Another Unknown Growth

[hheldorfer]

How awful for you, having to wait to see the surgeon while Addie is in pain.  I hope the anti-inflammatory drugs help make her comfortable until her appointment.  Buffy sends licks and wishes for a quick resolution.

[pkcrossley]

it is so distressing when they have such sharp pain. if it is not an infection than i guess a pinched nerve makes sense --addie has probably been compensating for the sore leg and may have twisted something that needs time to untwist itself. i hope she is more comfortable very soon and can start her treatments. 

[Dempsy's Mom]

Crap.  So sorry little Addie.  ... and sorry for you Whits.  It is emotionally draining seeing our best buddies in distress.  Keeping you in our thoughts.

[kjwarnold]

Aw, poor Addie.  We hope she's feeling better soon.  Packy and Kirby send licks...

[_whits_]

Small but exciting victory: Addie can back up again! 

The anti-inflammatory seems to be working. We still have the check up with her surgeon and radiation consult this coming week. 

[Sam I Am]

[Lynn in TN]

I am so glad to hear it was benign but sorry to hear of the setback. Sending from all of us to you and Addie.

 

[hheldorfer]

Wonderful that Addie is feeling a bit better!  That's an adorable pic of her.  We're all anxious to hear what the surgeon and radiologist say about further treatment.  Thinking of you.

[sanford]

Thanks for the adorable pic!

[Autumn & Lola]

Glad to hear the meds are working. She looks sooo cute in that pic.

[Malcolm's Dad]

Happy to hear the meds are working. She is so cute. Hope she has a fast recovery.

[Dempsy's Mom]

She looks super bummed.    It'll get better sweet Addie.  Love your soft blanky.

[_whits_]

After a check-in with her surgeon, it appears the process to remove the infiltrative lipoma likely irritated a nerve (which the lipoma was wrapped around, in addition to wrapping around her tendons and ligaments and muscles and bones). She's on an anti-inflammatory specifically for nerves, and it appears to be working very well. Addie hasn't limped in days and jumped on the couch yesterday for the first time in weeks. Her surgeon was very comprehensive and helpful and stayed in touch with her regular vet the whole time. 

Addie and I met with the oncologist last week and I've been struggling to put into words how I feel. I am profoundly lucky and glad that Addie does not have cancer. Unfortunately, the type of non-cancerous tumor she has needs to be treated as if it is cancer. As Addie's oncologist explained to me last week, "Addie does not have a life-threatening disease, she has a limb-threatening disease." 

Here's a summary of what her oncologist had to say:

Infiltrative lipomas very frequently grow back because surgeons rarely get them all out, due to how they grow and infiltrate surrounding tissue (they need a margin of healthy tissue removed around the tumor, and it's rarely possible with an infiltrative lipoma). They are not cancerous, but they grow back and they are very destructive to non-organ tissue (muscles, tendons, nerves, bones). As they grow back, they can become very painful. And in - extremely rare - cases the pain and damage they do makes putting a dog down the humane choice (the oncologist mentioned the only case he knew, where one of his patients had an infiltrative lipoma that had compressed the dog's spinal cord and was essentially slowly crushing it). The only way to 100% remove Addie's infiltrative lipoma with a margin of healthy tissue would be to remove her entire leg. 

As I told her doctor, I'd like her to have as many legs as possible for as long as possible, but of course her overall health is more important. Thankfully, radiation therapy has a very good success rate at destroying these particular lipomas, but only before they start growing back (which can happen as soon as 3 months post-surgery). Addie's oncologist estimated a 90% success rate in her case, although he said that rate will decrease the longer she goes without radiation. The course of radiation requires radiation 5 times a week for 3.5 weeks. The duration of radiation ensures she receives the lowest possible dosing but with the highest success rate. She'll need general anesthesia each time, albeit for a very short period of time and at a very low dose. 

Due to the speed at which these can grow back (and Addie and I had a scare last week when her surgeon thought for a second it had already started growing back, but realized it was a pocket of inflammation), her oncologist wants her to start radiation immediately. His earliest appointment for the initial dose (which takes longer than subsequent doses) is Tuesday, July 5. She'll finish her course of radiation about 2 months to the date of her initial surgery. 

Like I said, I am immensely grateful that Addie does not have cancer. I am also grateful that there is a treatment available to eliminate this tumor without the need for amputation. Her oncologist is one of a very few in the country with a lot of experience dealing with these infiltrative lipomas (they are rare, and academic research is even more rare). I'm grateful I have insurance that will cover most of the cost and parents willing to help with some of the rest. I know how lucky we both are. But it has been a difficult emotional journey for me, going from 2 months ago thinking Addie had an infected bug bite to last week being told that Addie was likely to lose her leg if I didn't get her in radiation 5 times a week for the next month.

I hate that Addie's spent most of the last month being poked and prodded and in pain, and will be spending most of the next month dealing with the same. I'm also completely inexperienced with radiation (my mom had it to treat her breast cancer, but I was only 2 at the time, and my dad the veterinarian doesn't do oncology), and hate not knowing what to expect. I'm worried about the likely radiation burn. Most of all, I'm heartbroken that Addie is dealing with all this pain and she has no way of understanding why or knowing that what I'm subjecting her to now is to ensure she has a happier and healthier future. 

I had my dad send Addie's health history to an oncologist he knows out in Colorado, who agreed 100% with Addie's Virginia oncologist on both the treatment and success rate. So I know I'm doing the right thing. I just wish my little girl didn't have to deal with all of this. 

I've attached the most relevant findings from her oncologist's consultation. 

 

 

[Sam I Am]

I know you will worry and be  upset, as I certainly would be also, but thank goodness it isn't cancer. No doubt it won't be without its stress also for Addie, but perhaps think of it this way. 3.5 weeks in the big picture is just a blip on the radar, with a whole life time ahead of her and you to enjoy this wonderful bundle of a Cairn. Otherson this forum, like PK have experience with dogs and radiation, and no doubt will help you and support you through the next weeks as of course I will and everyone else here. Big hug to you and Addie.

Edited June 29, 2016 by Terrier lover

[pkcrossley]

i think you appreciate how good this prognosis is overall, and we all appreciate it too. 

the radiation redmon had for his pituitary macroadenoma was nearly exactly what is being prescribed for addie. in his case, the plan was to get him a year of good life, and it worked. i am so happy that in addie's case you can do the same program but in the hope of a profoundly better result than was possible for redmon.

i had to drive redmon each weekday for a month two hours away to the nearest radiation facility (not a pleasant drive at all, into and out of a very busy city). in our case i just got up very early each day, drove down, spent about half an hour on the treatment, and drove back. i was generally home by lunchtime, which left some time to do normal things for the month devoted to this.

redmon was not allowed to have breakfast on radiation days, so i had a meal packed and he happily ate it when we returned to the car after his treatments. 

for redmon, missing breakfast was really, truly, the only painful aspect of the treatments. he enjoyed the rides, and he was perfectly happy with sitting in the waiting room. he trotted in for the treatments and about 20 minutes later came back, a little groggy, but very rapidly rebounding. he was treated like a little prince and looked forward to getting his meal once we were back in the car.

of course, for me, it was different. i was extremely concerned about the anesthetization. it is very brief each day, and redmon showed no ill effects at all, though i did not know at the time that that was the way it would be. sitting in the waiting room was difficult, but also uplifting in a strange way. the room was full of people whose dogs (and a few cats) were profoundly or hopelessly sick (though most of the pets were radiantly happy). in some cases, people were struggling to buy only a few weeks of good life for their pets. in the context of the "short" (in comparison to us) life of any pet, weeks and months were actually a big pay-off. some people obviously did not have a lot of money and had scraped together or worked out a finance plan for the two or three thousand dollars they needed for the treatments. i remember an elderly and clearly not rich farming couple from northern vermont who made the trip every day in a beat-up pickup with their elderly lab, to reduce the tumors she had all over her body and let her live about three months or so without pain. but they were there every day (sometimes driving four hours each way) because every day they could get was precious to them. they were just buying time and nobody was embarrassed about it. really, all life is about is buying time. we just were aware that that was the only reason we were there. what we all learned was that that awareness allowed us to make weeks or months or as much as a year have the meaning of twenty or thirty years. i still remember so well each of the dogs we shared the waiting room with, sometimes overlapping by as much as a week or a little more. a middle-aged man was there with a young and very sweet chow-chow, starbuck, for whom he was trying to buy a good six weeks. the man's heart was clearly breaking, but starbuck was a happy lad. 

radiation is a very effective intervention, and it brings great comfort to small animals whose tumors are significantly reduced in size. they do not get great big doses and it causes them no pain. in some cases it was impossible for people to drive their pets to the clinic each day.  the pets could be boarded during the week for their treatments and go home for the weekends. less often, the protocol could be adjusted to administer bigger doses once a week (not the best choice, since the experience for these pets might not be as comfortable as for those doing the regular program). if you are lucky enough to live within striking distance of new york city and a very few other cities, you might be able to get "laser knife" treatments, which are even more precise and might (the results are still not enough to be very clear) be even more effective than computerized radiation. 

virtually none of the pets we shared the experience with had a hope of recovery; i am so very happy that addie's diagnosis is not cancer, even though it challenging, complicated and scary. i hope you can work it out as quickly and conveniently (though it can never be really convenient) as possible, and that you get the very best results. 

 

Edited June 29, 2016 by pkcrossley

[Autumn & Lola]

I'm so glad as well that Addie doesn't have cancer. I'm sorry, too, for the treatment course, that she may be uncomfortable and you will  worry and be upset about putting her through the process. At least she has a very good prognosis and you have an expert surgeon, which all point to an excellent outcome. You are in our thoughts. Big hugs. x

[Hillscreek]

Have no experience with radiation and dogs myself but hear of it being very helpful like pk says. In Addie's case hoping it will allow her to have not just weeks and months ahead, but years and years - good luck to both of you and hugs and licks from me and Angus

[hheldorfer]

As pk said, this will probably be much harder on you than it will be on Addie.  We'll all be with you in spirit through the next few weeks, hoping and praying that everything goes well and that this will be a permanent solution to Addie's issues.  

[sanford]

I was very touched with the support expressed here for you and Addie. It's another example of how invaluable this forum is. Thanks to Bradl for creating this forum, you do not have to go through this alone. 

Pk, your description of Redmon's visits to the radiation facility touched a deep chord within me. Thank you for the thoughtful kindness and compassion you always show!

Edited June 29, 2016 by sanford

[pkcrossley]

thanks, sanford.

[Sam I Am]

Oh my.. what a lovely picture!

[hheldorfer]

Seeing Redmon's handsome, ready-for-anything, bright-eyed face brings a tear to my eye.  What an amazing boy he was.

[tlwtheq]

I'm so glad Addie doesn't have cancer.  And I'm also glad you live close enough (in Virginia) to the same place our veterinary team recommended for radiation therapy for Olie.  We opted out of that because Olie was so sick, and the thought of putting him  through the hours of commute each time, with his age, would have been cruel.  You have the advantage because of location, Addie's age, and the finances being covered to make this work for Miss Addie.   God bless. 

[Malcolm's Dad]

Hoping the best for Addie and you. Saving the leg will be worth all the trouble.

[Lynn in TN]

I am so glad to hear it is not cancer. I know this will be difficult on you and her. I have no experience with radiation on dogs as well, and can't imagine it. I am so glad you have the resources available to you.