Koda has metastasized lung cancer

Tuesday, July 12, 9:30am - Had a morning appointment to see Dr. Munjar, Koda's surgeon. I'd given Koda some Rimadyl over the weekend because his leg really seemed to be bothering him. Dr. M felt his leg, but it was his spine that caused him to yelp when he pressed on it. He took him back for some x-rays and I could hear Koda yelping holy hell.

The x-rays showed that his knee looked great - no inflammation of the patellar tendon and the bone looked good. But it was other things on the x-rays that were troubling.

There was a large mass pushing his large intestine, causing it to curve around and not go straight out to his rectum - as would be normal. I could see the mass with my own eyes.

But even more disturbing was the chest x-ray. It showed white splotches —nodules— in several places all over his lungs. Dr. M was very concerned about these and told me they could be cancer.

Cancer?!?!?!

We talked about options, like having his colleague, Dr. Simpson, perform surgery to remove the tumor in Koda's abdomen. But first he wanted us to see Dr. Franklin, an internal specialist veterinarian. It's hard to read doctors' expressions and determine if they are playing things down or just naturally stoic because they see so much in the medical world. Or if they don't want to freak out the owners. Hard to say.

The vet tech at the desk asked me how things went and I started crying as I relayed the bad news. She was very sympathetic. She said she hoped to see us back, because that would mean we'd be having the surgery to remove the tumor.

I burst into uncontrollable sobs when I left the building. I just couldn't believe what I'd seen in the x-rays and the news of likely cancer. Shock. How could this be happening?

I stopped bawling long enough to call Dr. Franklin's office from the parking lot. After explaining the situation, they were able to squeeze us in right away. We showed up around 12: noon.

Dr. Franklin looked at the x-rays Dr. M had just taken, felt Koda, then told us he's like to take another set of x-rays. He also said he would need to do an ultrasound of the mass, as well as a guided aspirate (like a biopsy), to try to determine the type of cancer we were dealing with. He probed Koda via his rectum and said he could feel the enlarged lymph node there. Perry had joined us half-way through this office visit. We left Koda with Dr. Franklin after signing-off on a $1000's worth of diagnostic tests. I'd be able to pick him up later that afternoon.

At about 4pm, I returned to the Oregon Veterinary Specialty Hospital to pick up Koda... and see the second set of x-rays. Dr. Franklin took me back and pointed to the ultrasound on the monitor. It was supposedly of the tumor, but to tell you the truth, I couldn't tell what I was looking at. When he brought up the digital x-rays, I could clearly see the white splotches all over the lung area - which in a healthy dog, would be all black. There was a "lacy" pattern with several white nodules of cancer. It had definitely metastasized from the abdomen tumor.

Koda definitely has cancer. And it is advanced. Advanced enough to have "metastasized" or spread into his lungs.
Most likely, the tumor in his abdomen is the "primary" cancer.

But we wouldn't know what KIND of cancer Koda has until we got the results of the aspirate back from the cytologist (someone who studies cells). Without knowing the exact type of cancer, Dr. Franklin could not give me any information about what treatment options we have. With CDs of the x-rays, a print of the ultrasound, and some antibiotic pills in hand, I paid my bill and walked out with Koda.

I lost it again in the parking lot.

Tuesday had been a rough day. I couldn't stop crying. The thought of those cancer cell multiplying and killing Koda every moment was crushing. Now all I could do was wait until Wednesday to find out about the aspirate results and what our options were.

Wednesday, July 13 - I went about my day in shock. I was hoping I'd wake up and this whole cancer thing was just a bad nightmare. But it wasn't.

I took Koda for a walk in the morning. He must've been really worn out from the stress of the office visits and tests. He seemed happy enough to go out for "walkies", but could only make it down 7 houses, having to stop a couple times already. We turned around and made our way back. He had to stop at almost every driveway to sit and pant. So sad. This was a heart-wrenching experience, only made worse by knowing these walks would eventually be remembered as the "best days" he has left.

I waited all day to hear from Dr. Franklin. He finally called around 7pm. The aspirate didn't yield any results. Apparently the tumor cells don't "stick" very well to the needle, so the lab didn't have anything to go on. But he was pretty sure Koda has hemangiosarcoma - which is "a rapidly growing, highly invasive variety of cancer. It is a sarcoma from the lining of the blood vessels; that is, blood-filled channels and spaces are commonly observed microscopically. A frequent cause of death is the rupturing of this tumor, causing the patient to rapidly bleed to death. Dogs with hemangiosarcoma rarely show clinical signs until the tumor has become very large and has metastasized."

Unbelievable.

Our options became this:
1) Re-aspirate (no charge/reduced fee) - but we might not get an answer.

2) Do a 2-cut biopsy ($539-$708)
Cons: Requires anesthesia; vascular risks = massive bleeding
Pros: Better than 90% chance of identifying the cancer

3) Exploratory surgery of the abdominal mass
Cons: Requires anesthesia; Is a major surgery; Stress & recovery from surgery; Risk of infection; Tissue could be too damaged to identify. Costs $3-$5K
Pros: Better than 90% chance of identifying the cancer; Can see extent of it and can take it out - removing the primary cancer mass.

Radiation therapy is out - lungs too close to the heart.
Chemotherapy is only an option if we know what kind of cancer Koda has. So that would require the biopsy or exploratory surgery. And chemo is stressful - 6-8 weeks of treatment for Koda. And very expensive, about $3K.

All of these would involve more stress and risks for Koda. Office visits, procedures, surgeries, going under. There are risks of losing Koda "on the table" during any of this and never having the chance to enjoy the time he has left or say goodbye. There would be multiple risks no matter what we chose. And if we chose to do nothing, Koda would have only weeks to months left. Even if we were to go through with a successful surgery, tumor removal and chemotherapy - we might only extend his life a couple months. And at what cost? Koda's quality of life would be compromised. It doesn't seem worth it.

I hung up with Dr. Franklin and wept. It seemed like the only humane option would be home hospice care. Perry and I decided to lavish love on Koda and try to make his remaining time as comfortable and long as possible at home.