Pulmonary Metastasectomy
Yet, when given the opportunity, I felt I could only make one decision. We had to go for it. Jogger was not ready to die and I could only live with the decision of trying versus not trying. If we did nothing, I knew the outcome. If we took the risk, we have hope.
Other factors came into play to also help make this decision easier. The first is the location of the lesion. It was in the outer right lung area that presented the opportunity for thorascopic surgery that is less invasive. In addition, even if we had to do lateral thoracotomy, the breaking of the ribs was not necessary. My understanding is that median sternotomy, although an option, would require breaking of the ribs and I don’t know if I could have put Jogger through such a surgery especially being a front leg amputee.
In addition, we decided on additional tests to ensure that Jogger was clean going into the surgery. So, besides the bone scan, we would do an ultrasound of the abdomen, and a CT of the lungs. The CT can see more things that would be too small to show up on radiographs.
Here are the criteria that Jogger met and became a candidate for surgery:
1) Primary tumor in complete remission, preferably for a long relapse-free interval (>300 days) [Jogger was clear at 372 days; x-ray showed nodule at 428 days]
2) 1 or 2 nodules visible on plain thoracic radiographs [ Jogger had 1 10mm nodule]
3) Cancer only found in the lung (negative bone scan) [Jogger showed reactive areas but no spread of OS confirmed by CT of spine]
4) long doubling time (>30 days) with no new visible lesions within this time. [Jogger showed 30% increase of existing nodule but no new additional nodules via radiographs]
Additional tests:
1) Ultrasound of abdomen. [Jogger tested clean]
2) CT of Spine [Jogger had areas that were reactive in the bone scan – tested clean of OS. Thinning of bone]
3) CT of Lungs [Jogger had a “dot” of an additional nodule present]
Jogger was a candidate for surgery and we proceeded. Thorascopic surgery was not successful and they had to revert to thoracotomy. I was disappointed, as I knew that this was a bit more invasive, but relieved when they told me that both nodules were in the same lobe and they were successful at getting them both.
Jogger stayed the night. The next day I went and visited and we all agreed she could come home. She was on morphine as her only pain med. She looked almost exactly like the time of amputation, with the entire side shaved and about a 6-inch incision. Unlike the amputation, she showed absolutely no signs of pain and was mobile and getting around fine. I can’t tell you the relief. I just put my dog through major surgery and she acts like I just sent her in for a bad haircut.
Now, to say that this was not stressful would be a down right lie. The two days of testing and of the surgery were filled with its share of roller coaster rides with decisions and actions that could have aborted the surgery at anytime. The CTs and the surgery were all done with Jogger under general anesthesia and the results of the bone scan requiring additional x-rays and then the additional CT of the spine, added to the time that Jogger remained under anesthesia. To abort the surgery was almost secondary to the fact of what it meant if some of these tests came back positive. To me, if osteosarcoma had spread to the bone, I would have been crushed. We would be back facing bone-deep pain. Thankfully, I only had to stress about this for about an hour while they did the CT of the spine.
Dr. Walter, Jogger’s oncologist, stepped up big time. It is times like these that you know you have the right people on your side. Time was of the essence, the ability to evaluate and adjust to the results, the ability to guide me with the decisions, and the strength and confidence to move into action. The intensity was so great at times that it took me hours to stop shaking. Yet, when I look back at it, everything was done in an orderly calm but directive manner. Dr. Walter held the entire process together. From my point of view, she was the only reason I held it together.
Now there is a whole team behind the scenes. There are the surgeons, the anesthesiologists, the ICC nurses, the CT and radiograph personnel, and many more that I will never know or meet, but were critical in this success. The entire medical team was outstanding. They have my heartfelt gratitude and appreciation.
Jogger’s tumor was extracted and some of it was sent to confirm that it is osteosarcoma. The remaining portion will be sent to the lab to have a vaccine built specifically for Jogger. At this time, that is how we will start our next step of the journey.
