Healing from Radiation

Strider is continuing to heal from the radiation treatments.  I have attached a photo of his healing nose.  I haven't made him open his mouth to see the burn there, but he is eating more enthusiastically, so I assume it is healing as well.  He is still only eating canned food from my hand, as it appears to be uncomfortable for him to pick up the food himself.  So... for anyone ever faced with feeding canned dog food by hand, let me highly recommend Prescription Diet g/d.  It has little odor and is almost solid and easy to handle.  I had been feeding him Prescription Diet i/d, but it is smellier and squishier, for lack of a better word.  Our vet here suggested we try the g/d while I was hand-feeding, and it has been a blessing.  Hopefully, Strider won't get bored with it.  We are out of leftover turkey, which he also ate enthusiastically.  When he was sick from the chemo and wasn't even eating canned food, I was boiling chicken and he would usually eat that.  For some reason, he has refused to eat hamburger, which used to be a favorite treat.

He is still fairly low energy and spends most of his time napping and lying around.  The photo shows him being annoyed with me for disturbing a nap.  I am hopeful that as his nose and mouth heal, he will feel better and have more energy.  Of course, the next round of chemo is in a few days, so that will be a new challenge.

Side Effects of Radiation and Chemotherapy

I had been told that dogs do not typically have the same, severe side effects from radiation and chemotherapy that humans do.  I was still surprised, however, that after the first couple of weeks of radiation and one dose of chemo, Strider seemed energetic and happy, with no visible effects from the treatments.  He had not been eating much while at Auburn, but we attributed that to the stress of being away from home, and on the weekends, he ate fairly normally.  At 105 pounds, he could certainly stand to lose a little weight, so we actually thought it was a good diet plan.  He did drop to 95 pounds over the first 3 weeks of treatment, but that is still large for a golden.  He is a big boned dog, and not obese at 95 pounds, but 90 would be better.

The first radiation treatment was given on November 29 and the first chemo was given on December 7.  One week after each chemo treatment, blood tests are performed to make sure his blood counts are staying high enough.  On December 14 or 15, I was told his test results were fine and he was feeling well.  He had started showing signs of irritation in his gums, but nothing major.

I picked him up at Auburn on December 17 to come home for the weekend, with only 3 more radiation treatments to go.  We got home about 2 pm and he was running around, playing with our other dog and chasing tennis balls.  I was quite smug about how well his treatment was going.

About 6 pm that night, he became very lethargic and refused food and water.  That continued through the night, and I took him to our local vet at 8am the next morning.  His temperature was 103.7, so Dr. R prescribed 2 antibiotics, metronidazole and amoxicillin, and an anti-inflammatory, previcoxx.  Dr. R believed he had an infection caused by his immune system being suppressed by the chemo.  It happened 10 days, instead of the expected 7 days, after the treatment was given.

We went home and I gave Strider the medication.  He immediately vomited it up.  I waited a little while, and gave it again with the same results.  I returned to the vet (luckily it's only a 5 minute drive from our house) and he gave him an injection of Cerenia for nausea.  I waited an hour, gave the medication again and he kept it down.  The Cerenia made him sleepy, so for the rest of the weekend Strider didn't do much but sleep.

We returned to Auburn on Monday and I explained what had happened over the weekend.  His temperature was normal at that point, so he was getting over the infection.  His gums were much more inflamed, even with the previcoxx, so there was some consideration given to waiting to give the next radiation, but ultimately, they decided to go ahead with the last 3 treatments.

I picked him up after his final treatment on December 22, very glad to get him home for Christmas.  The attending vet told me they had decided to delay his next chemo treatment, which was scheduled for December 27, by a week, to let his mouth heal a little from the radiation.  He was having trouble eating due to the irritation, and they wanted him strong for the next chemo.

We woke up on December 23 and Strider's nose looked really dry and scabby.  By the next day, Christmas Eve, it was much worse.  On Christmas morning, the scabs had come off and his nose looked completely bloody and he had lost most of the hair around his nose.  It looked terribly painful, but it didn't appear to bother him.

I need to back up and explain what else was going on from the time he came home on the 22nd.  He had started sneezing and snorting occasionally the prior weekend, and by the time he came home, it was constant.  During the night, he was keeping my son up almost all night with noise, since he sleeps in his room.  I tried to convince my son to kick him out, but he's too soft-hearted to do that.  Apparently, the sneezing and snorting is his trying to clear out the tissue, both cancerous and healthy,  in his mouth and nose that is dying from the radiation.  

I took him back for a follow-up with our local vet on December 27 and he said that in addition to the nose burn, there is a radiation burn on the roof of his mouth. 

As a result of the discomfort in his mouth and probably some loss of smell, Strider has been eating only soft food that he takes out of my hand.  He tries to eat it out of his bowl, but it seems to cause him discomfort to do so.  I am speculating that maybe the movement required of his tongue to pick up the food is hurting the roof of his mouth.  

I have attached some photos of him with the radiation burn on his nose.  It looks awful, but doesn't seem to bother him.  

The hardest part of the side effects so far is emotional, because before we started treatment, he was in no pain and was energetic and happy.  He just had a little lump in his mouth.  Seeing how sick we have made him, with more chemo to come, is difficult, but makes me feel better about the decision to not have surgery.

I discussed with the attending vet at Auburn that we would need to monitor the degree of side effects from future chemotherapy and weigh that against the uncertain benefit, and he agreed.  If Strider only has a short time left, I don't want him to spend most of it sick.  We have 4 months of chemo left, and that's a lot, relatively speaking, compared to his life expectancy.

So, we go back in 6 days for the next round of chemo.  It will be a different drug this time, so I don't know what to expect.  They are alternating carboplatin and doxorubicin, for 3 treatments of each.  For the chemo, I check him in early in the morning and pick him up late in the afternoon.  Hopefully, there will be some good movies playing to pass the time in Auburn.

As things change, I will update his progress.  As I posted earlier, I'm not sure that I can justify the $5-6 thousand that this will end up costing to prolong Strider's life by a year or so, especially given that the effectiveness of the treatment is totally uncertain, and the treatment itself may be more painful than the cancer. So I am hoping that the veterinarians at Auburn will learn something that will help other dogs in the future, and that maybe if anyone out there is looking for information, they will stumble upon this blog.   I have to almost view this process as a donation to veterinary science, and also hope that Strider's life in prolonged in a positive, healthy way.

I know he looks sad in the photos below, but that expression really means "I really want that piece of turkey in your hand, so please stop taking pictures and give it to me."

Normal nose on Ozzie
Radiation burn on Strider

Strider with radiation burn on his nose 

Mid November - Treatment Options

Dr. H at Auburn, who I am informed is one of the best veterinary oncologists in the country, presented me with several options for treatment of the fibrosarcoma.  As I had already discovered through internet research, he explained that fibrosarcoma is rare and there has been little research.  Any studies are primarily anecdotal and the sample sizes are very low.  Thus, any treatment is relatively experimental with little confidence about the outcome.  The only certainty is that we could not expect a cure, only to prolong Strider's lifespan from anywhere from 9 to 18 months.

That news was fairly staggering to hear.  He seemed healthy and symptom free.  Without treatment, I was told the tumor would progress rapidly and we would be faced with euthanizing him within 4 to 6 months.  I will discuss that later, but Dr. H was clear that the tumor itself would not kill him if left untreated.  Before that could happen, we would be faced with the decision as to when his quality of life had become unbearable due to the tumor basically taking over his face.

The options for treatment we discussed were:

1.  Surgery to remove a portion of his upper jaw.
2.  Radiation
3.  Chemotherapy

The decision as what treatment options to pursue with a dog with cancer is a very emotional and difficult one.  First, the treatments are very expensive.  Any of the above options would cost several thousand dollars, with the best outcome being to prolong a dog's life by a year or so.  To some people, to do that would be foolish.  To others, it isn't even an option financially.  To others, there isn't ever a consideration to not do whatever is possible to prolong the dog's life.

More difficult for me than the financial aspect of the decision was the fact that I was choosing what level of pain for my beloved dog to endure, not knowing if it would even do any good, and knowing I can't explain to him what is happening to him and why he is being subjected to what seems like torture.

We ultimately decided to forego the surgery option and pursue radiation.  After that decision was made and initiated, we also decided to add chemotherapy.

Initially, the oncologists at Auburn were strongly encouraging surgery.  They told me that most dogs recover easily and eat normally after having half of their upper jaw removed.  Honestly, I found that very difficult to believe.  Dr. H did say that it would be impossible to get clean margins with the surgery, meaning that they would not be able to remove all of the cancer cells. After much emotional turmoil, my husband and I finally decided that since Strider's time might be very short, we were not willing to put him through the ordeal of major surgery and learning to eat with half his jaw missing.  If we knew this was a cure, we might have felt differently, but we were told repeatedly that none of these options were a cure and the outcome was uncertain.  I still am not completely at peace as to whether we made the right decision or not, but I think we did.

The decision was made to begin a series of 18 daily radiation treatments.  Strider would stay at Auburn during the week for the treatments, and come home on weekends.  We live 1 1/2 hours away, so his coming home each day was not practical, though that was an option.  My biggest anxiety at this point was how he would adjust to being away from home.  I dropped him off each Monday morning and picked him up each Friday afternoon.  I don't know what he did while he was there, but he went back every Monday with his tail wagging.  I was called each day he was there by a veterinary student who took care of him while he was there.  In a later post, I will go into more detail about how great the doctors and staff at Auburn are.

On the sixth or seventh day of radiation, Strider also received the first of 6 doses of chemotherapy, to be given every 3 weeks.  Initially, I had been told that fibrosarcoma was not typically responsive to chemotherapy, but one of the oncologists there had recently had some success with a dog with a fibrosarcoma, so they suggested we try the same protocol.  I am not sure we are going to finish the planned chemotherapy, but I'll discuss why in the next post about some of the side effects of the treatments.

Strider came home five days ago after completing the 18 doses of radiation.  He was supposed to have gone back today for the next round of chemo, but his attending vet at Auburn decided to put it off a week due to side effects from the radiation.  Tomorrow, I will post some pictures of him after radiation and discuss the side effects from the radiation and chemotherapy.

The Next Step...

Our vet, Dr. R, told me that he was fairly certain that the growth was a fibrosarcoma and that we should go the the Auburn University Vet School as soon as possible to have it looked at.  I could tell from his demeanor and from the tears in the eyes of the vet tech with him that this was very bad news.  I immediately called Auburn and arranged to take Strider in a couple of days later.  Once there, I was informed that he did have an oral fibrosarcoma and we immediately began to discuss treatment options.  

One thing that I do not remember is when I first heard the explanation as to the benign biopsy results.  I believe it was our vet, Dr. R, but it could have been at Auburn.  The explanation, as best I can relay it, is that the material that looks like the tumor are actually collagen fibers that are created by the cancer cells, but are not cancerous themselves.  So that material can test benign if a large enough sample is not tested that includes the actual cancer cells.  I am sure I am not stating this correctly, but the phrase on some of the paperwork I have is "low grade histologic, high grade biological."

Initial Misdiagnosis

In August 2010, I took Strider to our vet for a swelling in his upper gum, above his left canine tooth.  I first noticed a swelling on the outside beside his nose and thought it was a bee sting or snake bite and that it was the skin that was affected.  I looked inside his mouth and saw what looked like extra gum material on that side.  It was hard and looked exactly like gum, but there was more on that side than on the other side.  The extra material was pushing out his lip, causing it to look slightly swollen.  You can see in the pictures below that the swelling is fairly subtle.  At this point, he exhibited no other symptoms at all.

Our usual vet was not in on that day, and the vet that we saw suggested that we get a biopsy performed, just to be on the safe side.  We did that and a few days later, he called to say that the biopsy had come back as benign and showed the material to be scar tissue.  That seemed strange, but we also have a year old Golden puppy and the two dogs play fight very hard.  I speculated that Strider had gotten hit hard on the mouth while playing and that was the cause of the scar tissue.  To me, benign meant benign, and I gave it no further thought.

Over the next few months, I noticed the swelling seemed to get slightly larger, but I wasn't concerned.  We had done due diligence, gotten a biopsy done, and I felt there was no need for further concern.

In November, we returned to the vet office for the removal of a benign tumor on his eyelid that we had been monitoring, and this time we saw our usual vet, who has been in practice for over 35 years.  He took one look at Strider and knew there was a problem.

His summer cut is just growing out.

Later Summer 2010

Strider and Fibrosarcoma

Strider is my beautiful 8 1/2 year old Golden Retriever who is currently undergoing treatment for an oral fibrosarcoma in his upper jaw.  I decided to post about his diagnosis, treatment, and progress, after finding very little on the internet about fibrosarcoma.   There is tons of information about many of the other multitudes of cancers that Goldens face, but fortunately, fibrosarcoma is relatively rare.  Unfortunately, that also means that there is little information about the cancer and effective treatments.  Since we are spending a large amount of money on treatment that we have been assured will only buy time, not a cure, I hope that our experience can help others who are facing the same situation.   We are almost 6 weeks into treatment, so I will back up and try to remember as much as possible about where we have come in that time.  I am not a medical professional, so I ask your forgiveness for any errors I make.


Here he is in healthier days.