Direction Connection

Today at closing, the attorney actually said “Wow” when he saw my credit score.

Josie has had some health adventures recently. On a Sunday at the end of June, I spied a lump on her left forearm elbow; it seemed to be cyst-like, so I took her to the vet the following Monday. The vet agreed that it looked like a cyst, but took some cell samples and looked at them anyway. She thought the cell samples didn’t look quite right, so she sent them off to be analyzed. That Friday I learned that the cells were indicative of a soft-tissue cancer, either hemangiopericytoma or fibrosarcoma. The “good” news was that either one of these types of cancer is typically locally invasive, meaning that it’s a cancer that doesn’t like to migrate to other body parts, except after it’s been around for a while (this is my loose interpretation).

The vet said that a definitive diagnosis could not be made based on the cytology results, and that Josie could have surgery to biopsy the lump. She said that I could just get the lump removed (which likely would require a skin graft to preserve her range of motion due to the lump’s location on her elbow) or amputate the leg entirely. I was initially extremely opposed to amputation, but throughout that day and the next day, Rebecca and I did some research. It seems like three-legged dogs do really well–they’re certainly able to balance with only three legs (we’ve even found stories about some dogs who can get along with only two legs), and they have no body image, so that’s not an issue.

This past Tuesday, we went to the NC State Veterinary Teaching Hospital in Raleigh, and discussed our options. I had thought that if they could do a biopsy without putting her under general anasthesia, I’d do that and then make a decision about amputation based on the histopathology results. But I learned on Tuesday that they needed to put her under regardless of whether they did a regular old (tissue sample only) biopsy or an excisional biopsy, so I figured since that was the case, I’d have the excisional biopsy (there was a price difference between the two, but it wasn’t enough of a difference to persuade me one way or another). Also, the surgeon who examined her said that there was enough skin to work with that they wouldn’t need to do a skin graft. They took her blood on Tuesday to make sure nothing was out of whack prior to surgery, and all looked good, so we were a go for surgery on Wednesday.

After providing a detailed explanation of Josie’s severe separation anxiety to both staff members we met with on Tuesday, I took Josie in yesterday morning for her surgery. They were going to try to get her in early in the day so that she could definitely go home that night, so I expected a call around mid-day to let me know how she was doing post-surgery. Instead, I had a bit of a scare when the fourth-year resident on the case called around mid-day to tell me that there was a “suspicious nodule” that appeared when they x-rayed her lungs to be sure there were no metastases prior to the surgery. She asked if they could do a fluoroscopy (live x-ray) to get a better look. The price was miniscule compared to the overall bill I was expecting for the day, so I said to go ahead. Then I freaked out for about 25 minutes, IMed Rebecca to let her know what was going on, and practically broke down when a former supervisor asked how my dog was. Then the resident called me back and said they weren’t able to find the suspicious nodule on fluoroscopy, so it must have been a shadow or something.

Finally, I got a call around 4:00 to tell me that Josie was out of surgery and starting to wake up. The resident said the surgery was really quick, and that the surgeon’s gross assessment was that it was cancerous (which we already kinda knew, based on the cytology), and that we’d probably need to follow-up with Oncology to discuss the next steps after we got the histopathology results in a few days. She told me we could pick Josie up around 7:30, then called me back at 5:30 to say that Josie was doing so well, we could pick her up anytime.

She’s home now, with a shaved front left arm and wearing a positively demeaning cone collar, but other than that, she seems to feel fine (by the way, she felt completely fine prior to surgery too–she clearly had not begun to feel any of the effects of the cancer by the time we caught it). At this very moment, she is obviously having interesting doggie dreams because she is making her super-cute “whoop-whoop-whoop” noise. She limps a bit whenever the pain medication starts to wear off, but I don’t anticipate that she’ll have a limp after she heals further.

Next steps? We don’t know. I’m not too keen on radiation. It’s expensive, requires frequent vet visits, and does not have as high of a “cure rate” as amputation (also, um, she’s a dog…). Amputation may seem drastic, but it’s less expensive, requires only one initial multiple day, heavily-sedated hospital stay, and prevents recurrence at the initial site (because the initial site is no longer there), thereby reducing the risk of metastasis. At this point, that’s where I think we’re going…but probably no earlier than August.

Oh, and did I mention we close on our house this afternoon? Yeah, it’s been a busy week. The movers come on Monday. Yikes!