The prognosis for a Grade 1, Stage 1 Mast cell tumor responding
completely to surgical excision is good. In a review of mast cell
tumors from 1988 (Vet Med, Paul Dean, 2/88), 44% of dogs with Grade
2 mast cell tumors survived more than 1500 days after surgical removal
of the tumors, without additional treatment. A paper from the Animal
Medical Center in Manhattan (Saraff, et al, 1996), of radiation
therapy for the treatment of Grade 2 mast cell tumors in 32 dogs
with Grade 2 tumors of the skin, had a better prognosis, with 86%
of dogs treated with surgery and radiation making it to five years
post treatment. Based on this, it seems like a good idea to consider
radiation therapy, even when clean margins are obtained during surgical
excision. Chemotherapy is an option but does not seem to be as effective
as radiation therapy. However, radiation therapy is not as effective
if the tumor has spread (Stage 2 or greater) --- so in this case,
chemotherapy may have an edge. The oncologist will be able to help
you decide which approach will be best.
We
are lucky to live in an area where we have a number of oncology
specialists available to consult. We particularly respect the abilities
of, because of our experiences with, both Dr. Rodney Ayl
of Animal Specialty
Group and Dr. Ravi S. Dhaliwal of All-Care
Animal Referral Center in Fountain Valley, California (when
Goldie developed Transitional Cell Carcinoma in 2001).
In
January of 1999 in preparation for cancer surgery, Goldie was given
an ultrasound and had a blood panel done. As a result of the ultrasound
and blood work it was found that Goldie's heart wasn't what it should
be and her thyroid level was low. Our family vet immediately
started Goldie on Thyroxine and referred us to Dr. Michael Lesser of Advanced Veterinary Care Center in Lawndale, California. Dr. Lesser specializes in Cardiology. Dr. Lesser did a thorough examination by performing an Echocardiogram (Ultrasound of her heart) and an Electrocardiogram (to assess the electrical activity of the heart). The echocardiogram gives the most accurate determination of the size of each heart chamber and permits measurement of the thickness of the heart walls. The echo allows the doctor to see in actual time the contractions of the heart and can measure the contractions and compare them to the normal animal. The electrocardiogram assessed the electrical activity of the heart - or that is to determine the heart rate and to more accurately identify any arrhythmia which might be present. The combination of these tests resulted in Goldie being diagnosed with Dilated Cardiomyopathy with Ventricular and Supra Ventricular Arrhythmias.
Arrhythmias
are abnormal rhythms and can be, with the right medications, managed.
Dilated
Cardiomyopathy means that the heart muscle, especially the thick
muscle wall of the left ventricle, becomes much thinner than normal.
The pressure of the blood inside the heart then allows this thinned
wall to stretch, resulting in a much larger left ventricle chamber.
Dilated Cardiomyopathy is the most common cause of heart failure
in large breeds of dogs and can occur, less commonly, in all dogs
in general. Dilated cardiomyopathy develops over many months or
even years. Its effect on blood flow also develops slowly. As heart
function declines, the body is able to compensate. However, at some
point in time, the body's ability to compensate is no longer effective.
At that point, dogs go into severe heart failure in what appears
to be a matter of hours. Rapid, heavy breathing, a blue tongue,
excessive drooling, coughing and/or gagging or collapse may be the
first signs of problems or heart failure. We were lucky because
the ultrasound performed at our family vet found
the problem fairly early so that Goldie could get treatment.
Dr.
Lesser prescribed Goldie Atenolol, Digoxin and Enalapril. Atenolol
is a Beta Blocker. Digoxin (Digitalis or Lanoxin) is used to help
the heart contract better and to slow the heart rate down if certain
arrhythmia exist. Enalapril (or Vasotec, Enacard, Zestril, Prinavil
and Lotensen) is a Diuretic that is used to help both to control
and prevent accumulation of fluid in or around the lungs. Be aware
that each patient is different and it takes care and time to get
the right combination of drugs that works best. Usually long term
prognosis for dialated cardiomyopathy varies considerably. Unfortunately,
most dogs with signs of heart failure at the time of diagnosis die
as a result of the disease within 6 months to two years. Some dogs,
especially certain breeds with a more severe form of the disease
may survive only weeks to a couple of months. We got 2 years and
7 more months with her before she died peacefully in her sleep after
an uneventful, pain free day.
We
have a second home in Mammoth, California. Because of Goldie's condition
we were informed that she would not be able to go to that elevation
again - too much stress on her heart (We are blessed with the best
dog sitters!!!!!).
Dr.
Lesser had to be called on a number of times in the ongoing care
of Goldie that did not specifically deal with her heart but could
affect it. Dr. Lesser worked with Dr. Rodney Ayl at Animal
Specialty Group in Los Angeles to insure that Goldie would go
through her surgery to remove the Mast Cell Tumor
and the Spindle Cell Carcinoma with the least amount of stress
in January of 1999. Dr. Lesser then in August of 1999 worked with
Dr. David Nielson at Animal Medical Group in Manhattan
Beach, California to inform him of Goldie's condition and to insure
that she was properly monitored during her oral surgery to remove
an Ossifying Epulis, again to prevent any
undue stress. Dr. Lesser, on two separate occasions, then worked
with Dr. Robert L. Rooks of All
Care Animal Referral Center in Fountain Valley, California when
Goldie had back surgery in July of 2000
and again in January of 2001 when Goldie had to have a large
growth removed. As a matter of fact Dr. Rooks would not perform
the surgeries unless Dr. Lesser gave the go ahead. Dr. Lesser's
care and work with Goldie's various vets allowed Goldie to live
comfortably and fairly event free during the last 2 years and 7
months of her life.
Because
of Goldie's condition, she did have some 'episodes''. These episodes,
we believe, are not uncommon when a dog has this type of heart condition.
Many times a simple adjustment of the medications is all that is
needed. Dr. Lesser was always quick to respond to our needs and
answer all our questions. At one point, when Goldie had an episode
when we were out of town and our dog sitter was afraid to move Goldie
herself, two of Dr. Lesser's staff came to our home to pick up Goldie
and get her back to his office to be examined. We then were able
to pick Goldie up from his office later in the day. He had put a
monitor on her to wear for 24 hours to find out if there was something
going on that we needed to be aware of. Luckily it was an episode
that did not do any permanent damage to her heart and he was able
to adjust the amount of her medications so that her heart would
work more efficiently.
| Back
Pain and the Surgery |
|
In
June of 2000 Goldie began experiencing a lot of pain, was having
difficulty getting up, much less getting comfortable and was not
eating. We took her to our family vet. They saw that Goldie
was in such a condition that they referred us to a vet at a 24 hour
veterinary hospital in Los Angeles. We immediately took Goldie there.
The vet that saw us said that we had a 10 year old great dane with
a heart condition and there was nothing he could do for her. Over
the next two days we took her to two more vets that were recommended
by friends. They shrugged their respective shoulders and said that
there was nothing that they could do. Not one of these vets even
address the pain Goldie was in.
One
of our dog sitters then told us about Dr. Robert L. Rooks
and All-care Animal Referral Center
in Fountain Valley, California. We called them and explained our
situation and they found room in Dr. Rooks' schedule for us to see
him that same day. Dr. Rooks did a thorough examination of Goldie
and said "you have a dog in pain and I think I can do something
about it". He wanted to do an MRI (folks they have their own MRI!)
so that he could better diagnose Goldie's condition. Before the
MRI was performed Dr. Rooks insisted on consulting with and getting
the approval of Goldie's cardiologist, Dr. Michael Lesser of Advanced Veterinary Care Center in Lawndale, California. Dr. Lesser told Dr. Rooks to go ahead with the procedure. At this time Goldie had a hyperthyroid
condition and Dr. Lesser was treating Goldie for dilated
cardiomyopathy with ventricular and supra ventricular arrhythmias.
The MRI showed that Goldie had two discs that were pinched in her
lower back. Dr. Rooks recommended that the discs be fused. Again,
before he went ahead with the surgery, Dr. Rooks spoke with Dr.
Lesser to get his go ahead. The surgery was performed early on the
morning of July 4th, 2000. Dr. Rooks called us as soon as the surgery
was completed to tell us that everything went great and her heart
held up just fine. He called again letter in the day to update us
on her progress. Once Goldie was home and recuperating, Dr. Rooks
and or his staff found the time to call us to check on Goldie's
progress. Each time we were told to call them at any time if there
were any questions or concerns. When we did have a question we were
immediately called back by a D.V.M. who had Goldie's chart in front
of them and got our answers.
Please
note that before the MRI and the surgery Dr. Rooks sat us down and
explained that no procedure that requires anesthesia is without
risk. We assured him that we were aware of the risks however her
quality of life as it was was worth taking the risk.
Goldie's
surgery was a success. She immediately got her appetite back, was
no longer in pain, regained her mobility and started to play with
our english bulldog, Linda Louise. Without this surgery Goldie would
probably have had to be put down because the pain was obviously
so great.
Not
only was Dr. Lesser kept updated as to Goldie's progress but Dr.
Rooks and All-Care sent progress reports to our family vet.
If
at any time your regular vet is unavailable or your pet needs special
care we feel All-Care
Animal Referral Center is the place to go. All-Care's philosophy
is to provide the Mayo Clinic type of care for your pets. All-Care
will gladly provide a tour of their facilities. Along with their
own MRI, they do ultrasounds, perform arthoscopic surgery, treat
hip dysplasia, do hip replacements, treat cancer (they have oncologists
on staff), provide dental care, perform kidney transplants, provide
physical therapy, etc! Just sitting in the waiting room at All-Care
and talking to folks about their pets gives you an idea at the incredible
things that All-Care can do there to improve the quality of life
for your pet.
| Growth
Removal - Abscessed |
|
In
January of 2001 we noticed that one of Goldie's many benign growths
was getting rather large. It was in left rear leg. She was beginning
to have problems getting around (she was tripping and had fallen
on the stairs) and had problems defecating. The muscles in her leg
were also beginning to atrophy. We took her to see Dr. Robert
L. Rooks at All
Care Animal Referral Center in Fountain Valley, California.
Dr. Rooks saw all that and told us she was also in pain and it looked
like the growth was pressing on her sciatica. At that point Goldie
was 10 years and 8 months old with a severe
heart condition. Dr. Rooks thought that
she would benefit from surgery however, he wanted Dr. Michael
Lesser of Advanced Veterinary Care Center, her cardiologist, to give his okay before the surgery. Goldie was examined by Dr. Lesser who said that Goldie could have the surgery however, she could be under anethesia for no more than one hour. Dr. Rooks went one step further and arranged for a board certified anesthesiologist to anethetize her.
The
surgery was scheduled to be performed on January 7, 2001. Dr. Rooks
performs most of his surgeries very early in the morning - beginning
as early as 3:00 a.m. Therefore the 'patient' needs to be at the
hospital the night before for any lab work and preop. In consideration
for Goldie's age and heart condition, Dr. Rooks wanted Goldie to
have the least amount of stress, therefore we were allowed to bring
Goldie in just prior to surgery (well before dawn). Dr. Rooks also
sat us down before Goldie was taken into surgery. He reminded us
that like all surgery, this one was not without risk, more so for
her because of her heart. We all made the decision that if Goldie's
heart were to stop during the surgery he was to let her go, or that
is, to not resuscitate her. She did fine and luckily we did the
surgery. As it turns out the growth was bigger than we thought and
had actually grown up into her pelvic area and was around the sciatica
and had abscessed. If we had not done the surgery Goldie would have
been in increasing pain and would have had to be put down or suffered
a very painful death when the abscess burst. After the surgery both
the anesthesiologist and Dr. Rooks recommended that Goldie get acupuncture
(see photo above) to assist with her healing. We are lucky to have
an acupuncturist (who is also a D.V.M) that will come to our home.
Dr. Rooks even took the time to call the acupuncturist and explained
to them exactly what the procedure was and entailed and then reviewed
her medical history, most specifically her heart condition. Within
a month her muscles were coming back, she wasn't tripping and was
having no problems defecating.
All
we can say is - thank you Dr. Robert L. Rooks and all of
the staff at All-Care
Animal Referral Center - another great moment in surgery!!!!!
Not one 't' was left uncrossed, no 'i' was left undotted. All-Care
allowed us to make an informed decision for our pet. We felt that
she could get no better care anywhere else.
In
July 2001 Goldie developed a bladder infection. She has had them
before and we started her on a course of antibiotics. Then two days
later (on July 5th, 2001) she started urinated more frequently and
blood reappeared in her urine. She usually responded quickly to
antibiotics and never had this happened before. We knew immediately
that something was not right. We called Dr. Robert L. Rooks
at All-Care Animal Referral Center
in Fountain Valley, California. Dr. Rooks called us back within
the hour and asked that we come to All-Care immediately because
he wanted to do an ultrasound to see if something else was going
on.
An ultrasound was conducted and a mass was found of which they got
a sample of to biopsy. On the evening of July 6th, 2001 Dr. Rooks
called to tell us that Goldie's biopsy came back and she had Transictional
Cell Carcinoma (TCC) in the trigone area of her bladder. It was
like being kicked in the stomach. He wanted to immediately start
her on piroxicam (Feldan) and Cytotec and said he would be speaking
with Dr. Ravi S. Dhaliwal of his staff, who is an oncologist,
first thing the next morning. On Saturday, July 7th Dr. Rooks called
6:30 a.m. and said that he had spoken to Dr. Dhaliwal and told us
to come into to speak with Dr. Dhaliwal that day. Dr. Dhaliwal took
x-rays to make sure the cancer had not metastasized - it had not,
however, Goldie was given 6 to 9 months to live. We reviewed the
treatment options with both Dr. Dhaliwal and Dr. Rooks. Surgery,
chemotherapy and radiation therapy were not going to extend her
life any more then the drug therapy we decided upon. Also the drug
therapy was the least invasive and had the least amount of side
effects. This is the first time we ever felt defeated. Goldie had
been through so much in her life to get this diagnosis.
TCC
is a cancer of skin cells, often the skins cells lining the bladder.
It is classified as Stage 0 to Stage 4 depending upon how localized
the tumor is: whether it is confined to the skin layer or penetrates
surrounding muscle and/or tissue or whether it is metastatic (has
formed new tumors in distant sites). There are currently four main
options for treating TCC in dogs:
1.
Drug Therapy with prioxicam (Feldan)
2. Chemotherapy
3. Radiation Therapy
4. Surgery
As
mentioned above we chose the Drug Therapy which we will go over
last.
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