Mid November - Treatment Options

Dr. H at Auburn, who I am informed is one of the best veterinary oncologists in the country, presented me with several options for treatment of the fibrosarcoma.  As I had already discovered through internet research, he explained that fibrosarcoma is rare and there has been little research.  Any studies are primarily anecdotal and the sample sizes are very low.  Thus, any treatment is relatively experimental with little confidence about the outcome.  The only certainty is that we could not expect a cure, only to prolong Strider's lifespan from anywhere from 9 to 18 months.

That news was fairly staggering to hear.  He seemed healthy and symptom free.  Without treatment, I was told the tumor would progress rapidly and we would be faced with euthanizing him within 4 to 6 months.  I will discuss that later, but Dr. H was clear that the tumor itself would not kill him if left untreated.  Before that could happen, we would be faced with the decision as to when his quality of life had become unbearable due to the tumor basically taking over his face.

The options for treatment we discussed were:

1.  Surgery to remove a portion of his upper jaw.
2.  Radiation
3.  Chemotherapy

The decision as what treatment options to pursue with a dog with cancer is a very emotional and difficult one.  First, the treatments are very expensive.  Any of the above options would cost several thousand dollars, with the best outcome being to prolong a dog's life by a year or so.  To some people, to do that would be foolish.  To others, it isn't even an option financially.  To others, there isn't ever a consideration to not do whatever is possible to prolong the dog's life.

More difficult for me than the financial aspect of the decision was the fact that I was choosing what level of pain for my beloved dog to endure, not knowing if it would even do any good, and knowing I can't explain to him what is happening to him and why he is being subjected to what seems like torture.

We ultimately decided to forego the surgery option and pursue radiation.  After that decision was made and initiated, we also decided to add chemotherapy.

Initially, the oncologists at Auburn were strongly encouraging surgery.  They told me that most dogs recover easily and eat normally after having half of their upper jaw removed.  Honestly, I found that very difficult to believe.  Dr. H did say that it would be impossible to get clean margins with the surgery, meaning that they would not be able to remove all of the cancer cells. After much emotional turmoil, my husband and I finally decided that since Strider's time might be very short, we were not willing to put him through the ordeal of major surgery and learning to eat with half his jaw missing.  If we knew this was a cure, we might have felt differently, but we were told repeatedly that none of these options were a cure and the outcome was uncertain.  I still am not completely at peace as to whether we made the right decision or not, but I think we did.

The decision was made to begin a series of 18 daily radiation treatments.  Strider would stay at Auburn during the week for the treatments, and come home on weekends.  We live 1 1/2 hours away, so his coming home each day was not practical, though that was an option.  My biggest anxiety at this point was how he would adjust to being away from home.  I dropped him off each Monday morning and picked him up each Friday afternoon.  I don't know what he did while he was there, but he went back every Monday with his tail wagging.  I was called each day he was there by a veterinary student who took care of him while he was there.  In a later post, I will go into more detail about how great the doctors and staff at Auburn are.

On the sixth or seventh day of radiation, Strider also received the first of 6 doses of chemotherapy, to be given every 3 weeks.  Initially, I had been told that fibrosarcoma was not typically responsive to chemotherapy, but one of the oncologists there had recently had some success with a dog with a fibrosarcoma, so they suggested we try the same protocol.  I am not sure we are going to finish the planned chemotherapy, but I'll discuss why in the next post about some of the side effects of the treatments.

Strider came home five days ago after completing the 18 doses of radiation.  He was supposed to have gone back today for the next round of chemo, but his attending vet at Auburn decided to put it off a week due to side effects from the radiation.  Tomorrow, I will post some pictures of him after radiation and discuss the side effects from the radiation and chemotherapy.