Lip Service

damaged lips

Ever since we returned from visiting our daughter in Los Angeles last month I have been having a problem with irritation on my lower lip. Because I wore a wide-brimmed hat and use Z Blok on my lips, I was surprised to have any issues. To be fair, my lips are always sensitive due to prior sun damage. With my history of 19 skin cancers to date, my dermatologist had suggested a couple visits ago that I put a chemotherapy cream on my lips due to the sun damage. I've used the cream once on my forehead with dreadful side effects, so I did not jump on that suggestion. I don't know how you would eat or drink during that treatment. 

Regardless, my lips have gotten worse over the past two weeks, to the point where I was indeed having problems eating and drinking. My usual Carmex didn't help, nor did Vaseline or Aquaphor for lips. Concerned that I might have an underlying infection going on, I called my dermatologist first. She is on vacation, so they suggested I go to my primary care doctor. She also is on vacation, but one of the other physicians could see me last Tuesday.

After asking me a lot of questions and looking at my lip, he feels that this is just a cold sore. While I admit that I do get those on occasion, they are always on my upper lip and I have never had them spread across the entire lip. It also did not start out with the usual tingling sensation I get when a cold sore is coming on. He prescribed Valacyclovir, which is a drug used for cold sores and also shingles, chicken pox, etc. You only get four pills and take two at a time, twelve hours apart. He also said to use Abreva on my lip.

My pharmacy did not even get them in until Wednesday afternoon, so I took the first dose at 5:30 p.m. Sadly I was awake early enough the next morning to take the next two at 5:30 a.m. Unfortunately, this medicine works best if you take it just as you experience the first symptoms, and I was already two weeks into my ordeal.

The good news is that I did not suffer any side effects from the drug. That's good to know for the future when I get another cold sore. But while the lip definitely looks better, it is still not 100%. I have not been going outside during the day at all as I don't want to experience a setback. The doctor said if it didn't get better, and for sure if it got worse, to let them know as it might turn out to be a different kind of infection. I'll probably see how things go over the next few days before I make any decision on the next steps.

Update on Kirby's Cancer

Kirby at the clinic

On Thursday the 22nd we took Kirby to see the oncologist, Dr. S. It was our first visit to Veterinary Specialty Services, a clinic filled with board-certified veterinary specialists. So basically every animal that comes in there is in some sort of a crisis situation. I filled out the paperwork, and we had a short wait before the vet could see us. We found Dr. S. to be a no nonsense type of person, but with a wonderful bedside manner. We discussed Kirby's surgery and the pathology reports, and she suggested doing an ultrasound to see if there were any additional tumors in the belly area. If he was loaded with tumors then followup treatments would not make sense. We agreed that was a good starting point.

They took him in the back, shaved his tummy and did the test. It was questionable whether they would have to put him under for the ultrasound, but in the end a muzzle took care of the issue. We met again with Dr. S., who said that the good news was she did not see any new growths. She also did a needle aspiration on a lump on his leg, and that was just one of the many fatty growths he has on his body. Her recommendation was to do chemotherapy, whether through pill form or IV. That would be up to us. She explained that she hates mast cell cancer because it is so unpredictable, and the fact that he had it in a lymph node was very troublesome. We discussed the pros and cons of the pill versus IV therapy, and honestly my biggest concern at the time was that the pills are very dangerous to humans. You have to wear special gloves when you handle them. It makes sense to me to have them administer the IV in a controlled setting where they know what they are doing. The treatment would involve going in once a week for four weeks, and then every other week for four additional treatments. So three months, essentially. The pills, on the other hand, would be administered every other day for three months. Whichever way we go, Kirby's saliva, urine and feces will be toxic to us and other animals, so we'll need to exercise caution with that. His immune system would be compromised either way, and he would not be allowed around any other animals. Not even at the groomers.  After further discussion, we set up the first IV treatment for the next day, Friday the 23rd.

At 4:00 in the morning on Friday, Jim and I were both wide awake and fretting. I could not stop crying, worrying about whether or not we were making the right decision. We finally decided that if we were both concerned, then we should listen to our guts. We are not impulsive people who make major decisions without looking at all the facts and options, and I think that was part of the problem for us both. I called and cancelled the appointment, and asked for Dr. S. to call me. She returned my call a few hours later and answered all of my questions to the best of her ability. Basically, mast cell cancer cannot be cured. It will come back in Kirby, so it's not an "if" but a "when" situation. What you are hoping to accomplish with chemo is to destroy or disrupt the mast cells that have gone rogue in his system. Unfortunately there are no good statistics to help with the decision. It's not like she can say if you give him chemo, he can live for another 2-3 years. Or if he doesn't get chemo he will die in 3 months.  If he was five instead of going on eleven, that would make the decision easier.

We have since talked to a couple of people that worked in clinics that treated dogs with cancer, and they both said most dogs handle the chemo better than a people do. But all I can think is, if he is one that gets really sick, how in the world do I get his toxic waste out of hardwood floors and tile grout? Would he have to be kept in a kennel? Can we even take him on any walks if his waste is hazardous to other animals?

Lots of questions and no easy answers. At the moment, we are doing nothing other than keeping him on the medications he has been on since surgery - Benadryl twice a day, a Pepcid AC cut in half twice a day, and an Apoquel once a day. The mast cells release too many histamines in the body, causing itching and a chance of damage to the stomach lining, so these drugs help to keep that in check. I am taking him tomorrow for his grooming, which we do every two months and he is due for that. And Jim's parents want to see Kirby while he is still feeling good, so the two of them are going to do a road trip soon. Then we'll have to make an executive decision on which was to go. It is hard because Kirby has no say in this whatsoever. What decision would he make???

Stupid Cancer

Kirby June 2016

When the new vet called me late last week, I did not immediately think the worst. He was asking how Kirby was doing, and truly the dog is doing well. He bounds up and down the stairs, jumps off the couch and bed, and does not seem to be in any pain. He has adjusted to his new normal of wearing the cone of shame. The only thing that has given me a little concern is the fact that his appetite seems to be off. Fortunately he still will take a bite of ham from me, which is great as that is how I disguise the pills he has to take. And he will normally eat the hard boiled egg that he and Jim share each morning, but he has not eaten much of his dry food. I suspect that he may be playing me a little, hoping he can hold out for more ham.

But then Dr. M. mentioned that the pathology report came back, and that is when my heart dropped. I figured it was probably bad news if he was calling me himself. The report stated that Kirby has mast cell cancer. Mast cells are present in all dogs, and they help other cells get to where they need to be to fight an infection. The mast cells release histamine, which causes tissue swelling so the white cells can travel through the tissue to reach the infection. But when a dog has mast cell cancer, the amount of histamines being released can be dangerous. A tumor is formed when the mast cells reproduce out of control. Mast cell tumors are the most common form of skin cancer in dogs. Certain breeds are at increased risk to get this type of cancer, including the Boston terrier, Boxer, English Bulldog, Bullmastiff, Labrador retriever, and other bull breeds. As a cockapoo, Kirby does not fall into any of those, so it is certainly odd that he got this.

Because Dr. M. found a second tumor when operating on Kirby, and that tumor involved a lymph node, Kirby's cancer is considered a Grade II out of III, and he has been given a "guarded" prognosis. I was advised to start him on 25mg of Benadryl twice a day to help combat all the histamines that the cancer is pouring into his system. And removal of the stitches was pushed back one week as this type of tumor has a tendency to come "unzipped". When asked if this means Kirby has to wear the cone for an additional week, the vet said that was up to us. He said we can remove it and see if Kirby leaves the stitches alone. My plan is to keep it on for the full two weeks, and then remove it to see how he does. I don't want to take if off and then have to put it back on.

Dr. M. said at this point he can recommend some veterinarian cancer specialists in St. Louis if we want to go that route. I have been reading up on mast cell cancer, and it sounds as if the first six months following surgery will be crucial. If Kirby doesn't have a recurrence of the cancer in that time period, studies show that 44% of dogs survived over four years following surgery. Since he is already over ten years old, that would be a good run.

Jim & Kirby

Jim was out of town for work when I got the call, so I waited until he got back home to tell him about
Kirby. He wasn't going to be able to do anything from where he was at, and I certainly didn't want him driving home alone with this weighing on him. We both love Kirby, but Jim is number one in Kirby's eyes. They are best buds. Jim and I are on the same page as far as thinking that we'd like to meet with a specialist if only to learn what to expect with this disease. We certainly would not be in favor of doing anything that would cause Kirby unnecessary pain, or make him extremely ill for whatever time he has left with us. But if there is something that can give us more time together without hurting him, we'd like to explore the options.

Skin cancer on both me and my dog - what are the odds?