It is said that bad things, and perhaps good things, happen in threes. I am not a strong believer in superstitions, but maybe I should pay more attention to such things.
We lost Tuni in January... http://vetrescue.blogspot.com/2011/01/two-coats-are-only-good-when-painting.html .
We lost Raven just weeks ago... http://vetrescue.blogspot.com/2011/03/raven.html .
Just after losing Raven, my Golden Retriever, Ellie, started licking her foot. She has always been an obsessive foot licker, so I did not pay much attention. Two weeks ago, I heard Missy ask Ellie why she was licking. She walked over and felt her foot and asked me to take a look at it. I felt a small nodule between two of her toes about the size of a bebe. I put her on antibiotics in the hopes that she had stepped on something, and had a small abscess or infection, but they didn't help.
After a few days with no improvement on antibiotics, I decided to take a fine needle aspirate of the lesion which was now the size of a pea. I placed a needle into the small nodule and pulled back on the syringe. The suction created will withdraw cells from the lesion into the needle. I then ejected the cells onto a glass microscope slide. By pressing the slides together, we make smears of the cells on the slides and send them to the lab in hopes of gaining a diagnosis. It is less invasive, less costly, and less painful than a biopsy.
I anxiously awaited their impression of the smears (no pun intended). Two days later, the report came back... Plasmacytoma. As usual this diagnosis has it's good side and it's bad side. It is benign, but locally invasive.
Plasmacytomas are an odd little tumor that are considered benign because they do not commonly travel to other parts of the body with the frequency that a malignant tumor does. But a plasmacytoma is locally invasive so it needs to be surgically removed before it causes too many problems in their current location. A surgeon must remove a lot of the skin and tissue around this tumor in order to be certain that all the tumor has been removed and it will not regrow in this location. Almost any part of the body would be a better location to have such a lesion.
Location is where the problem lies with Ellie's tumor. There is not a lot of extra skin around the toes. In order to remove enough tissue to be certain the entire tumor has been removed, there would not be enough skin left in order to be able to close the incision for proper healing.
I consulted with another veterinarian who specializes in cancer, a veterinary oncologist. He and I discussed removal of her outer two front toes. The tumor was nestled between them. The consensus was that she "should" be able to get around without those two toes, as long as one of the two weight bearing toes was left to support her weight. Dogs place most of their weight on the two central toes of the forefoot, and Ellie is a ninety pound dog. That is a lot of weight to bear on an incomplete foot. People who lose toes, often have to learn to walk again.
Last week, on the morning I was planning to do the surgery, I palpated the lesion. That is when I realized how rapidly this tumor was progressing. The lesion had quickly spread to the third toe from the outside. The lesion now included both of her weight bearing toes on that leg. Needless to say, I had to cancel her surgery. All of this is transpiring within a two week span.
Tomorrow, Ellie and I are heading to Iowa State University College of Veterinary Medicine to talk to the oncologists about her foot and possible treatments. The way I see it, there are few treatment options:
- Full forelimb amputation with or without chemotherapy.
- Chemotherapy in the hopes of shrinking the tumor so we can remove just the toes.
- Chemotherapy alone, and keeping her as comfortable as possible.
- Do nothing, and euthanize her when her comfort level is unacceptable.
My Ellie is a nine year old girl. I was worried about the difficulty and comfort level of her recovery from toe amputations. I am terrified of making the decision to amputate her leg.
I absolutely believe that dogs and cats are born with three legs and a spare. But removing an entire leg so late in life, and on such a large dog has me very concerned. I know there are many people that have chosen this option and their pet has done well despite age, but it is SO different when it is your baby that needs the surgery. I guess it is my turn to rely on another doctor and trust in them.
I, of course, will do what I can and what I believe is best for my girl. She has been a wonderful companion for me and my family, tolerating ear pulling, doggie climbing, and tail lassoing kids.
I, just like you, still worry that I will make the "wrong" decision despite my education and experience. In my heart, I don't think there is a wrong decision if it is made from the heart, but I still fear making it! I am quite good at second guessing myself. I have been practicing second guessing for years.
Ellie is currently on pain relievers. She started limping the day the biopsy results came in. She is still playful, eating and happy, but you can see her lift her leg a bit in this video of her with Kirby from this morning.
http://www.youtube.com/watch?v=G-b_yRGvipk
I am hopeful that another aspirate and another opinion will reveal that this lesion is not cancer at all. By this time tomorrow, I should have more information.
Some good news is that Ellie had been rather...round. She has been on a diet for a while now and is losing weight. The weight loss will be in her favor if we do need to do a major surgery, and will aid her recovery.
I have to admit, the urge to give her all the treats she wants right now is incredibly strong! I guess I will have to indulge for her...
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