Even dog-girls get the blues

I weighed Kekoa on Tuesday and I am happy to report that she is back on track at 74.5 pounds- one more pound gone! She really is a trooper. She has this great talent of utilizing her lower center of gravity to butt Brody out of the way when they are jockeying for position at feeding time, so despite her shrinking weight she still had mad leverage skills.

We ran into someone who hasn’t seen Koa since shortly after she came to live with us in March. He was floored. “She’s so shiny!” he said. “And so skinny!” I told him about the Nulo Challenge and how well Koa was doing on the food, how Brody was also scarfing it up and also how jealous Koa was that Brody’s ration was quite a bit more (darn that slow female metabolism.)

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I also told him about Koa’s nerve sheath tumor and my conversation with the oncologist. I excised the mass with generous margins but, without knowing what it was, I didn’t take radical measures and cut out muscle and bone. The path report showed the margins were not clean. In short, there is microscopic tumor left that will likely regrow.

There are three options:

1. Do nothing. It is a slow growing tumor, and even if left alone, only 10% of those tumor types spread to other organs. As I learned with Emmett, though, relying on the numbers only works when you aren’t in that 10%.

2. Radiation. After going through this with Mulan, I had told myself that I wouldn’t put another pet through that trying process. It’s a different type of tumor with a different protocol, but still… I am really hesitant to go through that journey again. It was so hard on her, poor pup.

3. Surgical revision. Although I’m not comfortable doing the more radical surgery myself, my boss is willing to go in and go after the muscle and possibly bone of the scapula in order to try to get clean margins on the tumor. It would be invasive, obviously, and poor Koa would have to recover from a second procedure- but if the margins are clean, that should be the end of it.

None of the choices are that great, truth be told. How I wish I had a little magic zippy wand to just wave it all away. See? Even when you think you know what you’re doing, the answers aren’t always clear.

Filed: Cancer sucks, Health Tagged: ,
  • http://www.calmingcollars.com Deb Mendez

    Koa, you’ve got a whole bunch of “fans” pulling for you. All those prayers and positive thoughts will help you beat this.

  • Cathey

    This is one of those times where having previous experience makes the decision much harder, not easier. You will need to step back a moment, give Koa a big hug, and then go with whatever your BEST advice to me or any other layperson would be. She’s a good girl that has already been through a lot in her life. Whatever you do I know it will be done with love and care and accompanied by many prayers from those of us out here in ‘blogger land’ who have come to love Koa, too!

  • Tonya

    What Cathey said!
    I am with you on the radiation. Although it didn’t seem to be so hard on Shaq, my lab with bone cancer, it did absolutely NOTHING to help him either. So I just felt it took one day per week away from my very short time left with him, stressed us both and didn’t prolong his life for one hour. Would I do it again? I have absolutely no idea. That’s a tough one.
    Hugs to you and Koa! If I run across that magic zippy wand, you’ll be the first to know!

  • http://www.VetLIVE.com Dr. Laci

    I am sorry you are in this situation. It is particularly frustrating, I think, as a vet to not be able to cure your own.

    For what it’s worth, which isn’t much, our girl Madi did well with radiation. It was the chemo I regret.

    Hope you find some peace about your decision.

  • Lisa W

    I feel for you, and my heart is with you and Koa. Given my experience with Bailey’s cancer, I know how hard the options are. But I know that, whatever you decide and whatever the outcome, you will make your decision based solely on your love for her. I’m still trying to hold onto that for myself… {{{{hugs}}}}}

  • Kelly

    There are no good options. I’m so sorry…

  • http://www.hiddenexposures.com hidden exposures

    not sure if you’re looking for advice from non-vets (but a human medical provider), but i’ll give it to you just in case. :) if it were my dog, i’d go for the surgery. i’d have a problem mentally with knowing my dog was walking around with a slow growing tumor…like a slowly ticking time bomb, which then has the potential to push you to make those same kind of decisions at a future point. it strikes me that while the surgery is invasive, it does lend the most to a fix that results in the shortest amount of “i’m feeling really crappy” time on her part, and as you said, it should be the end of it. i do realize the key word in that sentence is “should”.

    know you have all of our support no matter what you decide!

  • Tricia Carter

    So sorry for the decision you have to make. Dogs (animals) just shouldn’t get cancer at all (in my pretty, happy little world). They aren’t here with us long enough, it would be nice if all we dealt with was old age or ‘cars’ for our beloved pets. I would go with the surgical decision — being just recently through the cancer/chemo/surgical route. I would probably do surgery but after that I’m pretty sure (yes, we do change our mind once the little eyes are looking at you) I would not make the same decision to go with chemo or radiation ever again. Surgical removal though I would do — and perhaps meds/herbs/vitamins that help in slowing the growth of cancer at minimal dosages perhaps as a prevention type measure. Love and kisses to Koa!

  • Jen

    I agree with Cathey; think about what you would recommend for a patient.

    Presented with those options myself, I think I would choose surgery. Better safe than sorry and I think on the whole, animals tend to recover quite quickly.

    Keep us updated; she’s such a lovely girl!

  • http://bunnyjeancook.blogspot.com/ Vicki Cook

    I’m so sorry that you’re going through this. If it were my dog, I would probably go with the numbers, but I realise that your experience with Emmett makes that a much tougher choice for you. Whatever you choose to do, I’m certain that it will be in Koa’s best interest. Good luck – I’ll keep you both in my thoughts and prayers.

  • Melissa

    I hate to hear this. I had to make a tough decision when my previous dog had lymphoma. I went the chemo route and was able to get another 10 months together. I don’t know if I would do it again though. Just thinking about it makes me tear up. With all your knowledge I know you will do what is best for her. Hugs from me and Madison!!

  • http://www.k9diabetes.com Natalie

    I thought Hidden Exposures summed up my feelings well:

    On November 04, 2010 at 8:38am, hidden exposures said…
    if it were my dog, i’d go for the surgery. . . .a slow growing tumor…like a slowly ticking time bomb . . has the potential to push you to make those same kind of decisions at a future point. it strikes me that while the surgery is invasive, it does lend the most to a fix that results in the shortest amount of “i’m feeling really crappy” time on her part, and as you said, it should be the end of it. i do realize the key word in that sentence is “should”.

    And of course I’m right there with ya with whatever you decide.

    I look at Koa’s face and I cannot even begin to fathom the “Black Dog Problem” shelters have.

  • http://www.biscuitsbylambchop.com AnnetteFrey

    So sorry to hear this news! I know it was a completely type of tumor but Lambchop did really great with radiation twice – aside from the Addison’s crash in the midst of the first treatment, but in a way, pushing him into the AD crash finally got him diagnosed after many issues that couldn’t be accounted for.

    I’m sure you will make the right decision for her. Our thoughts are with you both! xo

  • Sylvia

    I agree with what everyone has said. Whatever you decide it will be done out of love. You have alot of support here Doc. {{{{{{{hugs}}}}}}}} for you and Koa.

  • http://petsadviser.com Pets Adviser

    Oh what a sad set of choices. Well, please know that you’ve got readers who are pulling for you and Koa. Good luck.

  • http://www.kimchicrafts.com kimchi

    Oh Koa… I am sending you and your female human a big hug bc none of the choices are ideal. but you are a brave girl and a strong girl and whatever your mom/family decides for you, we are all supporting you and sending you lots of Nulo, in the biggest bowl evar…
    xoxoxo.

  • Kim

    Oh man. I don’t know the answer. I’d say surgery but Koa is a gentle soul with a past of shelters and trauma. I get why it is so tough.

    Whatever you decide, though, I’ll just say it because you are a very concerned pet owner who I know will not take any decision lightly, let me say this: you’re doing the right thing. You will always do right by her. Just know that.

  • macula_densa

    I think I would proceed with surgery as well. That’s such a bummer that the margins weren’t clean. However, it seems to me that surgery is your best chance to get that thing out of there, and the post-surgical after-effects usually don’t last too terribly long.

    In light of the location of that mass, will it limit her mobility a lot to resect more?

    My mother is feeling your pain right now. Her dog just had a splenectomy after her vet discovered two softball-sized tumors coming off of it. Doesn’t look like HSA from what they found, but still sounds gnarly.

  • http://www.somethingwagging.com Pamela

    Sometimes I think these decisions are so hard because we think there is a “right” one and there just isn’t. Whatever choice you make will become the right one as you and Koa go on from there.

    Best wishes to you and Koa.

  • Ann

    Whatever decision you make will be made out of love and the knowledge of what is best for Koa, and will be the right one for both of you. As several people have said, consider what advice you would give the owner of one of your patients who was in a similar situation.

    For what it is worth, our Murphy (the sheltie who is curious as to why he has to pose for a picture instead of being able to chase squirrels) is now eleven and a half and has had 3 different cancers: a very aggressive squamous cell lesion in his mouth, when he was 5 years old, which necessitated the removal of his jaw on the affected side, a mast cell tumour, which was removed under local anesthetic in the office and a nasty fibrosarcoma on his lower back, when he was almost 10 years old, that necessitated the removal of a very large chunk of skin and muscle. Both of the 2 major surgeries were very invasive, and required a fair amount of convalescent care and recovery time (fortunately, I was able to be at home with him), but in all cases, his recovery was uneventful and at the moment he is a happy and relatively healthy senior. He has no problem eating (he eats kibble) and the loss of muscle in his back does not seem to have had any long-term effect on his movement. The jaw surgery has bought us (so far) almost an extra 6 years, and the fibrosarc surgery, so far an extra 2.

    One thing our vet said to us was that animals do not spend time worrying about what has happened; they become aware of whatever has happened to their body and focus their attention and efforts on figuring out how to deal with it. That was certainly our experience with Murphy, and should he develop yet another malignancy, should it be definitively treatable by surgery and should he be healthy enough to withstand the surgery, we would not hesitate to deal with the problem that way yet again.

  • Erin

    You’ll find the right decision for you and Koa Dr.V you are smart and caring, you’ll figure it out. What a gorgeous girl, she has such cute expressive eyes.

  • Sue & the crew at Dream Valley Ranch

    Hi Dr V-
    I am a new reader and am sooo happy i found your blog! I am terribly sorry about the margins not being clean-how upsetting. Koa is such a beautiful dog. I hope you are able to choose an option that makes you feel at peace that you are giving Koa the best possible chance at a happy and peaceful life. The choices are never as clear as we hope with cancer, are they? I’m a biologist and love statistics but always say just that…if you happen to be in that 1 or 10% then the odds being in your favor aren’t much solace are they.

    Thanks for having his wonderful blog for us dog (and pony) moms and dads to read!

    I am looking forward to getting to know more about your crew and your world-the world needs more vets who are kind, compassionate, and funny!

    Squishes to the pups and cute kitty,
    Sue and the crew at Dream Valley Ranch
    Colorado