NEVOG update

Last Monday, we trekked to NEVOG in Waltham, MA for yet another vet visit. A medical team of five and counting! Not looking for a miracle cure here. My only intention, really, was to discuss palliative treatment options for Brian, with the experts in canine cancer. While most vets just prescribe pain meds, oncologists typically have a more open-minded and innovative view of how to treat cancer pain for terminally ill patients.

Left the house at 1045am, got there at 1230, walked the dogs a bit and waited for my 130 appointment. Lobby scene, from one parent to the next: "So, what type of cancer?" Valid question. It is an oncology center, after all. A yorkie and a spaniel both had nasal tumors, while the kitty next to us had breast cancer. I pretty much won the "worst prognosis/most painful illness" contest there.

Comet and Brian, having waited the longest at the reception area, decided that this was their turf and barked at every dog that walked in. "We'll give you your own room," offered the receptionist. Embarassed again by my noisy and highly exciteable dogs...

Met Dr.Rosen at 2pm. Like the entire staff, she was very warm and positive. I guess compassion is the #1 job requirement if you're employed in the cancer care business! That, or they're just all plain nice folks, you almost forget why you're there, they're so nice. I originally was scheduled for palliative radiation, per the advice of my regular vet and the oncologist in Norwalk, CT. but Dr.Rosen (a radiation oncologist) had doubts about that original diagnosis, and had doubts about the efficacy of radiation in this case, where the disease is so spread out. She didn't even use the "C" word. I liked how she was critical of previous reports, explained to me why exactly she was critical of them, and then tried to look at the case history with a fresh set of eyes. She won my trust and respect right then and there. She explained how the language in his bone biopsy pathology can be vague. In any case, she decided to do more non-invasive diagnostic tests by taking 5 lymph node aspirates. They also took an ultrasound of the liver and spleen, for which a belly-shaving was required. Histiocytic sarcoma (the Norwalk, CT onco's suspicion) typically affects the liver and spleen, and this ultrasound could serve as another diagnostic test, another piece of the puzzle. *sigh* A hairless tummy, yet another stark, visual reminder of his sickness. I rubbed his belly to say goodbye to the fur before they whisked him away for half an hour.

We were the last to leave the center at 5pm. Long day indeed.

Fast forward to Wednesday (today) and I was informed that pathology of ALL five sites were suspicious for lymphoma. Lymphoma!?! I don't even know what to think now! What about the disintegrating bone that was our focus from day one? Dr.Rosen gave me all the possible scenarios ranging from best to worst cases, also stressing that Brian's symptoms were truly far from classic.

Quick search for "canine lymphoma" yielded the following:

Stage I:	only one lymph node involved
Stage II:	several lymph nodes in the same general area involved
Stage III:	all peripheral lymph nodes involved
Stage IV:	all peripheral lymph nodes plus the spleen, liver, and/or anterior mediastinum in the chest involved
Stage V:	bone marrow involvement, regardless of any other areas involved

His "Stages" are in reverse order, if this was indeed lymphoma. But the spleen and liver came back clear. Go figure. The case is so interesting that even the pathologist offered to do a bone marrow aspirate for free. NEVOG comes highly recommended, and I heard through the grapevine that they are among the top 10 best canine cancer centers in the entire US. If they're perplexed about the weird symptoms -- a cross between osteosarcoma, histiocytic sarcoma and lymphoma -- then I'm not sure who else can figure this out. And is it worth figuring out at this point, when it may very well be too late? They suggested an excisional lymph node biopsy, where they take the whole dang diseased lymph node out for analysis. I can't bear the thought of putting him through another surgical procedure. On the bright side, it will be much less invasive that the 2nd bone biopsy, from which Bri easily recovered from within a day.

I don't know - so confused at this point. Do I want to subject him to more procedures, or just follow the path of least resistance? Lymphoma can be responsive to specific chemo agents, potentially offering several months of remission. Provided that the diagnosis is not too late. And it can kill a dog within 4-8 weeks if left untreated. Brian's symptoms started with a 5-second limp way back in September. He should've been kaput 3 months ago, then.

Again, back to square one. What the heck is wrong with my dog?

I go home and discuss with hubby. After deliberating, we decide to keep pushing for answers. How can we arm ourselves with the proper tools, after all, if we don't know what it is we're fighting. The palliative treatment options (pain meds/chemo/radiation) would depend on exactly which type of cancer. Again, it's all about the quality of life, even if the length of remaining time stays the same.

Side note: Dogs do not suffer from adverse effects of chemo and radiation that humans typically do. No pain and suffering there, if we were to go that route.

I left messages with our surgeon-vet and regular vet to see what they thought of this new development, and will go from there. I feel like I ran a marathon. So exhausted.