Okay, I had a gajillion questions and stayed up late reading... oops.
So by the time dawn finally rolled around on Friday AM and I was totally a mess, I figured I should just book an appointment with a veterinary oncologist. I called and they could see us the same day, so we went in at 11AM.... and about twelve hours later, Booker came home. Here is what happened in the middle. Sorry, this is long, but I figured if people are reading this thread, they may have a vested interest in the information.
First, I remembered this thread and took some pictures of his bumps. Once I resize the pics, I will post them here. Then, off we went to the vet specialists. We met with a DVM who is working in the oncology department, along with a very nice young DVM doing a residency in the oncology department. They were awesome and went over some of the information I had learned online. We decided to do FNAs (Fine Needle Aspirates) of any bump they found on Booker, and they actually found every little scar I have looked at and poked and felt before, too. Then they looked at these cells. They did this while I went out and emotionally shoved some hot wings and sweet tea in my face. Yes, really.
Anyway, they called and said the only bump with abnormal cells or cells of concern was the one we already knew about, on his left ribcage. Because there did not seem to be any other tumors, I decided not to do the staging. Staging involves having lymph node aspirates taken (to check to see if the cancer has spread; apparently MCTs tend to like to spread to local lymph nodes, BOOOO!), chest x-rays, and ultrasound of the dog's abdomen. These diagnostics are expensive, but totally informative. I actually had Booker's chest x-rayed a couple months ago because it was part of a discounted package at our regular vet, and it was a huge relief then. But in this case, I couldn't justify the cost of these diagnostics, since they recommended we do surgery and could fit him in the very same day, and there is only so much money.
So I drove back to the vet from the wing place to meet with the head of the oncology department about the surgery, she is additionally board certified with the ACVIM. She was the person doing the surgery. She explained that since the lump was on his ribcage and was small, that she felt good about getting clear margins since this part of a dog has some extra skin and isn't a high-use area. Tumors on legs and feet are much harder to get clear margins, since the general idea is to get 3mm on all sides and deep. There really isn't that much flesh on a dog's leg, plus the dog stretches and contracts the leg very often, and in a huge way.
She also wanted to remove a lump in his right armpit. She removed a nearby skin tag along with that bump, in one incision. I asked her to remove a tiny broken incisor that wasn't bothering him but was obviously split; she hadn't removed a tooth since vet school since she is an oncologist but she agreed.
She said that the no-carb cancer diet is specifically for canine lymphoma cells, not MCTs. She said she would definitely recommend it if he had lymphoma but otherwise his regular diet (already grain-free but with potato in it) will be fine to continue unless I wanted to make a change, which I would like to but need to figure out expenses given this newest one. I asked her about supplements and showed her Booker's medley of pills; she said that none were harmful, that there has been some feedback that certain supplements do seem to help dogs with cancer, so that I should continue his antioxidant combo pill, the SAMe, and milk thistle unless he reacts poorly to them, and that giving curcumin was OK to try (many people swear by it) but to be careful, since it can be toxic in high doses. If he develops another bump or if we couldn't get clean margins this time, I will definitely be starting curcumin; individuals have reported it is very helpful with a wide variety of cancers.
She also addressed the idea that surgery equals more bumps. For Booker, who had one new ungraded MCT, it is important to remove it and grade it. If the "fingers" are all removed (ie, clear margins) it can be curative to remove it, especially if a low grade with low mitotic index. I would not know the grade or index if I left it alone. Also, if it comes back as, say, a Grade 3, then perhaps it is time to do the aforementioned staging to see if he is a candidate for chemotherapy or radiation. Without removing it, we don't have the information, and the tumor may possibly be allowed to metastisize to his lymph nodes. Battling lymphoma is much worse IMO than removing an MCT. He was injected with antihistamines, in case despite careful handling and wide margins, the tumor granulated during surgery, as well as injectable Pepcid, since MCTs tend to cause nausea. She also has him on oral antihistamines.
I paid a deposit that was more than the amount I put down on my car, (gulp!) and left to go eat some more and watch a movie. Thank goodness for FransterDoo and HankNibbler, they live close by and were off work on Friday afternoon to watch me shovel a gyro down and make faces at Captain America and generally assist with distraction. The oncologist called me as soon as she left the OR when B was still under, and told me the surgery went well, and a couple hours later I was able to pick him up.
I then paid a couple more hundred bucks on top of the deposit (thank goodness for CareCredit; it means that I won't have to be totally stressed and can take up to 12 months to pay this off, rather than having to front the whole amount at once, plus hopefully PetPlan insurance will help with the costs) and was standing in the waiting room and FINALLY out he came. I started laughing hysterically, partially from relief and joy, and partially because he had the most ridiculously oversized and hideously printed inflatable cone I have EVER SEEN. Of course I will post a picture as soon as I can here.
So. He is on twice-daily Pepcid, on twice-daily Benedryl, also Metacam and Tramadol for pain control, and continuing the cephalexin he had started earlier in the week. They were very serious in their search for bumps, and with the two areas of removal, well, he is shaved from mid-ribcage across his belly up to the other side mid-ribcage and down to his groin. He also has 30-something metal sutures and huge incisions. And to me, he is just as beautiful a creature as ever. I was so, so happy to see his sweet face.
I am hoping for the best for the biopsy reports. I am also anxious about his bloodwork; he had a full panel done since the last time he had some slightly elevated liver values. Since then I started him on the SAMe and milk thistle; hopefully his levels are holding steady or have declined. For now I am just very glad to be done with this week, to have answers on the way, to have a great vet specialist resource nearby and the ability to pay for this (seriously, I have had my CareCredit card for years and never used it and this is exactly the right sort of situation, plus I am so glad that Siberian on here finally convinced me to get pet insurance a year or two ago!) and most of all, to have Booker home with me. I love that friggin brown dog.