Update Nov 2003

On Tuesday, Oct. 28, 2003, 14 months post amputation; we went in for a regular check-up that consisted of blood work and a chest x-ray. Jogger was feeling great and so I was shocked and into denial when I saw Dr. Walter walking toward us with Jogger’s x-rays. I knew exactly what that meant. Her mouth moved but the words did not penetrate my mind. We went and looked at the x-ray and on the right side was a single nodule about 10mm. My heart sank. The average time of survival once we have visible signs that the cancer has spread is only 2-3 months.

At the time of initial diagnosis, we knew that 90-95% of the time it had already spread. However, we go on with hope and prayer that we would beat the odds and be the lucky ones in the 5-10%. Reality slowly sank in and I looked at Jogger and prepared for her final days. I knew our options were limited once it spreads to the lungs.

One option is pulmonary metastasectomy, which is surgery. This is the only option that I knew that would remove the tumor. All other options were chances of slowing down the tumor’s growth with possible chances of reduction. The average survival time with metastasectomy is 6 months but offers hope that Jogger could go longer. However, it still is major surgery.

Here are the criteria that Jogger would have to meet in order to be a candidate for surgery:
1) Primary tumor in complete remission, preferably for a long relapse-free interval (>300 days)
2) 1 or 2 nodules visible on plain thoracic radiographs
3) Cancer only found in the lung (negative bone scan)
4) long doubling time (>30 days) with no new visible lesions within this time.

Jogger met the first two criterias since the first clinical sign of a single nodule was detected at 14 months post amputation and had a clear chest x-ray at 12 months. So, we had to wait and retake x-rays to determine the growth of the single nodule and to determine if additional nodules show up. One month would put it at Thanksgiving so I scheduled her appointment 3 ½ weeks out on Nov. 20th.

The waiting was painful. I found solace in the fact that Jogger was showing absolutely no signs of distress and my mantra became that she is asymptomatic and is feeling well. I did have a plan. I immediately put her on Artemisinin, a Chinese Herb. On the recommended canine dose, Jogger showed signs of “glee” and increased activity. I described it as a dog on speed. After reading that there might be absorption issues and seeing Jogger acting like a child with ADD, I quickly reduced her dose to the human dose. At this level, I felt comfortable giving it to her once a day at night (3 hours away from food) and keeping her on it continuously and not cycling off and on.

Jogger also had Deramaxx added to her metronomic treatment of drugs. We had to monitor as we still have kidney issues to be concerned with. Jogger appeared to handle this drug well.

During this time, I also made a “Quality of Life for Jogger” list. I did not trust myself that I would recognize the signs of when to let her go. I thought it important to have it written down. I cried during the entire time I composed this list.

I consulted with a holistic vet to find out options because I strongly felt that we were running out of the “traditional” side of treatments. I also visited a pet communicator because I always wanted to have this experience and if I was going to do it, Jogger was the dog I wanted to do it with.

I found out some options and studies and trials and tentatively laid out an if/then type scenario of possible paths we could take. I thought I prepared during the 14 months post dx for this day. Nothing was closer to the truth. Nothing prepared me and I felt lost.

On Nov 20th, 2003, we went in for x-rays. I almost did not want to know. The single nodule grew about 30% and no new nodules showed up. We met another criteria. It also meant we had a slow growing tumor, so even if we did nothing, her survival rate was more like 4-7 months. I chose to go for the surgery and get the additional tests. Please see the section, "Pulmonary Metastasectomy”.