The 29th rolls around and we head in for our appointment.

Oskar practically drags me from the car to the vet’s office. He knows the routine and heads straight over to the scale to get weighed. 34.4kgs… a bit on the chunkier side for him, but nothing a few long walks wouldn’t burn off. Ida was running a bit behind so Oskar had to watch as the other vets came out to get patients other than him. I don’t think he’s up on Copernicus’s theory that the entire universe doesn’t revolve around him. He did manage to get all of vets to pet him before they could take their real patient back to a room.

Ida arrives and calls Oskar back. BEST DAY EVER! Oskar follows her around the room whilst she and I discuss the history of the mysterious white spot. He leans on her a few times trying to get a bit of extra loves. We decide that it would be easiest if we can get him up on the exam table and take down the Covid sneeze guard meant to separate the pet owner from the vet. Oskar’s parkour training is always helpful in these situations. I give him the “Two paws” command and he puts his front two paws on the top of the table and then helps me lift him up to the table by giving a little bit of a jump.

Assessment

Ida lets him sniff her equipment before she asks him to sit still so she can look in his eye. She immediately saw what we had been missing in the photos. There is a tumour growing on the inside corner of his eye. The opposite side than the side we had been photographing. The bulk of the tumour is on the side of his eye but it has started to grow into his iris. Oskar has a very pronounced and pigmented third eyelid. Unless you can get him to look towards his outside corner and you have a very bright light, the tumour wasn’t visible. And the tumour is a dark brown, practically the same colour as his iris. The only real difference is that the tumour is a solid colour and is on the surface of the eye. There isn’t the clear water depth that you see in front of the iris or the slight variation in colours. The more she looked at the tumour, the more serious her tone and demeanour became.

The appointment lasted an hour and a half so a lot of it has blurred together in my memory at this point.  She took pressure readings of his eye to see if the tumour was building pressure inside the eye. Whilst there wasn’t a huge difference between the pressure readings of his eyes, the eye with the tumour has already started to build more pressure than the non-tumour eye. She checked his tear production to make sure that hasn’t been affected and both eyes have great tear production. (A reading of 18 is considered good and he scored 22 on both eyes) She took some reflective images of his pupils and the eye with the tumour is already slightly less reflective. That indicates that the pupil is starting to be affected by the tumour as well.

Outcome

We let Oskar off the table to discuss what she is seeing. She estimates that 30% of the area of Oskar’s eye is now just tumour. She starts using the word melanoma. There are basically three possible scenarios we need to think about.

There is a slight buzzing in my head during this conversation, but I try desperately to absorb everything she is saying. I’m going to have to break my husband’s heart by giving him the news and I need to remember everything so I can answer his questions. I feel sick to my stomach. This can’t be happening. He’s only 3 and a half years old! But it is happening. And we must make decisions on Oskar’s behalf so snap out of it and be here, right now.

Possible scenarios

The first scenario that this is an isolated tumour that is benign. In that case, the tumour will continue to grow, slowly eating away at his eye, but is not life threatening. However, the larger the tumour becomes, the higher the risk of complication during surgery. The most common complication with the type of surgery he would require is bleeding. As the tumour is growing right at the blood supply to the eye, waiting to see how quickly the tumour grows doesn’t improve his prognosis. This type of tumour can become extremely painful for a dog if left untreated.

The second scenario is that the tumour is malignant but is the first site of the cancer. Eye cancers tend to not spread to other parts of the body as the eye is a pretty contained organ. But given enough time left untreated, it would eventually spread. If this is the scenario we are dealing with, waiting to remove the tumour increases the possibility that the cancer will spread in additional to the risks discussed in the first scenario. We need to know if the cancer has already spread so we can develop a plan to make sure Oskar is a cancer survivor.

The third scenario is definitely the worst-case scenario.   In this scenario, the tumour is malignant but is a secondary tumour meaning the cancer originated somewhere else in his body and has spread to his eye. If this is the case, this type of cancer tends to be very aggressive and does not respond to chemotherapy. If Oskar is going to survive this, we need as much information as quickly as possible so we can start him on the correct protocol. We’ve already lost 3 months and we have no idea how long the tumour has been growing. Statistically, this is the least likely scenario given his age and overall health. But it’s still a possibility and pretending it isn’t doesn’t improve anything.

Next steps

The tumour must come out.

The tumour will continue to grow and it will affect Oskar’s quality of life regardless of which scenario we are looking at. There are only two variables we can look at; how quickly we should book the surgery and if we want to do a full body CT scan to look for other indicators of cancer. But the tumour removal isn’t going to be easy in this case.

For the tumour removal, there are normally a couple options. First is laser surgery. That burns up the tumour entirely and is wonderful at preventing unwanted bleeding. However, given the size and location of Oskar’s tumour, laser is off the table. It wouldn’t leave him enough health tissue to have a functional eye. And if you burn up the tumour, you can’t test it for cancer. So no laser.

The next option is just old school surgical removal. But we again have the problem of not being able to get ALL of the tumour and having enough healthy tissue to maintain a functional eye. In theory, transplanted tissue could help replace the area removed so he could keep his eye. But the consultant didn’t think the chances of a successful transplant was high in this case due to the size/location of the tumour.

uh·nyoo·klee·ay·shn

So we can’t laser the tumour and we can’t surgically remove just the tumour and be left with a healthy eye. That leaves only one option: Enucleation.

I had never seen that word before. I can’t get comfortable saying that word.

Our beautiful, loving, trusting, innocent dog, who depends on us for absolutely everything, is going to lose his eye. Our dog that loves to swim and chase bunnies. Who immediately knows if a football has been left as an offering to a brambles bush and will dive in to retrieve it. Who wants nothing more in life than to spend his evenings curled up on the sofa with one or both of us, being cradled like a baby. We couldn’t protect him from a mass of cells unknowingly growing in his eye. And now he’s going to be a one-eyed dog.

But, it’s going to be okay.