Excruciating Medical details Nov 5, 2002

Following provides excruciating details if you're interested.

First of all, doctor says it's large enough, and with Remington's very active lifestyle, that it's "amazing" that it hasn't already ruptured and killed him. It's also amazing that he's shown few symptoms, although there are lots of little and a couple of larger things recently that are now explained. He always was a stoic on discomfort & pain.

Vet says they're pretty confident of the diagnosis because there aren't many other things that show this kind of growth, behavior, and appearance in this location, and they see this kind of tumor in this location fairly often, enough also to predict how treatment will work.

This type of thing is usually very aggressive & very fast-growing, so it could've been around only a couple of months or several months longer; with no previous xrays or ultrasounds or anything to compare it to, we'll never know when it started.

It also tends to metastasize fairly easily, usually first into the lungs, which can also be fatal fairly quickly. This could still happen.

What got Remington last night, and probably back at West Valley at the end of August (best guess), is pressure on the heart from fluid & bleeding from the growth backing up inside the pericardium (sack around the heart) putting so much pressure on the heart that it can't pump properly. His heartrate had elevated to 200/minute this morning before they drained about 500 CC of fluid from there.

The good thing on that behavior is that the pressure also tends to stop the bleeding when the tumor breaks or splits or ruptures, which it apparently tends to do often in a small way. But that's a minor benefit compared to the related risks of blood clots ending up in his heart or lungs and of cardiac arrest from the heart's inability to function under such pressure.

The treatment for that pressure build-up is to open a window in the pericardium & let it drain into the chest cavity, as I said. This works well unless there's a major rupture of the tumor, in which case he can also more easily bleed to death (but if there wasn't a window, the bleeding pressure could cause cardiac arrest, so you lose either way...). Until recently--and still in some places--the way to do this is with major chest surgery. There's a fairly new procedure--thoroscopy--where only a slit or 2 are cut in the chest cavity and thin tubes are inserted with scope & knife to do the operation. Pain, risk of complications, and recuperation time are greatly reduced over the old way, although if something goes awry, they still might have to open up the chest the old way.

For this new method, which has apparently been around only a year or 2, there's one surgeon in L.A. who's apparently done it hundreds of times, and these particular surgeons have done it dozens of times and are the most experienced at it in the Bay Area--they say that they've done it successfully every time so far. With this method, Remington comes home after about 36 hours instead of 3 or 4 days, or more, later.

However, this is worthwhile only if we also try to reduce the size of the tumor to decrease the likelihood of ruptures & decrease its own pressure on/invasion of the heart. Chemotherapy can do this, they're very confident.

My concern here was quality of life--would Rem be miserable from the chemo. Vet says that some of the dogs aren't bothered much by it at all; most others have 2-3 days of not feeling well for each treatment (every 3 weeks) but inbetween feel much better than they would have otherwise because the tumor is becoming smaller.

Risk from the chemo is that it can greatly reduce the white blood cell count, which opens the dog up to an elevated risk of infections from various other sources. So they do a blood test a few days after every dose, and if necessary prescribe antibiotics as a preventive measure if the white blood cell count goes too low.

He'll be getting 2 kinds of chems:

  • Adriamycin is the best in this situation, which is given IV and was the first thing he got. He'll get that about every 3 weeks. 20-30% of dogs have gastrointestinal upset from this medication. (Risks just don't quit, do they.)
  • Cytoxan, which is given in tablet form. He's supposed to get that twice between adriamycin doses (so altogether he's getting something once a week).
  • After all of this, this kind of agressive & fast-growing tumor tends to stop reacting to the chemo and starts growing again & then there's really nothing to do after that.

    Vet says that Davis does some surgery for this kind of growth, but not much because the risk of bleeding to death is extremely high, it's major surgery which is also high-risk on its own, regrowth is very likely, and the overall results & quality of life don't tend to be any better than the course of treatment they're recommending.

    I'm not inclined to go racing all over the place trying to find 2nd and 3rd opinions and alternative treatments; I'm fairly convinced they know what they're talking about although I can't say why I'm so convinced.

    And--yes--it's very expensive.

    Cancer Info Page  |  Dog Diary Updated 11/17/02