October 27, 2010

It's Doggie Cancer, and It's Bad

I hate when medical people lead you off with what sounds like good news, and then lower the boom.

When I was a freshman in high school, an aunt of mine wound up in the hospital due to an accident, and while she was recovering we got a call asking us to get to the hospital ASAP. I remember standing in a stairwell of the hospital with my mother (apparently all the consult or "family" rooms were occupied) while a doctor rambled on and on and. on. about her various health problems.

It sounded bad, but like there was still hope. Finally, I couldn't stand the sound of his voice anymore, and I just cut in and said "So you mean she's still alive, right?" And then he said, "No, she's gone. She died about an hour ago."

Everything went black, and he reached out to catch me as I collapsed. To this day, I still don't understand why he kept rambling incessantly when she was already gone.

This afternoon was a little like that.

We got to the vet's office, and the front desk told us the doctor was preparing the instructions. One of the vet techs handed us a couple of bottles of pills. She sounded so perky and happy, not like she was telling someone horrible news.

One of the bottles was a steroid. The vet had said if it was the best case scenario, steroids would be what the dog needs.

There were instructions to give him the pills for 8 days and then call to let them know how he's doing. "If it was cancer, they wouldn't want a report on whether he's improving," I thought.

Hope crept in.

"For once, we're not landing on the rare side of the odds," I thought. "Thank God."

Ha. When the vet finally came into the room, she seemed perky for a few moments, too. Then she told us it's bad. Very bad.

He has a rare nerve sheath cancer. It's big, and it's spreading.

If it was just in his leg, she would recommend "taking off" (they use that term, as if it's just a piece of clothing) his leg without a doubt. She says it isn't the kind of cancer that recurs in multiple places, so that usually cures it. And he's a strong, mentally tough but very happy-go-lucky dog, so she thinks he wouldn't be fazed much by losing the leg. I agree with that assessment of him.

But. But.

The tumor has spread, and it's now involving a couple of roots along the spinal cord and it's touching the spinal cord (I think at the beginning of the cord).

If it was in the cord, they would recommend palliative care until progression to the point that it was time to say goodbye.

However, from what they can tell, it's touching the cord but not within it yet.

So there is another option, which is take off the leg and remove as much of the tumor as possible. But they're not sure they can get all of the tumor cells where it's touching the cord, and if they don't, it will grow back. In that case, it likely will continue to grow down the cord, and then he will start to lose function of his hind left leg. (It's the front left one they would need to amputate.)

Chemo doesn't address this kind of cancer, and she said that the amount of radiation that would be needed to kill all the remaining cancer cells after surgery would damage the spinal cord.

The vet thinks he has 2-3 months without surgery, and maybe 6 months with surgery if they don't get all of it. If they do get all of it, he could have a normal lifespan (he's a cattle dog, they often live to 12-13 or longer).

The surgery would probably be at least $5,000. Maybe 6 months. But how do you put a price on time with a being you love, even if it's an animal? He has such personality. He's such a sweet, loving, happy dog. He just wants to play all the time - you'd never think he was 8 years old. We have 4 dogs, and he doesn't care what place he's in in the pack. Even with the limp and the pain he's been enduring, there have only been a couple of days when he hasn't been his normal, happy self.

If we don't do the surgery, our choices are put him down now or wait until he progresses further. I wouldn't want to keep him alive just for us if he isn't having a good quality of life.

On the other hand, how do you put down a dog who, when he is just sitting there looking up at you, you would think is 100% healthy?

We've had to make the tough call before, and we knew when it was time. But in that case, the dog went from being fine and us not knowing anything was wrong to suddenly being very not fine. Watching a dog progress slowly into "not fine" is a whole other thing.

I don't know what to do.

$5,000 is a lot of money. We're going to have big bills coming up for our next transfer. But on the other hand (and I realize this is my 4th or 5th hand at this point), would I be able to live with myself if we didn't try? It would feel like we were saying he isn't worth it.

Is it fair to do that to the dog? Is he better off if we just do palliative care until the time becomes obvious? Or is it better if we say goodbye now?

In some respects, it would have been easier if it had been the very worst case scenario, where the tumor was already growing down the spine and surgery wasn't an option.

This is a special kind of hell. I am so devastatingly sad.

Not to whine and fall into a pity party, but just how much more do we have to endure?

I understand that dogs die. They don't live as long as we do. I get that, I really do. But with the exception of one, it seems that ours don't even seem to have normal lifespans.

Need Doggie Prayers

I think I've mentioned that one of our dogs has been limping. Mom and I took him to a veterinary neurologist this morning. He's undergoing an MRI.

He may have a very rare nerve sheath cancer.

It may be in his spine.

They may not be able to do anything about it.

We will find out in about 3 hours. He's the youngest of all of our dogs - he's 8. He's the only male pet I've ever had. I refer to him as our "baby boy". Out of the 3 dogs R and I have had together, one other one is still with us and the third one died several years ago of congestive heart failure when she was only 6.5 years old.

All I can keep thinking is "Are we destined to lose every creature we love like a child at an early stage? Does God really hate us that much?" 7 dead babies, 1 dead dog, possibly another.

I'm not coping well. And somehow, I have to pull myself together enough to attend a work meeting (thankfully over the phone rather than in person) in two minutes.

October 23, 2010

Gold Star Uterus

Beta 3 integrin results are in: I tested positive, which is good. So between that and the other endometrial biopsy testing that also produced good results, I guess this means that my uterus isn't the issue.

Mo and Libby, in answer to your question about what the other biopsy testing was - they were checking for CD57+ cells, which they don't want to see, and FoxP3+ cells, which they do want to see.

I had none of the CD57+ and FoxP3+ cells that were "adequate in number, suggesting adequate stromal regulatory activity" according to the report.

So I guess it's looking like my immune system in general is the culprit.

We also got the results of the repeat bloodwork. While the NK cell levels in my uterus were good, they were still slightly off in my bloodstream. Not a surprise, as that was also the case during the transfers we did for IVF retrieval #1 a few years back. IVIg is still recommended, no surprise there.

My Leukocyte Antibody Detection levels (T cells and B cells) were also low, so LIT is recommended. And one of my Cytokine ratios was high, so Humira was recommended.

So, what's the plan?

I'm not doing the Humira. It has an increased risk of cancer, usually lymphoma, which is in the same family of cancer that my dad has (leukemia) and that his dad had (multiple myeloma). R and I decided pretty quickly that it's not worth the risk, and that view hasn't changed. If Humira is what's standing between me and a biological child, so be it.

I think we're going to do LIT. I'm still afraid of crossing the border, but we did go and get our passports yesterday and requested expedited processing. Two rounds are being recommended (3 weeks apart), so hopefully we can do the first trip in November and second trip in December.

We also plan to do the IVIg. And hopefully transfer in January.

At the same time, I'm ready to be done with this and move on to the next step. (Or so I say now - I realize I may sing a different tune if we wind up with one single line in January/February.)

To that end, I've contacted a local adoption agency to request a recertification application, and I've scheduled carpet cleaners to come out in mid-November. I'm not going to obsessively clean, but we have 4 dogs and 2 (indoor only) cats, and our carpet is just embarrassing.

I also need to work on getting a pool fence installed, and once we get the application completed and fence installation scheduled, I'll contact the social worker to do the home visit. If we can get that done by the end of November, we should have our certification around the time we get transfer results.

We haven't totally decided which way we would go on the adoption front. I'm still hesitant to do international for fear of being rejected. What I've decided to do with the home study is give the health forms to our family doc and mention that certain things would possibly disqualify us, but leave it up to her whether she thinks they are a possible impairment to our ability to parent and puts it on the form or not. (I haven't seen the form yet, so I don't know if it's a very specific questionnaire or if it just asks for a general statement.)

Then during the home study visit, if questions come up we'll answer them honestly, but we won't go out of our way to point out things that the social worker doesn't ask about. Once the certification is done, we'll request a copy of the home study and review what the report says and decide whether we think it would knock us out of the running internationally.

We'll see what happens.

October 12, 2010

Good News - Not Sure What To Do With This

The results of the NK tests that were done on the biopsied tissue came in today. Apparently there are two types of cells they look for - one type is bad, so they don't want to see that in the endometrial lining, and the other is good, so they want to see lots of those.

It turns out I have none of the bad cells and lots of the good cells.

In other words, good news on one small front in the infertility fight.

It's been so long since we've gotten good news relating to infertility that I just sat there stupified for a minute. I don't think I trusted my brain to interpret what I was hearing, because I had to ask "You mean, my test results are good? Really??"

I'd like to think that this means my uterus isn't killing off the embryos, but I haven't heard the results of the other endometrial biopsy test (for the beta-3 integrin) yet, so I guess that thinking is still a bit premature at this point.

I sent an e-mail to ask the clinic when they think those test results might come in, so hopefully we'll also have that answer soon.

October 05, 2010

A Random Thought 'Dancing' Through My Head

This is completely unrelated to anything about infertility, but...

I'm catching up on last night's TV, and can I just say - I hope I can move like Florence Henderson when I'm 76 years old!

I couldn't even dance half as well today, when I'm less than half her age. That lady is amazing!

October 04, 2010

Survived the Biopsy

Apparently I should have researched the endometrial biopsy process a bit before undergoing it.

I was thinking that it involved literally snipping some of the uterine lining out, much like the sudden, sharp pain felt when a dermatologist uses that little tool to cut a chunk of skin out of your arm/leg/back/wherever to make sure it isn't skin cancer. At least, I assume it's a sudden, sharp pain, given the face R makes when it happens. Fortunately I haven't had occasion to undergo that particular form of torture.

Anyway, based on that assumption, I showed up to the appointment this afternoon more freaked out about a procedure than any other time I can remember in the last decade or so.

It wasn't fun, but fortunately it also wasn't as horrible as I imagined it to be.

Actually, for the first bit of tissue that local RE took, I just felt a little bit of mild cramping. Had the process stopped there, I would have classified it as "no big deal at all". But I'm having two tests done - the integrin-B (I think that's what it's called, too lazy to look it up at the moment), which RE is doing, and NK cell testing, which RI is doing.

Which meant that I had to have two bits of tissue removed, instead of just one. While the second bit was being removed, that was more like "lay in your bed moaning about really bad menstrual cramps" kind of pain. But I did a lot of deep breathing, and clearly I survived.

As soon as the second one was done, I took my feet out of the stirrups and sat up (probably subconsciously thinking that if I was in an upright position, he couldn't take any more tissue even if he wanted to).

Then he started to ask me about how many embryos we have, what protocol we used, what our next steps are. (Even though he's the RE I do all of my local monitoring with, so we've already covered this ground.)

But I tried to answer the questions anyway, and then I realized that my own voice was starting to sound a little bit distant and hazy and the room was starting to sway. Suddenly in the middle of a sentence about our protocol, I announced, "I think I'm going to pass out."

Fortunately I didn't, but they did have me lay back down and stay there for about 15 minutes. I don't usually get dizzy, and I've never fainted in my life, but I guess I had just stressed myself out about this so much that I got a little lightheaded with relief once it was over.

Oh, and after it was over, I found out that the tissue doesn't actually get cut out - some cells are sucked out with a pipette. If I would have realized that beforehand, I probably wouldn't have been so freaked out to begin with.