(please skip to after the picture to just read about the next steps)It will be 2 weeks tomorrow since we found out Ellie’s osteosarcoma had spread to her lungs. the 1st few days were pretty much pure emotion of sadness, anger, disbelief, overwhelmed, hopelessness. I think that’s important to state, because everyone is very quick to say “There are more options!” “It’s not over yet!” and it would be easy to just put a blind eye and soldier on with positivity slapped on my grief. I’m not saying go pure doom and gloom, but as someone who shoved all emotions down for years because I thought that most emotions were bad- it’s simply not sustainable. Those pent up feelings will find a way out and if they are forced down it will probably not be the most constructive outlet.
With that- the situation really sucks. If you go by the numbers a dog diagnosed with osteosarcoma has a median survival rate of about a year with treatment. A dog with lung metastasis has a median survival rate of about 6 months with treatment (of Palladia/Losartan). So statistically it really sucks! I knew I wouldn’t be able to make any decisions until I let myself really feel the reality of the situation- all of it. Not just the negative side, not just the beating the odds side- all of it. The overwhelming feeling I had was the unfairness of it all. I was mad that I had put in all this effort, money, followed all the advice only to be in this situation so soon. I felt I was entitled to more time. These emotions were extremely selfish and came from a really arrogant space- I won’t lie, but they were there and I let myself feel them without judgment or placation. Accepting that, and letting it out allowed space for everything else to breathe. I wouldn’t say I’m at peace with it, but I can see clearly again. Enough to reprioritize, refocus on what’s truly important, and decide the next course of action.
Before choosing what to do, I re-evaluated what my goals were. Before it was semi-vague- for Ellie to have a good quality of life, and I hoped she would make it a year. That goal was very conflicting, I knew in my head I always say quality over quantity, but I still had this quantitative goal. so in re-evaluating I looked more at what am I willing to potentially put Ellie through. I looked at the risks of treatments, common side effects, possible outcomes, and recovery periods. I found that I have 4 options:
- Palladia/Losartan- an oral chemotherapy given on different days that can shrink tumors in 50% of patients. Common side effects are most commonly lethargy, GI upset which can cause lack of appetite, vomiting, diarrhea. Some dogs handle it pretty well, some don’t, but they can adjust the timing of the medication and supplement with prednisone or cerenia to help with side effects. It would cost ~300-700/month for vet visits (depending on if they took xrays or not).
- Palladia/Losartan + study drug clinical trial- There is a clinical trial at CSU for dogs with lung metasasis the Ellie would qualify for that is the same Palladia/Losartan protocol plus an additional drug that I can’t remember the name of. It would have been very similar to the previous trial Ellie was in with a little less intense check-ins, but we’d need to go in every 2 weeks or so for blood work. Ellie would also have to get a bronchial lavage twice throughout the trial. So all the same common side effects as well as a couple appointments where she would need to be put under general anesthesia for the lavage, but the lavage itself there was really no recovery period from. Costs would be covered by the study.
- Minimally Invasive Metastasectomy in Canines (MIMIC) clinical trial- There is a whole tripawds podcast dedicated to this, but this trial is where enrolled dogs have a minimally invasive surgery to physically remove the diseased lung. because it’s minimally invasive most dogs get to head home in 24 hours after surgery (their goal is to eventually have this be an outpatient surgery). recovery is pretty minimal only needing to keep dogs quiet so they don’t pull any of their stitches, very low pain. Ellie would need to have a CT scan to be enrolled in the study, and then 2 more one at 2 months and 6 months post-op Some patients will have chemo after surgery, some will not. the study covers the cost of the ct scans and up to $5000 of the surgery, usually the owner will pay around $4,000-$5000.
- Do nothing- Ellie’s nodules are very small, at this time she still has 99.9% lung capacity and that can go down to as much as 65% before you start seeing symptoms. We could get bloodwork/X-rays every few months to track the progress and go from there.
There’s pros and cons to all of them so it really comes down to my goals on how best to proceed. my biggest needs were to keep any discomfort to an absolute minimum, that took out options 1 and 2. I know the side effects are common and can be treated, but seeing how Ellie has bounced back more and more as we haven’t been on any chemotherapy reinforces my decision that even though she wasn’t throwing up and would eat her normal kibble (sometimes had to be convinced with added broth) she still didn’t feel 100% on it…and without those signs I don’t know how bad she might be feeling. It was not worth having her on this protocol for the rest of her life in which is will make her feel not so great to buy us a few more months…if that. So that left options 3 and 4. I’m not ready for 4, and I don’t think Ellie is either. So that leaves 3- with a caveat. I am going to get new xrays done here in a couple weeks to see how things have progressed. I am still really worried that Ellie got the super short straw and has an extremely aggressive form of osteosarcoma, so if we get new xrays and the number of nodules has doubled then the surgery probably won’t be very effective and thus not worth doing, but if they aren’t new ones we will move forward to do the surgery and not do any chemotherapy afterward. Ellie will have 3 kinda drugged out crappy days and then be done and whatever the world decides to give we will take joyously and not have to schedule vet visits or worry about side effects and just go live life.
So that’s where we are at!