In mid-April, I took Bow to our primary vet for follow up visit on her recent dental work and to have an abnormality in her right eye. The vet was concerned and said that there was a slim chance that it could be related to a tumor but to monitor it for a few days and recommended one of the top canine ophthalmologists in the Bay area. After seeing no progress and her eye lid drooping, I felt it could not wait and took her to the ophthalmologist who was deeply concerned when she saw muscle paralysis on several spots on the right side of her face. She recommended us to a neurologist who then sent us to have an MRI. There was a clear abnormality in her brain between the optic nerve and pituitary gland. There was the chance of it being a tumor, lymphoma or an nerve infection. Since a biopsy would be almost impossible except for permanently removing the eye, she suggested a spinal tap. Over the next few days we had to wait on the results. She shared the potential treatments which included chemo, radiation or letting things take their course and hope for the best and keep her comfortable. The possibility of the renowned UC Davis veterinary school was brought up as a possible resource.
In the meantime our primary vet recommended Dr. Michael Kent, an oncologist at UC Davis who has been doing work on canine cancer with stereotactic radiosurgery, a process that has been very successful with humans but is very new with animals. In fact there are only four or five places in the world that offer it, and UC Davis has only had it since November.
Last Monday we had our first visit with Dr. Kent and his team. To say that UC Davis feels like the Mayo Clinic for small animals is an understatement. After doing extensive research on Dr. Kent, I was convinced that he was brilliant and on the cutting edge of veterinary medicine. What I was not prepared for was that he is so personable and humble. I was hugely impressed that we were greeted in the lobby not by a technician or nurse but Dr. Kent who himself who introduced himself humbly as just “Michael”. He was able to explain the process, risks, side effects and potential benefits of the surgery. While the dogs that have been through it so far have done well, he qualified that they have only a few months of history. I have my qualms about exposing an otherwise happy and healthy dog to radiation and anesesthia, but not addressing it seems negligent. There is also the cost to be considered. At UC Davis, it costs around $6,000, not inexpensive, but most private clinics are charging $12,000 or more and would require flying or several days of driving to get there.
In short, and in my lay version of what happens with this therapy – we had a CT scan last week which will provide a map of where the radiation will hit her brain. Dr. Kent spent 12-15 hours after our visit preparing for the procedure. She will have three treatments this week as opposed to 12 or more treatments with traditional radiation. Because of the detailed map of the brain from the CT scan and the fewer number of treatments but at higher levels of radiation, it is considered to be more effective and less invasive. We will then monitor results, and she will return in three months for an MRI to see what has happened with the effected area.
There is still a great deal of uncertainty and concern in this process. She might suddenly go downhill, have a reaction, not respond to the radiation. She has had significant muscle wasting on the right side of her face that might be permanent, and she could go blind in her right eye or lose it. We are closely monitoring it and putting in artificial tears 3-4 times a day. On the other hand, there is reasonable hope that the radiation will cause the tumor to go into complete remission and that because optic nerves can be resilient, they might go back to their original capacity.
As I write this, we are just back from UC Davis where Bow had her first radiation treatment without any complication. She is enjoying her regular 4 – 6 p.m. sunbath in the front sitting room, albeit with an IV catheter.
There has been great support from the BRAT community, friends, family, coworkers and others. We appreciate the many kind and supportive words as we remain optimistic but realistic about the uncertainty of the days ahead.
Below is a video of Dr. Kent talking about his work and the Morris Animal Foundation.
UPDATE: At 4 p.m. CST on May 12, we are back from round two of three radiation treatments with no complications and one more to go this Friday. We remain hopeful and have reason to hope for the best but are prepared to face bad news. As a cousin in Riverside County put it today on my Facebook link: "Keep up the optimism! Your love for Bow is a journey, not a destination... enjoy the journey however long it lasts!"
UPDATE II: Bow completed her radiation Friday afternoon without any complications. She continues to have normal energy and mobility. I know to take it one day at a time and cherish each day, but I continue to be optimistic while grounded in the reality that all animals are mortal. Thanks for all the support and well wishes from the BRAT community.