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.