Appointment with the oncologist ...

So we met with Dr. Fulton, a veterinary oncologist, yesterday afternoon. She explained Tucker's x-rays to us, and pointed out a golf ball-sized mass in one of his lungs. She said that it's possible that the mass has been there his whole life, and is benign. It is also possible that it could be cancerous and completely unrelated to the hemangiosarcoma. She didn't think it was related to the hemangiosarcoma, because lung metastasis from HSA usually involves lots and lots of tumors, not just one. When she examined Tucker, she felt a few lumps on his side and one on his ear that she was concerned about. She also said that his abdomen felt a little "full", meaning that there may be cancer metastasis there as well. We got to see his splenic tumor on the x-rays (they were taken by our vet before surgery) ... it was huge!!! She also pointed out an enlarged lymph node near his sternum (breastbone), which may indicate cancer spread in his abdomen.

She explained that every time he had an "episode" (a total of 4 times before surgery), the tumor on his spleen was rupturing and bleeding into his abdomen. Not only was it bleeding, but it was also spewing out poisonous cancer cells into his abdomen and who knows where else. That means that it is very likely that there are many, many microscopic tumors all over his body. This was very hard to hear. I keep thinking, what if we had been more aggressive with everything after the very first episode? What if we could have had his spleen removed right then, instead of going through 3 more horrible episodes? The time from his first episode until his spleen removed was almost 3 months. How much damage did the cancer do to his body during this time? This thought process has been eating away at me, because I feel like we somehow have not done everything we could do to keep him healthy. I know that this is irrational, and there is no point in stewing over the past, since there is nothing that can change it. But, I still find myself thinking about this often.

So anyway ... Dr. Fulton explained our options. We can either do chemotherapy, or not do chemotherapy. If we decide to do chemo, he will have 5 treatments, each one 2 weeks apart. It is an outpatient procedure each time, so we would just have to take him to the vet (oncologist, not our regular vet), and they would administer the IV chemo, and we would take him home. She explained that chemo affects dogs very differently than it affects humans. Dogs generally don't experience many of the negative side effects that humans do. There usually isn't much nausea and vomiting (if there is, oral anti-nausea meds work well) and not much hair loss, if any. However, there are plenty of risks. He could become anemic, and this could cause problems. His white blood cell count will likely go way down, meaning that he will be much more prone to infection. This combined with the fact that he no longer has a spleen (which also makes him more prone to infection) would make him extremely susceptible to infection, and an infection could end up taking him. Chemo can also cause heart problems. The chemo itself could kill him if his body doesn't react well to it. Statistically, chemo would extend his prognosis to 6-8 months from date of diagnosis, while surgery alone (which he already had) gives a prognosis of 2-4 months from date of diagnosis. We're leaning towards not doing chemo. While it may give us a few additional months with him, there is no guarantee that he would be feeling great during those months, and there is no guarantee that we would even have those extra months. Plus, would we be doing the chemo for him, or for us? Whatever we end up doing should be in Tucker's best interest. If we choose chemo and he lives for 8 more months, but is sick for 4 of those months (from the chemo), then we have not given him good quality of life. Maybe we should just keep him comfortable until it is his time to cross the Bridge, and just let nature take its course. But would we be somehow shortchanging Tucker by doing this? Who knows? I guess we have some thinking to do.

I found a great blog (thanks to my friend Rochelle) that is written by a cancer vet in Hawaii. One particular recent post really caught my eye. It talks about measuring quality of life in a sick dog and uses a "Joys of Life" scale. It really made me think. Once these "Joys of Life" start to go away, the dog is no longer experiencing good quality of life. Check out the blog entry: http://www.dogcancerblog.com/29/life-quality-in-dog-cancer-dr-dresslers-joys-of-life-scale/

Tucker is still doing great ... eating well, playing a lot, and generally seems like a happy dog. This makes us very happy. We are enjoying every minute with him.