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Thursday
Apr102014

Soft Tissue Sarcoma 101

"Mommy, where are the posters of dog breeds, and all the pictures on the walls like at our vet's?" My daughter's eyes scanned the walls. I explained this is not a fun vet to see. It's a specialist that people only go to when their animals are too sick for posters of breeds. She continued to play a game on my phone, squealing gleefully at the dive bombing of alien invaders. I imagined each explosion the disintegration of cancer cells beneath Reggie's uneven skin.

The last two surgeries have left concave bowls of excavated tissue beneath his fur. The girls pet his back and pucker his skin as they get to the surgical site - a putting green of velvet baby fur left behind from a razor's edge. They pushed gently into the bubble of flesh at the end of the scar where sutures lurked beneath, then watched the skin regroup. A game of sorts that Reggie did not mind. The pain is gone for now. I tried to explain the layers of muscle and fat, and how the doctor had to stitch below the skin and staple it on top. Staples are out now, but the puncture wounds left over from the prongs make him look like he could spring a leak at any time.

The oncologist walked in. A gentle but confident presence. She offered her hand with the expression you only find in places you don't want to be - An apologetic raising of her eyebrows before any words could be exchanged at all. I wondered how many times she said hello this way. I imagined what it must take out of you to specialize in veterinary oncology and greet each new patient with regret. Regretting they had to meet you at all.

She took him back for weight and X-rays. The good news was he lost two pounds. Those who know Reggie, he is what we call my little tater tot. A husky long haired dachshund who was supposed to be a miniature. Until he grew to nineteen pounds. So this was good news. Then, better news. It looks as though the cancer has not yet spread to his lungs. Soft tissue sarcomas most often enter the blood stream and then go directly to the lungs. X-rays are not 100%, as microscopic cells could be present, but I chose to look at it as a positive in what has been a pretty trying month. However, upon a call to my vet back home, this doctor learned the surgeon who performed his second surgery never tested the tissue removed from the site. He said he thought he saved it, but upon inquiry discovered it had been thrown away. Thrown away. I just had to say it again to make sure I heard myself correctly. My jaw hit the floor. My eyes filled with haze. She allowed me to stir. Then continued.

The prognosis is that Reggie needs a third surgery plus CT scan, performed just prior to surgery and after anesthesia, that will tell exactly how deep to go into the tissue this time and how far it has advanced since his last surgery. During surgery they will assess the health of the tissue by monitoring it under a microscope. Certain tissues with cancer are visually recognized, but others cannot be determined unless viewed microscopically. IF this surgery goes well, the doctor feels there is a 95% chance he will not need radiation. Surgery will include a necessary two day post-op stay.

If Reggie does need additional treatment, this kind of cancer does not react as well to chemo as radiation. With chemo, he would take a pill every day for a year.
Radiation would be the likeliest avenue for this kind of cancer. It is an aggressive cancer as it develops a root system. So it can go deep and once it goes into the blood stream it goes directly into the lungs. It is a slower moving cancer, but that still just means it's a matter of months rather than days or weeks.

They will know once they do this surgery if radiation will be needed.
Radiation would be performed at another facility. Reggie would stay there during the week and receive daily treatments for a month. We would be able to pick him up on weekends.

I sit here tonight with Reggie's chest rising and falling into my arms. His trusting eyes closed for now, a retreat from visions of vacant walls. For now, some peace.

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