Lulu Fights Cancer

Prepping for Halloween

2010-10-10T00:40:00.000-07:00

This is Lulu's week off, and she's back to "normal" again now that she's back on Prednisone. Her foot has healed and she had her first grooming since she's started treatment at Healthy Spot. They made her fluffier than usual and kept her hair pretty long, so she's super soft and fuzzy.

The left side of her nose is starting to grow more fur now and the top of her muzzle has a few sprouts as well. The front of her lips are still pink and hairless.

I subjected the pups to their annual trying-on-of-the-Halloween-costumes and you can see they weren't all too happy. Here is Lulu (and Cora) in their Halloween outfits.

Quick Dr. Visit

2010-09-29T18:22:00.000-07:00

It's been about a week since Lulu has started Cycle 3 of her chemotherapy and she's been experiencing some side effects. Starting last weekend she has been a bit sluggish (especially coming up the stairs) and pants a lot in exhaustion. Also she's lost her appetite, which is very unusual for her. She'll start her meal but have a hard time finishing, even after we've topped it off with some pumpkin (girl loves her fruit and veggies) or dried meat.

Also we learned our lesson with putting off her grooming. She has been biting at her paws (poor, itchy things) and must have bitten through the skin because one started to bleed and it looks infected. We took her in to see Dr. Turner today and the team was surprised to see her so shaggy.

Today's diagnosis:
• Stopping the Prednisone early may have affected Lulu's appetite and energy level. Starting today she is back on at 10mg 2x daily for three days, 10mg 1x daily for another three days, then back on to 10mg every other day.
• The doctor gave her an antibiotics injection to last her two weeks. Hopefully this will fight off that nasty infection on her foot. She is to soak it 2x daily for 5 minutes in a Chlorhexadine dilute and is back in the cone so she can't chew on her foot.
• Lulu's white blood cell count is normal so she is to continue on the Lomustine tomorrow.

The peach fuzz on the right side of her muzzle is slowly turning into fur and the left size now has some peach fuzz. Top of her nose, not so much. :( The pigmentation is starting to return too so you can see parts of her nose and top lip that is starting to match her bottom lip. When we take her out people have stopped asking about her nose -- I suppose she just looks like a "mature" dog now that has lost a bit of her fur. :P

Chemotherapy: Cycle 3

2010-09-23T18:01:00.000-07:00

Lulu has incredibly fuzzy feet! We've been trying to scope out a new groomer in the area. Lulu and Cora have both been going to Paw House in Cypress since we've moved out here and Cora got a pretty bad allergic reaction the last time they gave her a bath so I'm hesitant to bring Lulu in. (Especially since her skin still looks so sensitive)

So in the meantime, Lulu has grown fuzzies all over, especially on her feet. Lulu also went in to start Cycle 3 of her chemotherapy today. She has run out of prednisone but the doctor said she doesn't need it anymore. Maybe now she'll shed her extra pounds?

A typical chemotherapy cycle (3 weeks) looks like this:
Evaluation with Dr. Turner
Vinblastine 10 x 0.1mg (chemotherapy by injection)
Catheterization, butterfly
CBC w/o differential
Blood Draw
Oral chemotherapy handling fee
Lomustine Cap 10 x 10mg (chemotherapy by oral capsule)
Recheck with Dr. Turner within 1 week
Recheck with RDVM within 1 week
CBC check within 1 week

Chemotherapy: Cycle 2

2010-09-13T11:44:00.000-07:00

Lulu just finished cycle 2 (out of 3) of chemotherapy. She is doing well and back to her usual antics. How do we know she's back to normal?

• She yawns (audibly) in the mornings to ask for attention
• She scavenges for food when we are gone
• She's smiling again
• But most of all, she's her usual, lazy self

We've started taking her out more often now that most of the scabbing around her nose has fallen off. Her facial fur has started growing wild so it's a big contrast against the bare skin around her muzzle. We're just crossing our fingers and waiting for her fur to come back. (She's developed a little peach fuzz on one side :P)

Chemotherapy: Cycle 1

2010-08-23T10:00:00.000-07:00

Lulu has just finished her first full cycle of chemotherapy and is taking a break this week. The skin around her muzzle is healing fast so we took this as an opportunity to give her a bath -- her first one in months! We had always been hesitant to give her a bath even though Dr. Lyons gave us the go ahead after she was done with radiotherapy. Lulu likes to rub her face all over the carpet after a bath and we didn't want to encourage too much irritation around her scabs.

So fresh and so clean!

Hungry Bear

2010-08-22T11:45:00.000-07:00

Lulu is getting FAT. She has gained almost 3 pounds since she started her treatments. Apparently prednisone makes dogs unusually thirsty and persistently hungry which means that Lulu is always hungry, even after she eats.

She is always waiting for food. Here she is leading the pack in eying my mom's birthday cake.

Out and About

2010-08-16T11:50:00.000-07:00

Now that Lulu's nose has dried up considerably, we're starting to take her out on outings. After being in the house for a couple of months straight she was excited to be outside.

We headed to The Camp in Costa Mesa for brunch. She barked a little more than usual and was very alert the entire time. (Mostly searching for birds) But she was happy! We're going to have to do a lot of retraining to get her to calm down in public areas, especially since her medicine makes her super anxious.

This week Lulu will be going back to see Dr. Turner for a quick CBC Test (Complete Blood Count) and her first dose of oral chemotherapy if all looks good.

Lulu's Medical Oncologist: Dr. Turner

2010-08-13T12:29:00.000-07:00

Avenelle Turner, DVM, DACVIM (Oncology)

Veterinary Cancer Group's latest addition to the team of dedicated veterinary professionals is Board-Certified Oncologist Dr. Avenelle Turner. Dr. Turner received her DVM Degree from Colorado State University and completed her internship at Garden State Veterinary Specialists in Tinton Falls, New Jersey. She completed a three-year residency in Medical Oncology at Gulf Coast Veterinary Specialists in Houston, Texas. She was most recently practicing at a progressive multi-specialty practice in New York City for the past few years. Dr. Turner has extensive training in oncologic emergencies, clinical pathology, exotic animal oncology, and grief counseling. The focus of her approach to the practice of oncology is compassionate care and strengthening the human-animal bond. She has many personal interests including traveling abroad, reading, baking, and personal fitness. She is the proud parent of two tortoiseshell cats and a very long Dachshund named Sookie.

Starting Chemotherapy Treatments

2010-08-12T11:54:00.000-07:00

Today we met Dr. Turner for the first time, Lulu's medical oncologist. Dr. Turner will be monitoring and administering Lulu's chemotherapy over the next couple of months. She's found the trick to befriending Lulu: feeding her constant treats as she conducts her physical exams.

She explained to us that Lulu will be doing three cycles of three weeks each to administer two different drugs. The first drug will be given by injection the first week, the second one orally the second week and on the third week Lulu will rest. At the end of the nine weeks, Lulu should be cancer free.

The scabbing around Lulu's nose has completely dried up and is starting to fall off. You can see that the new skin underneath the scabs is a very light pink color and very smooth. Her nose is also a very soft pink color but that should be darkening over the next couple of weeks. It seems very sensitive (like baby skin!) so I'm guessing it will toughen up over time too.

Still in the Cone

2010-08-05T12:19:00.000-07:00

Poor Lulu. She keeps trying to scratch off the scabs but they are not ready so it makes her bleed even more. She has no more radiation treatments so hopefully it doesn't get any worse than this. I can't wait for everything to dry up -- makes me so sad to look at her!

Done with Radiation Therapy!

2010-08-04T12:11:00.000-07:00

We had our last discharge appointment with Dr. Lyons today. She is done with radiation therapy! The worst is over. Dr. Lyons is confident that they got rid of all of the cancer cells in the muzzle and lymph node, though he did just a visual assessment. Apparently at this stage a cat scan won't do much to see what is leftover at the molecular level, so that's what chemotherapy is for.

Lulu already had a couple of milder doses of chemotherapy during her radiation therapy but now that she's done, the medical oncologist will step it up and give her the full doses. We meet with her next week!

The fur on the right side of her nose is getting dry and crusty. There are chunks that peel off at a time and I try to remind myself that it's normal. It just seems so much more harsh when it falls off with a huge chunk of fur attached to it. :P

Dry is Good

2010-08-03T21:49:00.000-07:00

So I *think* Lulu is getting a little better today and starting to heal. The wetness is gone and her nose has started scabbing around the affected areas. The top of her nose is peeling and still very dry but I'm hoping all of this will heal and her skin (and fur!) will regenerate. She's been a little less persistent about rubbing her nose (maybe because it's much harder with this plastic cone) but was all sniffles through the night and morning.

I wish there was something topical I could put on her skin to help it heal faster but she just licks anything right off. Tomorrow we have a follow-up appointment with Dr. Lyons where we'll assess her progress as well as start the next dose of chemotherapy.

And yes, that is her prednisone pot belly. :)

A cone upgrade!

2010-08-02T21:25:00.000-07:00

Lulu is building quite the collection of cones. She's upgraded to an extra-large... we needed one as long as we could find so that the tip of her nose can't reach anything she's trying to rub it against. This one is a little better for her to walk around in too, since she will have slightly better peripheral vision. Hopefully it doesn't bother her when she's sleeping.

And.... it got worse.

2010-08-02T21:14:00.000-07:00

These pictures make me so sad but in the spirit of documentation, the posts shall go on!

Lulu was able to get a good scratch on the nose twice, and both times it ripped chunks of her fur off her muzzle. The growing raw and bloody areas plus these two open wounds are driving Lulu crazy and she is trying to rub her head on the wall, ground, anywhere she can, cone or not!

The soft cone is good for comfort but not great for preventing rubbing or scratching. Max is out shopping for a plastic cone. We need to do what we can to stop her from making the area worse. I keep reminding myself to be patient and that by this weekend she will start healing. *crosses fingers*

"It will get worse, before it gets better."

2010-07-29T21:00:00.000-07:00

Oh, Lulu. This week the raw, tender area on Lulu's nose is getting bigger. It's irritating her even more now so she is back in the cone. When we don't watch her she tries to rub her nose against the wall since the cone prevents her from rubbing against the ground.

She is now on Tramadol (pain medication) 3x a day to keep her knocked out and pain-free for as much of the day as possible. The top of her nose is crusty and dry and the inside of her mouth is still raw and s-m-e-l-l-y. Fortunately she still has her appetite and is eating well. An ice cream a day, keeps the doctor away!

Last Day of Radiation

2010-07-28T20:41:00.000-07:00

Today is Lulu's last day of radiation therapy. I thought I'd finally give you a peek into the place Lulu has to go to everyday! We start off at the parking lot at the roof of the building. As soon as Lulu sees the stairs she starts walking slowly and more hestitantly.

Here is the entrance to 9599... radiology on the left and cancer therapy on the right.

This is the wall of radiation graduates. Can't wait til next week when they will post Lulu's picture up!

Lulu hides under the chair as soon as she hears them calling for her.

And this is Swix, the cheerful gal that takes Lulu in and out of the radiation therapy room. Lulu likes her for one reason, and one reason only: she's the one that feeds her lunch when she wakes up!

A Frozen Treat

2010-07-27T22:24:00.000-07:00

Lulu is entering the beginning of the worst... two more weeks and we'll hopefully see some healing. Every day her nose is redder than the next. We can see more bare skin around the lips now and her right nostril is misshapen: bloody, swollen and ridden with crust. Tomorrow is her last day of radiation therapy and her discharge appointment... we can't wait!

We had a hard time getting her to drink water during the day to keep the area licked and clean until a co-worker gave me an idea about ice cream. Duh! Lulu loves doggie ice cream! We bought her a dozen treats to last the next couple of weeks. Though with Cora always demanding her own cup, I'm not sure we'll last that long.

Almost there~

2010-07-26T11:16:00.000-07:00

I can't believe Lulu has been to the vet almost everyday for over a month. Also can't believe that in 17 of those times, she's been knocked out under anesthesia.

I had a short chat with her doctor today about the side effects and again he reminds me that it will continue to get worse over the next two weeks as radiation effects are typically delayed by 3-4 weeks. Her breathing will be more and more labored as more discharge (both wet and dry) starts building up in her nose and around her muzzle. He advised that we up her pain medication intake to 3x a day to help her knock out and sleep more.

He says she is walking slowly most likely due to being groggy on all of the medication but I still think she looks pained. Her mouth is the stinkiest ever but unfortunately we can't do anything to flush it out. We tried "forcing" her to drink some water but if a dog doesn't want water, there isn't much you can do.

For now all we can do is make sure she is as comfortable as possible when she's resting. She is pretty uncomfortable during the night and makes funky sounds. Most of the time she sounds like Darth Vader but she's also started this weird clicking sound in her throat, almost like her mouth is too dry as she tries to use it to inhale. Since I am a light sleeper, that means I have barely gotten any sleep over the last 3 nights. Also, she gets into sneezing fits that freak her out a little and she jumps up to sit as close to me as possible when she's not feeling well. Needless to say we've adopted a towel system to try to keep as little of her bloody mucus/discharge from spraying on our faces as possible.

She has 3 more radiation treatments left and will be discharged from radiation therapy on Wednesday. She will continue chemotherapy for the next 5 months. We'll welcome the less frequent vet visits!

Radiation Therapy: Week Four

2010-07-23T21:02:00.000-07:00

Lulu isn't doing so well. This must be the "worse" that the doctor kept warning us about. She is miserable. She is sniffly. She is wheezy. She can't stop sneezing and doesn't have the energy to get up and walk around anymore. We picked up a new cone for her because the other one just didn't look comfortable. She spends all day sleeping (loudly) and doesn't even get up to greet us at the door. :(

We forced her to take a short walk with us to the park but she was walking so slowly she didn't even need a leash. She kind of slumped along and looked like she was in pain. But once we were at the park we caught a couple of tail wags and she enjoyed sitting in the shade for a few minutes. After that she napped through the rest of the day.

The "open sore" areas around her muzzle are larger and more prominent. The front and top of the nose look like a raw open wound and the inside of her mouth is tender. She can no longer eat dry dog food so we are keeping her on wet canned food for now. The good thing is she still has her appetite so she hasn't lost any weight yet.

Lulu pretty much sleeps in the same spot all day unless we move her. We have to carry her out to the grass to force her to "go" and bring her food to her. She is so miserable -- I hope the pain meds are helping her. If she has trouble breathing through the night again tonight then I might bring her into the vet tomorrow, just in case.

Chemotherapy: Dose 2

2010-07-19T21:00:00.000-07:00

Lulu had her second dose of chemotherapy today. The doctor gave us special gloves to pick up Lulu's poop and we were instructed to keep other dogs away from her eliminations as it will have hazardous traces of chemotherapy that passes through her system.

So now I'm wondering... if chemotherapy is so "safe" for dogs and only 20% ever get side effects, then why is it so dangerous for other dogs to accidentally step in pee which will only have trace amounts of the chemotherapy drug in it? I'm getting a little worried that this is doing more damage to Lulu than we can see.

We picked up a new dog bed for Lulu so she has a safe spot where she can be alone. So far she's loving it, as uncomfortable as it might be with that crazy cone around her head.

Radiation Therapy: Week Three

2010-07-19T11:02:00.000-07:00

Oh, poor Lulu.

We're midway through week three and Lulu has picked up mucositis among other side effects. Mucositis is a painful inflmmation and ulceration of the mucous membranes lining the digestive tract and the mouth. It's very common to chemotherapy and radiotherapy and Lulu has started antibiotics and pain meds to help counteract the discomfort.

The fur around the muzzle is starting to look sparse and you can see more of her pinky brown skin showing through. The top of the nose is starting to become bare and you can really see where the mast cell tumor has taken over close to the skin. The original bump by her nostril which disappeared in the first two weeks of radiotherapy has come back in the form of a large, raw pink bump. The doctor explained that the skin has degraded a little bit and the tumor is fighting back, releasing histamines which has reformed the bump.

Lulu's nose is constantly runny and she sneezes throughout the day (and night). She sneezes even more when she gets excited (like when we come home from work) so we're trying our best to keep her calm. She's also having a tough time sleeping through the night, waking up in fits of sneezes, so I'm going to hunt down a dog bed for her so she can keep her chin up and her respiratory tract clear while sleeping. Unfortunately this probably means no more park visits or playdates for Lulu. Maybe just long quiet walks at night so she can still get some exercise.

Radiation Therapy: Week Two

2010-07-10T17:53:00.000-07:00

After 2 weeks of being dragged kicking and screaming to the vet, Lulu is finally having a long, relaxing weekend at home. The radiation machine is broken! Okay, not a great thing to be happy about but for Lulu it meant 4 days off of treatment.

It was a weekend full of play since all of the sister's dogs are over... and it has definitely brought Lulu's energy level back up to normal. For a few days she started getting grumpy and slumpy, but this weekend we even caught a few smiles.

Also, we've noticed that the muzzle area is looking like it's back to normal: no swelling, the "wart" isn't as visible and her nose even looks symmetrical now.

Lulu hates the vet.

2010-07-04T17:49:00.000-07:00

There isn't much changing on a day-to-day basis. If anything, she gets smart a little earlier every day in realizing that we're headed to the vet. At first she was excited to get in the car, to get out of the car, to go into the vet and freaks out at the weigh machine. A few days later she was excited in the car and changes her mood as soon as she recognizes the vet parking lot. Now she won't even get out of bed in the morning.

The saddest part of all is dragging her into the radiation room every morning, with all four of her paws pushing against the floor. :(

Radiation Therapy: Week One

2010-07-03T17:37:00.000-07:00

Lulu has completed her first week of radiation therapy and so far all is going well. They've shaved the parts of her muzzle and shoulder that need the treatment and drew a grid to help focus the radiation gun. I couldn't do anything but laugh when I picked her up -- she looked like an intense football fan that painted her team's colors on her face. :P She also had a hot pink bandage around one leg (for IV) but she chewed that off in about 2 minutes.

I am not allowed to give her a bath for these 4 weeks so I guess she'll look like graph paper the entire summer. :) The side effects (hair loss, skin rashes) don't start until the 3rd or 4th week in so the next couple weeks should stay easy.

Lulu's surgery site is drying up pretty well. They haven't removed the stitches yet but you can barely see the scar now that her fur is growing back in. You can see that her skin is rashing up on some parts that were shaved though -- she's always had sensitive skin and had past rashes from the groomer shaving too close. :(

Overall she is eating, drinking, sleeping normal. The only change is she seems to be a little lazier in the afternoons, but a quick trip to the "dog park!" usually fixes that.

Good luck Lulu!

2010-06-29T00:56:00.000-07:00

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!

2010-06-28T14:44:00.000-07:00

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...

2010-06-25T17:49:00.000-07:00

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

2010-06-23T22:33:00.000-07:00

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.

2010-06-23T11:53:00.000-07:00

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

2010-06-22T17:09:00.000-07:00

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?

2010-06-22T16:28:00.000-07:00

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

2010-06-22T15:55:00.000-07:00

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

2010-06-21T19:55:00.000-07:00

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

2010-06-21T07:18:00.000-07:00

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

2010-06-10T16:52:00.000-07:00

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

2010-06-09T23:32:00.000-07:00

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

2010-06-09T16:43:00.000-07:00

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

2010-06-08T23:37:00.000-07:00

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

2010-06-08T16:30:00.000-07:00

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