Tulip vs. Cancer Round 2 Update: Stalemate
Ok, to recap:
- Back in March, Tulip was diagnosed simultaneously with both kennel cough and liver cancer.
- The kennel cough turned into pneumonia, but after several months of treatment it cleared up, thus allowing us to turn our attention to the liver cancer.
Now, the last time Tulip had cancer the tumor was on her knee and it proved to be relatively simple to remove it all, with no follow up complications to date. It was probably too much to hope that would happen again, but going into her early July appointment, all we knew from the initial ultrasound and a needle biopsy was that this new cancer was a tumor on her liver, and that there were basically three options:
[1] The cancer has spread everywhere and nothing can be done.
[2] The cancer is in one place now but spreads fast. Surgery or chemo might keep it from spreading.
[3] The cancer is in one place now and is very slow moving. Depending on symptoms, doing nothing may be the appropriate treatment.
The good news is that over the course of the pneumonia treatment she had multiple chest x-rays, all of which agreed that there were no tumors in her lungs. This argued strongly against [1] and also somewhat against [2]. The July appointment consisted of another ultrasound to monitor the growth of the tumor and to evaluate the potential usefulness of surgery.
First the good news - according to the second ultrasound, the liver tumor has barely grown at all since early March, nor has it spread to other parts of her body. In other words, we're definitely in category [3].
Now the bad news - the tumor is pretty substantial. It covers the two left lobes of her liver. In the words of the veterinary surgeon vet, it's not utterly impossible to remove the tumor as it would be if it was on the right side, but due to the size of the tumor it would definitely be a challenging surgery. Given her age, there's a very real chance that she wouldn't survive the operation, and if she did the aftercare would probably last months and likely cause more pain and suffering than the tumor is currently inducing. In particular, given how poorly her immune system handled pneumonia, any post-operative infection would also be dangerous. This is the very definition of high risk surgery. As an extra little kicker, the price starts at around $4,000 and could go up substantially depending on what complications ensue. After weighing all of these considerations, we've decided to forgo surgery. If she was three years old we'd probably go for it, but she'll turn thirteen later this month, and it seems like we'd be doing it more for us than for her. Chemo is also unlikely to help and would similarly impact her quality of life.
For Tulip's size, she's already relatively elderly. Right now, she's leading her best life, and unlike most humans the pandemic has actually improved her life. Because M and I are both home all the time she gets to wander around the yard a lot more than usual. M frequently takes her on car rides to a nearby park that is usually devoid of humans, and she has a giant papasan cushion dog bed that requires minimal effort to sprawl out on. She has some pain from arthritis upon occasion so our walks are shorter, but she still perks right up when a squirrel or a rabbit runs in front of her, and we've got painkillers for when she's clearly struggling. She's pretty much gone deaf, but that actually helps because the usual Independence Day fireworks barely phased her, whereas when she was able to hear they turned her into a quivering mass of terrified dog.
Although she's gained some weight since beating pneumonia, her appetite is still inconsistent. M had a grandmother who late in her life really only wanted to eat cookies, and Tulip has pretty much gone down that road herself. Fortunately, we are happy to oblige with many treats spiked in her food to trick her into eating. Pureed pumpkin? Cooked chicken? A wide assortment of dog treats? Cooked salmon skin? Watermelon? All of those and more have ended up in her bowl in the last couple of months, to her obvious gustatory pleasure.
If there's any real downside in Tulip's life right now, it's that with her compromised immune system we've been told not to try to renew her vaccinations as it could go poorly. This means she can't go to doggy day care (not that we're going anywhere anyway) or the dog park, which since she's still basically the friendliest dog ever and wants to say hello to every dog she sees means she is often disappointed.
So, basically we wait. Maybe the liver cancer will kill her. Maybe some other malady caused by old age will do it. Hopefully we won't find out for a long time, but it's been a good run since gotcha day. I have no complaints, and I hope she doesn't either.
Lastly - if I had a dollar for every time someone has told me Tulip is the sweetest dog ever I could buy her a lot more treats. The surgical veterinarian had never seen her before and led off our phone call with "I have to say that Tulip is one of the nicest dogs I have ever met. She loves everybody!"
- Back in March, Tulip was diagnosed simultaneously with both kennel cough and liver cancer.
- The kennel cough turned into pneumonia, but after several months of treatment it cleared up, thus allowing us to turn our attention to the liver cancer.
Now, the last time Tulip had cancer the tumor was on her knee and it proved to be relatively simple to remove it all, with no follow up complications to date. It was probably too much to hope that would happen again, but going into her early July appointment, all we knew from the initial ultrasound and a needle biopsy was that this new cancer was a tumor on her liver, and that there were basically three options:
[1] The cancer has spread everywhere and nothing can be done.
[2] The cancer is in one place now but spreads fast. Surgery or chemo might keep it from spreading.
[3] The cancer is in one place now and is very slow moving. Depending on symptoms, doing nothing may be the appropriate treatment.
The good news is that over the course of the pneumonia treatment she had multiple chest x-rays, all of which agreed that there were no tumors in her lungs. This argued strongly against [1] and also somewhat against [2]. The July appointment consisted of another ultrasound to monitor the growth of the tumor and to evaluate the potential usefulness of surgery.
First the good news - according to the second ultrasound, the liver tumor has barely grown at all since early March, nor has it spread to other parts of her body. In other words, we're definitely in category [3].
Now the bad news - the tumor is pretty substantial. It covers the two left lobes of her liver. In the words of the veterinary surgeon vet, it's not utterly impossible to remove the tumor as it would be if it was on the right side, but due to the size of the tumor it would definitely be a challenging surgery. Given her age, there's a very real chance that she wouldn't survive the operation, and if she did the aftercare would probably last months and likely cause more pain and suffering than the tumor is currently inducing. In particular, given how poorly her immune system handled pneumonia, any post-operative infection would also be dangerous. This is the very definition of high risk surgery. As an extra little kicker, the price starts at around $4,000 and could go up substantially depending on what complications ensue. After weighing all of these considerations, we've decided to forgo surgery. If she was three years old we'd probably go for it, but she'll turn thirteen later this month, and it seems like we'd be doing it more for us than for her. Chemo is also unlikely to help and would similarly impact her quality of life.
For Tulip's size, she's already relatively elderly. Right now, she's leading her best life, and unlike most humans the pandemic has actually improved her life. Because M and I are both home all the time she gets to wander around the yard a lot more than usual. M frequently takes her on car rides to a nearby park that is usually devoid of humans, and she has a giant papasan cushion dog bed that requires minimal effort to sprawl out on. She has some pain from arthritis upon occasion so our walks are shorter, but she still perks right up when a squirrel or a rabbit runs in front of her, and we've got painkillers for when she's clearly struggling. She's pretty much gone deaf, but that actually helps because the usual Independence Day fireworks barely phased her, whereas when she was able to hear they turned her into a quivering mass of terrified dog.
Although she's gained some weight since beating pneumonia, her appetite is still inconsistent. M had a grandmother who late in her life really only wanted to eat cookies, and Tulip has pretty much gone down that road herself. Fortunately, we are happy to oblige with many treats spiked in her food to trick her into eating. Pureed pumpkin? Cooked chicken? A wide assortment of dog treats? Cooked salmon skin? Watermelon? All of those and more have ended up in her bowl in the last couple of months, to her obvious gustatory pleasure.
If there's any real downside in Tulip's life right now, it's that with her compromised immune system we've been told not to try to renew her vaccinations as it could go poorly. This means she can't go to doggy day care (not that we're going anywhere anyway) or the dog park, which since she's still basically the friendliest dog ever and wants to say hello to every dog she sees means she is often disappointed.
So, basically we wait. Maybe the liver cancer will kill her. Maybe some other malady caused by old age will do it. Hopefully we won't find out for a long time, but it's been a good run since gotcha day. I have no complaints, and I hope she doesn't either.
Lastly - if I had a dollar for every time someone has told me Tulip is the sweetest dog ever I could buy her a lot more treats. The surgical veterinarian had never seen her before and led off our phone call with "I have to say that Tulip is one of the nicest dogs I have ever met. She loves everybody!"