Good luck Lulu!

Lulu has just had her last meal before tomorrow's procedure. Because she will be anesthetized for each treatment, she has to fast 8 hours before she is put under. She will be a very grumpy dog for the next 4 weeks!

This will be the last time in several months that we'll see Lulu's face like this. Tomorrow they will shave the right side of the nose/muzzle that needs the radiation treatment and there will be a 50/50 chance that the hair in that area will grow back. I'm not sure how big of an area they will treat but we'll find out tomorrow I suppose.

P.S. The prednisone makes Lulu farty.

Park!

It's the last weekend before Lulu starts radiation and chemotherapy treatments. We wanted to take her out to play but I was a little worried that her no-collar restriction would make the dog park and hike too tough. Instaed, we let them romp around our neighborhood park. Lulu had a great time (as she always does) and even saw her first hummingbird. She just doesn't smile like this indoors!

Misery is...

Misery is having an itch you can't scratch. Poor Lulu is stuck in her cone and unable to scratch her ears, nose or lick herself. That doesn't mean she isn't trying -- she halfheartedly lifts a leg here and there and when she remembers the cone is blocking her progress she just slumps into a huge sigh and goes to sleep.

The Cone of Shame

I came home to find Lulu in an e-collar. Apparently I spoke to soon and just today she started scratching fervently at her neck so my mom put it on her. Seeing as radiation therapy is starting next week as well, it looks like Lulu will be stuck in the cone of shame for quite a while.

Back to her usual, anti-social self.

Lulu is back to her quiet, anti-social self. She spent most of the evening yesterday downstairs (alone) on her favorite couch but responds quicker than normal to my regular "Who wants vitamins?" call. (Vitamins are popular in our household as they are made of chicken liver.)

I am surprised at how clean and dry the surgical site has stayed, with just slight staining as tiny drops seep out of the scar. Do dogs heal faster than humans? I am also surprised that Lulu doesn't scratch or rub at it -- it doesn't seem to bother her at all.

Cora, however, is extremely distracted by Lulu's new smells and also acting like a complete whine-baby, protesting while that Lulu gets all of the attention. Can we say high maintenance?

Meanwhile Dr. Lyons wants to move up Lulu's radiation therapy so we will be starting next Monday instead of after the July 4th holiday weekend. Her treatment will be Monday through Friday for 4 weeks straight. It's a good thing City of Angels has wi-fi in their lobby.

Dear Friends

Thank you so much for all of your support and kind words as my family and I go through this difficult time! It's only been a couple of weeks and yet I still don't feel as if Lulu "has cancer"... the word cancer itself still seems surreal and far fetched yet here we are making it through treatments to remove this vicious tumor.

I've created this blog to document Lulu's progress as she goes through treatment for an aggressive mast cell tumor, mostly for myself but also to share with all of you. It somehow makes it easier for me to be able to talk to myself about these things rather than randomly announce details about Lulu's treatment on Facebook or Twitter. I wanted a dedicated place to document my thoughts, research, emotions, information and just anything I run into while Lulu is on the fast track to recovery while keeping my everyday life as normal as possible.

Please check back often for updates as I will be here posting as often as I can. I hope to be adding information and resources to this blog as well in case anyone in the same situation needs information or referrals. Please pray for our little one as she goes through this difficult time and think positive thoughts!

Love,
Sheena

When did it start?

I was going through old pictures to pinpoint when that little growth on Lulu's nose started to appear when I ran into this picture taken about a year ago when Cora was still a puppy.

Looks like the tumor wasn't around yet, BUT, this seems to be the start of Cora's obsession with Lulu's ear.

The Morning After

Lulu did very well her first night out of surgery. She rarely scratched or rubbed against her neck -- it didn't seem to bother her at all through the night. And her appetite was just as healthy this morning.

We've exiled her to the living room to keep her away from carpet (which she likes to use to scratch her neck by dragging her head across the floor) but had to separate Cora because she's gone back to trying to attack various Lulu body parts.

Photo taken last month.

Post-Surgery

We picked up Lulu from surgery after work today -- she was so frantic! She was restless and could not sit still while we received instructions from the doctors. She just wanted to get OUT of that place.

The right side of her jaw and neck were shaved clean and there was a 2" incision near the jawline. With her ears down, you can barely see the shaved section. The stitched area was clean and dry and just slightly swollen. It didn't look like it bothered her at all. Her front paws were also shaved clean for IV's, making her look a bit like a long-legged poodle.



Because of the location of the incision, she can't wear an e-collar (cone of shame!) for fear of rubbing against the stitches. Hopefully we won't have too much trouble with her trying to scratch the area. The good thing is that her ear naturally covers it.

In the car she was high-strung and wouldn't leave my lap. She was hungrier than ever and was very alert. About halfway into the commute she finally succumbed to a nap and snoozed the rest of the way home.



Cora was so excited to see her after an entire day alone so we tried to separate the two to protect Lulu's neck area (since Cora's favorite thing to do is chew on Lulu's ear). Cora immediately noticed something was different about Lulu and proceeded to sniff out every part of her that was shaved. After a few minutes of invading Lulu's personal space, Cora went back to her regular evening routine and played by herself so we found no need to keep the two separated.

CT Scan + Lymph Node Removal Surgery

Today Lulu gets a 2-for-1. She'll be dropped off at the Cancer Group for a CT scan of her muzzle to for her radiation plan. Then, while she is under anesthesia, they are going to wheel her over to the Critical Care group to undergo a quick surgery to extract an affected lymph node.

Here's what's on the menu today:

CT Scan
CT Electron Radiation Therapy (the actual scan)

RT Plan 3-D, Advanced (the digital imaging plan for her radiation treatment)

Dosimetrist Fee (a second set of eyes to check the radiation plan)
Induction - Anesthesia Prop
PropoFlo
Catheterization, Peripheral
Anesthesia, ISO / 30 min
Doppler Monitor
Contrast Material

Surgery
Surgery - Lymph Node removal
Diphenhydramine-Inj 50mg/ml
Dexameth Sp-Inj 4mg/ml
Famotidine Inj 10mg/ml
Cefazolin Injection (100mg/ml)
Anesthesia- simple SX
Surgery Room+Supplies
Biopsy of Lymph Node

More Bad News

Dr. Carey called me today with the results from the cytology analyses. The reports showed that one lymph node (right where her jaw meets her throat) was compromised and had to be removed surgically. She suggested that we perform the surgery while Lulu is under anesthesia for the CT scan and informs us that this is an additional procedure to be done alongside the radiation and chemotherapy.

Looks like Lulu needs the whole she-bang. :(

Lulu's Radiology Oncologist: Dr. Lyons

Jarred Lyons, DVM, DACVR (Radiation Oncology)

Dr. Lyons received his DVM degree from the University of California at Davis and completed a surgical and internal medicine internship in the Los Angeles area. After completing his residency in Radiation Oncology at North Carolina State University in conjunction with Duke University and the University of North Carolina, Dr. Lyons joined Veterinary Cancer Group in January of 2007. His special interests include medical oncology and palliative radiation therapy to improve the quality of life for end-stage cancer patients. Dr. Lyons has worked hard to cultivate the collaborative efforts of Veterinary Cancer Group's radiation department whose teamwork ensures our patients receive the high quality care they deserve. In spare time, Dr. Lyons enjoys writing both fiction and articles for veterinary medical publications.

Day 2 of Exams

The next day we returned to meet Dr. Lyons. He went over Lulu's radiation plan and estimates and explained the different symptoms and risks associated with radiation therapy. He also told us that he recommends a full dose of chemotherapy (5-6 months!) to really make sure that we get all of the bad cells out since they were already showing up in a couple of her lymph nodes.

It was so much information to take in all at once! The radiation treatments all require anesthesia and would take about 20-45 minutes to do. She needed 20 treatments so that would be 4 straight weeks of daily treatments. Before radiation, we would do a CT scan so that Dr. Lyons could create a 3D imaging plan for the treatments. As for side effects, he said we could expect them to start 2-3 weeks into treatment where we would see her skin start to turn into a raw, wet, carpet-burn like wound and there is a 50/50 chance that the hair would not grow back in that area. There might be other side effects too like vomiting and loss of appetite.

At the same time, Lulu would be starting chemotherapy which apparently doesn't have as many side effects as it does for humans. Chemotherapy is 40-47% effective and only 20% of the patients experience side effects. The treatment would take over the course of 4-5 months in pill form.

He reiterates that the best course of treatment would be to go with both options, ASAP, starting with the CT scan the following week. Not having pet insurance, going with the full treatment plan doubles our original estimate. The numbers start to become a blur and I decide to start a Care Credit account so I can worry about finances later and focus on what is best for Lulu.

Today's services:
Evaluation - Consultation
New Patient Set Up
Prednisone 10mg Tablets

Lulu's Surgeon: Dr. Carey

Kim Carey, DVM, DACVS (Surgery)

A native of southern California, Dr. Carey returns to her roots at ACC. After receiving her Doctor of Veterinary Medicine degree at the University of California, Davis in 2001, she completed a small animal surgical and medical internship in San Diego. In 2002, she embarked upon a surgical residency at The Animal Medical Center in New York City and became board certified by the American College of Veterinary Surgeons in 2006. She then served as an associate staff member in orthopedic surgery at the Animal Medical Center prior to joining ACC. Dr. Carey is trained in both the TPLO and TTA procedures, arthroscopy and total hip replacement. Working closely with the Veterinary Cancer Group, she has special experience in surgical oncology, reconstructive wound surgery, minimally invasive procedures and surgery of critically-ill patients.

City of Angels - Initial Visit

Today was Lulu's first visit to City of Angels Veterinary Specialty Center to see Dr. Carey.

After a quick examination on the table, Dr. Carey immediately recommended that we do another aspirate of the swollen area to take a look at the cells and figure out exactly what is causing that lump. (Since they did not find anything other than "blood" at VCA Lakewood) We left Lulu there for 30 minutes while Dr. Carey used a needle to extract cells from the front of her muzzle and analyze them under a microscope.

When we returned we were met with bad news: she had found what looked to be a mast cell tumor on the muzzle as well as mast cells passing through two of the lymph nodes on Lulu's right side. She immediately recommended further testing, including sending the cells for a complete cytology report, aspirating the spleen and the liver, an x-ray of the chest and an abdominal ultrasound to quickly assess whether the cancer has spread.

She also estimated Lulu's mast cell tumor to be a stage 2, but acting like an aggressive stage 3 because of the location. Also, because of the location, she recommended that we think about radiation therapy instead of surgery, which is roughly twice the price. Being right at the tip of her nose/muzzle it would be extremely intrusive to try to remove the tumor with surgery since they like to take out an additional 2cm radius of the tissue around the tumor. They'd have to remove about half of her muzzle, leaving behind open nostrils, similar to a pig's. (She actually used that analogy and I thought that might be fitting, seeing as to what a piggy Lulu has been lately.)

We left Lulu at the vet for the remainder of the day for testing and made an appointment to meet Dr. Lyons, the radiation oncologist, the next day.

When we picked up Lulu, they let us know that the x-ray and ultrasound came out clear but we'd have to wait until the next day for the full cytology reports on the lymph nodes, spleen and liver. Eek!

Today's services
Examination - Specialist Consult
Butorphanol 10mg/ml
Acepromazine Inject 10mg/ml
Dexameth So-Inj 4mg/ml
Ultrasound - Abdomen
Cytology ANTECH
Healthchek Plus IDEXX
Urinalysis IDEXX
Radiographs- Met Check
Radiograph Interpretation