The oncologist said to phone by 4pm if I hadn’t heard from him. I left a message with reception who couldn’t get hold of him and got on with work. I phoned again at 5.45pm and was disappointed to hear the automated message saying they were now closed. I expected to hear nothing until the next day so was surprised when the phone rang later than evening and it was the oncologist apologising for the delay.
He confirmed that the ‘cyst’ on his foreskin is another a mast cell tumour and is a typical presentation. As it is now bleeding and ulcerated, that suggests that it’s fairly advanced and has the potential to spread. Although his liver, spleen and lymph nodes are enlarged there is no sign of tumours having spread internally. They are unable to tell if the tumours on his side and the one on his penis are related – and if so, which one is the primary tumour. Common sense tells me that the one I went to the vet about last December is the primary tumour and the ones on his side are secondary but they can’t confirm.
The treatment of choice for mast cell tumours is surgical excision, but in Ash’s case this is difficult. Firstly the tumour on his shoulder is undifferentiated i.e. there is no clear edge to the tumour. The scaly patch covers a large area, bigger than my hand, and the red hairless patch is a little smaller but connected to the scaly area. A successful excision removes the whole tumour and 3-5cm of surrounding tissue. If they can’t tell where the tumour starts and ends, this is an impossible task. The tumour on his penis is equally tricky because of the amount of tissue they would have to remove.
They recommend starting with Prednisolone for a week and returning for a further assessment with the surgeons. Prednisolone (a steroid) can shrink tumours potentially making Ash’s tumours easier to identify and possibly remove. However, this is not always the case.
Chemotherapy was also discussed. This is different to human chemo in that it aims to improve the quality of life rather than treat the cancer. Dogs react less harshly and the dose is smaller and less toxic. Typical side effects (e.g. vomiting or diarrhoea) can be treated easily and more severe reactions are uncommon. However, the practicalities of chemotherapy are challenging; a morning in hospital once a week for a month then a morning in hospital every two weeks for a further two months.
I asked what the prognosis is with and without treatment. He couldn’t tell me because of the nature of Ash’s tumours and the unusual presentation of the one on his shoulder. He did tell me that dogs whose tumours are successfully removed by surgery have a median life expectancy of a further 8-12 months. That doesn’t really seem very long given the fact that they probably can’t operate on either tumour. Would pursuing surgery or any other treatment be best for Ash, or would it be just keeping him alive for me? I wouldn’t want his quality of life to deteriorate. I don’t want his last months filled with hospital visits and tablets and pain.
Mountains and rivers and beaches
We have walked in dozens of forests together, climbed Munros, swum in seas and rivers, camped in tents, run by moonlight deep in the forest when the torch battery failed and jumped into the North Sea together on New Year’s Day (twice). The only compromise we have had to make because of his recurring ear infections is to avoid complete submersion in water. That’s pretty easy, except when he falls into a river that’s way deeper than he expects, but the submersion is short-lived and funny.
I already find our walks have shortened because he’s out of breath after 20 minutes or so. He rarely has his infamous Labrador loopy turns now, running with legs splayed and ears flapping round trees and through puddles, tumbling in mud and leaves and coming to shake dry right beside me.
I have a feeling our last run together was last Sunday at Loch Leven and it makes me cry to write it down.