Tolerance to radiotherapy interventions - 20 x anaesthesia in 4 weeks

[okslater]

As some of you already know, my 7 year old Lemming has a peripheral nerve sheath tumour on her vertebrae (C2 - so right up in her neck). She had debulking tumour removal to slow progression of the disease, but actually the neurosurgeon did such a good job, she completely removed the tumour with clear (small) margins (marginally excised), which is pretty much unheard of in this type of location. Lemming was referred on to the cancer treatment centre in Edinburgh, UK, where they have suggested a course of definitive intent radiotherapy to kill any cancer cells that remain, to further prolong her prognosis (which could be years now, instead of the couple of months we were expecting). 

This is all great news, except the RT program, due to the location on the nerve root, requires a gentle approach, so 5 sessions a week for four weeks, with short anaesthesia each time. Our girl is very sensitive, and hates intervention/noise/new people, so this is going to be really hard on her. She also developed facial palsy from the anaesthesia last time (potentially, although it may have been idiopathic). 

Has anyone put their grey through this level of prolonged intervention? Did they cope ok? How about all the IVs etc. She still has bruising and sores on her legs from the last round of cannulas, she licks the wounds for weeks later making them worse. 

If she was older there is no way I'd put her through so many anaesthesias, but at 7 I'd hope she'd be ok. Any similar stories gratefully received while we try to make our decision.

[greysmom]

If I had a dog that was really super chill, loved new places and people, and was fine being away from home on their own for extended periods, I wouldn't hesitate.  Our boy who had osteo, was like this and he LOVED going in for chemo since he was the center of attention of a whole gaggle of people for a whole entire day.     Since your girl is pretty much the opposite of that, I would definitely consider the trade offs carefully.  The value of the radiation treatment vs the possible extended lifespan.  And if any other combination of oral chemo and/or radiation is possible.  You might want to contact Dr Couto and ask his opinion.

I also would think they would put a port in if she's going to need an IV that often.  You still need to keep her from bothering at it, but it won't be having to be put in and taken out every other day.  Also, I would really talk with them about out of the box alternatives to their "normal" routine.  Most greyhounds will lay still for short periods of time under a combination of easily given injections and pills that is easily reversible (propofol and a fast acting anti anxiety drug for example), but this depends on her reaction time and how long she needs to be still.  (As a side note, do not let them use acepromazine, which is an older drug often used for anxiety.  Greyhounds can have very bad reactions to this drug.)

I was so glad to hear about the success of her surgery.  Hopefully, you can find a good way forward for her from here.  {{{hugs}}}

[tbhounds]

As a vet tech that worked in a radiation center I have seen all types of dogs with various personalities actually do really well.  I assume your dog will be receiving CFRT radiation.  The treatments are super short but, as I’m sure you’re aware the patient needs to be completely motionless.  We used a short acting sedation (typically IV butrophanol) and propofol as the induction agent.  The pet was placed on anesthetic gas..in our case we used sevoflurane but, many clinics use isoflurane.  The first few treatments are trial and error regarding medication dosages..often they are tweaked once it is realized the needs of your pet.  If the treatments will prolong the duration of remission I would pursue.  Remember if it becomes too emotional to continue for you or your pet treatments can be discontinued..but, remember without doing the full protocol the expected remission will not be achieved.

[okslater]

Thank you both for the replies. Chemo for this type of tumour is pretty ineffective. As it's a rare type (in humans and in dogs) not much effort has been put into finding any optimal chemo therapies, and the type of cell doesn't respond well to traditional chemo combos. That sounds like the protocol they said they would follow, tbhounds. I think they are the UK centre of excellence for small animal cancer treatment and they have high tech kit, so I think we're in good hands. 

Lem is a very smart greyhound. She's anxious but very observant, and she learns quickly, so maybe she will get into the swing of things and just get on with it if none of the intervention has caused any immediate pain, which it sounds like it wouldn't, especially if she has a port for the IV. 

Yes Greysmom we've been so happy with the surgery, we were really expecting the worst, especially when we saw how bad she looked when we got her back. But each new report brings more hope with it. That's not my usual experience with cancer, so I don't want to get my hopes up too much, but we're very grateful to have our little girl almost back to normal again now, except for all her shaved patches. She's getting lots of attention out on our walks. 

 

[BatterseaBrindl]

 

[MP_the4pack]

I can't help but think she'll get comfortable with so many visits so close together. Especially if she gets loved on and treats after.

[EllenEveBaz]

Sending best wishes to your beautiful black girl.  When would the RT start?  How far away do you live from Edinburgh?  

[okslater]

Hi @EllenEveBaz 

Thanks for the message. 

We are 250 miles from Edinburgh, so we are renting cottages during the week. Fortunately we are both working remotely these days, so we can do this. 

She starts radiotherapy today. They did an MRI and CT scan yesterday and confirmed there is no evidence of macroscopic disease, so the RT is to further expand the clear margins with the expectation that her prognosis will now increase to years. This is amazing, as we were only aiming to get an extra few months with the initial surgery, but it went so well the outcome greatly improved. 

She is taking trazadone to help with her anxiety, but she actually seems fine. The cannula isn't bothering her at all, and she was happy enough at the hospital yesterday. Hopefully we can just plough through this month of treatment and then we can finally relax!

[EllenEveBaz]

Great news on the scans!  All paws crossed for you here.  

[Jerilyn]

What a great update! I hope things continue to go well for you.

[greytpups]

Wonderful update

[Patsy]

Sending all good thots from North Dakota to you all. Hang in there.