Monday, February 20, 2012

days 10 to 20, hope returns

Wow, I didn't realize I hadn't updated for over a week!  Curzon's recovery from his surgery is going fantastic, as every day he gets a little stronger and more energetic.  His fur is growing back nicely, and once I removed the last bandage on Day 10 post-surgery he's been much less itchy and in fact we've left his t-shirt off for the past two days.  His main discomfort appears to be from where the adhesive on the bandage was stuck to his skin, as that part is very itchy and is flaky when I brush it, but he doesn't react or seem interested in any of the scar tissue around his incision.  He's been off the pain meds entirely since about Day 10, although I did give him one at bedtime this past weekend after his first swimming session since he was kind of stiff and sore from all of his exuberant exertion.

Day 12 post-surgery, two days after bandage removal.

Day 14 post-surgery, the day after I took him to meet with the oncologist at the Veterinary Oncology Center, down in Renton.  Right after my last blog post, we did hear back from Dr. Kirkby that the final pathology on the removed tumor came back as an osteosarcoma with a higher mitotic rate than expected, and she recommended we see Dr. Sarbu at the VOC.  I took him in on Monday 02/13, just 13 days post surgery, and we had a consultation on our options and what that could mean for him.  The standard protocol would be to do a total of 8 chemotherapy treatments, spaced 3 weeks apart, and alternating two different chemo drugs.  He would have a genetic test done to determine if he could tolerate the second drug, as herding breeds carry a genetic mutation that makes the second drug much more dangerous, and there would be an option to add an antiangiogenesis drug after the first four treatments were complete.  The doctor would have us stop using the Hoxsey's herbal treatment during the course of chemotherapy, and there would be chest x-rays done every 8 weeks and bloodwork done with every chemo appointment.  The side effects are typically very low with canine chemotherapy, and the cost would be around $500 or so per treatment (so a total of over $4000).

Chris and I talked about the chemotherapy option for two days, and we finally decided against going ahead with the treatment.  Our reasoning is as follows, and perhaps it will be helpful to someone who stumbles upon our journey posted here in the future.
1) The tumor was fully removed with 3cm clear margins around the entire perimeter.
2) Curzon's CT scan on 01/27 was completely clear of any visible metastases throughout his entire body.
3) Curzon's ultrasound on 01/30 cleared his liver, kidneys, and adrenals.
4) A chest x-ray he had last August was completely tumor-free, and our best guess is that it started growing around Christmastime as he had no lumps when he had a bath around Thanksgiving.
5) His ALP levels were low for a normal dog, let alone low for a dog with an osteosarcoma.
6) His healing rate was AMAZING - if he was already riddled with cancer metastases, there's no way he would have healed up the way that he has.

Based on all of this information, the cost of the treatment with a low predictor of success, and our own gut feelings, we chose to not perform chemotherapy.  Our treatment regimen moving forward is to continue the Hoxsey's tincture, add in the artemisinin/butyrex protocol under supervision of our regular veterinarian, and monitor and adjust as needed.  I'm giving him full body checks every few days, and our flyball club vet techs have offered to check his lymph nodes each week when he returns to practice, and we will do a chest x-ray in six months.  We feel this is the right decision for us, and for him, and we are hopeful that Curzon will continue to do well and be with us for a long time to come.

This picture was taken on Day 15 after surgery, in the exam room where he had his two-week post-surgery checkup with both Dr. Kirkby and the rehab technician at SVS.  Curzon amazed both of these wonderful ladies with his enthusiasm and impressive healing abilities, as they both were surprised at the extent of his condition and how much motion he had.  Dr. Kirkby called him a "rock star" and is considering featuring him as a patient case of the month, which is pretty awesome!  She cleared him to resume normal daily activity, including going up/down the stairs, going out to potty off-leash, and light supervised play with Ezri.  He's not ready for flat-out running or serious jumping just yet, but she said that unless something drastically changed she expects to clear him for all activity (including flyball!) at his six-week checkup and sees no reason why he can't compete in the May tournament.

The rehab tech was really awesome and showed me how to do some exercises with Curzon to ensure he regains his stability, flexibility, and strength in the arm and chest where his ribs were removed.  She started by putting him into a gentle "play bow" sort of position, and when I realized what she wanted I gave him his "bow" command and he dropped into a perfect, full-extention play bow - much to her surprise!  Apparently he shouldn't be able to do that just yet!  We also went over some exercises to do using the exercise ball and the little "fit disc" saucers, although he was much more interested in throwing those around than in standing on them.  Our program for the next four weeks is to do his PT exercises twice per day and start off with 10 minute walks on level or gently sloped ground, and gradually increase the time and intensity of both.

Curzon is not a fan of gradually increasing anything.  The first evening I brought the exercise ball out, he immediately jumped on top of it with all four feet!

 Day 17 post-surgery - velvet fur!

 All curled up and ready for bedtime - he just barely poked his head up when I flicked on the light to check on him!

And at long last, the quilt I'm making for my niece is finally in the last stage of hand-sewing the binding.  I finished making the binding and putting it on the quilt last week, and I'm about 3/4 done with one of the long sides so far.  Looks like more TV in my future to get the sewing done in time for her birthday which is just four short weeks away!  I doubt Curzon will complain, however, as he's been snugly curled up against my hip every time I've sat down to sew...

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