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.


CCR picked Mini up from Pima on Friday the 22nd of June. When putting her in the crate in the Van to take her home, Mini rolled onto her side and I was horrified by the wound on her chest and under her left arm. There was a large, gaping and necrotic hole that appeared to have eaten into her underlying muscle. It was constantly oozing and draining and so large you could easily stick an entire finger into it. Several of her mammary glands were large and hard...

 
Mini's open wound (left) June 22 & post surgery (right) July 7

While Pima's medical staff did blood work and X rays on this very sick little girl the antibiotics they gave her had not stopped the infection raging through her body.
 
I drove back to Tucson the next day after speaking to one of Pima's Vets and discovering Mini had not been sent home with the correct medications. After viewing the photos of her wound, surgery was moved up to Thursday morning. 
 
Over the next few days it was obvious that changing her antibiotics and giving her pain medications improved her disposition, but she had become increasingly anorexic. We had a hard time getting her to take her medications.

Before surgery she had been "working" her wounds, licking and scratching, and they had gotten larger. The odor of necrosis was minimized, but there was still bloody discharge on her bed, toys, as well as dripping on the pee-pad when she walked around.

SURGERY:
Mini was scheduled for surgery Thursday June 28th and would remain in hospital through Saturday.

We left at 5:30 for her 7 AM drop-off at the Pima Animal Care and Control's hospital for the surgery to remove her masses and close up her wounds.

Before surgery they performed another blood test to insure that she was able to have surgery. Apparently everything was within acceptable parameters. The surgeon decided that Mini needed complete radial mastectomy i.e. all mammary glands and lymph nodes removed. They told me this would be done in two stages about 4-6 weeks apart. The skin, given the size of her open wound, did not allow for enough skin to close both sides at this time. Around 11 Am they took her into surgery and began. They told me surgery would take 1-2 hours.

They also asked whether our regular veterinarian could perform the second procedure. I called our Vet in Benson, and she agreed to see Mini, look at her medical records and give us an estimate for costs.

All of this was before the shit hit the fan.

Pima's clinic staff told me to be back in an hour or two. So I left to do a bit of local shopping. Shortly before noon I received a call: Mini's surgery was stopped after the removal of the major mass, lymph nodes on the left side and they had closed her up.

Mini had almost died!

Her temperature had dropped from a normal range of 101-102 to 92.6 degrees. She was in shock. We all feared that she was dying.

Mini was placed on a heating pad and covered with a blanket. A Vet tech sat with her for the next few hours.

 
Mini on the heating pad, wakes up from surgery

At around 98 degrees, she woke up. Slowly her temperature crept back up to 100.8. They took her off the heating pad. Within a few hours she was up on her feet and by 4 PM she was drinking a little water on her own.

They gave me the tumor they had removed which was about 2.5" by a half inch thick as well as the lymph node which was about an inch in diameter. I rushed the tissue samples up to University of Arizona Diagnostic Lab, where CCR has an account. U of A would have the results Monday.

At 4:30 I left Tucson and headed for home.

The hospital called me around 7 PM. Mini, they told me was stable, although unwilling to eat.

The next day, Friday, she began to eat. Pima kept her on strong pain medications and IV fluids.
 
Mini comes home - Saturday June 30

I picked up Mini noon Saturday. She was so happy to see me!

She came out of the back wearing a blue and white striped T-shirt with an orange skull. Pima's staff gave us a pink "Love" T-shirt for Mini to wear when the striped one becomes soiled. She had to wear a shirt rather than a cone, just to keep the wound clean and keep her from licking or working the staples and incision site However, on Sunday, when I try to take the shirt off, raising her legs, she screamed...even with the pain meds. The staples were pulling and were very painful.

Jeff and I had set up small pen in the bedroom complete with her favorite bed and favorite stuffed toys. The pen is next to our bed so Mini could be close to us. Upon arrival, she was placed in the pen and when I offered her cooked shredded chicken, she readily ate. Later I gave her antibiotics and a pain pill and she ate them in meatballs made out of cooked hamburger.

 
Mini's bedroom pen, her first night home after surgery - June 30

In doing cancer research it was apparent that Mini should eat a lot of protein but not carbs, as carbs turn to sugar which cancer feasts on.

I lay on the bed with her while I read and watched TV. There were six other small dogs on the bed including Bella (two dual inguinal hernia surgeries) and Buddy (recent leg amputation) all cuddling and relaxing together When it was time to go to sleep we put her back in the pen. Mini whined for a few minutes but eventually fell asleep...till 5 AM when she woke us - and the rest of the pack - up.

I fed her cooked hamburger this morning with her medications in little "meat balls" and she ate every bite with relish.

We transferred her into the living room senior pen mid-morning today, so that she would not feel so isolated, but she still whines and prefers to be with me.

 
Mini on right in the Senior Pen with Princess and Feo, left

Sunday Mini and I took a lazy day so she had my attention.
 
Mini's Update July 4th

Mini has been on a rocky road since surgery.

On July 2nd we received the pathology report from the University of Arizona Veterinary Diagnostic Lab. I called and had a long and educational conversation with the pathologist.

The cancer has spread to her lymph nodes. She will require more surgery to remove the existing tumors, if possible given her fragile state, followed by treatments by an oncologist, to buy her time.... 

The hope is that cancer has not metastasized into the lungs or abdominal organs and that the surgery (combined with chemo and X ray therapy) will slow down the spread.
Right now her lungs sound clear and her liver and kidney functions (as per her blood work) are doing well too.


Mini's X rays from Pima

The night of July 2nd to 3rd was terrifying. A large amount of leakage became apparent from her large incision. She was not feeling well, and spent the night sleeping in my arms.

Yesterday morning, July 3rd, we rushed her to our Vet in Benson, as she would not eat at all. We feared she might not make it. Her blood work was redone and showed that things had not improved, in fact had become somewhat worse due to the stress of the surgery.

Our Benson Vet, Dr. Monica, assured us that the seepage was normal and that the incision itself was looking good. She also told us that the staples should remain in longer than we were originally told at Pima, as Mini's skin is thin and due to her cancer will heal very slowly. The staples are stainless and we were assured that they will not harm her in any way.

Mini had been eating well since surgery but yesterday refused food. The Vet put her on a appetite stimulant and by afternoon she was eating and becoming more active.
 
Mini definitely has become a mommas-girl, following me around, making sure I am always within her line of vision. The only time she cries is when she cannot see me...and as a second choice, Jeff.

We are delighted that by the next day, July 4th, Mini was doing much better. She received her morning medications and received appetite stimulant, a liquid called Entyce, again around noon. She ate chicken for breakfast (not as much as we would have liked) but then had some cheese and a little hot dog. Since she cannot eat carbs sue to the cancer, anything else she wants, she can eat so far as we are concerned.Mini has wormed her way into our hearts very quickly. This is a physical roller coaster for Mini and an emotional one for us.

July 7th 2018 Update

Mini is doing better, her strength is improving a little at a time, while we are taking this one day at a time.
 
She is eating three specially prepared meals a day. WE are cooking hamburger to help with her anemia, and high protein/high fat/low carbs for the cancer.

Mini is taking antibiotics twice a day. She has been on Clavamox since June 23rd, and will be on it for the next two weeks at least. As long as her white count its high, our Benson vet, Dr. Monica, feels it is an absolute necessity. She is on Tramadol twice a day and Rimadyl once a day. She is taking Entyce, an appetite stimulant every day at noon and it is working wonderfully to increase her desire to eat and to eat well !

This morning she had a small bowl of freshly cooked hamburger for breakfast and ate every bite. For lunch she has been having a mix of a spoonful of soaked kibble, topped with a mix of wet dog food and pumpkin (to keep her pooping well) topped with shredded chicken. At night, when she has her night-time meds, she has another small bowl of shredded warmed chicken to keep her tummy full over night.
We are delighted that Mini has been eating every bite!

Although Mini is going outside to go to the bathroom, and is on the kitchen foor while I am working there, she is still weak. She spends time, like right now, sleeping on my lap when I am on the computer, or curled up in my armpit or with her head on my calf when I am reading or watching TV in bed. 

Mini's left front leg, where the lymph nodes were removed, had been weak before surgery, and is still very weak, perhaps due to some nerve damage. As a result, she limps on the left side but does not appear to cause her discomfort.
 
She is integrating herself with the pack, often surrounded by other small dogs. If anyone "bothers" her she even growls and bares her teeth. If things become chaotic we always pick her up, carrying her or placing her in the Senior pen...She really is too cute!
However Mini is nowhere near to being out of the woods. Until her white count drops and her red cells improve she cannot safely have her second surgery which would remove the other cancer-ridden tumors, nor can she take any steroids which are used as part of chemotherapy.
 
Mini is slowly healing but will need the other tumors removed ASAP

Mini has been seen twice in the last week by Dr. Monica, and they call every morning to make sure she is doing well. We are very pleased with their care and their concern.

On Monday I will be calling Integrative Veterinary Oncology in Phoenix to set up an appointment for her to be seen by Dr. Hershey and discuss further options. I will have IVO connect with our local vet here in Benson before going up there so everyone can be on the same page....

Little Mini

June-July 2018