MSU's Oncology Consultation Part 2

Tap. Tap. Tap.

My leg was tapping again as we sat down on the bench in the room.

Dr. Paulo and an intern were with us and I remember taking a deep breath bc I just knew we were about to get bad news.

As he started to talk, I swear a rush of calmness & peace rushed over my body. The only other time I have ever felt this was when we were at our ultrasound and our doctor couldn't find our baby's heartbeat.

I felt it then.

I feel it now.

That day in December we too felt a sense of doom when we walked into the ultrasound room. We were quiet the entire drive to the doctor's office and the only words we spoke was just before we got out of the car to pray together. We had this awful feeling, just like we did now.

Dr. Paulo told us that Max was not a candidate for the stereotactic radiation treatment because he was not stage 1.

Max's cancer had in fact already metastasized and he had a very large lymph node and he had 6 cancer nodules on his lungs.

Our boy not only has prostate cancer but it's worse than that.

We could have been mad and questioned why last week we were told Max was stage 1. We could have been pissed at his specialists for missing this and for not telling us. But what good would it have been. Why waste any more of our energy on things that we can't change.

We needed to focus on the facts and then what could be done.

My husband took a deep breath and choked up.

I stopped rocking and tap tap tapping.

We listened intently on what Dr. Paulo was saying.

In the blink of any eye Max went from a stage 1 diagnosis where he could possibly have had 2-4 more years with us to now having cancer in 3 places.

Max's prostate cancer was behaving like most prostatic cancer in dogs behaves. It starts on the prostate and grows. Then, the cancerous cells move on to the lymph nodes and from there, the lymph nodes carry the cells onto major organs, usually starting with the lungs.

This was horrible news.

It was devastating.

Yet, I remained calm. The peace and comfort that I mentioned earlier was still there. I didn't have that panicked feeling any more.

It was as if right when we were about to get this horrible news, that God took a blanket of peace & comfort and draped it right over us. We were surrounded by it. We were covered with it. We were thankful for it.

Dr. Paulo told us that we had to move now toward what they call palliative care for Max. This means that instead of trying to treat the cancer, the approach is to focus on providing relief from symptoms and pain. The goal is to improve the quality of life that he has left.

The time he has left. I can't believe I am typing that out. (tears)

We were given a ton of information about chemo and radiation and then Dr. Paulo wanted us to make another appt to come back and speak with the head of the radiology dept - a woman who we would trust and love.

Once we had a meeting with her, we could make our final decision about what treatment protocol we wanted to try with Max, if any.

We left with our Maxie who was a bit groggy from his sedation and headed home. We made another appt with the head of radiology and went back the following week to meet with her to discuss options.

The treatment protocol we decided on was to finish out Max's Immunotherapy treatments to build up his immune system and to give the Torigen a chance to work and then on 8/5 we are starting a 5 week round (once per week) of radiation on his prostate and lymph node. The hope is that they can shrink his tumors in those areas.

At the same time, we will be doing chemo (same day as radiation) on Max (starting with Vinblastine) and he will do this for 5 weeks long, monitoring his white blood cells and other functions each week. If he can tolerate this form of chemo, we will do this for 5 weeks, then take off 1 week, and then start chemo again, switching to Mitoxantrone. The hopes with the chemo is that it will stabilize his disease so that it doesn't continue to grow.

Side note: The reason they switch up the chemo is bc cancer is smart and can adapt to certain types of chemo/medication so by switching it, this will hopefully not give it the chance to do that.

As long as Max can tolerate the chemo, he will stay on it in some form indefinitely. This could mean he slides back to a few treatments a month, 1 treatment a month, chemo pills administered at home, etc. But time will tell for all of this.

Side affects for these treatments:
Radiation: He will be placed under general anesthesia for the treatment. Most dogs tolerate radiation very well. We may notice a slight sun burn on his belly and the fur on his hips may have a color change to a salt & peppery color (We probably won't notice this bc Max is already that color). We may notice him straining week 5-6 but that should go away.

Radiation has a good response rate of 75%-85% in dogs.

Chemo: Max will probably be tired the day after chemo but then we should see an influx in his energy level after that. A side effect that people seem to notice is that their dog gets fussy with what they want to eat. Some foods maybe they loved will not be appetizing to them, so finding what they will eat and feeding that will be important. We will have to watch Sammy around Max's urine and we will need to wear gloves if we come in contact with his urine for 3 days after treatment.

Chemo by itself has a low response rate of 30%.

There has been research that states by coupling treatment (Immunotherapy, Radiation, and Chemo) it is showing good results in dogs with cancer. There is no way to tell if this will be the case for Maxie or any other dog, but we remain hopeful.

It's important to note that dogs treated with cancer is NOT the same as a person treated with cancer. With people, they get very high doses of treatment to try and cure them so they can live decades longer. That is why people have such awful side effects.

With dogs, they don't try to cure the disease. They try to stabilize the disease so that it can buy the pet some time while keeping their quality of life good.

Specific prayers that we need right now are this:
-That the Torigen has strengthened his immune system enough to help with the chemo and that the Torigen is doing what they hoped it would do, which is to kick that cancer's ass. :)
-That the 5 weeks of radiation will be enough to significantly reduce the tumors
-That Max can tolerate chemo well so that his tumors will be stabilized


Cost of treatment:
Consultation fee:$140
Carprofen: $32 per month (he will be on this NSAID indefinitely)
5 weeks of radiation: $2,300
Chemo: $400 per treatment (we will know more of a definite price when we go next week but it is sounding like it will be around $1,000-$2,000 per month in the beginning.)