Like I talked about on Day 16, I’ve been awaiting on the results of the additional prognostic and proliferation tests and today I finally got the path report.  
I took a pic of it with the ole trusty I-Phone and if you can’t read the image, basically it’s damn good news 
My decision is no chemo as I feel the potential downside exceeds any preventative or prophylactic benefit.  
Delivered on the eve of my planned departure, I can leave tomorrow to head back up to New England in good conscience and positive spirits.  
…Don’t think much.’  Ted Williams

‘True.  But that’s precisely when you should be doing your research!’  YBD

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I feel quite confident now that I have a firm understanding of Mast Cell Tumors (MCT) and I wanted to share some of that with you.  

First off, I searched extensively for the most thorough though lucid account of this type of cancer from a microbiological and immunological perspective.  And that follows:

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A normal mast cell is part of our immunologic defense systems against invading organisms. Mast cells are meant to participate in the war against parasites (as opposed to the war against bacterial or viral invaders). They are bound within tissues that interface with the external world such as the skin, respiratory or intestinal tract. They do not circulate through the body.
The mast cell possesses within itself granules of especially inflammatory biochemicals meant for use against invading parasites. (Think of these as small bombs that can be released). The mast cell has binding sites on its surface for a special type of antibody called IgE. IgE is produced in response to exposure to antigens typical of parasites (i.e., worm skin proteins, or similarly shaped proteins). IgE antibodies, which are shaped like tiny “Y”‘s, find their way to a tissue mast cell and perch there. With enough exposure to the antigen in question, the mast cell may be covered with Y- shaped IgE antibodies like the fluff of a dandelion. The mast cell is said, at this point, to be sensitized.
As said, the IgE antibodies are Y-shaped. Their foot is planted in the mast cell while their arms lift up hoping to capture the antigen for which they were individually designed. When the antigen comes by and is grasped by the IgE antibodies, this should indicate that a parasite is near and the mast cell, like a land mine, degranulates releasing its toxic biochemical weapons. These chemicals are harmful to the parasite plus serve as signals to other immune cells that a battle is in progress and for them to come and join in.
At least this is what is supposed to happen.
A mast cell, coated with IgE antibodies, is exposed to pollen and degranulates, releasing its biochemical weapons of destruction.
The problem is that we live in a clean world without a lot of parasites. What unfortunately tends to happen is that the IgE/mast cell system is stimulated with other antigens that are of similar shape or size as parasitic antigens. These “next best” antigens are usually pollen proteins and the result is an allergy. Instead of killing an invading parasite, the mast cell biochemicals produce local redness, itch, swelling, and other symptoms we associate with allergic reactions.
As if the mast cell isn’t enough of a troublemaker in this regard, the mast cell can form a tumor made of many mast cells. When this happens, the cells of the tumor are unstable. This means they release their toxic granules with simple contact or even at random creating allergic symptoms that do not correlate with exposure to any particular antigen.

There’s additional info on diagnosis, grading, treatment etc. here.

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To Chemo or Not to Chemo

Now that we have received the initial pathology report as a Grade II with a low mitotic index, some of the oncologists with which I consulted have recommended a ‘Wait and See’ approach with quarterly re-checks since we had wide surgical margins.  

However, since some Grade II  tumors don’t always behave predictably, others suggested two additional tests. The first is the mast cell tumor panel that consists of two proliferation markers – PCNA and Ki67.  It has been demonstrated that dogs that have more rapid rate of cell proliferation are more likely to have an aggressive form of MCT and chemotherapy might be warranted.  

The second is know as the c-kit mutation.  It’s been shown that about half of grade II MCTs have mutations in the proto-oncogene, c-kit, and were more likely to recur after surgery and metastasize.  

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Mac and Me

Hudson’s tumor, affectionately known now as Mac, has been sent out and we’re awaiting the results of both tests. By Monday, hopefully, as that effects the decision I make about his treatment plan.  For now, more waiting.  And waiting. But having completed my research, I guess I can go back to not thinking much. 
I’ve compiled in excess of over fifty pages of research, links, etc. that I’d be happy to share upon request.  Email me at 2dogs2000miles@gmail.com  Some of the information is repetitious but for me, that’s just a way I make certain I retain it.  


Before I head off for a week for my fast I wanted to share my speech from the Chicago walk with you.  I had intended to post it when we arrived in Memphis but that Monday kinda threw a monkey wrench into my plans with Hudson’s diagnosis.  
But here it is.  
I wrote on Facebook awhile back as response I made to one of our supporters who said, ‘You sure have started a great organization.’  
‘I didn’t found an organization’, I replied. ‘I started a family.’  
And at every Puppy Up! walk we’ve been to these past four years that’s precisely what I’ve felt.  A simple pride not only for all of the people a part of it but how 2 Million Dogs has effected their lives, too, and the pleasure it gives me when a city organizer, or PUPP as Ginger calls them, puts on a successful walk.  
Two years ago back in San Antonio, one of the participants in the walk there said, ‘I’ve been to a lot of these dog events but none of them had an energy like this.’  Well said.  
As we continue to grow this great grass roots movement of ours, my Chicago speech was about the meaning of ‘Puppy Up!’ since I’m the knucklehead who came up with that rally cry prior to my Austin-to-Boston walk back in 2008.  And I still get questions about it.    
I hope the speech finds you well on this special day and forgive the Ray Charles like swaying.  I was freezing my bollocks off.    
Happy Thanksgiving.  Now Puppy Up and Chow Down!
Though initial path results were favorable, we’re going to do some additional analysis just to be sure, thanks to the advice of our good friends.  
Since the tumor is traveling about now trying to find out who and what it is, it seems a decent thing to give it a name other than, ‘Haired skin and subcutis’.  
BTW – Toomey and Poly are taken.  
There’s a nautical term I’m thinking about tonight from my days of sailing.  It’s the time between high and low tides, the ebb and the flow.  When the seas don’t pull or push yet sit quiet for a second or two.   

It’s the flux between the coming and going of gravitational forces that’s almost entirely theoretic and a scientific impossibility since nature knows no true homeostasis and if it did, only fleetingly so.  

But It’s the question we wake up to every morning but don’t know how to go to sleep with every night. 

We all search for the Slack Tides of our existence.

Buddy, Murphy both lost to cancer.  Hudson is the last remaining of that sacred cabal we formed back in 2011.  

I suppose that’s why I’m taking this so hard.  Or one of the reasons.  As Fiorello LaGuardia, the famous chubby bad hair mayor of New York City (way before the dictatorship of Uncle Mike) once said that if a sparrow dies in Central Park he felt responsible. 

I do, too.  

We got the pathology report back today: Mast Cell Grade II. Dr. B’s a bad ass diagnostician so it was as we expected.  Now I have to determine how to proceed.  

As I previously wrote, with wide surgical margins Hudsito’s prognosis is favorable. Here’s a pretty good article about grading MC tumors, treatment options, etc. from Washington State.

Had Hudson’s tumor been grade I, my decision would’ve wait and see for recurrence.  I’m not so sure now so I’ll be conferring with a handful of experts before I determine what, if any, the treatment plan is.  
I’ve made it through the worst of my existential crisis in large part due to the outpouring of support.  For that I am thankful.   
Hudson is convalescing well though he’s still hopped up on Tramadol and feeling no pain.  Hopefully we’ll get the results back from the lab Friday so we can know what we’re up against. Everything is on hold til then.  As most of you know, the waiting is excruciating especially for my personality type.  

Dr. Blackburn feels like he got clean margins which is good news and from my preliminary research even if it’s a grade 2, the prognosis is pretty promising. There’s a lot of hope to hold on here.  
I reintroduced Indiana to Hudson for the first time today and he played the dutiful little brother role perfectly.  Except when he tried to pull Hudson’s cone off which was cute.