Pet Patients It’s brain tumor time again! Sophie Sue’s saga, redux

Yep. For those of you following the saga of my ten year-old French Bulldog and her brain tumor the news is in: Sophie Sue is officially 100% done with her radiation treatments.

The upshot? It’s no stretch to say that six weeks and 18 radiation sessions later Sophie Sue is a new dog.

From an emaciated dog too weak to stand upright or swallow her home-cooked meals to a robust, rowdy Frenchie plumped to perfection after being plied with all manner of juicy tidbits handed her by anyone who knows her.

For your reading pleasure, here’s a recap of Sophie’s recent past:

Sophie rang in the new year inauspiciously with a debilitatingly painful neck. Surgery for two “slipped” intervertebral discs proved a resounding success; Soph was in top form by February.

Four months later, Sophie collapsed after a long day of uneventful slumber. Her low blood sugar and relatively high insulin levels after this and other, increasingly frequent events like it pointed to an insulinoma, an insulin-secreting tumor whose diagnosis is notoriously elusive.

She began her quest for healing with a well-intentioned, if ultimately misguided attempt to solve the forecast concern—so much for the collective wisdom of veterinary medicine.

Three veterinary specialists’ recommendation suggested we either CT her or, preferably, considering the ultrasound study suggested the possibility of a nodule on her pancreas (not to mention the expense of the CT scan), perform an exploratory to visually inspect and biopsy her innards.

In the end the abdominal surgery yielded little but a collection of negative findings, suggesting the evolving condition might well be neurological (as was increasingly obvious the case).

By this time things were deteriorating severely with Sophie’s lethargy, chronic wobbliness and frequent episodes of stiff-limbed collapse leading her veterinary team to conclude that an MRI (better than a CT for identifying brain and spinal cord tumors) was indeed indispensable.

A horrible, prednisone-infused weekend later (during which time I frequently assumed she would die in my arms), she received her MRI and the brains tumor was

identified.

So now for the decision: How to kill the cluster of cells causing her decline…

Veterinary neurologists and oncologists were prevailed upon, MRI images were sent out by email and favors were called in. Despite the prevalence of differing opinions (so you know, 10 docs = 20 opinions), one statement was a constant: “Don’t talk her out of radiation.”

Sophie’s eighteen doses of radiation was the sticking point. Wasn’t there any option that wouldn’t require me to stress her (and me) out with eighteen anesthetic procedures (in six weeks!) and thirty-six trips to a hospital two hours away?—not to mention the enormous expense of it all…

Hmmm…maybe not. A bird in the hand, you know?

Up first, the CT:

As if an MRI wasn’t enough (because it wasn’t), a CT scan was required to determine the tumor’s geographic boundaries. A linear accelerator, the tool that produces the radiation, was then synchronized to the tune of the CT’s landmarks for precise irradiation of the tumor at its exact location.

And then the seemingly endless visits:

Three mornings a week Sophie was driven to Cooper City Animal Medical Center to the Veterinary Specialists of South Florida where the linear accelerator lives. She was given an inhalant drug (isofluorane) to induce anesthesia via mask, thereby skipping the one step Sophie abhors: IV catheter placement.

Eighteen times.

The first couple of visits she resisted in her stoic way (by shivering at drop-off). The next sixteen? Nada. Inexplicably, Soph seemed to enjoy her visits almost as much as the staff clearly enjoyed having her there.

On her last drop-off, armed with a gigantico Tupperware container full of assorted home baked goodies, I left her off and superstitiously crossed my fingers. Not that visit eighteen should be any different than any other, but Murphy’s Law being more the rule than the exception where another vet’s pet is the patient, I felt justified in stressing—not that Sophie seemed to mind…

And now I’ve got a healthy dog—well, sort of. The brain tumor’s still there. It’s still lurking somewhere in her brainstem in a broken, battered sort of way. It’s going to come back, no matter what we do. But Sophie’s beaten the odds—if only by virtue of having belonged to someone with the means to give the tumor a good fight.

Ten years ago my seven year-old boxer, Bruno, suffered the same sort of condition—presumably, that is. Back then there was far less attention paid to the survival of pets post brain tumor diagnosis.

Just one decade.

Sure, it’s expensive—prohibitively so for most at about $12,000 (retail) from start to finish (including the initial misdiagnosis and surgery)—but it’s absolutely doable. And the prognosis is generally good. 50% of these patients live a year beyond their radiation treatments (that’s more than a tenth of their lives, on average). The other 50% don’t respond so well.

I can only hope Sophie will again beat the odds set before her. For now, she’s back to her happy old self. All I’ve got to do at present is curb the calories.

Shouldn’t be too hard. For starters, all that “poor Sophie, have another guava pastry” behavior will have to cease. It sure won’t be pleasant, whittling her waistline down to size, but if I’ve learned one thing since January it’s that there are far worse battles to fight.

August 26th, 2008

Add Comment59 Comments

I'm surprised they used Iso rather than Sevo with a dog undergoing so many anesthetic procedures. Iso IS cheaper, but the induction and recovery are so much slower and (potentially) more stressful. Regardless, I am so glad she's doing well!

lindabcs August 26th, 2008 02:14:00 PM

Yay Sophie! and Yay Dr. Patty! I'm so glad she's feeling so much better. Did she have any skin burns from the radiation? Any side effects you noticed?

Barb August 26th, 2008 02:23:00 PM

I'm so thankful she is on the mend....excellent job Dr. Patty! :)

Creature of Habit August 26th, 2008 02:45:00 PM

No question, all of us were sitting on pins, along with you, with guarded hopes. Yay, Sophie Sue, you tough little Frenchie!! I vote for special treats anyways! She is one special gal and so are you, Dr. Khuly

Barbara A. Albright/New Hampshire August 26th, 2008 03:26:00 PM

Wishing Sophie a long & trouble free life ahead! Way to go, girl!

Ellie August 26th, 2008 03:30:00 PM

I have nothing but the warmest wishes for you and Sophie, however I do have a comment. Once again, I understand the immeasurable love you have for Sophie, my pets are my life, but.... I have recently lived through this with my mother, who could obviously articulate the pain and suffering that go hand in hand with radiation and chemo treatments. My mother passed away, but only after "living" through 3 months of torture. Literally, torture. My question to you is, with all the respect in the world, would Sophie have wanted to endure all these treatments?

Dana Marcus August 26th, 2008 03:44:00 PM

"My question to you is, with all the respect in the world, would Sophie have wanted to endure all these treatments?"

This is a tough situation in veterinary care. We have to decide what they would want and what is best for them without being able to ask for their input. Obviously, Dr. Khuly cares for Sophie and don't think she would have exerted all this time, energy, and money if she didn't think Sophie was up for it.

Shannon Watts August 26th, 2008 04:52:00 PM

I have no doubts that Dr. Khuly considered what was best for Sophie when she went through all these treatments. It is wonderful to hear that the treatments have helped this dear, sweet little dog. I hope her physical problems are behind her, even though the tumor still lurks hidden somewhere in her brain. Thanks, Dr. Khuly for the update.

Vicki T August 26th, 2008 05:35:00 PM

dana marcus: I am sad for you about your Mom, I have recently lost mine to cancer. I can't answer for Dr. Khuly but state my opinion. When our family thinks back to the many doctor visits shortly before her death, clearly by the things said and serious looks, they knew it was iminent, though never used those words. And her change to a private hospital room, should have been a clear clue.

It is my belief a medical human or animal doctor knows when death is near and not "reversible", they have seen it over and over to see all the signs. Sophie S. was not at that door.

Barbara A. Albright/New Hampshire August 26th, 2008 07:07:00 PM

Congrats to both of you for making it through such an ordeal! I hope you have lots of time together to enjoy your victory.

Therese August 26th, 2008 11:38:00 PM

dana marcus- it's the chemo that gives the horrible side effects, not the radiation. I would never wish chemo upon anyone after watching my own mother suffer through it. It didn't help her in the end. The radiation did relieve some of her pain though, as the cancer had spread to her bones.

It sounds like Sophie Sue actually enjoyed her hospital visits! Congrats on her pulling through the treatments. :)

clover August 27th, 2008 06:22:00 AM

Yay! I'm glad she is doing so much better and that her radiation is finally finished. That must be a huge relief for you.

katie August 27th, 2008 07:21:00 AM

Dana: Thanks for asking--it's truly an excellent question.

My answer: No. Most pets would probably not elect to go through any of this any more than they like you clipping their nails or having their teeth professionally cleaned. Would any child submit to these treatments if they could choose not to? We have to make careful decisions on their behalf as to whether the relief is worth the rewards. And it's never easy.

Moreover, radiation, contrary to popular opinion, is not painful. Similarly, chemo, as it's designed for use in pets, should not produce severe side effects. If it does, we typically stop the treatments.

Back to Sophie: If she had absolutely resisted her visits I would have had reason to reconsider my choice on her behalf. As it was, Sophie made it easy for me.

Dr. Patty Khuly August 27th, 2008 08:19:00 AM

Oh yeah, the sevo thing. Lindabes: I, too, thought they would be using sevo (quicker up and down, less of an excitement phase, etc.). I asked before her first visit and was told that, no, they still like the iso. Lots of vets still prefer iso. I'm not entirely sure why. In this case, I'm sure the decision has little to do with its (much) higher price but I failed to ask. Sorry--I wasn't exactly thinking clearly then and forgot to address it later.

Dr. Patty Khuly August 27th, 2008 08:53:00 AM

Thanks for the article, and the discussion. Trying to decide on radiation for Nora, my 10.9-yr-old Giant Schnauzer. It's not just the $$, it's knowing that the squamous cell carcinoma on her LR leg (its 5th occurence and 5th location) will return sometime, someplace else, or else the bladder cancer (TCC) that's been cut out 3 times. If she gets 6-9 months of comfortable life it's worth it, but there are no guarantees.

Larry August 28th, 2008 03:10:00 AM

Larry, Both transitional cell and squamous cell can invade the bladder, but it is not the same cancer cell. You have had bladder surgery on your dog 3 x for squamous cell carcnoma? Curious & interested.

Barbara A. Albright/New Hampshire August 28th, 2008 08:38:00 PM

I was not as clear as I thought. Nora's had bladder surgery for TCC 3 times, a year apart, with chemo in between the recurrences. Chemo after the first 2 surgeries was mitoxantrone (sp?). She had ITP secondary to the TCC, so was on prednisone to control the ITP, which meant she couldn't have piroxicam. The mitoxantrone made her so sick (bloody diarrhea & crashing white blood cells) that the dose was reduced each time she got chemo. After the 3rd surgery, (different oncologist) she was put on low-dose daily chemo at home ("metronomic chemo?") with different drugs.

She's also had 3 toe amputations, also about a year apart, I think, for SCC. SCC was detected in a lymph node about 6 weeks ago; the lymph node was removed in her 4th surgery for SCC.

I think she'd already had her first 2 toe amputations before the TCC showed up in the bladder.

Larry August 29th, 2008 01:47:00 AM

Larry: Sorry about Nora's troubles. If it makes you feel better, the radiation was easy compared to the decision-making process that preceded it.

If they're using a linear accelerator for radiation, there are very few side-effects as long as vital structures are out of the way. Sophie had no side effects at all, despite the proximity of her ears.

As long as Nora doesn't resent vet visits radiation is actually a very humane approach--far less painful than any one of the many surgeries she's had (in fact, it doesn't hurt at all).

Dr. Patty Khuly August 29th, 2008 07:56:00 AM

Larry, There was a time when I thought the word "cancer" broke out in a letter-formation rash on my forehead. Anyone, heavy into reading, should sign up for New England Journal of Medicine & Physician Health Watch e-letters. So much chemo has been withdrawn & replaced. Notice that "Pro-crit" (non-chemo)is no longer advertised heavily, as support to making red cells.

Gosh, when multiple cancers enter the picture, it is pretty hard. Nora has been a tough gal and so have you, her advocate.

Barbara A. Albright/New Hampshire August 29th, 2008 07:04:00 PM

Congrats on Sophies recovery. We have a Frenchie, BullTwinkle ( six years old)who may have a tumor but really dont think we are going to go for the radiation as from what I hear it will only buy a year, and that is for only 50% of dogs treated. , from diagnosis which sounds like alot to put a little animal through for so little time. Plus the possible side affects sound sad too. I respect you for doing everthing you can to help Sophie, and pray that she lives a long and wonderful life!!!!

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