August 6th: Erde's situation (revised 10pm 8/6)

Edre's vet called me today with the results of the biopisy.  She has a  locally-aggressive acanthomatous ameloblastoma epulis (AA), which is exactly what I was suspecting after doing my research. If a gingival tumor is benign, this is the worst kind, although most oral cancers are this type. AA is now  classified as an "ameloblastoma"; however, controversies exist as to whether this tumour should be classified as a basal cell carcinoma, epulis or an odontal origin tumour."

There were five different general results I could have gotten from the biopsy report, in order of low concern to high concern.

1- Non-neoplastic lesion; Dentigerous cyst; benign cheek chewers granuloma.

2- benign least aggressive epulis: fibromatous or ossifying

3- benign locally-aggressive acanthomatous ameloblastoma epulis 

4- malignant locally aggressive squamous cell carcinoma tumor or fibrosarcoma tumor

5- malignant metastasizing melanoma tumor or osteoscarcoma tumor 

Since last Thursday, I have been trying to educate myself so that I could understand where I go from here with each on of them, depending upon the results of Erde’s biopsy report. I now only have one to study further, the benign locally aggressive acanthomatous ameloblastoma epulis . This was what Erde’s biopsy found. That is not a good result, but it is not the worst it could have been.

What little I know about AA is that it does not metastasize but is locally aggressive, invades the bone in the surrounding area, will grow back, and can develop into a malignancy and metastasize. Radical surgery, removal of several teeth, part of the upper jaw and palate is the most curative solution; radiation therapy is also recommended as an option or as a supplement, although this can cause the tumor to transform into a cancer. Chemotherapy is generally reported as not very helpful, although one study I read reported good results with intralesional bleomycin.

I have  appointments set up with oral surgeons and oncologists for the next seven days. This, of course, is my highest priority at this point.  But as far as the trip to Alaska goes, I have several choices:

(1) Do nothing now, take the trip, and wait and see what happens over the next several months.
(2) Go ahead with either the radical surgery and/or radiation now.  In any of these cases, the trip is cancelled.

I have no idea at this time what my decision will be. It depends on what I learn over the next few days. But one of the thoughts that comes to mind right away is that I was down this same road last year with Leben, I took the surgery route and we both lost big time.  I have to keep in mind that this may very well be the last chance I get to take a road trip with these dogs.  I also have to keep in mind that Erde is 12 and will probably not be here in two years for other reasons.  I also have to keep in mind that surgery and radiation might very well work after a delay of two months.  I also have to ask myself how I want Erde to spend the last years of her life: in and out of hospitals or having fun?  These risks associated with these options are what I have to explore over the next five days. But I cannot rely only on the advice I get from the vets because they have been wrong in the past.  Three years ago, Leben's vet told me that he had to wear a brace on his leg for the rest of his life to prevent a hyper-extended carpus; well, he hasn't worn it in more than 20 months with none of the consequences the brace was supposed to prevent.  Last year, I was advised by Leben's  vet to go ahead with surgery to arrest any further decline of his spinal compressions; well, the operation paralyzed Leben. I have to understand that vets are just like anyone else: they are in business to promote what they do.  

Over the last few months, years really, I have had to deal with numerous obstacles to prepare for this trip. Every one of them was solved to my satisfaction. I cannot think of a more serious problem than what I am faced with now with Erde. That dog has been such a sweetheart, so I intend to do everything I can to make sure that her problem is solved too.