Because I'm a veterinarian I can expedite some of the steps to getting a diagnosis of a problem, but just like any pet owner I can't necessarily expedite the emotional processing of the information.
The feelings come in waves from denial to acceptance to grieving. There's a feeling of something being stolen from me; a betrayal. This was not the plan. Cody was supposed to get stem cell therapy for his arthritis and live to be 16 years old. Now that is not possible because stem cell therapy is contraindicated in patients with cancer (can make the cancer grow).
On July 25th the radiologist performed a fine needle aspirate (FNA) of the mass. Since the tumor is big and is located right up against the body wall, this was a relatively easy procedure. Cody was heavily sedated and a large gauge needle was inserted into the tumor from the outside of his chest. Several small core samples were obtained and shipped off to the lab for histopathology.
I got the results on the 27th. The pathologist's diagnosis is papillary bronchogenic pulmonary adenocarcinoma. Well, this was the expected diagnosis because this type of tumor is the most common primary lung tumor in dogs. As I collect the cold hard facts from reliable sources the reality of the situation is sinking in. According the the numbers, the best case scenario is that Cody will be with me another 494 days, or approximately 16 & 1/2 months after surgery and chemotherapy.
There are a number of factors to consider that help to stage the cancer. Cody appears to be a T1 which means there is only the 1 solitary tumor. There's no evidence of metastasis either to other lung lobes or to lymph nodes (that was determined with the CT scan and an abdominal ultrasound). These tumors are also graded as well, moderately or poor differentiated. A T1, well differentiated tumor has the best prognosis.
I'm polling my co-workers and others in the business to find a surgeon. There is a surgeon about 45 minutes away who comes highly recommended. I will contact her this next week to talk about surgery. I'm fairly certain I will proceed with surgery. I'm not sure about chemotherapy. If I do nothing eventually the tumor will cause fluid to develop around Cody's lungs making it very hard for him to breath. It is hard to say when that might happen. These tumors grow slowly and according the the oncologist some dogs live another 1-2 years even without doing anything.
Friday, July 29, 2011
Monday, July 25, 2011
Wednesday, July 20, 2011
Big Day
Today was a big day. Cody went for a CT scan.
X-ray computed tomography (CT) is a medical imaging method employing tomography created by computer processing.[1] Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.[2]
Thank you Wikipedia.
A CT scan for an animal is a big deal. It means general anesthesia. It is not for long, but you want to know that your animal is being watched over by the best. That means you really want a board certified anesthesiologist (veterinary) in charge. Lucky for us Cody had that today. Not only did he have an anesthesiologist, but I know him personally. Nice. And I only had to drive about 10 minutes down the road from where I work to have this done today.
Cody sailed through with flying colors...he did well under anesthesia - blood pressure and heart rate all good. As of tonight I do not know much except that it appears that the mass (tumor) is close enough to the outside of the lung or close enough to the body wall that we should be able to obtain a fine needle aspirate (FNA) of the mass. Using an ultrasound guided technique it is possible to insert a needle into the mass and extract some cellular material. This small sample is sent to the lab for identification & hopefully a diagnosis.
Hopefully tomorrow I'll hear from the radiologist regarding the scan. The big question is.... is it only 1 mass or many? If there are many small tumors then we go looking for a primary tumor elsewhere in the body. If there appears to be only the 1 tumor in the lung then that means that it is probably the primary tumor. Not to get ahead of myself, but I am preparing for the sit-down I'll have to have with my budget and my dog regarding surgery to remove this thing.
X-ray computed tomography (CT) is a medical imaging method employing tomography created by computer processing.[1] Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.[2]
Thank you Wikipedia.
A CT scan for an animal is a big deal. It means general anesthesia. It is not for long, but you want to know that your animal is being watched over by the best. That means you really want a board certified anesthesiologist (veterinary) in charge. Lucky for us Cody had that today. Not only did he have an anesthesiologist, but I know him personally. Nice. And I only had to drive about 10 minutes down the road from where I work to have this done today.
Cody sailed through with flying colors...he did well under anesthesia - blood pressure and heart rate all good. As of tonight I do not know much except that it appears that the mass (tumor) is close enough to the outside of the lung or close enough to the body wall that we should be able to obtain a fine needle aspirate (FNA) of the mass. Using an ultrasound guided technique it is possible to insert a needle into the mass and extract some cellular material. This small sample is sent to the lab for identification & hopefully a diagnosis.
Hopefully tomorrow I'll hear from the radiologist regarding the scan. The big question is.... is it only 1 mass or many? If there are many small tumors then we go looking for a primary tumor elsewhere in the body. If there appears to be only the 1 tumor in the lung then that means that it is probably the primary tumor. Not to get ahead of myself, but I am preparing for the sit-down I'll have to have with my budget and my dog regarding surgery to remove this thing.
Monday, July 18, 2011
What Makes a Beautiful Dog Poop?
Forgive me blog for I have sinned. It has been 11 days since I last posted. I know you all are waiting with baited breath for the next installment.
Well so far not a lot has occurred except for some creativity in the kitchen (and actually some phone calls to various veterinary connections). I will ramble on about the kitchen antics in a minute, but first how is the dog?
Cody seems fine. Other than the fact that mom (that's me by-the-way...us wacky folks in California who call ourselves "mom" and guardians) is now hypersensitive to every breath he takes. Ok, he pants ALL the time... is that new? No... I'm just freakin' out.
The diarrhea resolved and now the poops are beautiful. And what pray tell make a beautiful dog poop? I'm sure you're very curious. Well in Cody's case, not diarrhea is a good start, then we look at consistency, color and whether or not whole chunks of food are passing through undigested.
NOTE: IF you're queazy about poop this is not the blog for you. Yes, we veterinarians look at poop, talk about poop at the dinner table and generally regard discussion about poop as normal polite conversation.
I noticed after the first batches of home-made food that whole pieces of carrots and rice were showing up in the stool. There were also some strange long black stringy looking things that were later identified as arame sea weed. My dog is a LABRADOR... read: garbage disposal. Do not try this with a Poodle or Chihuahua - you will not succeed.
So blenderizing the rice and finely chopping the carrots has lead to a smooth, firm burnt amber feces which is a delight to pick up. Will I share my recipe secrets? Well I've actually starting contemplating starting my own cooking show for dogs (oh wait I think someone already tried that...yes really. It didn't make it past the pilot episode). Ok my recipe came from Dr. Ihor John Basko's book: Fresh Food & Ancient Wisdom. I made some modifications...why? Because I'm just that way ok? No seriously, it is ok to use what you have on hand and do not stress if you forget the celery! Variety is good.
Dr. Basko is a well respected Traditional Chinese Veterinary Medicine veterinarian. He has a whole chapter dedicated to cancer diets. From what I've read, it seems that the basics of a cancer diet boil down to (pun intended) low carbs, no simple carbs (commercial dog foods are loaded with these), antioxidants, veggies, high quality easily assimilated proteins, essential fatty acids, and complex high protein grains. According to Dr. Basko if you do not include vegetables in your dog's diet, then you should supplement with the following antioxidants: Vitamin E & Selenium, medicinal mushrooms (shiitake, maitake, coriolus, ganoderma), Vitamin C & Zinc, omega-3 fatty acids, chlorophyll (chlorella, spirulina).
Very helpful kitchen appliances: rice cooker, crock pot, blender, food processor and/or chopping device - big knife :-).
What I made: Large Pot Meat Stew
Into the crock pot until meat falling off bones. Remove bones, add:
Simmer on low heat until cooked. Add cooked brown rice, arame, nori, dulse flakes, fresh chopped leafy greens (sea weed and leafy greens are my addition) and voila! Wonderful dog food!
Now in general, veterinarians are concerned about diets being balanced. Well, if you include the above listed ingredient categories and offer a variety, the diet will be balanced over time. Of course feeding the same thing day in and day out will not only be BORING but will run the risk of missing some essential nutrient. So variety is the spice of life they say...give it to your dog. Oh, if you're in a pinch for dinner just serve up a bowl for yourself (I did!).
Well so far not a lot has occurred except for some creativity in the kitchen (and actually some phone calls to various veterinary connections). I will ramble on about the kitchen antics in a minute, but first how is the dog?
Cody seems fine. Other than the fact that mom (that's me by-the-way...us wacky folks in California who call ourselves "mom" and guardians) is now hypersensitive to every breath he takes. Ok, he pants ALL the time... is that new? No... I'm just freakin' out.
The diarrhea resolved and now the poops are beautiful. And what pray tell make a beautiful dog poop? I'm sure you're very curious. Well in Cody's case, not diarrhea is a good start, then we look at consistency, color and whether or not whole chunks of food are passing through undigested.
NOTE: IF you're queazy about poop this is not the blog for you. Yes, we veterinarians look at poop, talk about poop at the dinner table and generally regard discussion about poop as normal polite conversation.
I noticed after the first batches of home-made food that whole pieces of carrots and rice were showing up in the stool. There were also some strange long black stringy looking things that were later identified as arame sea weed. My dog is a LABRADOR... read: garbage disposal. Do not try this with a Poodle or Chihuahua - you will not succeed.
So blenderizing the rice and finely chopping the carrots has lead to a smooth, firm burnt amber feces which is a delight to pick up. Will I share my recipe secrets? Well I've actually starting contemplating starting my own cooking show for dogs (oh wait I think someone already tried that...yes really. It didn't make it past the pilot episode). Ok my recipe came from Dr. Ihor John Basko's book: Fresh Food & Ancient Wisdom. I made some modifications...why? Because I'm just that way ok? No seriously, it is ok to use what you have on hand and do not stress if you forget the celery! Variety is good.
Dr. Basko is a well respected Traditional Chinese Veterinary Medicine veterinarian. He has a whole chapter dedicated to cancer diets. From what I've read, it seems that the basics of a cancer diet boil down to (pun intended) low carbs, no simple carbs (commercial dog foods are loaded with these), antioxidants, veggies, high quality easily assimilated proteins, essential fatty acids, and complex high protein grains. According to Dr. Basko if you do not include vegetables in your dog's diet, then you should supplement with the following antioxidants: Vitamin E & Selenium, medicinal mushrooms (shiitake, maitake, coriolus, ganoderma), Vitamin C & Zinc, omega-3 fatty acids, chlorophyll (chlorella, spirulina).
Very helpful kitchen appliances: rice cooker, crock pot, blender, food processor and/or chopping device - big knife :-).
What I made: Large Pot Meat Stew
- meat bones
- celery (if I hadn't forgotten it at the store)
- garlic
- ginger powder
- tumeric (loads of info about the anti-cancer properties)
- water
Into the crock pot until meat falling off bones. Remove bones, add:
- carrots
- squash
- broccoli
- chicken meat
- chicken livers
- coconut oil
Simmer on low heat until cooked. Add cooked brown rice, arame, nori, dulse flakes, fresh chopped leafy greens (sea weed and leafy greens are my addition) and voila! Wonderful dog food!
Now in general, veterinarians are concerned about diets being balanced. Well, if you include the above listed ingredient categories and offer a variety, the diet will be balanced over time. Of course feeding the same thing day in and day out will not only be BORING but will run the risk of missing some essential nutrient. So variety is the spice of life they say...give it to your dog. Oh, if you're in a pinch for dinner just serve up a bowl for yourself (I did!).
Thursday, July 7, 2011
Now He's Got the Runs
Good morning! We're up at 5am today because Cody's got diarrhea. Oh joy! This is entirely my fault. I'm a vet. I should know better. Well if getting up at 5 am isn't punishment then at least I'm learning my lesson.
Why does my sweet puppy have the trots? Well if I'd been posting daily or even twice daily like the blogging guidelines suggest you would know that I implemented a new home-cooked diet. This weekend I enthusiastically read everything I had on home-cooked diets for cancer. On Sunday I brewed up a magnificent batch of organic brown rice, organic broccoli, Rocky Jr. free range chicken, beef broth with turmeric and garlic, sea weed, organic carrots and a slew of fresh organic green leafy stuff. Wonderful. I was so thrilled and he was so thrilled that I didn't even think about doing a gradual diet change over...lesson learned - practice what you preach veterinarian.
What you're supposed to do when you change your dog's diet is mix the new with the old, in gradually increasing amounts of the new food until you're feeding 100% of the new food. This process should take about a week. Ah...I mixed a little of the old kibble in with the first meal. No diarrhea that day, so no problem right? Wrong.
Since we now live in a condo without a back yard we were outside going potty before the birds were even up this morning. I think the poor dog was up earlier, but was just too polite to wake me up. He's now crashed out again. I'm up typing. Might as well take advantage of the extra time, right? Groan...
Breakfast this morning (for Cody, I haven't eaten yet) was regular kibble (Wellness brand) and some canned food (Organix) with Pepcid (antacid), carafate (gastroprotectant) and metronidazole (antibiotic with anti-inflammatory properties on the gut). Hopefully we can get the diarrhea resolved quickly because 5 am is nice if you're bird watching, but not for much else if you ask me.
Why does my sweet puppy have the trots? Well if I'd been posting daily or even twice daily like the blogging guidelines suggest you would know that I implemented a new home-cooked diet. This weekend I enthusiastically read everything I had on home-cooked diets for cancer. On Sunday I brewed up a magnificent batch of organic brown rice, organic broccoli, Rocky Jr. free range chicken, beef broth with turmeric and garlic, sea weed, organic carrots and a slew of fresh organic green leafy stuff. Wonderful. I was so thrilled and he was so thrilled that I didn't even think about doing a gradual diet change over...lesson learned - practice what you preach veterinarian.
What you're supposed to do when you change your dog's diet is mix the new with the old, in gradually increasing amounts of the new food until you're feeding 100% of the new food. This process should take about a week. Ah...I mixed a little of the old kibble in with the first meal. No diarrhea that day, so no problem right? Wrong.
Since we now live in a condo without a back yard we were outside going potty before the birds were even up this morning. I think the poor dog was up earlier, but was just too polite to wake me up. He's now crashed out again. I'm up typing. Might as well take advantage of the extra time, right? Groan...
Breakfast this morning (for Cody, I haven't eaten yet) was regular kibble (Wellness brand) and some canned food (Organix) with Pepcid (antacid), carafate (gastroprotectant) and metronidazole (antibiotic with anti-inflammatory properties on the gut). Hopefully we can get the diarrhea resolved quickly because 5 am is nice if you're bird watching, but not for much else if you ask me.
Tuesday, July 5, 2011
Monday, July 4, 2011
Introduction to Cody
Well, I am new to this blogging thing so bear with me. This is my first post about my dog, Cody. Cody is a 10 year old, male neutered black labrador. I am a veterinarian. And as luck would have it Cody has a big 'ol mass in his lung.
I was informed of this bad news on June 28th in the written report I got from the radiologist that reviewed Cody's radiographs (x-rays). Ok, ok so here's how it happened.
On June 27th Cody went to work with me and I decided it was high time to x-rays his left front leg because he had been limping pretty badly on and off for a couple of weeks. I knew the kiddo had some arthritis and wanted to know just how bad things were. Well, since we were gonna take x-rays of the leg I thought... oh what the hell, let's shoot the rest of the dog too - chest, abdomen, hips, knees...the whole sha-bang.
We've got digital radiographs at our hospital, so I viewed them before sending them off to the radiologist to review. Yes, I saw the mass...what did I do? Like all good veterinarian-owners I immediately went into denial and told myself it was old dog changes...it couldn't been seen on both views....it was artifact, etc. I certainly didn't show it to my boss or co-associates. I just noted the arthritic changes (pretty bad osteophytes, but that is probably the subject of another blog) and went on my merry way ignoring my little subconscious that was screaming "your dog has a tumor!!!" But my dog is fine...just a little lame from arthritis, certainly not having trouble breathing or coughing or giving any indication that there is an alien inhabiting his lungs!!
Next day...radiology report: 6cm mass in right caudal lung lobe, obscured by diaphragm on VD view... Argh! Oh black and white reality...confirmation from a board certified specialist. So I turned to one of our nurses with tears creeping out of my eyes and asked her to retake the chest films (3-views this time) to confirm this nasty news.
We take 3-views of the chest when we are looking for metastasis (spread of cancer) or to get a more complete look at the heart, lungs and all the structures in the thorax (chest). There it was on all 3 views....might as well have been in 3-D damn it!
So now what? Well there are things to do to find out exactly what it is and I'm pondering this next step. To better image the mass we should do a CT scan (better known as a CAT scan). To get a sample (small biopsy) we can guide a needle into the mass from the outside and collect some cells from the mass. These cells are then sent to the pathologist for identification. Sometimes we get an answer, sometimes we don't. Depends where the needle happens to poke. You can miss the crucial cancer cells and get what would be considered a false negative - you get healthy cells or non-cancerous cells, but there is actually cancer cells. You just missed with your needle. So that's the chance you take.
Or you can just go to surgery if you know an excellent surgeon and get the thing out - done deal. Send in the whole lung lobe and find out exactly what it is.
Ok, that's enough for my first post. There's more and I'll keep you updated and fill in some back story along the way. I'll even try to get some pictures posted.
I was informed of this bad news on June 28th in the written report I got from the radiologist that reviewed Cody's radiographs (x-rays). Ok, ok so here's how it happened.
On June 27th Cody went to work with me and I decided it was high time to x-rays his left front leg because he had been limping pretty badly on and off for a couple of weeks. I knew the kiddo had some arthritis and wanted to know just how bad things were. Well, since we were gonna take x-rays of the leg I thought... oh what the hell, let's shoot the rest of the dog too - chest, abdomen, hips, knees...the whole sha-bang.
We've got digital radiographs at our hospital, so I viewed them before sending them off to the radiologist to review. Yes, I saw the mass...what did I do? Like all good veterinarian-owners I immediately went into denial and told myself it was old dog changes...it couldn't been seen on both views....it was artifact, etc. I certainly didn't show it to my boss or co-associates. I just noted the arthritic changes (pretty bad osteophytes, but that is probably the subject of another blog) and went on my merry way ignoring my little subconscious that was screaming "your dog has a tumor!!!" But my dog is fine...just a little lame from arthritis, certainly not having trouble breathing or coughing or giving any indication that there is an alien inhabiting his lungs!!
Next day...radiology report: 6cm mass in right caudal lung lobe, obscured by diaphragm on VD view... Argh! Oh black and white reality...confirmation from a board certified specialist. So I turned to one of our nurses with tears creeping out of my eyes and asked her to retake the chest films (3-views this time) to confirm this nasty news.
We take 3-views of the chest when we are looking for metastasis (spread of cancer) or to get a more complete look at the heart, lungs and all the structures in the thorax (chest). There it was on all 3 views....might as well have been in 3-D damn it!
So now what? Well there are things to do to find out exactly what it is and I'm pondering this next step. To better image the mass we should do a CT scan (better known as a CAT scan). To get a sample (small biopsy) we can guide a needle into the mass from the outside and collect some cells from the mass. These cells are then sent to the pathologist for identification. Sometimes we get an answer, sometimes we don't. Depends where the needle happens to poke. You can miss the crucial cancer cells and get what would be considered a false negative - you get healthy cells or non-cancerous cells, but there is actually cancer cells. You just missed with your needle. So that's the chance you take.
Or you can just go to surgery if you know an excellent surgeon and get the thing out - done deal. Send in the whole lung lobe and find out exactly what it is.
Ok, that's enough for my first post. There's more and I'll keep you updated and fill in some back story along the way. I'll even try to get some pictures posted.
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