Moving Forward

On Monday, I dropped Molly off at our vet clinic for removal of the mast cell tumor near her nipple.   The vet performing the surgery gave Molly a thorough feeling-up and found two more small tumors and gave me a phone call to ask if she should remove them as well.

Sigh.

Okay.

One was in her left armpit, one was at the end of her sternum.   I really don't want her to have more surgery...at least not for say, the next month, so I was happy to say yes.   After the surgery the vet called to say that all had gone well, and that the additional tumors seemed like lipomas.   I actually thought the other day, "Why can't Molly just get lipomas like normal dogs?"  Well, maybe I wished them into existence.

All masses will be biopsied.

I also received a phone call from the oncologist: Molly has T-Cell Lymphoma.   We will begin chemotherapy next week.   The first week of Molly's protocol will involve prednisone and that can slow down healing.   The oncologist wants Molly's surgical incisions to have some time to heal before we begin, and with Molly's lymphoma not being as aggressive as the disease normally is, we have time to wait for Molly's body to heal itself.   I noticed she called the lymphoma "atypical" rather than "indolent."   Well, I am glad that Molly has an "atypical" version, because T-Cell lymphoma has statistically shorter survival rates than B-Cell.   But, my girl has already become a weird-case scenario, a best case scenario.   Screw statistics.   We're gonna give it our best and that's that.  This chemo protocol will also work against the mast cell tumors, along with the daily oral benadryl/pepcid combination that Molly has been on for the last week.

I have a lot more questions for the oncologist (I am hoping to draft up an e-mail to her, actually), a lot more research to be done.   One day at a time.

I am nervous for our first chemotherapy appointment next Thursday.   But I am ready.   Let's go.

Admission to Oncology

Leave it to Molly to keep things leaning towards the unexpected!   Today's oncologist visit did not play out at all like I thought it would - but that's okay!   I went into the whole thing thinking she would get a dose of chemo, fretting about the side effects, and all of the questions I had written down on a piece of paper were geared towards that outcome.

Waiting room cuteness.

The oncologist had Molly's x-rays up on a computer screen in the exam room, and she reiterated that they looked great.   I told her I was paranoid about them actually being good!   We reviewed the normal bloodwork, normal x-rays, normal clinical presentation.   The oncologist told me that she wanted to run an additional blood test called "LDH" - the levels of this test can be off in patients with lymphoma.   She suspected this would also be normal, and it was.   They ran it right at the clinic - so nice to have instant results!   The vet palpated all of Molly's lymph nodes, and could not feel them.   Another good sign!   She wants Molly to have an ultrasound to check for lymph nodes that might be deeper in the abdomen than can be felt, so that we can see if they are enlarged - I am planning to have that done on Thursday if I can get the time off of work.

Molly's lymph node, somewhere in a lab far far away, will now be tested to determine if we are dealing with "B-Cell" or "T-Cell" lymphoma.   When we find out the answer to that, we will start treatment.   However, the oncologist says that it appears we are dealing with "indolent lymphoma" based on all of the test results and normal clinical presentation.   Indolent is a very slow growing and not so aggressive lymphoma, so that would be very very awesome if that was what Molly is dealing with.

The mast cell tumors were next on the list.   This kind of surprised me, since Molly's MCTs were all grade 2, low growth.   Benign.  Right?   I did show where all of Molly's tumors had been, and I mentioned that Molly has a really small, flat pink little bump near her nipple right near the same area.  
Our oncologist had a list of clinical indications that would require us to treat mast cell tumors: Recurrent and/or multiplicity of tumors, dirty surgical borders, malignant anatomic site ie inguinal area, mammary gland, digit or oral cavity, Histiological grading or high mitotic index.

Molly meets two of these criteria, since she has had two MCT recurrence since her original surgery last May, and two of those tumors were near the mammary gland.   When Molly went in the back to have blood drawn for the LDH test, she also had the little pink nipple bump aspirated and it was definitely full of mast cells.   Now the bump is larger and red and angry - so they gave her a shot of benadryl.     Molly is scheduled for surgery next Monday to have it removed, my poor girl.   She will also be taking pepcid and benadryl orally at home until further notice - this is a common course of action to get the histamine over production under control.   The ultrasound that Molly will have will also check for any sort of issues caused by her MCT, since it is in a high risk area.

So: ultrasound, another MCT removal surgery and waiting on results of lymph node testing.   Things are feeling a little more positive, that's for sure.

Lymph Node Removal Surgery Day

I dropped Molly off at 7:30am for her surgery today.  

She was suspicious when I did not give her breakfast.   Or treats.   And when I let her sit up in the front seat.   When the tech came to take her into the back, I gave her a kiss goodbye.   Molly usually goes pretty happily with the tech.   Maybe it is all of the anal gland expressions, or the surgeries she has had in the last year, or the fact that the last time she went in the back she got a needle stuck into her throat...but Molly did not want to leave.  Maybe she was feeding off of my stress and fear.   I have never felt so apprehensive about a procedure with any of my dogs.   And I'm sure Molly knew it.  Molly started shaking and trying her best to pull away from the tech back to me.   I made it worse, I know, by comforting her and telling her to go with the tech.   It only made it worse, but I could not help myself.

And then I sobbed the entire way to work thinking about how I betrayed her and how frightened she was.   It was so painful.  I just wanted to run away with her, buy a dozen donuts and eat them together and go hiking and swimming for the day.   Screw that surgery crap.

I got a phone call around noon that Molly's surgery was done and she was sleeping.   The work day crept along and finally I was able to pick Molly up.   The vet who discharged us said that Molly had not made a peep all day, but as soon as she saw me she turned it on.   Chattering and whining, she turned the drama up to high.  

Biopsy results in 3 days, most likely.    

Molly also had a very mast cell tumor looking growth on her shoulder.   Her vet and I had chosen to keep an eye on it for any changes, but we both agreed that doing surgery after surgery every time Molly has a MCT is not the best idea.  (I am very protective of Molly's quality of life.)   We assume it is a grade 2 low growth MCT like the other two that were removed last spring.     Since Molly would already be sedated for the lymph node removal, I wanted to take advantage of that and take the other growth off.  It will be sent for biopsy as well.

Biopsy Results

Molly and I went to our vet today to have her stitches removed.   I was hoping that the biopsy results from her tumors were in, and that I had simply not be phoned with the results.  

Grade II Mast Cell Tumors.  I am so glad they are gone.  I have a very confusing pathology report that I was sent home with but the vet who discharged us today told me that they were "low grade" and  her report showed that her tumors were very slow growing and non aggressive.   It felt like we were dancing around the C-word but not actually saying it.  

So, not the best news.  Not, "You spent 700 bucks to take a wart off" news that I wanted to hear.   But it felt like "it's very good you made this decision and your dog will be okay because of it" news.

We are going to leave those tumors in the dust and if more come in the future we will deal with that if it happens!   We went to agility class afterwards and danced together on the course.   She ate delicious treats, she made everybody laugh, she ran hard and fast and with her whole big-as-Texas heart.   And I love her and I am so grateful for her.  Everything is going to be just fine.