For those who are sensitive to expletives, this post will likely contain enough four letter words that it deserves it's own "Parental Advisory" sticker. If such colorful language offends you, you should probably stop reading now. However, I'll try to temper the language with adorable photos of our beautiful Lulu.
But it's only because I'm so fucking pissed off at cancer! It's been a really shitty couple of weeks, and in the last seven days things have taken a turn that none of us expected.
As we updated everyone last week, Lulu's mild, unassuming bump on her arm was confirmed as her second official mast cell tumor. At our trusted veterinarian's direction, she had surgery last week to remove the tumor, it was sent for a pathology report, and then the waiting game began. While we were expecting a 3-6 day wait, we were surprised to get a call last Wednesday letting us know the results were in. Unfortunately, and heart breakingly, they weren't what we were hoping for.
After the mast cell tumor was removed, it was shipped out to the University of Colorado's veterinary program for further analysis by a lab. The lab was looking at many things—most of which are medically way over my head—and they reported back to our vet. The tumor is also graded on a scale I - III (I being best, and III worst), and this one, like the last, came back as a "low grade II." While this was relatively good news, we were hoping it would come back as a grade I, given the size, lack of change over a few weeks, the fact it didn't "act like" a mast cell tumor, and how early we caught it. Grade III tumors, on the other hand, are more aggressive and mean that the cancer has or will likely metastasize, so we were relieved and considered ourselves lucky that it was a low grade II. So put a check in the win column for that bit of news.
The shitty news of it all, though, was that our vet was unable to get good margins when she removed the tumor due to the location on Lulu's forearm. What does "getting good margins" mean? In a nutshell (and in a simple way that I can understand), it basically means there has to be a specified distance between the last cancer cell and the edge of the removed area. In her case, up and down her arm as well as side to side around her arm was fine, but going deep enough into her arm to get a good margin was a problem as it would mean cutting out part of her arm muscle. This part of her arm muscle is the portion that allows her to do all of the things in life she enjoys, such as walking, running, and making flying leaps up the trunk of our tree while chasing squirrels.
Since we didn't get the good margins we were hoping for, we scheduled an appointment with a local oncologist to figure out treatment options. We made the decision to change to a new oncology center that was a little closer to home after the same oncology specialist was recommended to us by friends, a few blog readers, and even our primary vet. This oncologist also happens to be one of few board certified veterinary oncologists in the country, and has written articles on mast cell tumors that included information specifically on how shar-peis are more susceptible to them. We were sold.
We gave them a call, scheduled an appointment, and then we spent a really long week waiting for the appointment. All of the loving sentiments from readers of the blog, friends, and family were so incredible, and we are so absolutely grateful for the support. Thank you, to everyone!
We had the appointment today (yesterday by the time I click "publish"), and while much of it was a blur (Hey, I only burst into tears once, a new personal record!) here's the important information that I took away from it.
Why is This Happening to Lulu?
Well, a lot of reasons, not the least of which is just plain old "bad luck." As I mentioned above, shar-peis are prone to mast cells tumors due to a genetic predisposition that causes their body to make mast cell tumors. There are also several other breeds that are more likely to develop them, and pugs are on the list as well.
Since she's a shar-pei pug mix (or an ori pei if you want to go all "designer breed"), we call that a double whammy, and the odds are stacked against her on this one. However, the types of mast cell tumors Lulu's body makes depend on which genetic mutation she happens to have, the pug's or the shar-pei's. In this case, pug mutation equals better outlook, shar-pei mutation equals worse outlook.
What's Lulu's Prognosis After a Second Tumor?
We were concerned that Lulu's odds of having a recurrence, or a worse systemic response, jumped exponentially after a second tumor showed up. At the oncologist we learned that just because she's now produced two tumors, instead of the obviously preferred one tumor (who am I kidding, we'd rather zero tumors), doesn't mean that she's more likely to get them in the future, or that it is systemic or possibly short term terminal. But, on the downside, there's a 50/50 chance that she'll get another one in the future, even after dealing with this one. I'm not real fond of those odds, but we'll take them after everything we went through with Ollie.
What are Lulu's Treatment Options?
There are actually several approaches, each with an associated protocol, odds for full recovery, long term effectiveness if she creates a new tumor, impact on quality of life, and cost. These include radiation, chemotherapy, tyrosine kinase inhibitor drugs, more aggressive surgery, and straight steroids.
Per the oncologist's recommendation, we have decided to follow the protocol of three weeks, Monday through Friday, of localized radiation focused directly along her surgery scar. Without it, it's possible the cancer would spread. The other approaches are either not as effective in this given situation and actually impact her long term likelihood of a full recovery if a new tumor shows up in the future, or in the case of more aggressive surgery, equally effective but will drastically affect her quality of life. The good news is the radiation protocol is 95% likely that we'll be able to contain and eradicate this tumor. Now those are odds I can get behind.
When Do We Start?
Almost immediately. Monday we'll be starting the radiation.
Before scheduling the treatment Lulu also had an ultrasound to see if the cancer had spread internally to any other organs. We had to leave her at the vet for several hours until they could complete the scan, and we were relieved, thrilled, elated, to get the call that she's all clear on the inside! At this point we can not only move forward with treatment, but also move forward knowing our focus is on this one tumor and not just one of many.
In summary, the bad:
- Cancer is an evil, ugly disease that no family should ever have to deal with in any of their loved ones.
- I simply cannot believe that of our three pets, all three have had cancer.
- I'm devastated that Lulu is going to have to go through treatment, and that there's a 50% chance we'll be dealing with it again in the future.
On the other hand, I'm immensely grateful that:
- Veterinary medicine is to incredibly advanced.
- The cancer hasn't spread internally.
- The radiation will more than likely eradicate the tumor/remaining cancerous mast cells in her arm.
- We have pet insurance.
- So many people have expressed concern and well wishes.
- This beautiful and sensitive soul came into our lives in the first place.
I titled this post, "Cancer Sucks -- But We Plan to Beat It!" because it's absolutely how I feel about Lulu, but unfortunately it's not contained to Lulu's situation alone. On Sunday, one of my and Alex's dearest friends (going all the way back to high school) called me to share the news that she has breast cancer.
I'm simply overcome by a tremendous mix of feelings with this news. I'm so angry that she and her husband have to go through the emotions, uncertainty, fear, pain, and anxiety that come with a diagnosis of this kind. I'm sad her sweet one and a half year old son can't understand what his mom is going through. She's an incredibly strong, brave, and assertive woman, and she's gearing up for her fight against this monster called cancer. And I'm touched by her undeniable friendship when she called me earlier in the week to let me know her possible diagnosis, she was so selfless to first ask how Lulu is doing, and took the time to discuss Lulu's situation and to try to assuage my fears. Our history with her goes way back, and she was the parent of a sick pet as well and has compassion for our situation in spite of her own. She's an amazing person, and I know she, and her whole family, would greatly appreciate all good vibes, karma, and prayers you can send her way as well.
So as I sit typing this, I have my sweet Lulu curled up at my feet, occasionally glancing out of the top of her eyes at me between restful snoozes, and I count my blessings that she came into our lives and we have the means to treat her. As with Oliver, we will go to the ends of the Earth to give our four legged family members every opportunity at good health, happiness, and a blissful life in which they know they are safe, cared for, and loved unconditionally. We can look at our situation in two ways. On one hand, we can ask the unanswerable question of "why are we so unlucky with our pets' health?" But on the other hand, we can accept that it's possible our furry family members were brought to us for a reason. We have the capacity and desire to do whatever is necessary, and though it may make us neurotic or crazy pet people to some, we may be just the people that our animals need. We just need to occasionally remind ourselves that every day we have with Lulu and Mel is a gift, as it shows us what pure love and unadulterated happiness is all about.
Over the next several weeks we'll be giving periodic updates on Lulu and how her care and treatment are progressing. It's our hope, like many items with our blog, that our experiences will help others in the future. This may not be stripping paint or restoring windows, but it's going to be all consuming and it's a way scarier endeavor. Hopefully our experience will help someone in our situation make a more informed decision in how to treat their loved one.
Oh, and Cancer, in case you're listening? Sentiments from Lulu, Mel, Ollie, our family, and anyone affected by or who will be affected by the nasty C, "Cancer, you can fuck off!"