Four Life Altering Words

I’ve been sitting on some not great news for over a month now and not knowing what to do with it. I’ve told family and close friends, but I wasn’t sure whether I wanted or even how to tell my extended network of friends on Facebook. But by not doing so, I felt like I was withholding something that has or will soon come to define me. Four life altering words that are almost as hard to write as they are to say: I have ovarian cancer.

I was diagnosed a week before Thanksgiving. I’d been struggling what I thought were symptoms of gastroesophageal reflux disease for months, and they had grown increasingly difficult to treat with multiple handfuls of Tums throughout the day and night. I now know all the things I was experiencing–heartburn, upset stomach, difficulty eating, nausea, vomiting, bloating, loss of appetite, fatigue–taken together are symptoms of ovarian cancer. But it wasn’t until they began to  persist, and when normal interventions didn’t help that I took them seriously enough to make an appointment with my GP. And even then I thought I just needed a prescription for acid reflux. I was wrong. Test results showed something entirely different.

So here I am several weeks, many tests and a diagnostic surgery later waiting to learn when I’ll begin chemo–within the next 2 weeks is what they’re saying. The diagnostic surgery indicated the best course of action would be 3 chemo treatments over a 9 week period, surgery, and then a repeat of the chemo.

In the past several weeks I’ve moved from deer in the headlights denial to a desire to get started with treatment. I’m frightened, and I’m worried, and I still find it difficult to wrap my head around this reality. There’s no history of cancer in my family, so I never imagined I would hear the words: you have cancer. Now that I have, I’m not sure how to proceed other than to take the pragmatic course and prepare as much as I can for what my immediate future holds.

Yesterday I had my hair cut really short so there is less of it to fall out when that process begins. Thus far, that’s been one of the most difficult things to accept. Cultural scripts are tough to escape. I’m hoping to have the new do hang in there long enough to get used to it!

I’m sharing this information now because I feel the need to express myself, my fear and my determination. And I know I will need the support of my family and friends, those here and those in cyberspace, and my sense of humor to get through this. I have always been an extrovert. I like people and from daily living to my profession, my life is mostly talking to people.

I’m trying to keep a brave face and have fun with the hand I’ve been dealt. My friend Sharon gave me a card that perfectly sums up how I feel:

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The unknown is the hardest, but I have an excellent gynecological oncologist and a great team working with her. She’s optimistic, and while there are no guarantees, she feels confident that I’ll leave treatment in remission and will stay so for a good many years. I’m counting on that and entering the New Year with her optimism, my determination, and the love and support of family and friends. And let’s not forgot the Princess Pooch who has wrapped up her months of chemo and is doing well. She’s my role model.

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The Princess Pooch’s Cancer Treatment

Although I had planned to document the Princess Pooch’s cancer treatment, a number of things conspired over the summer to make that difficult to do. Now that I have some time I want to share her and our experience.

As I last wrote in  July, we had a consultation appointment with Dr. Hershey at Integrative Veterinary Oncology and upon her recommendation, began treatment on July 21, 2017. The treatment plan was as follows: treatments of Carboplatin every 3 weeks for a total of 6 treatment and blood work and chest x-rays at specific times during this treatment to monitor her white cell count and to look for metastasis in the lungs. These are ways of assessing the effectiveness of the treatment.

Although the Princess Pooch experienced some nausea a few days after her first treatment, she had no such reaction during her subsequent treatments. In fact, if not for the bandage over the IV site, no one would suspect she’d had any treatment at all. Now, 5 months since her initial diagnosis and just a little over a month out from her last chemo treatment, the Princess Pooch is tumor free and living the life of a happy senior pup. She’s as active, playful, and loving as ever. We couldn’t be happier!

She had her first post-chemo exam on December 5th, and since all was well, her next examine will be in early February. Although the cancer will eventually return, our goal is to keep her as healthy and happy as possible for her remaining days.

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FHO Recovery, Osteosarcoma and the Path Forward

I haven’t written since sharing the results of the Princess Pooch’s bone biopsy. I was in a kind of fog for awhile, and then I began doing what academics do: reading everything I could find on osteosarcoma in dogs. In addition to all that’s available on the internet–general veterinary publications and people sharing their own experiences with their dogs–I am fortunate to have access to a university library and all the wonderful databases that are available. I found a number of studies published in the journal of Veterinary & Comparative Oncology particularly informative.

After getting recommendations for veterinary oncologists from our regular vet, I called the folks at Integrative Veterinary Oncology. When the person I spoke to said their first available appointment was August 16th, my heart sank, but she then informed me that the doctor held times open for urgent cases and once she received the necessary records from our vet and the hospital where the Princess Pooch had surgery and had time to read them, I would get a call about finding an opening much sooner. True to her word, I received a call that evening. The doctor had received all the necessary records, taken the time to read them, and could see the Princess at 3:00 on Thursday. Whew!

By Wednesday I had read everything I could wrap my mind around, so I decided to make a list of the things that brought the Princess joy. I wanted to have this list when we spoke to the doctor so I could be clear about what “quality of life” meant for the Princess. Also, and anyone who knows me will not be surprised by this, I wrote up a list of questions and concerns. I did this so if I fell apart during our discussion with the vet, I could hopefully return my focus to what the Princess needed.

Thursday was a big day for us and for the Princess. First, we had an 8:30 am appointment with her surgeon for a post-op visit and to remove her staples. She’d been such a good dog about leaving her incision alone. I’d caught her licking it a few times, but as soon as I said “leave it,” she’d stop. I also was diligent about keeping an eye on her throughout the day, then putting the e-collar on her overnight. So that morning, Mr. Desert lifted her into the car and onto the bed we had there for her and off we went. She was excited to be in the car but was a good girl and mostly stayed in her bed which we appreciated because we didn’t have to worry about her slipping and sliding around.

Once we arrived at the hospital, we didn’t have to wait more than a few minutes before a tech took her back to remove the staples while we waited in an exam room. When the surgeon brought her back, he told us there were no staples to remove! We were both shocked; in fact, I think we both asked if he was sure. I knew the staples were there when I put the e-collar on her and tucked her into bed the night before, so where the hell did they go? Thankfully, her incision was healed and the surgeon was pleased with her progress, so we headed home. 20140181_10155343574666071_5728962414438881682_nHere’s a photo of her happy on her sofa for the first time since her surgery.

After we got home and got her settled, I decided to dig around in her bed: sure enough, I found five staples! I don’t know how many were in the incision, but she’d clearly pulled them out as we drove to the hospital. The little sneaker took advantage of the fact I wasn’t really paying attention anymore because we were on the way to get the things out! She’s one smart pup!

Oncology Consult
We arrived for our appointment a bit early, and the vet ended up running a bit late, so we spent some time in what is a lovely waiting area with big comfy sofas and chairs, cold bottles of water, coffee, a table with jigsaw puzzles, and a big glass door that opens into a room where the house kitties available for adoption. Yesterday there were 4 young adult tuxedo cats romping around, playing, and flying up and down the cat tree. We also met a couple of folks whose animals were being treated. One woman had an 8 year old cat who had been undergoing treatment for a year, and another woman said her dog had been undergoing treatment for 4 years and was now 11 years old. She couldn’t say enough about how fabulous Dr. Hershey is and how much she’d helped her dog. Her dog finished up his treatment before we went in to see the doctor, so we got to meet him. He’s a handsome grey and white pitbull. He ran up to his person with a big smile and a powerful tail wag. So by the time we were called back, we were feeling more hopeful.

We were taken to a huge room with more comfy sofas and easy chairs, and when the doctor came in she introduced herself, shook our hands then sat down on the floor to greet the Princess. She checked her out as she talked to us about her observations and what she’d learn from reading the records she’d received. She was very down to earth and clear, so much so I didn’t even open the notebook I’d brought!

In some ways, she said, the hip fracture was good because it drew attention to the bone which in turn helped them diagnosis the cancer early. She was clear that there is no cure for oseosarcoma, and that the goal of any treatment is to address pain and provide extended quality of life. She talked about recent studies, confirming what I’d been reading; answered my questions about the various drugs used to treat the cancer; and explained why she was recommending a particular treatment plan. Essentially there are 3 drugs used to treat oseosarcoma in dogs: Carboplatin, Doxorubicin and Cisplatin. Although Doxorubicin is the cheapest of the 3 drugs, it can cause irreversible injury to the heart, so it’s not a good choice. She explained that Cisplatin used to be the drug of choice because the cost of Carboplantin was prohibitive–often exceeding $1,000 per treatment while Cisplatin cost between $300 to $500 per treatment. The problem with Cisplatin, however, is that it is distributed widely into the liver and kidney and so requires tests on renal concentrating ability, azotemia and presence of abnormal numbers of granular casts in urinary sediment; because of the effects on the liver and kidney, a fluid diuresis pre treatment of several hours is required. Fortunately, the price of Carboplatin is no longer prohibitive, and studies show it is as effective if not a bit more so in treating Oseosarcoma. And, it doesn’t require fluid diuresis pre treatment; this is particularly important for the Princess Pooch because last year she was diagnosed with early renal disease.

So, the treatment plan is as follows: treatments of Carboplatin every 3 weeks for a total of 6 treatment and blood work and chest x-rays at specific times during this treatment to monitor her white cell count and to look for metastasis in the lungs. These are ways of assessing how effective the treatment is. In addition to being a board-certified veterinary oncologist, Dr. Hershey has also studied traditional Chinese veterinary medicine with Dr. Xie at the Chi Institute in Reddick, Florida and combines conventional Western therapies with acupuncture, herbal medicine, nutrition, ozone therapy, ultraviolet therapy and other therapies. Here a video of an interview with Dr. Hershey where she talks about this training.

The Princess Pooch had her first treatment yesterday afternoon, and other than some lethargy has had no side effects. The good news about chemotherapy and dogs is that side effects such as vomiting and diarrhea are rare, and if they do occur usually last a day or two.

In the meantime, her recovery from the FHO surgery is progressing well, and we’re hopeful this treatment plan will give her good quality of life for at least a year. Given her age, 12, that would be a wonderful gift.

 

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The Worst Possible News

Yesterday we received the worst possible news, something we knew was a possibility but were hoping wouldn’t be the case: the Princess Pooch has osteosarcoma, an extremely aggressive cancer that generally spreads rapidly to other parts of the dog’s body; in fact, the cancer has often metastasized by the time it is discovered. The National Canine Cancer Foundation reports that

Osteosarcoma is the most common primary bone tumor found in dogs. It accounts for up to 85% of all malignancies originating in the skeleton. It mostly occurs in middle aged to older dogs, with a median age of 7 years. Primary rib OS tends to occur in younger adult dogs with a median age of 4.5 to 5.4 years. Larger breeds have a high propensity for the disease. Dogs like Great Dane, Irish setter, Doberman pinscher, Rottweiler, German Shepherd and Golden Retriever are at greater risk of contracting osteosarcoma because of their size and weight. Intact males and females are also highly predisposed. Osteosarcoma can occur in any bone but the limbs account for 75%-85% of all affected bones and is called ‘appendicular osteosarcoma’. The remaining affects the axial skeleton comprising maxilla, mandible, spine, cranium, ribs, nasal cavity, paranasal sinuses and pelvis. Osteosarcoma of extraskeletal sites is rare, but primary OS has been reported in mammary tissue, sub-cutaneous tissue, spleen, bowel, liver, kidney, testicle, vagina, eye, gastric, ligament, synovium, meninges and adrenal gland. It develops deep within the bone and can become excruciatingly painful as it grows outward and the bone is destroyed from inside.

We knew this was a possibility when her fracture was diagnosed, and they used the bone removed during the surgery for the biopsy. The surgery, however, was necessary to address the fracture and, since the pre-surgery x-rays of her lungs were clear, this was the best first step. Often in the case of “appendicular osteosarcoma,” the limb where the cancer is located is amputated; we’re hoping the FHO surgery will stand in for the amputation and have decided we’re not going to put her through another surgery even if that’s not the case.

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Princess Pooch, July 15, 2017

We’re devastated by this news but are doing our best to think about what’s best for the Princess. We’re waiting for an opportunity to talk with our own vet before moving forward, but our most likely next step will be to consult a veterinary oncologist. We’re lucky to live where there are a number of such specialists and facilities. A standard treatment for this cancer, in addition to amputation, is chemotherapy which apparently can present very few to no significant side effects in dogs. So, we’re open to that course of action if our vet and the oncologist believe it will help. From what I’ve learned, the surgery addresses the pain of the cancer, and in the Princess Pooch’s case the fracture, and the chemo provides additional time during which the dog doesn’t suffer the effects of the cancer.

According to the Princess Pooch’s surgeon and echoed by this canine osteosarcoma fact sheet, the prognosis is as follows:

  • without any sort of intervention, the average survival time is approximately two months after diagnosis;
  • if amputation is performed the average survival time is increased to six and a half months with 2% of patients alive after two years;
  • if amputation is combined with chemotherapy the average survival time is increased to one year with 20% of dogs still enjoying a good quality of life two years after surgery.

So, if she’s a good candidate for chemo and we can afford it, that appears at this time to be our best option. In the meantime, she’s doing really well and is more active and more like herself everyday. She’s putting that foot down when she walks more often than not now, and she’s back to being aggressive toward Reilly, spinning at the door, and her other routines.

For now we’ve decided to be cautiously optimistic and give her all the love and care we can until we know what’s best for her.

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FHO Recover, Day 5

The Princess Pooch continues to heal. She’s been up and around quite a bit today and is steadier on her feet with each passing day. Today she’s been putting her foot down while standing and sometimes while walking, but she’s yet to put any weight on it.

She’s back to indicating she needs to go outside when what she wants is a treat and not to pee. She’s never learned to scratch at the door or bark; instead, she peers around the recliner and stares, then gets excited when we ask if she “want to go potty.” I’m so happy p_pooch_sunto see her on her feet that I don’t care if she’s trying to trick me for a treat.  She’s also decided to catch some rays when she’s outside sometimes now. We don’t let her do so for long so she won’t burn, but I imagine the sun feels good.

I continue to move her hips in a “bicycle” motion in reps of 10 several times a day. This doesn’t seem to cause her any pain, but she stares at me with a look that says “what the hell are you doing?” Speaking of pain, we gave her the last of the pain pills last night, and she hasn’t shown any signs of pain.

She still shows little interest in her incision, and when she does on occasion, we just tell her to “leave it,” and she does. She hates the e-collar, but we continue to put it on her over night. She looks so sad when I put it on her; it breaks my heart.

 

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FHO Recovery, Day 4

Not much in the way of new developments today, but the Princess Pooch continues to get back into her routine. We moved from cold to warm compresses, and she doesn’t seem to enjoy those as much. And she looks longingly at the sofa and recliners where she likes to sleep but are now covered with chairs so she can’t get on them. She seems to have decided her original bed is the choice spot for now, but she does use the new bed on occasion.

We continue to try to stimulate her appetite: tonight’s dinner was rotisserie chicken with a bit of gravy mixed in with her regular food. She found a way to eat around most of her regular food, but we’re just happy she’s eating.

Here’s a photo of her on her favorite sofa from March 2017.
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FHO Recovery, Day 3

The Princess Pooch is even stronger today and is getting back to her routine. The pest guy was here today, and she was as wound up as she has been every time he’s been here. She didn’t jump on the sofa and spin and bark at him–we’ve blocked the sofa with a chair so she can’t get on it–but she did everything else in their usual routine.

She continues to put her left foot down in a normal position when standing, but she has yet to put any weight on it. We were told she probably wouldn’t for at least a week, so we’re not concerned. She is putting it in the more usual position when she squats to pee, and she even managed a bit of a poop today–not much since she hasn’t been eating much.

Speaking of eating, tonight we got her a carne asada burro of her own, and she chowed down with tail wagging enthusiasm. It was good to see her eat and enjoy a meal. She loves carne asada burros, and I usually share mine with her. I think she knew getting one of her own was a big treat.

We’ve moved her pain medicine schedule from every 6, to every 8 and now to every 12 hours, and she seems to be doing well. She’s now resting on either hip as her mood dictates, so that his is clearly no longer bothering her.

So far I’ve just been walking her around inside the house because it is brutally hot outside; it’s supposed to cool down to just above 100° by Sunday, so I hope we can begin walking outside then.

new_ecollarFinally, her inflatable e-collar arrived today, and she seems to hate it less than the big plastic one. She hasn’t tried to lick or go after her incision at all today, but we’ll put it on overnight just to be sure she can’t get at it if it starts to itch.

I am very pleased with her progress. Even though she’s an active 12-yr old, I was concerned this surgery might take a lot out of her; I am happy to see it hasn’t.

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