Sunday, August 14, 2011

Cancer






It is strange how the importance of things in your life can change so quickly.  Over the last couple of weeks, I feel like hormones and stress had me finding a new “tragedy” to battle each day.  There was morning sickness, diabetes, fainting, deciding whether to switch OB’s, deciding which hospital to give birth in, etc.  And then, yesterday, all of those things became inconsequential, paling in comparison to the new dilemma placed in front of me. 

Yesterday, we took our furry puggy babies to the vet for their annual check-ups and vaccinations.  As usual, our boy pug – Napoleon, was very healthy and happy.  When it came time to examine our girl pug – Josephine, I raised my concern about a large mass that had formed in her mouth, on her gum line.  For a couple of months, I thought she was getting a condition common to pugs, where their tongues begin to hang out of their mouths.  Only last week did I realize that it wasn’t her tongue that I was seeing peeking out of her mouth…it was a tumor.  Josephine had also been itching much more than normal, but she has allergies, so I wasn’t as concerned about the itching.  Once I raised my concern about the mouth growth, the vet began looking over Jospehine’s body for other tumors.  She has four.  And after a needle biopsy of three of the tumors (they didn’t pierce the one in her mouth to avoid the risk of infection), we were told that Jospehine has mast cell cancer.  She is only 9 ½ years old.

The vet recommended that we get the tumors removed immediately, but explained that it is likely that the tumors will come back.  They are growing aggressively and the number of tumors is not indicates that her prognosis may be “not great.”  We would essentially be removing the tumors to gather information about the stage of Jospehine’s cancer and to determine whether radiation or chemotherapy should be pursued.  We would also buy her some more time.  If she only has Grade 1 cancer, she would have a 90% chance of long term survival.  If she has Grade 2 cancer, she has a 50% chance of living beyond 35 weeks.  If the cancer is Grade 3, she has a 4% chance of surviving beyond 7 months.  No one knows what Jospehine’s prognosis is without removal of the tumors, as no studies have been done about survival rates of dogs not undergoing removal and grading of the tumors.

Because Josephine is a pug, surgery for her is much more complicated than for a dog that has a snout.  It is more dangerous and more expensive.  The estimate for the initial surgery alone is over $2000 (and we already spent almost $400 yesterday, just for the examination and biopsies of the tumors).  The surgery price does not include any subsequent treatment, aggressive or otherwise.  Because of the location of Josephine’s tumors, it is unlikely that the vet would be able to get “clean edges” around the tumor.  He explained that he has to cut 2-3 cm around the tumors (including under them), and he would hit bone well before getting that far in.  The vet will almost certainly have to cut a piece of Josephine’s jaw away to remove the tumor in the mouth.  Despite all of this, the vet assures us that the surgery rarely affects the dog’s quality of life.  The Prince isn’t so sure about that.  He is adamant that our goal should be to give Josephine the best life we can, while she is still alive, and not to subject her to treatments that will be “buying her time.”  He feels that we cannot afford thousands of dollars in treatment with the baby coming (it would mean shortening my maternity leave by a couple of months).  We agree that we would not get Josephine chemotherapy or radiation treatment (or, perhaps we should say “could not afford to get Josephine chemotherapy or radiation therapy”), and, thus, we should look into palliative care now.

My heart is breaking.  I understand the logic of The Prince’s position, but I feel like I am serving my child a death sentence.  What kind of a parent am I if I don’t do everything in my power to help Josephine live as long as possible?  Josephine has been my “baby” for years.  Am I an awful person for putting our human baby ahead of her by allowing finances to enter into our decision about how to care for her?  I cry every time I look at Josephine.  I cry every time I hear her itching, because I now know that the tumors (which release histamine throughout her system) are making her itch.  If there was nothing that could be done for her at all, perhaps I could come to peace with the situation and move past this sadness and shock.  But there are choices here…and that makes it so much harder.  I feel stupid now for having stressed so much about the decisions I need to make about my healthcare provider.  There is a more immediate, more pressing issue that has been sitting right in front of me without me even noticing.  I am trying to tell myself to calm down, as stress isn’t healthy for the human baby growing in my stomach, but I’m not sure how to speed up the grieving process, so I can get to acceptance more quickly.  This is miserable.      

10 comments:

infertilenanny said...

I am so sorry hun! I have 3 cats and a dog all of whom were/are my "babies" so I can't even imagine the feelings you must have. Just remember what a good life you have given your little pug already. She had a much better life than so many other dogs out there. And I'm sure she knows that.

Willow said...

I'm so sorry! Back when we were new to our IF diagnosis, our beloved cat, who was only 4, got really sick. They determined it was kidney disease but because she was so young, thought surgery could save her and then she'd be just fine. I was such an emotional wreck at that time already over our struggles to have a baby, and she was our first "baby," and so we just went for it. $6000 later, she had to be put down anyway, because nothing had worked. I am still upset about that wasted money--so much money!--but I felt we had to try. So I understand your dilemma--personally, because of that experience, I will never spend large sums on extreme vet measures again--I feel like we're maxed out already. But, I know how precious our furry friends are, and completely get the urge to do anything you can for yours. Good luck with your decision, and hugs to your pup!

meant to be a mom said...

I am so sorry! I have two pugs as well and both are my babies! I can't begin to imagine what you must be going through right now. (((Hugs)))

amiracle4us said...

I am so so sorry! Pets become for many people (myself included) one of the family and in many cases closer and more loved than the human members!! (haha). I think when women in particular are faced with IF our puppies become even more loved an appreciated, and definitely spoiled. I am looking at my Roxie and tearing up imagining the grief you are feeling right now. Sending hugs.

S said...

Oh, I'm so sorry to hear about Josephine. (My 9 1/2 year old golden retriever died from a ruptured hemangiosarcoma in June.)

I realize that you are making your decision not to pursue surgery and further treatment because of financial considerations, but I for one think that this is a humane decision as well. What kind of quality of life would she have with part of her jaw missing, or while experiencing the side effects of chemotherapy? A person could understand that these treatments are necessary to save/prolong life, but a dog cannot.

For what it's worth, I think the decision you have made is the humane one, even putting money considerations aside. I'm sorry that you had to make it, though. It's hard, I know.

Christina said...

I'm so sorry to hear Josephine has mast cell cancer. It is a difficult position to be in, and one that I have been to before. The way I've rationalized these things in my head is to consider their quality of life up to this point. Then, think about how things will be after all the treatments. Will all that money, side effects and surgery be worth the chance at a little while longer with her? Or is it in Josephine's best interest to just make the time she has remaining worth every minute?

This is unfortunately a decision that has to be faced far too often. The dogs don't complain about any of their discomforts and keep on living their life to the fullest in the face of it all.

I actually work in the dog cancer field. What I've seen in cases submitted to us with mast cell sarcomas, treatment is either hit or miss. Those that relapse, unfortunately, go downhill very quickly.

Thinking of you, DH, Napoleon and Josephine at this time.

Hillary said...

I'm so sorry to hear about your poor puppy. So far it has happened twice to us where I was pregnant when one of our dogs got really sick. The first dauschund we had slipped a disc in his back and severed his spinal cord. We had the choice to do surgery and possibly buy him some time or to put him to sleep. It was aweful. I was 40 weeks and 5 days pregnant when we made the choice to put him to sleep because we knew we would be having our first baby the very next day. My hubby cried like a baby (it was his dog from before we met) but knew that in the best interest of our human family we couldn't afford the thousands of dollars it would take to maybe make him ok. The same thing has happened now with our second dauschund. I'm 32 weeks pregnant and he has back problems too. Thank God not as bad as the first puppy but getting there. I know that we will once again have to make the same heart wrenching choice to put down a dog that is only 8 years old for the sake of his pain level and our newest little baby.

I hope that you find peace soon in what ever decision you make! xoxox

Jennifer said...

So sorry for what you're going through. She's been lucky to be your "baby" for so many years - the vast, vast majority of dogs are not loved like that. It's impossible to advise you - many humans choose palliative care of chemotherapy - others fight to the last. But regardless of your decision, she is lucky to have such a loving owner.

Lindsey said...

I'm so sorry to hear about Josephine, I'm sending lots of hugs your way. She really is lucky to have you as her mom. My only advice is to remember that 9 1/2 years is a long time in dog years, neither decision will be easy but if you do decide to let her pass with out treatment she has lived a long and happy life.

One Cycle at a Time said...

I'm so sorry. I know its so hard losing a furbaby, even without the added guilt of trying to decide between your human family and your 4-legged family. I know you've given Josephine a life full of love and joy. Hugs to you.