Wednesday, August 28, 2013

Complete excision


The oncologist confirmed the histology report indicated a "complete excision" of the tumour. As far as I can tell, the tissue margins removed have not affected Munson's mobility. While he's happy on or beside the bed most of the day, he can't avoid an energetic malamute dance after a particularly good belly or back rub. He gets a short walk in the neighbourhood each day, and a few car rides to keep his mind occupied.

Munson will have his sutures removed on Tuesday while his ongoing treatment plan is explained to me. This is likely to be metronomic chemotherapy, a program of low-dose drugs over a period of months.

The generous support from this campaign has taken some of the "heat" out of the up-front costs so we could get it done quickly and move without interruption towards chemo. I understand that second stage will cost almost as much as the first, but we can at least stagger that out over the year. Some of you might be interested to read about the experience of other dogs  on the Tripawds  site.

Sunday, August 25, 2013

Blackwattle Bay


With all of the stress around Munson’s surgery this week, there hasn’t been enough “us” time for Gustav and myself. We took a sunset walk around Blackwattle Bay on the harbour. I hope you find these photographic memories as soothing as we did.

P8253008 P8253026 
P8253030  P8253032
Gustav goes a bit Doc Manhattan Blue light

Thursday, August 22, 2013

Home again, home again, jiggety-jig

The surgeon called this morning to say that Munson was ready to go home and wouldn’t need the three days of expected post-op care.  “Great! I’ll collect him now.” I’d put his blanket on the bed this morning as a symbolic gesture, never imagining he might be on it within hours rather than days.

Banket on bed awaits regular occupantNow wasn’t practical; he would need one more round of analgesia mid-afternoon and then I could pick him up. I had butterflies in my stomach all day, but at least these were better than the teeth-grinding anxiety I experienced the night before his surgery, which left my jaw so sore by midday I had to go home to find some pain-killers.

Much of this stress was soothed by the incredible reaction to the Munson v Cancer  fund-raising drive on GoFundMe which pulled in nearly a thousand dollars towards his surgical costs in the first day. I woke to the sound of my email inbox ringing in each donation like a New Year bell. Further generous donations appeared in my letter-box and by direct deposit. Thank you all, thank you all so much.

One side effect of my anxiety was that I got last year’s tax done in a few hours, so I could throw my small refund into Munson’s hospital kitty.

At our 4.20pm reunion he was quite perky, even with a band of stitches extending along half a shorn leg. He was quite the patchwork toy with bands of shaved hair where surgical tubes had been planted, all crowned with a fresh new plastic collar. With the hair gone, you can see what a slim leg he has, appearing to be tucked into a giant malamute-paw slipper. 

malamute paw slippers  Stitches
Tumour post-biopsyFor the curious, I’ve included a picture of the tumour last week after the biopsy, but scaled it down so you can avoid it, unless you care to click through. It demonstrates just how aggressive it was, coming out of nowhere to have a height comparable to the thickness of the joint. It’s been essential to attack it before it metastasized.

I had a debrief from one of the other doctors about his pain-killer and antibiotic regimen, and then Munson decided that I’d dilly-dallied enough and we should get out of there. back in the car Sleeping with pink hippo
It’s been a rough year for Munson, with unexplainable separations for his quarantine, and now several days of veterinary comings and goings, alternated with the space-helmet. All probably seem like terrible punishments, so I need to ensure that everything else is stable and reassuring. Once again, thank you to all readers for your love and support.

Wednesday, August 21, 2013

Munson vs Cancer

I saw Munson briefly this morning at SASH, still in good spirits and giving malamutes a great name due to his sweet nature. I took him for a spirited walk around the hospital before returning him to one of the veterinary nurses. There were a few confused looks back over the shoulder as he was escorted up the corridor, with only my verbal encouragement to set him at ease again.

Surgery was completed a short time ago, with the report that everything went well and no fancy tricks like skin-flap transplants were needed to close the wound. When such transplant options were discussed with me on Monday, the warning was that “hair would be going in every direction”, but I assured the doctor that this was not an unfamiliar hazard to a malamute owner. His youth, vitality and positive demeanour are just as conducive to getting through this as with any human facing a cancer diagnosis.

Munson’s oncologist will update me in the morning with his recuperation progress and talk to me more about radio/chemo-therapy options.

As a number of friends, far and near have offered to make some contributions to the Munson v Cancer fund, I have set up a GoFundMe campaign to receive them. I cannot tell you how touched I’ve been by the increasing number of messages and phone calls today, and I hope you can all communicate your love directly to Munson in future.

Love from us all.

Tuesday, August 20, 2013

Munson update

P1130833I’ve had some talks with various veterinary specialists at SASH over the last few hours.

First the best news: a CT scan shows no evidence of any metastasis of the cancer into his chest cavity. It’s conceivable that there are diabolical cancer-lets lurking at sizes below the screening resolution, but I’m not going to complain because my cup is 0.003% empty.

The good news is that the actual lump should be removable without any amputation BUT it pushes us towards a greater reliance on follow-up chemo/radiation therapy as some of the tiny outer fringes of the tumour remain, with the capacity to regrow and metastasize. 

There is a possibility of treating  the lump with just chemotherapy but if Munson is going to have any social future then the lump has to go – not least because it may continue to grow and threaten further complications. I’ve had to keep him nearby and leashed at the park because other dogs sniff out the problem and start bothering him. It’s also enough of an irritation to him that it he’s going to spend an inordinate amount of time licking it. So, out out damn lump!

The next hurdle  (the not-so good) is mostly financial as the running hospital tally CT scan, surgery and associated costs of anaesthesia, analgesia and is currently sitting around the $6k serious ouch mark. The operation won’t start without a 50% deposit and then the rest immediately on delivery. No negotiation. I was actually rather angry with their delivery of news as the information on costs came only after much delay and then with a “shall we book him in for surgery in the morning” question as if coming up with the money on short notice was not an issue.

Just as I was digesting this information and applying for a loan, the oncologist called to spring the news that the optimal after-surgery requirement was special radiation treatment for a further $6500 – but it’s only available in Brisbane, so add a few more thou for transport and accommodation. The local radiation ( a bargain at $4K ) was offered as a fall-back or, a year of chemotherapy at about $500 per month. I understand that costs are high (and not subsidised as human patients are, and insurance covers a fraction of the costs) and they mean well, but the communication of costs and treatment choices has been rather poor.

For now, Munson is still at the hospital awaiting a familiar face , luckily oblivious to the difficult choices being made for him. The decisions made over the coming days may have bigger ramifications for our household, bringing forward other matters to consider. Is it time for a move to the country ?!?!

Finally, I’d like to say thank you to all those of you who’ve sent in messages of good will here, via email, Facebook, YouTube , on the street and by phone. I want Munson to be around to enchant many more good people as he does me every day.

Sunday, August 18, 2013

Un homme et son chien

This video excerpts one of my favourite film scores in recent years, from a remake of Vittorio De Sica’s Umberto D. The music in Un homme et son chien is by Philippe Rombi.

After a visit with Gustav and Munson to Marrickville Markets this morning, I opened a book of miscellaneous music at the piano, and settled into a medley of Olafur Arnalds, Dustin O’Halloran, Bartok and then this lovely film theme. Munson trotted out after a couple of pieces and settled himself by the piano bench, one paw resting on my foot.

Saturday, August 17, 2013

And then the bad news

The vet called me at work at 11.30 this morning. She always sounds chirpy, whatever news she’s delivering. The news from the pathology lab quickly detuned me from her delivery. Grade 3 soft tissue sarcoma … histiocytic (that’s like evil icing on the bad news cake). I’m scrawling diagnoses, names of tests, costs, and treatment approaches on post-it notes that bleed across my desk. I can’t leave for another ninety minutes

The next step is to do a staging – work out via X-ray, ultrasound and blood test if and where it has spread to. A subsequent lumpectomy demands 3 cm of clearance around the horrible swollen mess, with two planes of tissue to be taken out  - fatty (easy) and muscular (difficult) – and because it’s sitting near his knee there’s not much room to move, so some level of amputation may be necessary.

We’re booked into SASH in North Ryde on Monday morning to start these tests.

I don’t know how ready I am for this. Since the phone call some seven hours ago, I’ve been with Munson, walking, moving, trying to outpace the dam of tears behind my eyes. But he’s in no obvious discomfort, and is less fixated on licking the site than he was two days ago.

Summer is coming, and Munson has to be fit and ready for the beach again.

Thursday, August 15, 2013

Munson à la mode

Munson in plastic Elizabethan collar (1)  Munson in plastic Elizabethan collar (2)
It’s the start of Munson’s last day in the collar, as he accompanies me on our early morning pilgrimage to Coffee Alchemy. He had a limited run in the park with not too much bother from the bandaged leg.

He’s really learnt to wear the collar with some style, quickly bringing to mind a lot of space-age mod 5fashion.
space-age collars

Tuesday, August 13, 2013

Resuming the position

IMG_5011Munson had a restless night, dealing with a heavily bandaged leg covering an undoubtedly worrisome wound, some pain as his post-surgery analgesia wore off, and the ongoing frustration and ignominy of the collar.

I took him out for a quick walk in the morning, whence he collided repeatedly with post after tree, until he learnt to slow down enough so the collar deformed rather than sending him ricocheting away.

I think he slept most of the day away on the bed – that was where I found him on the two occasions I stopped in to check on him. He was rather frisky when my day at work was done, and so we find him in the malamute classical position.

Monday, August 12, 2013

Angel in a plastic halo

lump - pre-biopsyI dropped Munson off at the veterinary surgery at about 8am with some paperwork kerfuffle that didn’t put me at the greatest ease. I was signing the necessary paperwork when I noticed that the quoted figure was much higher than what the vet had told me over the phone last week. When I looked at the breakdown of charges, it seemed to be for the full lumpectomy rather than the initial biopsy. While I would have been overjoyed to do both at once, saving Munson a lot of stress, and me a lot of money, the proper procedure had to be followed. I ended up having to leave Munson there and wait for a call from the vet at 10am to sort out the details.

Then home and to work, and ten anxious hours.

At 6pm I could hear the unmistakeable pounding of Munson’s 51kg across the surgery floor from across the waiting room. With an Elizabethan collar strapped to his neck, he had all the grace of a drunken dinosaur ambling through a forest. The biopsied lump was stitched and wrapped in bandages, its dizzy pilot very happy to see me, even if it meant crashing into every other door-frame to get to me.

Home again  IMG_4997
Munson hadn’t eaten since Saturday, his enthusiasm for a new meal overcoming the difficulty of getting food to his mouth without being able to lower himself to a bowl, or use his paws to assist with the delivery of a pig’s ear. The one side-benefit of his conical head gear was the residue of food grease that lingered within tongue-reach for hours…

Sunday, August 11, 2013

Munson: the story of a lump

Munson's lumpAbout ten days ago I discovered a very large lump under the skin of Munson’s right hind leg. My first thought was it was a cyst or benign fatty tumour. It’s not exactly attractive, and seems to have come up almost overnight like some exotic mushroom.

When I first saw it, it was covered by a thin film of hair, not unlike most of my possessions, and was about the size and hardness of an egg or golf-ball. It didn’t seem to bother Munson when I handled it but my quick reading on some canine lumps and bumps suggested I should get it checked out by a vet.

A few days later on a warm Sunday afternoon like today, vet Emily took a fine needle aspirate for testing. On Wednesday she reported back that it seemed to be a spindle cell sarcoma. It would be necessary to do a full biopsy (under anaesthesia) to do a more exacting diagnosis, one that would indicate the margin of tissue that would need to be subsequently removed around what had become a shiny red, angry passenger on Munson’s leg.

In the intervening days, it drew Munson’s attention, licking and worrying at it there was less camouflaging hair. The biopsy surgery is scheduled for tomorrow. I can’t say I’m not worried, as it’s only four years since I waved Bondi off, but my understanding is that they rarely metastasize, although they are prone to regrow, and regrow and regrow. The worst-case limited result – if I can say such a thing – is that he loses the leg.

With that ominous possibility lurking in the shadows, I didn’t want to waste any opportunity for Munson to be out and about. There’s more to a heffalump than its lump. Yesterday’s outing was with his buddy Scout. As fond of each other as they are, they don’t wrestle and tumble like Munson’s other playmates, so I wasn’t concerned about chafing.

2013-08-10 Munson and Scout
Today’s visit to the park was a bit more of a problem; either some blood or the mere scent of the tumour brought too much attention from unfamiliar dogs, so I kept Munson on his leash when he wasn’t in safe company. This afternoon is for sunshine and play, tomorrow brings what it brings.
King of the hill Gustav & Munson
Michael, Gustav & Munson