Identification of the alien in Cody's chest

Well folks, the alien is out and the results are in! It is the best news we could have hoped for...at least for cancer. It is a "well differentiated papillary bronchogenic pulmonary adenocarcinoma, grade I, excision complete".  The terms "well differentiated," "papillary," "bronchogenic," and "pulmonary" are descriptive terms. Read as: a protruding tumor of mature cells of the lung that orginates from the bronchi. Adenocarcinoma is a cancer of an epithelium that originates in glandular tissue. Tumor grading is a system used to classify cancer cells in terms of how abnormal they look under a microscope and how quickly the tumor is likely to grow and spread. Grade I tumor cells look almost normal and are less likely to spread. A complete excision means that the entire tumor was removed and did not appear to extend beyond the margins of the tissue that was sent to the lab.

There was also no evidence of cancer in the lymph node that was removed and sent to the lab. Good.

Better news would have been something totally benign like a granuloma, or abscess. But at least we are dealing with a cancer that has a lower probability of having spread. The oncologists have told me that we should always expect there to be some microscopic cancer cells lingering and therefore they do recommend chemotherapy.

At this point I am holding off on chemotherapy. I feel fairly confident that we got all of the tumor and that if there are stray cells floating around that we can deal with them another way. I've decided to investigate alternative therapies.

How is the dog? Cody is great! Back to urinating and defecating normally. Happy and really started driving me crazy about 10 days post-op asking to play with his ball. His incision is healing well. We just got a new 3B cold laser at our practice, so I've been using it to treat the surgical scar. The photo is from 13 days post-op and day 1 of laser treatment.

The long scar is the incision where they went into the chest. The 2 smaller parallel scars is where the chest tube was located.

I also noted grey hairs in Cody's muzzle for the first time today. Coincidence? Or is the grey the body's response to the recent stress (both from the cancer itself and the surgery). Humm...

How much?

Cody is home safe and sound. Our first night home was a little rough. Since IV fluids are standard procedure during and after surgery I expected Cody to have to pee, but holy urination Batman! He peed and peed and peed and dribbled and peed some more. Stop reading if you get grossed out easily...

I just couldn't say no to my boy on his first night home, so I allowed him to sleep with me. Oh joy...we both woke up in a puddle of urine. Now that's love for ya! I was very tired, exhausted actually from helping out a family member who is in the hospital (that's another story) so I pretty much slept through the enlarging wet spot. I did wake us both up twice to change bedding and go outside. The good thing is that he seemed happy and pain free the entire night.

Today he has continued to need to urinate very frequently. I'm starting to wonder if he might have a urinary tract infection from the urinary catheter that was placed while he was in the hospital. It is not uncommon for a UTI to develop after catheterization. I'm also wondering if it is not being caused by the pain medication (Tramadol) that he is on. We'll see how he does tonight.

Because you might be curious about what I paid for his surgery I'll share. The final bill came to $4122.51. That was with some pretty good discounts. So if one is not in the veterinary field and doesn't qualify for professional discounts you might expect to pay almost $5000 for this surgery. Yikes! That is significant. Now, I live in a somewhat affluent area in California and I sought out a surgeon and hospital that has a reputation for "gold standard" of care, so that may have been a factor in the final cost. I just wanted to share this number because many people do not realize that the cost to care for your best friend can hit the five grand mark pretty quickly. I recommend pet insurance folks. It might make a huge difference for your animal friend who relies on you to protect and care for them. Nothing is more sad to me as a veterinarian than owners who choose to euthanize based on finances. It is just wrong in my opinion. And this is just my opinion as a private person. As a veterinarian I have to walk a finer line and try to counsel my clients as best I can to help them make a decision that they can live with. I live by the old saying that you can't put a price on love, or is it life? Well both! My buddy has been by my side for 10 years and I've made a commitment to him so what the heck. It's only money right? You can't take it with you!

Future topic: poop and diet again! And watch for a post with the results of the histopathology...
Thanks for reading.

Post Op Update

As far as lung tumors go Cody's was text book perfect - exactly what a surgeon would want to work with. Everything went well in surgery. Cody was a rockstar anesthesia patient; meaning all his vitals (temperature, blood pressure, heart rate, etc.) stayed within the parameters one would want while under anesthesia. His tumor was very well circumscribed (sort of encapsulated; think of a billiard ball) and very distal (at the far end of the lung); two factors that help with removal. The closer the tumor is to the hilus (think of the hilus as the "top" of the lungs - the place where everything starts branching) the harder it is to remove. Cody's tumor was in the right caudal lung lobe far away from the hilus. The surgeon removed the entire lung lobe. Lucky for Cody he's still got two lobes on the right side. All in all he really didn't loose much lung capacity.

The surgeon had a hard time finding the lymph node because it was small. This is a good thing. She did find it eventually, removed it and reported to me that it was about the size of a bean. This is promising. We're hoping that a small lymph node is consistent with no cancer in that lymph node. Cross your fingers.

The entire lobe plus lymph node have been sent to the laboratory. Now we wait on the results.

Cody had a chest tube in after surgery. The tube is placed into the chest cavity to help remove air that gets into the chest cavity during surgery. After closing up the chest all the air that got in while the chest was open needs to be removed to create negative pressure so that the lungs work properly. When there is air outside the lungs it prevents the lungs from expanding...or otherwise known in lay terms as a collapsed lung. The tube stays in place over night and air is sucked out of the chest periodically. When no more air comes out of the tube it is removed. Cody's tube was removed this afternoon. When I visited he had the tube out and was comfortable. He got a little excited and whiny when he saw me, so we didn't visit long. He needs his rest. He's got his octopus friend to keep him company and I'm comforted knowing he is in good hands. He may be able to go home tomorrow.

Thoracotomy

Tomorrow is the big day. Surgery - a thoracotomy.

Thoracotomy is an incision into the pleural space of the chest.^[1] It is performed by a surgeon, and, rarely, by emergency physicians, to gain access to the thoracic organs, most commonly the heart, the lungs, the esophagus or thoracic aorta, or for access to the anterior spine such as is necessary for access to tumors in the spine.

Thoracotomy is a major surgical maneuver—the first step in many thoracic surgeries including lobectomy or pneumonectomy for lung cancer—and as such requires general anesthesia withendotracheal tube insertion and mechanical ventilation.

Thoracotomies are thought to be one of the hardest surgical incisions to deal with post-op, because they are extremely painful and the pain can prevent the patient from breathing effectively, leading toatelectasis or pneumonia.

Thank you again Wikipedia.

The surgery was supposed to be today, but it was rescheduled so that all the best nurses would be on the case. It is a big deal. Part of what makes it a big deal is that when you go into the chest you have to ventilate that patient because they can't breath on their own. This either requires a special machine or it requires a person manually squeezing a bag that looks a little like a black whoopee cushion. That person doing the breathing for the animal has to pay close attention to how much and how fast they are breathing for the animal. It is all about end title volume... or about how well you are able to oxygenate the patient. There is a measurement called the SPO2 which you can think of as the percentage of blood being oxygenated. The goal is to have that number at or higher than 97%. It kinda sucks to be the person ventilating the patient...no stress there, you're only breathing for the patient. Luckily there are machines that do the job quite well.

Another scary aspect of this surgery is the potential pain factor. The surgeon will be going in from the side. She'll have to spread the ribs apart and work down in a hole, so-to-speak. There will be excellent pain control before, during and after the surgery. He'll be on a Fentanyl drip. Fentanyl is 100 times more potent than morphine. Cody should be in la-la land and feelin' no pain.

The surgeon will remove the lung lobe and the entire mass will be submitted to the lab for analysis. There is still a remote chance it will be something benign, but probably not. Hopefully the surgeon will be able to remove the lymph nodes as well. Those will also be sent to the lab to look for evidence of spread of the cancer into those lymph nodes. If the cancer is in the nodes, then we most likely have a slam dunk decision about chemo - do it. If not in the lymph nodes, then I'll have to ponder it a bit... and of course get more advice from my oncologist friends.

Wish us well. Pray. Cross fingers and/or do whatever you do to send good vibes.
Thanks for your support.

Off to Surgery

Well, the decision has been made - we're going to surgery. A week from tonight. A week from tonight I'll be home worrying that he's ok. I've done my home work. I've found an excellent surgeon. We'll take out the alien and send it to the lab and find out without a doubt what exactly Cody has been growing.
I'm undecided about chemotherapy at this point. It will depend on the histopathology of the tumor. All my sources tell me that we assume that even after removing the tumor there are microscopic tumor cells floating around that we need to zap with chemo. We'll see.
We're pooped. Cody wore me out playing today. At least we got that going for us.