An x-ray showed that Bandi had a cruciate injury in her left hind leg–basically the equivalent of an ACL tear in the human knee. It would require surgery to repair. Bandi is 10 1/2 years old. The recovery of such a surgery would be about 4 months in length and there would be very little activity on her part during that time. Assuming Bandi, who was extremely healthy, had at least a few more years of life, it seemed that surgery was in order.
However, the veterinarian noticed something unexpected on the x-ray. It appeared that there was a tumor or an enlarged lymph node in her back lumbar region. The vet suggested that before we talked surgery to repair the knee, that we should take Bandi for an ultrasound to determine what it was we were seeing on the x-ray.
So, about a week later Bandi was at Seattle Veterinary Specialists having an ultrasound. Word came back very quickly that the mystery on the x-ray was indeed an extremely enlarged sub lumbar lymph node (henceforth referred to as SL LN). Normally the size of a kidney bean, Bandi’s SL LN was now about 2 inches in diameter.
It was suggested that this was a strong indicator of cancer. In order to determine what kind of cancer, I gave permission for them to do an aspiration biopsy of the LN. They put a needle into the LN and sucked out some of the fluid and/or cells from inside.
Lymphoma seemed like a possibility at this point. The next day, Dr. Jones from Sammamish Highlands Veterinary Hospital (our long-time regular vet) called us in to give us the results. The biopsy showed no cancer cells –only an inflammatory response. GOOD NEWS, we thought.
Dr. Jones seemed convinced that there WAS cancer, but without knowing what kind, there was no clear plan for proper treatment. The other possibility was an infection coming from the injured cruciate and draining into the LN. She suggested an x-ray to see if there was a tumor or mass anywhere else in the chest or abdomen. However, we were short on money, and therefore decided that we’d take a more conservative approach.
With the knowledge that there was inflammatory response going on in the LN indicating possible infection, we decided to try a round of antibiotics for two weeks, then do an x-ray to see if the LN had decreased in size, and to check for other tumors or masses.
That x-ray was done a little more than a month ago from today’s date. It showed NO tumors or masses in the chest or abdomen. YEAH! However, the LN had not decreased in size at all. Another x-ray of the leg showed that the injury in the cruciate was unchanged, but there was increased swelling in the knee joint.
Dr. Jones is still convinced that there is cancer. Doing an exam of Bandi’s anal sac, and colon as much as possible, did not indicate any cancer there. Dr. Jones suggested taking Bandi to an Oncologist to determine where and what type of cancer we’re dealing with.
We’re feeling very frustrated at getting no answers, and therefore no possible treatment for something that can’t be seen or detected, yet a doctor is convinced exists. UGH! Meanwhile, poor Bandi is still in pain from her leg, and it seems to be getting worse. No surgery on the knee will be done until we take care of the LN situation first.
I went back to Seattle Veterinary Specialists with Bandi to see Dr. Brooks. She is not an Oncologist (the Oncologist there comes from Wisconsin only a few days a month), but she is an Internist. I have a very long conversation with her on December 13th, a week ago today. Dr. Brooks echos Dr Jones when she says, “I know there is cancer, but I can’t tell you where or what kind it is. Therefore I can’t offer you any treatments”. But Dr. Brooks suggests more diagnostic tests in the following order based on priority:
- Biopsy the SL LN. This would mean surgery on Bandi to take part of the LN to determine what type of cells are inside.
- Redo the aspiration biopsy as before with the hope that we get different results since the cancer has had more time to grow
- Try a round of steroids, because it may be an auto-immune disease affecting the LN.
With the cost of between $400-$900 for the first or second choice, Dr. Brooks still could not guarantee that the results of either biopsy could give us real clear answers. We may be back to square one after spending a lot of money we didn’t have to begin with. I left her office with Bandi, and still didn’t know what to do.
By Monday, Dr. Brooks was convinced, after talking with Dr Jones, that the cancer was likely coming from Bandi’s injured knee. It is very rare, but cancer can start in the soft tissue of joints. What if the injury to the knee was the result of cancer? This seemed to make sense to me, and I had mentioned this to Dr Jones early on as a possibility, but the idea had been shot down.
Great. So now, I’m ready to amputate the leg to get rid of the cancer altogether. I also know that the LN should probably go to. With the leg and the LN to biopsy, we should have a very clear diagnosis as to the type of cancer we’re dealing with. THEN we could start chemo and Bandi would be happy, out of pain and since no cancer has been found anywhere else, the prognosis would be good.
Not so much, I guess. Yesterday Dr, Brooks tells me that, “Even if we acted as aggressively as you’re suggesting by taking the leg, the LN AND doing the appropriate chemo after the surgery, Bandi would very likely have less than 4 months to live.”
“Why?” I questioned.
Dr. Brooks answered that even though she can’t tell us what type of cancer is in Bandi’s leg, that it is ONLY the bad cancers that go into the LN. Since the LN is SOOOO enlarged, it has likely spread into other areas or organs that we just can’t yet see. Merely taking the leg and the LN would not buy Bandi any more time.
I’m devastated. You can see in the picture above, taken this very day, that Bandi still looks healthy. She doesn’t act sick. She is, however in extreme pain. Today I noticed that her entire left leg now appears swollen. The inflammation around the knee has slowly increased over the last couple weeks—but now the whole leg seems affected. Bandi never puts any weight on that leg, and her limping has definitely worsened in the last day or two.
I left a message early this morning for Dr. Brooks to find out if there is something we can do for this additional edema in the leg. She did not get back to me today.
Our decision will be tough. Bandi really hurts, but she’s still eating. I can’t stand the thought of doing nothing to ease her pain, but I’m not ready yet to let her go.
More updates on Bandi as we move forward. Your prayers are greatly appreciated.