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Friday, March 19, 2010

NEVOG

This past Wednesday was the big day. The day we went to NEVOG to get some more answers; to talk to an oncologist.

Typing that sentence makes me feel exactly how I felt when I was told Heidi had cancer. And it was exactly the way I felt making the trip to Waltham two days ago. I wasn't really thinking about anything on the way down. It was like my mind was wiped blank. I was focusing on the radio; probably a defense mechanism to make sure I didn't lose control while driving and sparing the lives of all the cars that joined me on a jam-packed rt. 128. I don't remember much about the drive itself; only that I wanted to make sure I didn't miss my exit and didn't fall asleep at the wheel.

I probably could focus more on "nothing" because I did feel like I was quite prepared. I read everything I could get a hold of on the internet; and luckily I have a pretty good sense of what is true out there and what is completely false. I wasn't necessarily looking for "answers"; no website or published paper could give me those. I was looking for information to compose questions to the human being (who happened to spend years in vet school) to be able to give me the answers. Because the answers meant closure. It is one thing to be able to type in an equation and get an "answer". But very often when discussing cancer (or any health problem) the equation can change so subtly that it is almost not really noticeable to anyone not trained to look for such small variances. But the difference in answers is huge. And even more important, is the way those answers are delivered. They need to be given in a soft, gentle and compassionate way. You cant get those feelings by reading something on the disease your dog has. So as I planned on seeing one of those people who would be able to give me the "answers" I was seeking, I owed it to them (for taking their time) and of course to my best girl Heidi, to show up with the right questions and a lot of them.

So feeling prepared and having a folder and note book full of stuff made me feel a little more at ease...you know, if that is even possible while trying to cope with the fact that your child (furry or otherwise) is sick.

I got to NEVOG with only a few minutes to spare. The traffic was not bad for most of the journey, but the last leg of 128 was bumper to bumper. And then when I got off at the exit they were doing construction. Great. Then when I did get on the right street, I passed the building. Then when I got to the right building, I went in the wrong entrance (I went in to the other vet, VESCONE by accident...I guess I missed the big blue NEVOG banner...duh!). I finally did walk in the right entrance and was glad to see other dogs waiting in the lobby. (I think I would have felt 100 times worse if I had to be there by myself...) It is small (well, I'm comparing this to our lobby or that of our sister hospitals) but was not cramped or crowded. I think it was nice for the type of hospital that NEVOG is-people are all there for the same reason; like everyone belongs to the same club. So the small-ness of it was conducive to people (and sometimes pets) getting to know each other. When I walked in, there were two Golden's and a small terrier mix that was being held, and their owners were chatting a bit. I walked up to the counter and started to check in.

I gave them Heidi's name, and they asked me to put her on the scale. It was a small one that was built right into the floor (I'm sure making it more comfortable for the dogs; I'm sure they need to be weighed every week and try not to make it a big struggle). I asked Heidi to "table" and she got right on and sat down. The people waiting were pretty shocked. They couldn't believe she just got right on and sat right down;no muss, no fuss. I explained she was an agility dog and knew her job well. They seemed slightly impressed...maybe it was a little bit of a surprise that an "agility dog" could get cancer too?

Her weight was just about what it has been through out the past few weeks; she has actually gotten back to her slightly heavier weight of 22#, but she is also bandaged, has not been able to exercise and has been drinking a ton. Not that I'm making excuses, but I would like her to be a little slimmer (I would like the same thing for myself too!) I went back to the counter where they had me fill out a registration form. I could have been taking the SAT's. In Spanish. I was STRUGGLING filling out the most basic questions. I wrote my cell phone number wrong. I couldn't remember the fax number for work. I couldn't remember the date (St. Patricks day?!? You know, why everyone was wearing green?!?!?!) That's when I realized I was really out of sorts; like I was in some sort of dream state. I finally finished (after many crossings out of misinformation that I am able to give correctly every other day of my life...)

I sat down and Heidi sat with me. She relaxed right away; but she always does. She just lays down and is completely content to watch the world go by...always on the lookout for a dropped morsel though! I hadn't fed her breakfast in case she needed to fast for any tests. I also hadn't brought Shelby (which I normally do-they go just about every where together). I felt like I should just spend this time, this important time, with just Heidi. Just while we got the initial consult out of the way. One of the Goldens went in for his "treatment" (which I assumed was chemo, but I could be wrong) and then left. After a bit of a wait (we were in no rush, we could have been there all day!) The Dr. came out and took us in an exam room. We saw Dr. Rosen-a fellow in oncology (but not yet board certified...which was fine with us! I understand that even though someone doesn't yet have the certification, they still have YEARS of experience and have access to many great minds should they find themselves with a difficult case. Maybe its from being at Mass Gen so often, but working in a "teaching" environment doesn't scare me at all...)

Dr. Rosen took us into an exam room at the end of the hall, invited me to sit down, and started to ask me some questions about Heidi: how old she was, how long shes been with us and about the tumor. I explained to her about her bandaging (and the slight complications after surgery-with her wound and kidney issues) and she asked if she had any other issues. I told her about her shoulder problems and arthritis, and also about her "choking" episodes where she hard-swallows and seems to gag. I found myself faltering again. I found I couldn't remember Dr.s names that we had seen in the past. When our Q&A session had ended and she was going to start talking about the MCT, I asked if it was alright if I tape recorded the visit as my mom couldn't come with me (and I didn't know if I was in the right state of mind to remember it all). She was fine with it, but cautioned me that she might be hard to understand as she just had her wisdom teeth out! So I pulled out my mom's Sony tape recorder (that is probably as old as I am) and it the red record button. The tape was rolling, and so was the Dr.

She explained what MCT's were (a collection of mast cells that for some reason grew out of control-like any type of cancer-and usually ended up as a mass on or just under the skin) and that the first most important part of treatment was to get the tumor surgically removed. After the surgery was done, the important answers could be obtained: were there clean margins? What grade was it given and why? Heidi's was removed with CLEAN but NARROW margins: which meant that the tissue around the excised tumor was free of cancer cells, but the AMOUNT of cancer free tissue from the very edge of the sample (the outside of the circle so to speak) was less that 1cm before they found cancer. Heidi's margins were clean at .6-.8cm. Heidi's tumor was then given a grade of II-but a LOW grade II. The importance of the grade was the mitotic activity-which means how many cells were seen dividing. A number under 5 had a very good prognosis as it meant the tumor was not highly aggressive. Over 5 was more worrying. Heidi had NONE. ZERO MITOTIC CELLS SEEN! Her mast cells also were clearly defined; meaning they were still cells as you would think of them, and hadn't burst. Both were VERY good indicators of how this tumor was going to behave. The Dr. said probably the only reason it was given a grade II versus a I because it had invaded past the skin and into the tissue just below it. But all those factors from the biopsy coupled with the small size of the mass and the fact that I (think) caught it early, means Heidi's prognosis is VERY good!! Yay!!! FINALLY some good news! But there still were things to discuss...

The Dr. then talked about 3 treatment options. She was very glad to see how non-aggressive this tumor seemed, but was worried about how narrow the margins were. She said that as MCT's grow, they spread out through the surrounding tissue-not down, but out. So if there are less than 1cm margins, there is a chance (hell, there is a chance even with the 1cm margins) that there are some cancer cells that remained. Which means there is a chance the tumor could grow back-and it could grow back bigger and more aggressive. She wouldn't be as worried if it were located somewhere else on the body; we could just go in and take nice big margins to hopefully get it all again. But where Heidi's is on her leg, there is only so much skin and actual BODY that is there. She said she was worried that if it came back and we needed bigger margins, there wouldn't be enough "Heidi" to allow us to get it all. So we had the three options: 1.) watch and wait-recheck the site with our surgeon every 2-3 months for a year. If it was going to grow back, it would probably be within the year. Obviously if this was the option I chose, I would need to discuss the options of future surgery with the surgeon; to make sure if it did come back, we would have options. 2.) Scar revision-where I mentioned Heidi may need a 2nd surgery to help close the wound on her leg (which used to be the skin flap) and she suggested we take off more skin and send it to be checked; to make sure those margins were still clean and therefore also achieve larger margins. 3.) Radiation Therapy-she said that with radiation treatment to the site, it would kill (at an 80-85% success rate) any cancer cells that remained. This would involve Heidi having treatments every day, Monday-Friday, for 3 weeks (a total of 5 treatments). She would need to be sedated for each treatment (with reversible sedation) but which would involve intubation. By week one, we wouldn't really notice anything. By the end of week two, it would be a burn-like a bad sunburn. By the end of week 3, it would bee a full blown burn-raw, red, painful and weeping. She would be healed in a week or two from the burns, and her hair would grown back in a few months-and it would grow back gray.

She told me the options, but then said there was no true rush to decide on them right away. She wouldn't be able to do any RT on Heidi until her leg was completely healed-at least another month. Unless I was going to have the 2nd surgery, there wasn't any rush to a decision. HOWEVER, she did then talk to me about other diagnostic tests. The talked about doing aspirations on her spleen, lymph nodes and bone marrow. She also suggested chest x-rays and an abdominal u/s. It would be about 1000$ for the diagnostics through them (but probably a lot cheaper at our hospital) and then it would be 3500$-4000$ for radiation therapy, should I decide to pursue that. Clearly I have some big decisions to make...

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That's the jist about how the consult went. As you can see, great news! Essentially, if your dog is going to get a MCT, the kind Heidi has is sort of the one you hope for: small, low grade, and seemingly not that aggressive. I'm glad we have not only have AN option, but several. I am SO THANKFUL that the prognosis is good. I am so GRATEFUL that my girl has such excellent care. And I am so HOPEFUL that we have a long and golden road ahead of us...
(next update will let you know what I have ultimately decided to do...I think, anyways! My mind keeps changing slightly from day to day...) Thanks again for the support and well-wishes!!! Heidi and I appreciate all of the good thoughts and vibes!

7 comments:

  1. Heidi's ordeal is very similar to what I went through with my dog Maggie last year. In a couple weeks will be the one year anniversary of her diagnosis of MCT. Her tumor was on her belly (grade 2 but lots of satellite cells)- so lots of tissue there to be removed and it was also very near a lymph node so the oncologist was worried it had spread to the lymph system. I opted to have marrow aspiration and the removal and biopsy of the nearby lymph node, as well as the usual abdominal x-rays. In the end, everything worked out in our favor - clean margins and clean lymph node/marrow pathology report.

    When I hear Heidi's story, it brings back all those feeling of stress and uncertainty that we face when dealing with something like this. I can really empathize with what you are going through right now.

    Your oncologist seems to be optimistic (and they always tell it like it is), so that is good news for Heidi. I will keep positive thoughts for Heidi (and for you).

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  2. I'm so happy that you got some good news, and maybe you will be able to sleep a little bit better now.

    I'll be thinking about you & sweet Heidi.

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  3. Im so happy that you got some good news. Good thing you were on top of things and took your dog right away to get checked when you noticed that little bump. I will definitly be more observent of bumps on my dogs. Diana

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  4. Glad you got some good news - we're thinking of you and Heidi too!

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  5. what great news! I hope things continue to go well for you both!

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  6. That's wonderful news. I hope you can make a decision on what to do next. It's so difficult to do that. She's such a beautiful dog. All the best to all of you!

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  7. happy for you..but i am going for the first time and you never mentioned cost..this is my concern

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