Monday, February 23, 2009
Indecision
On Friday, we executed our very own Veterinary Stimulus Plan taking Luna, Sol & Henry to the eye specialist and Sol to the specialist to find out more about the malignant tumor in her mouth. All went well at the eye doctor. Luna’s eyes are holding steady, Henry possibly has some floaters and while Sol has cataracts she has pretty good vision. Her main issue is with her close up vision and the Dr. assured us that that is normal with aging.
The appointment at the specialist for Sol’s mouth was a doozy. Just being in the building is a depressing experience. It isn’t like being at a normal vet’s office where the waiting room is filled with dogs and cats most of which are just in for routine care needs. The waiting room at the specialist was quiet, filled with animals all needing care for very serious issues, many of which were life threatening. You could see the worry on owners’ faces. There were many tears being shed.
Unsure of what to expect, we quietly sat in the waiting room with all four pugs. Sol’s name was called and we went to her room with the pugs in tow. The vet tech smiled and made a joke about how Sol brought her pack for support. After a few minutes the doctor entered the room, introduced herself, met Sol and then proceeded to ask us many questions. We answered the questions as best as we could considering Sol has been in our care for less than two months. After the question and answer session, they took Sol to the back for her examination and we went back into the waiting room. After about a half an hour they called us back to the room to discuss the examination and to discuss the possible treatment options.
They confirmed what we already knew. Sol had a gingival pappillary (verrucous) squamous cell carcinoma in her lower right jaw between the incisor and canine firm. During her dental cleaning a tumor approximately 8mm in size was removed for testing. Their recommendation was to do a set of chest xrays along with testing of fluid from the mandibular lymph nodes (if they were able to get a sample). These tests would help determine if the cancer had spread or stayed localized. If the results came back clear, the recommended treatment plan would be a CT scan and based on the CT scan results a hemi, partial or rostral mandibulectomy would be in order. In regular terms, to get rid of the cancer they would need to remove part of her jaw. How much and which direction they would need to go would be determined by the CT scan.
As they were delivering the news, I was trying my best to take everything in but it seemed like with every word they spoke 5 more questions popped into my head. By the time they got to discussing the possibility that Sol might need radiation if they did not get “clean margins” on the tumor removal my head was pounding. Really? This is the recommended treatment plan?
We talked with the doctor and got answers to many of our questions. But even though our questions were being answered my confidence in what to do and how to proceed was not getting any stronger. After hearing what was involved, I asked the doctor what she thought was the right thing to do for Sol given her age (now upped to 13 as per the eye specialist just an hour ago). I let them know that I hadn’t given up on her because she is on the older side, but I also wanted them to know that my main concern was her quality of life. Would a surgery to remove part of the little girl’s jaw be more than she could handle? They assured me that Sol could handle the surgery and that they would not recommend that treatment plan if they didn’t think she would be able to make a full recovery. Her bloodwork was normal, her kidneys and liver were all operating properly, her heart sounded good. Except for the fact that she had cancer, Sol was a perfectly healthy 12 (or 13?) year old pug. As long as her chest xrays and the lymph node tests came back clear she was an ideal candidate for the surgery. The answer only gave us more things to ponder.
We also asked them, what would be the treatment options if we did not have the surgery. Pain management was their answer. Given the nature of this type of tumor it will continue to grow both above and below the gumline. As the tumor grows into the jaw bone it becomes quite painful. At some point, Sol would need to be put on medication for the pain. The medication would help her manage the pain, but when taken long term it would also put a strain on her liver and/or kidneys (I can’t remember which one or both they said at this point) which would most likely result in failure after about a year’s time.
My next line of questions all pertained to radiation and how they would make the determination if it was even necessary and how this is administered to a dog. (Again, reflecting on the recent trauma Sol’s Grammy had endured.) Radiation would only be recommended if they did not get clean margins when they removed the tumor. What clean margins means is that the edges of the tumor do not test positive for cancer.
We talked for a bit more and then we gave them the go ahead to do chest xrays and to try to test the fluid from Sol’s mandibular lymph nodes. We didn’t need to make a decision that moment and those tests might make our decision for us. We went to sit in the parking lot to wait.
After about an hour they let us know that Sol’s chest xrays were clear and that they were uanable to get any fluid from her lymph nodes. The lymph nodes were very small, which was a good sign in itself. They also took a urine sample to send out for a urinalysis. The results of that test will be in on Monday and if all is well, Sol will be ready for a CT Scan. The CT Scan will show them where exactly the cancer is and will dictate how much jaw they will need to remove and in what direction. There is a possibility that the CT Scan will show that the cancer has spread too far and surgery is not a viable possibility. However, they do the CT Scan the day of the surgery so we will not know what the scan reveals until we have already made our decision.
As I write this, I can honestly say we have not made a decision yet as what to do. The surgery seems so invasive and the thought that radiation might be needed is too much to even think about. All I want is for Sol to live out her last years healthy and happy. We could have the surgery, they could get clean margins and Sol could adjust perfectly fine (they say dogs adjust very well to their new jaw after the surgery). Or we could have the surgery, they might not get clean margins and then we would have to face radiation and it might not fully rid the cancer from her mouth. Or we could do nothing and monitor her pain and wait until it is necessary to put her on pain medicine at which time we know it is the beginning of the end. What’s the right answer? What is the best treatment plan for Sol? What is best for Sol is the only thing that I trying to let influence my decision. I’m trying not to think about the money aspect either because none of this is cheap. At this point we are talking thousands and if radiation is necessary we will be approaching the 5 figure mark. I am just trying to look into Sol’s eyes and find the right answer. An answer we can all live with regret free.
