Dogs have internal medicine vets?

Josie and I arrived early on January 6th for her appointment with internal medicine. They welcomed us by name, making us feel special. I met Paige, the vet tech who would be assisting us all day. She sat on the floor, to be down at Josie’s level, while she and I talked about Josie’s history. Josie liked that. She’s always eager for some love and attention.

Shortly after, the vet came in and we discussed all the possibilities. The first step would be x-rays to make sure if it was cancer, it hasn’t spread. The second step would be an MRI. Although it seems extreme, the third step would be determined based on what she saw. She spent a lot of time explaining what would happen if the MRI indicated a fungal infection versus a mass. She also explained she would be specifically looking at the cribiform plate – that thin bone that separates the nasal cavity from the brain to see if it was compromised. After explaining all the options, she left to go write up the treatment plan, with a high-low estimate on cost before proceeding.

A short time later, Paige returned with the treatment plan, and took the time to explain some of the variables. She focused on what she would be in charge of – the anesthesia and monitoring Josie all day. Josie would be her only priority that day. I felt very encouraged by that.

I signed a bunch of papers and left my dog in the care of people I had just met. Instead of going stir crazy while I waited, I went and visited with a friend. It was good catching up. When I returned, the receptionist informed me the vet was just about to call me. She ushered me back to a room and I waited for someone to come and talk to me. I didn’t wait long. The vet came in and informed me the MRI showed a mass in Josie’s nasal passage. She pulled up the images and navigated them like a pro.

The first group of images she showed me was essentially a cross section of her snout. Imagine looking directly at the nose and take cross section after cross section, work your way towards the back of her head. The right and left side should be symmetrical. It was easy to see they weren’t. You could clearly see a mass.  And even I could see it had destroyed all the bones in her nasal passage (called turbinates). Looking at the images, I could understand why there was no air flow – it was blocked.

Cross section of Josie's snout. The bottom is the bottom of her mouth and tongue. Her nose is on top.

Cross section of Josie’s snout. The bottom is the bottom of her mouth and tongue. Her nose is on top.

The next image that stood out was her head. Once again, the right side is completely filled with a mass and with inflammation. Although I couldn’t see it in any of the images, the vet saw where the tumor was affecting Josie’s right eye. If it had not yet, it will at some point.

IMG_1167

Josie’s head. The two round things, one of either side – those are her eyes.

She proceeded to inform me the mass had broken through the cribiform plate. And there was cloudiness in the brain. She wasn’t sure what the cloudiness was, it could just be inflammation, but it shouldn’t be there. The good news is that I have not noticed any change in Josie’s behavior. But I need to watch for it.

Josie's brain. THere should be a black line separating it from all the white stuff on the left - you can see where it is broken.

Josie’s brain. The cloudiness on the left shouldn’t be there. And that is right where the cribiform plate is broken.

I tried to focus on what I was being told and shown. But every now and then, in my head, I repeated “She has a tumor. My dog has a tumor. I now know.” I felt myself starting to loose it, but forced myself to hold it together.

I still didn’t have all the answers. I still needed to wait for the biopsy results. Until then, they won’t say she has cancer. But to prepare for it, the vet told me to ween Josie off the prednisone. Apparently, prednisone works well for certain types of cancer, but not others. For those, NSAIDs work. And prednisone needed to be out of her system before starting any NSAIDs.

After she was done, I still had to wait for Josie to finish recovering from the anesthesia. It wasn’t long before Paige came out to tell me Josie was awake, alert, and responding. She had stayed with her until she was to that point. Josie still had some recovering to do, but she was doing good. It was comforting knowing someone had stayed with her while she went through that process.

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Josie, recovering from a long day, has one goal – sniff out and eat food.

It was about another hour or so until Josie was ready to leave. Paige brought her out and sat down with me to go over her discharge papers. Although sleepy, Josie was in excellent shape. There was some blood from her nose, but that was to be expected over the next day.

As we left, Josie had one mission – to sniff out food. She hadn’t gotten breakfast, and Josie never misses a meal. I put her in the back seat of the truck, completely forgetting about the stale fries I left in a bag in the front seat. In the amount of time it took me to get in the driver’s seat, Josie had found them. Yup, she was feeling fine, unaware of the tragic news I had just received.

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