[Dailydrool] Our Elsinore: To de-bulk a tumor, or to leave well enough alone?

[Elizabeth Lindsey]

Well, our Elsinore and young Charlie have just finished an after-dinner singing session with the piano, which needs tuning badly. The tuner will come on Tuesday, leaving me with no excuse for sounding so terrible when I play. But I know I can count on the hounds to stoically sing on regardless of how many wrong notes I hit. We did all of Elsinore's favorites tonight: "God Save the Queen" (because the queen is such a dog person), Beethoven's Sonatina No. 1 in G (without the repeats), "Marching Through Georgia" (twice on the chorus), and "Love Is Blue," with "Annie's Song" for an encore, played an octave higher than written because Elsinore finds high notes inspirational.

I had her back to the oncologist last week because cytology reports tend to trigger questions, and I had a 13-item list after reading Elsinore's report. I was also able to talk with the surgeon, and he provided even more food for thought. I went into this appointment pretty much decided against doing the de-bulking surgery. I had talked with the hospice vet on the phone several days before, and we'd decided we'd schedule an initial consult with her when it looked as if Elsinore's currently super-high energy and enthusiasm levels begin to dip. But talking with the oncologist and surgeon, well, the de-bulking surgery sounds as if it might be the way to go after all.

The two things our regular vet was most concerned about--the de-bulking adversely affecting nerves and muscle--weren't a concern at all for the surgeon. He said the mass isn't near the sciatic nerve, and he doesn't anticipate needing to involve the muscles. If he does need to do so, the muscles in that area aren't ones Elsinore would need for much of anything. I'm reminding myself that he probably does a whole lot more of this particular kind of surgery than the regular vet does--and he's a surgeon because he likes doing surgery, so he's going to be eager for an opportunity to do what he likes. 

If we have the surgery done, he said it'd involve an overnight stay in a recovery ward staffed around the clock, and Elsinore would have pain meds whenever she seems to need them. She'd go home the next day with pain meds as well. The first week wouldn't be a lot of fun (having to wear an E-collar won't help) but she should be back to herself again after the stitches are out. 

De-bulking the tumor wouldn't completely remove it. The surgeon won't be able to get all the little tendrils this type of cancer puts out. But the lump removal would buy her more time, maybe even enough to die of an entirely different kind of old-age thing. If we were going to eradicate the cancer entirely, we'd have to combine the de-bulking with four weeks of radiation therapy at the University of Tennessee vet school, with Elsinore having to stay there for four weeks and us having to find $5,000 to pay for the treatment. We're pretty sure that would not be a big quality of life enhancer for any of us.

Both specialists said the tumor shouldn't grow back rapidly after being de-bulked; it wouldn't be like trimming a shrub in that respect. They also said they would send the entire mass off for a pathology review, which would let us know exactly what kind of soft tissue cancer it is, which would let us know better how to plan for its behavior in the future and get an idea of how quickly that future would arrive. At the moment, we've been calling it "Elsinore's rump-lump cancer," for lack of a more specific name. Although, "rump-lump cancer" is pretty specific, since it's an accurate description of what it looks like (a lump) and where it's located (on her rump).

Elsinore's a good candidate for this kind of surgery since, with the exception of the tumor, she's in superb health and has plenty of stamina. This is also the time to get the tumor out because it's still not even the size of my fist. Both specialists are encouraged that its rate of growth has been fairly slow (we first noticed it at the beginning of the year but thought it was just another fatty cyst), though they say that in time, all the dividing cells in it will reach a point where there are so many cells dividing themselves in half and then each in half again and each of those in half and so on, that the tumor's growth rate will become very noticeable. Sort of like compounding interest, back in the old days when there was enough of an interest rate to make saving a gratifying thing to do. They said that de-bulking can be done only once or twice because it doesn't leave much skin to work with for subsequent times. But really, our savings (thanks in part to years of crummy interest rates that are like that of a tumor growing at glacial speed) can manage only one of these surgeries anyway. 

If we decide to do nothing, the tumor will reach the point of being too large for Elsinore's skin to contain, and we'll need to deal with ulcerations and possible infections. It'll also affect her ability to use the joints in her left leg. Already we're noticing that leg has a slight tremor when she's tired. If we have the tumor surgically reduced, we put these things off for an unknown period of time. But at some point, unless kidney failure or congestive heart failure or bloat or something else that takes her out first, we *will* have to watch the tumor destroy her skin and mobility. De-bulking puts off the inevitable. Yet, if the surgeon feels she can handle the surgery and will recover from it quickly, doesn't it make sense to do it if it'll extend her life in a good way?

We're leaning more and more toward de-bulking because the benefits described by the specialists seem to outweigh the risks and it doesn't sound as if it'd be a wrecking ball that would destroy her quality of life for the rest of what life she has. It's so hard, though, to know what exactly the right thing to do is. Ken and I have decided it basically boils down to what we value and what we feel we can live with later, after Elsinore's gone. Will we be okay with not having tried de-bulking? Will we regret having done it? Oh, for a crystal ball right now! 

I would continue to write of my angst over what to do, but Elsinore has been pestering for her evening snack. She's made the happy discovery that when you're walking around with rump-lump cancer visibly on display, you're much more likely to get what you've asked for and with a loving caress and some sweet talking thrown in for good measure. I'm starting to fear she's reaching the conclusion that her quality of life with rump-lump cancer is actually better than her quality of life would be without it. Our Elsinore knows how to work a situation, and she's definitely working this one.

Elizabeth