Mini June 27th 2018, presurgery
Update: August 17th 2018
What is so sad....what should be learned from all this...is that none of this had to happen.
Mini sits on my office chair
Yesterday July 16th, we got up at 3:45 AM and after medicating the morning animals and dosing myself with strong coffee, Mini and I left at 6AM for our long drive up to North Scottsdale and Phoenix.
Our first stop at 10 AM was at Dr. Brett Cordes at Arizona Animal Hospital in North Scottsdale. Dr. Brett has done a lot for CCR's animals and we consider him a friend. On this day he came in on his day off to help our little girl.
Dr. Brett did an ultra sound and lung X-rays (at a major discount which made it worth the four hour drive up there.) We discussed the pathology report I brought up for his review and after reading it and performing his examination on Mini, he suggested not doing any surgery.
While Mini's organs - liver, spleen, kidneys and on X-rays the lungs- did not show evidence of tumors, which as great news....all was not good.
In addition to the lymph node removed during Mini's surgery in June which had evidence of metastisis, he had found an enlarged lymph node behind Mini's bladder. The metastisis had spread to abdominal lymph nodes.
Dr. Brett gave me his ideas for giving her quality of life by providing her with an anti-inflamatory drug called Piroxicam, but also thought Dr, Hershey, the oncologist at IVO (our next stop) might have additional ideas.
Yesterday afternoon was the first time we met with Dr. Hershey, and I must state I really liked her and the other folks at her practice, IVO, in central Phoenix.
Dr. Hershey examined Mini including measuring the size of her breast tumors and we had a long discussion of options. She told me about small doses of daily chemo medication which is being found to provide the best outcomes for dogs who present like Mini...Dogs with Stage 4 Mammary cancer. We are hoping to give her a very comfortable year...but it has been known give dogs with similar disease spread like Mini's 2-4 years.
Dr. Hershey and Mini - August 16, 2018
Mini is a spunky little fighter so I can only hope for the best!
Given that this disease is ultimately in all likelihood terminal, and we are most concerned with providing her with the longest possible Quality of Life, this is the protocol we will be following:
Mini will receive the chemo drug Cyclophosphamide with another drug to help her bladder, Furosemide, once daily with breakfast.
She will receive the anti-inflammatory drug Piroxicam once a day with her evening meal.
These drugs usually are well accepted by the animals treated...but a small percentage have problems so we need to watch out for the obvious: anorexia, nausea, vomiting, blood in urine or stools.
We will need to be conscientious about picking up Mini's stools because it would be dangerous for another dog to try to eat the chemo-containing poop (which, unfortunately) we know dogs are prone to do (yeah, ugh!)
We have drugs here for both anorexia (from early on in Mini's recovery when she refused to eat) and for nausea (received from Dr. Monika.) Hopefully these will not need to be used but are on hand if needed.
I immediately ordered the three drugs in her new protocol to be shipped on ice overnight from Diamondback Compounding Pharmacy in Phoenix as neither of the compounding pharmacies in Tucson make the chemo drug. We ordered two months worth as that was most cost effective, and it will give us appropriate time to see if she does well on the drugs. If she does, we can order three months at a time the next time for even better pricing.
We will begin this protocol Wednesday (Augsut 22nd) as the drugs will be here mid-day on Tuesday.
Dr. Monika here in Benson will be doing another complete blood work in a month and again in three months, sending results up to Dr. Hershey. If all is going as well as hoped, Mini will go back up to see Dr. Hershey (we have an appointment for November 19th) to have another ultrasound and X-rays to see whether the cancer is spreading, and whether the size of the lymph nodes and tumors is - hopefully! - being reduced by the medications.
Obviously if the side effects are bad we will consider stopping this protocol as it is all about Mini's Quality of Life. However the goal and hope is to "buy" her a year or more of happiness and relative health.
We have become so enamored with this little girl. The knowledge that she has come into our lives for such a relatively short period of time is heartwrenching ... but even knowing the sorrow of eventual loss, we would not change having her here for anything.
We could not be doing any of this for Mini without all of your help...
whether you have provided a Grant to her care,
or a generous personal donation,
YOU are the reason we can give Mini more Quality of Life time.
We are nowhere near done and the costs for her care will continue to be high....
Let's work together to make sure we can buy her the time she needs to be stable and happy.
Remember: No amount is too small...any amount will help with Mini's medical care!
So, I started this with:
"What is so sad....what should be learned from all this...is that none of this had to happen."
THAT is the truth.
According to my research, only 40% of all breast tumors in dogs become cancerous. If a lumpy, tumorous breast is removed, usually by a simple lumpectomy, the dog in all likelihood will be saved even if the tumor is shown to be cancerous.
It is all about TIMING.
By the time we took in Mini, by the time she was dumped at the pound to be destroyed, she was already in stage 4 cancer with numerous tumors and lymph node involvement.
This situation was unnecessary.
It could have been avoided.
It should never have gotten this far.
THAT is the heart break.....
Dr. Hershey's comments....
Mini was evaluated today for treatment of a high grade mammary carcinoma with lympth node metastisis. A recent abdominal ultrasound showed enlarged sublumbar lymph nodes which is concerning for metastisis of her mammary carcinoma to the internal mymph nodes. Because of the presence of enlarged lymph nodes, I do not recomment more surgery for the mammary tumors at this time. (emphasis my own) We will start Mini on a low dose chemotherapy protocol that I have found to be very beneficial in patients with high grade mammary tumors post surgery (some living 2-5 years.) We will reassess her frequently and may reconsider surgery at another date. The low dose chemotherapy generally does not have any side effects but please monitor for any vomiting, diarrhea, loss of appetite or changes in urinary habits.
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