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Greetings,

I will truncate the first part of this story: Our 14.5 year old aussie, Britney, became a very picky eater about 6 months ago, and then she had a vestibular event about a month ago, and would barely eat anything at all. After the vertigo-like vestibular symptoms went away, she still wouldn't eat and was still dopey and wobbly. Across this time frame, we had blood-work and urinalysis done, and she was usually okay for a dog her age, but the vet did note finally the beginnings of kidney disease, so we have been doing sub-cutaneous fluids for a couple weeks, plus mirtazapiine as an appetite stimulant.

Since she STILL wouldn't eat, we went back to the vet and an ultrasound revealed masses in her liver, and kidneys, and I think elsewhere. The vet said she was 99% sure at least some of these were mast cell tumors. My wife and I thought about doing a biopsy to confirm, but ultimately decided against that because we also decided to forego chemo. We felt chemo wouldn't appreciably extend Britney's life too much at this point, but even if it did give her a few extra months (which was kind of the vet's estimate), those would be horribly unpleasant months for her.

She is now on prednisone, and Benadryl. Still not eating, but at least drinking regularly.

When my wife and I made the decision to forego chemo, it was over the phone with the vet, and we hadn't fully considered the chemo option. The vet certainly did not push for it. That was a couple days ago, and we haven't changed our mind, but I wonder if anyone in this forum thinks we should pursue the chemo path? It would of course be expensive, but that would not really be the deciding factor for us. The closest dog oncologist is an hour away, which complicates things. More importantly, however, Britney is 14.5, has other health issues (kidneys starting to go), seems to have a lot of tumors, would presumably be sick from the chemo, and the chemo may not extend her life much in the big picture. For the record, she is in no pain now that we can detect. Just dopey/wobbly.

Two other questions: I don't think her white blood count was high. Wouldn't the presence of mast cell tumors be somehow evident in the blood panel? Also, I presume Britney won't do us a favor and peacefully 'die in her sleep,' but we will have to wait until she is so debilitated that she can't stand (or some other subjective criteria is met), and then have her euthanized, right? Something like that happened with our last aussie.

Thanks for any advice/opinions,

Chuck
 

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There just is no right or wrong answer to your dilemma. Certainly understand your mixed feelings. I think I would be looking for quality of life, doing everything possible to keep her around, but comfortable and happy. When that is no longer possible, you reach that fork with more difficult decisions to make. I believe with a 14.5 year old dog with the health issues she has, I would probably not want to subject her to the chemo either, unless the Vet gave her some favorable odds for a long lasting remission. I guess maybe have a one on one with your Vet and have him lay out what is possible and what is wishful thinking. Whatever you decide, wish you the best.
 

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Sorry to read about Britney's continuing health problems :(

My APBT Haley had a mast cell tumor, but it was on her thigh, not internal. It had been present for about a year before we had it removed because it looked pretty innocuous, but I became concerned when I noticed it started to vary in size, and sometimes seemed to coincide with flare ups in her allergies (chronic, but worse at some times than others). It was classified at the time as a "low grade II", with a low mitotic index, so cells not rapidly multiplying. Unfortunately, it didn't have great margins (clean but tiny, with MCTs you want 2 to 3 cm margins, and some of hers were less than 1 cm!), which the biopsy report indicated might warrant treating it more aggressively, either through chemo or more radical surgery to obtain larger margins. I hemmed and hawed, and ended up doing neither because I was worried about side effects, she had other health issues that made her a less than ideal chemo candidate, plus it was a lot of money for no guarantee of success; and she only had 3 legs, so I was reluctant to potentially compromise the muscle mass one one of her legs by more invasive surgery. She ended up dying of an unrelated type of cancer (lymphoma) 6 years later, with no other MCTs that we knew of. Her bloodwork was fine at the time she had the MCT, and actually I don't think she had any significant abnormalities even when she had lymphoma, bloodwork won't necessarily show abnormalities in a dog with cancer.

I have known a couple dogs who had grade III MCTs, or multiple MCTs, and they have not done well long term, despite one having chemo. For what it's worth, the chemo didn't make him sick, but it didn't significantly extend his lifespan, either. In my limited experience, grade of the tumor is a big factor in how a dog does, as well as whether treatment options will help to extend the dog's life, so it can be helpful information to use in deciding how (or if) to treat. I don't know much of anything about internal MCTs, as it seems the skin variant is most common.

That said, if you even think you might want to pursue biopsying, chemo, etc you probably want to find out what you are dealing with as soon as possible. Might be worth a consult with a specialist, just to see what your options are, then you can decide from there. I know there have been some advances in treatment of MCTs since my dog had hers (in '07), Palladia is a newer drug which has shown some promise in treating MCTs, and from what I have heard, it has fewer side effects than some of the more traditional chemo drugs, and I'm fairly certain there are other newer drugs as well. With her current condition and other health issues, she may not be a good candidate for some chemo (and other) drugs, so that may limit your options.

You might ask your vet about putting her on an antacid if she's not on one already, as MCTs can cause GI effects and it might help with her lack of appetite.

Regarding euthanasia, you don't necessarily have to wait for some sort of landmark like not being able to walk to put her down. If her general quality of life is poor, and not likely to improve, that wouldn't be an inappropriate reason. If she's not eating at all, or not eating enough to meet her caloric needs, that could also be a valid reason. I'm sure there are others who might be able to give you more specific things to watch for, and I know there are some websites that make it easier to sort of objectively "weigh" your dog's quality of life. It's never an easy choice, and just about the only pitfall of pet ownership :(

Here are a couple links regarding MCTs:
http://www.vet.upenn.edu/docs/default-source/ryan/oncology-handouts/final-canine-mct.pdf?sfvrsn=4

Mast Cell Cancer

http://www.acvim.org/Portals/0/PDF/Animal Owner Fact Sheets/Oncology/Mast Cell Tumors.pdf

https://www.csuanimalcancercenter.org/assets/files/Mast_Cell_Tumor.pdf
 

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no idea how your vet determined the internal masses were mast cell tumors without a biopsy... just eenie meanie? Must be part of the story your are not relating to us. Tumors are just tumors until you sample them... no way I know of guessing on their make up by Ultrasound appearance alone. Some tumors are extremely responsive to chemo and I would recommend at least trying to find out what they are.... a LOT less guessing and wondering 'what if' that way. Even a simple cytology sample can often diagnose many internal tumors and is far less invasive that a tissue biopsy is.

Mast cell tumors cannot usually be diagnosed, or even suspected by blood work unless your sample is full of mast cells (very rare finding if it does show mast cells/basophils). Actually most tumors cannot be identified on blood work (with perhaps a few rare exceptions). Elevated white blood cell counts are more indicative of infection or inflammation, not necessarily anything to do with the presence of tumors. A biopsy may also help you make a decision about euthanasia... i certainly would NOT recommend waiting until your pet is actually dying to euthanize as that would likely mean unnecessary suffering would have occurred by that point.

Either way, hope they respond to the prednisolone and your pet improves.
 
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