill any remaining cancer cells from the site of the tumor that may have been missed/remained outside of the narrow margins obtained with surgery. The treatment is short, and the side-effects are temporary. Heidi will receive treatment for 15 days (5 days a week for 3 weeks in a row) and should be healed (from the treatment) 2-4 weeks afterwards. That's it. Those are the only pro's. And those pro's have con's.
Con's: Heidi will have to be sedated and intubated 5 days a week for 3 weeks straight. That is getting knocked out and WOKEN UP 15 times in a row. (I had 4 surgeries in 12 days and THAT was rough for me!) Although the side effects are temporary, they will obviously add on another 2-4 weeks of recovery-which means everything Heidi enjoys doing, she wont be able to because of the burns she will receive from the treatment. She is just finally able to do some of her normal activities (more about that in a bit). She will get major burns in a very sensitive area-her foreleg and ARMPIT. It will be uncomfortable to just "be", never mind walk. If we chose radiation, that is about another 5-9 weeks of her not being able to do anything except sit in the house or in the yard. And we're hitting the Spring; one of the best seasons to get out and DO. I know this sounds trivial (I'm going to risk my dogs life to let her enjoy some hikes during the spring? 1-2 months is more important than years?) but there isn't enough evidence for me to think radiation is the best way to go; that it is our best choice.

Although the margins were narrow, they were also clear. Radiation is just a "just in case"-just in case they didn't get it all. At this stage of the game, it is almost being used as a prevention. I'm not willing to let her go through such pain and discomfort for "just in case"; not when the odds are already stacked in her favor. The oncologist said that only 80-85% of dogs are cured with radiation. So there is a chance it may not even work. And if we do it now, and it does come back, it might be more aggressive and resistant to the radiation itself. What then? I did (of course) consult with the surgeon, and she assured me that should it come back (on the leg, where the odds are better of it returning to rather than somewhere else) that we did have surgical options to take wide margins again. And again, at that point (should it ever get there) we had radiation as an option. I also talked with the Dr. who has been taking such good care of us, as she knows how I feel about both my girls, and she said she wouldn't do radiation either. That made me feel even more comfortable with my decision. The decision about the RT came pretty easy. What diagnostics to run, however, is proving to be much more difficult.

The options I was giving for a full staging work-up are as follows: spleen, lymph node and bone marrow aspirates; abdominal ultrasound; chest x-rays. I'm having a much harder time deciding on what to do here. My decisions change as the days do. At first I wanted to do it ALL. My love for my girls is strong enough, (and so is my paranoia) to be willing to do it all. But my gut and very limited medical knowledge are telling me all this isn't necessary. The chest rads and ultrasound are pain free and non-invasive. A splenic and lymph node aspirate are simple enough; not non-invasive like the others, but relatively pain free. But the bone marrow aspirate...yikes! Stupidly I watched a video that showed the procedure (the video looks a bit old, but I've been told the procedure is basically unchanged: http://video.google.com/videoplay?docid=4953415127475383802#). OUCH! That definitely is invasive and painful looking! NEVOG told me they did it without sedation; she said the pet is given a local and it is not usually painful until the bone marrow starts getting sucked out. The dog in the video is knocked out, and the surgeon said she would do it under sedation as well. Although I think it would be the best diagnostic tool (I mean, if cancer cells are being manufactured in the bone marrow, there's definitely a basis to have everything else done too) but can I do that to her? Especially where her kidneys were so bothered by pain meds only a few weeks ago? What would I use if she woke up in pain or if she had a reaction to the sedation/anesthetic?

I'm still really torn about what to do. My desire to do everything possible (within reason; again, I'm not doing RT) and know as much as possible is causing conflict in my mind and heart about wanting to do the least invasive and painful procedures I can. Heidi has been through a lot. Do I want to do more to calm my own mind and get to sleep easier at night? And what if I do it all and Heidi has residual effects from the aspirates? Nothing is ever 100% safe or without risks.

I have to say that a very useful tool I have had through this whole process is the book "Speaking for Spot". I have heard great things about it all over the place: magazines, other blogs, other books and websites. I finally ordered my copy a few days before Heidi's NEVOG appointment and read the whole thing through by that day. I wanted to be prepared. And the book helped me. Working in the veterinary field has taught me a lot, and a lot of the book I already was aware of, and although it didn't help me in exactly researching or collecting information, it did reemphasize what I should be doing to be prepared for the appointment. And what I should be doing after I get the information from the appointment. I went in totally organized (what a HUGE help!) and left with all of my questions answered...and clearly got (and retained) all of the information that I got from them. I definitely recommend picking up the book before you find yourself needing it: when your dog is having a medical crisis. Its an easy read and is well organized itself. I can only imagine how much more information I would have gotten out of it had I not worked in the field! If anyone out there in the great big world is reading this, I hope you get two things out of our experiences: trust your gut, and don't wait...and buy this book! (Or see if you can borrow it at our local library!)

I really REALLY appreciate all of your kind and encouraging comments. I don't usually comment back, but I read every single one of them. It's a great way to feel connected-even though the people leaving them live hundreds if not thousands of miles away. It makes me feel included in this great "dog loving family" that includes us all. As with any family, people have different opinions and approaches, but ultimately everyone has the same goal: to do what is best for our furry charges; our "furkids". I also just want to mention that although I don't always comment on YOUR posts, I do read them...ALL. Every morning I have the same routine: check email, check facebook, check blog-roll. Overtime there is a new post, I read it. And enjoy every word. Keep writing!

And finally, the update on Heidi herself. She is doing WONDERFULLY!!! She is just about back to her old self. She had her last bandage change last weekend (after out NEVOG visit). The surgeon was changing them every day or two and decided that as the was starting to get irritated, only a few more would be needed. There is a fine line to using bandages: you have to make sure they are not doing more harm than good. Knowing Heidi's last bandage would come off last Sunday, (which meant her leg would then be exposed) I decided to take her to the farm for a walk. She couldn't even make it 1/4 of the way. And then I had to carry her for most of that 1/4 back. When we took off the bandage the next day, I found out why. The vetwrap (co-flex) that her bandage was being held on with started rubbing her fur and then her skin off. She had a crusty abrasion on her elbow and has redness and irritation on her side and forearm. I felt AWFUL! I had made her walk...and play ball the day before! She must have been really painful. But nothing will stop her from doing what she loves: playing and working. I relearned to trust her and listen to her-when she didn't want to walk, I knew something was up. It had become too ouchie for her.

But once the last bandage came off Heidi had a freedom that she hadn't had since her surgery. She could move! She was a little crunchy, as she had to use the rest of her body to over compensate for her bandaged leg, but soon got her spring and bounce back. She hasn't stopped since! The surgeon recommended this really neat cream to put on her site every day. Remember, that when the skin flap died and was then peeled off, her inner leg was pretty much exposed to the outside world. The bandage protected it and allowed it to heal quite a bit, but it was still an open wound. Well, this cream has fixed that! I bought her some shirts (they are made by "starter gear" and are very similar to the "under armour" that athletes wear-it hugs her body pretty tightly-including her legs, as it is a long sleeved shirt. I got them at Wal-mart for 3 bucks. 3 BUCKS! I bought 8!!!) and every night she gets her wounds cleaned with gauze and saline, a new application of the cream and a new shirt on. In even one week her wound has gone from its entire original length and the width of a "fat pen" to barely as long as my pinkie finger and barely as wide as a ribbon on a balloon. This is such a huge improvement! Her leg looks great and, as I said before, she is really doing well! The skin that was pulled from her side does need to stretch out a bit, but it doesn't seem like she's lost any ROM. I walked her twice last week at the park (paved surfaces) and took her to the farm again on Saturday. She did the WHOLE WALK including the "long way" via a detour on the way back. She's doing so well!!!

The girls annual PE's are coming up when I'll get their titers, HWT and 6 month blood work check and I hope to have decided on what staging tests I plan on doing. I am also seeing a holistic vet next Monday to get somemore natural ways to keep her healthy, and discuss options for pain management in the future...as we're no longer able to use NSAIDs. (We're seeing the same person Iris "The Rainbow Doggess" sees!) I will of course keep the blog updated on how things are going! Thank you all again so much for the time you take to read this journal of mine (well, the girls) and your thoughts and prayers. They all mean so much! And yes, Shelby is thrilled to have her sister (and in some ways, her Mom) back! Wrestling and tug-of-war have resumed! The best birthday presents I've ever received...