Monday, April 8, 2013

Mina and the Big C

In addition to cancer, I also have cute.
Mina has cancer.

It's been twelve days since her diagnosis, eleven since her surgery. But she has had cancer for more than a year, unbeknownst to me. Closer to two, actually.

Mina has lumps. Old dog lumps. When I returned from Maui (yeah, I need to post about that, geez), I noticed a strange bump on her chest. It looked like a pimple, very different from her other bumps. I ignored it, thinking it would go away. But after a month, it didn't.

Thirteen days ago, the lump doubled in size and bruising appeared under her skin. I took to the internet. So much information at your fingertips, but also a great panic-inducing creation. When I described the tumor to Google, it told me Mina has mast cell tumors. For more than an hour, I scoured the internet, becoming more and more convinced that Mina had cancer.

I wrapped my body around Mina that night. I cried into her fur and told her how much I loved her. I totally lost it, people.

The next day I set up a vet appointment for Mina. People told me I was over-reacting, that she would be fine. But I was 100% sure she had cancer. If my confidence wavered under the pressure of colleagues and friends, Mina's response to me fiddling with her tumor didn't.

Mast cells are the body's first responders. They release histamine, causing an inflammatory response and attracting the rest of the defenders to the site of invasion.

So when I manipulated Mina's tumor, the diseased cells released histamine. They caused the skin around her left eye to swell. This happened once before, but I mistook her swollen eye for a bad encounter with an angry bee. It wasn't, though. It was a disturbed tumor sending histamine to the tissue around her eye.

The vet gave Mina IV benadryl, just in case the needles she was using to take samples from caused a massive histamine release, sending Mina into anaphylactic shock.She took samples from seven lumps. Mast cells can be seen under a microscope.

Mina and I waited. When the vet came back into the room, I knew what she would say. Five of the seven samples contained cancerous mast cells. Five!

Cancer is ugly. It is one's own cells going rogue. It's just not right, folks.

Mast cell cancer is very common, particularly in Pit Bulls. It's generally found in the skin but can occur in the liver, spleen, and lungs. Mast cell tumors can occur singly or in groups. They can get large or stay small. They can change size daily! Unlike some cancer, mast cell tumors don't generally "root" heavily. They can sit on the surface, barely attached. Mast cell tumors release their cells and send them through the blood stream, so they can spread through the body easily.

My first talks with the vet were confusing. It's still confusing. There is no set treatment or diagnosis for mast cell tumors. The fact that Mina had at least five was disconcerting to the vet, but it didn't mean she was riddled internally with cancer (far more deadly than the skin version).

To remove all five would have required full anesthesia. And it was absolutely no guarantee that it would eliminate the problem. I'm not ashamed to admit this...but the fact it would have cost $1,200 for the full surgery factored into my decision.

My other two alternatives were a) do nothing and b) use sedation and local anesthetics to remove as many as the vet could (cheaper than general anesthesia). Before I made my decision, Mina's lungs were x-rayed and an ultrasound was taken of her spleen. If they showed up internally, Mina wouldn't have long left and it would be more about managing her quality of life. Thankfully, she had no internal tumors.

I opted to do the sedation and local anesthetic. Mina handled the sedation so well that the vet was able to remove four tumors. But she found a lot more. As she removed one, she would find another. Mina has so many that the vet doesn't believe they can all be removed, even if I wanted to have them cut out.

Here's the thing about mast cell tumors - they are so variable that it's hard to give a prognosis. Trying to get the vet to tell me how long Mina had left, how likely tumors would come back or go internal...she didn't have answers. People kept sharing stories of how their dogs had a tumor and lived five, six, seven more years. Sometimes this helped, sometimes it just made me want to cry more. Mina isn't other dogs. She's Mina, and there is just a lot of unknowable things when it comes to mast cell tumors.

I have to say, I felt really numb. I was trying very hard to process what it would mean to lose Mina in two months (one possibility). What it would mean to euthanize Mina. Because when it comes to mast cells, it's not generally fatal. It's the side effects that are - it's the bleeding gut, the constant histamine release, the inability to hold down food that results in the dog being humanely killed. Euthanasia can be a great mercy and I am not opposed to it, but the thought of intentionally taking Mina's life hurts my heart so much.

When I brought Mina home from her surgery, I finally broke down. She was a patchwork of staples and stitches. She was in pain. And the vet wasn't sure she had gotten all the cancer or how severe it was. She said worst case scenario was that Mina had only two months. I hated that I had put her through the surgery. I hated not knowing. I hated that the vet had said Mina was already on borrowed time. I cried and screamed and hit my fists against the steering wheel.

I carried Mina into the house and curled up with her on the sofa. She fell into a deep sleep, paws twitching.

I opted to send two of the tumors to histopathology. And let me tell you, that shit is expensive. You get a discount for the second tumor, which just makes me wonder why the first is so costly ($177 for one, $65 for the second). But I gave up, none of it made any real sense.

Waiting is best done with a toy.
And then it was the waiting game. Which really sucked. I vacillated between hating myself for putting her through this really painful surgery and hoping that, well, she's had some of these tumors for nearly two years, they haven't killed her yet!

Everyone around me was and is incredibly supportive. I'm lucky to work at an animal rights group, because I don't have to 'splain my bond with Mina. I don't have to censor myself or hold it all in or feel weird that I love Mina so damn much. Colleagues and friends send me text messages, phone calls, emails, gave me hugs and vegan cinnamon rolls. It's important to have that support network.

The news was good. The tumors were low level Grade II. Dogs have anywhere from 48-70 months from the time of the first tumor. I mean, that's like forever for Mina.

I recognize that Mina may get more tumors. They may invade her spleen. Or liver. Her new heart murmur may get worse and she could have a heart attack. She might die in her sleep. I might have to euthanize her. And I will hold onto her until that moment. I will cradle her in my heart, let her nest in my bones. I will make her life a joy, as I hope I have for the past 11 years.

Mina has cancer. I'm not uncomfortable saying that. It's a truth. But it's not the whole truth of Mina. It's just another facet of her constantly changing, growing prism.

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