A better photo...

Here is a better shot of what Tia's face looks likeat the moment.

Healing...

Not much news to report today, except Tia continues to lose the fur around the tumor site and the side effects are lessening slowly.  Tomorrow we start reducing her prednisone.  I've already lowered her pain meds and she seems to be ok.  These photos aren't very good, but you can sort of see how she is coming along.  The photo above shows some of her hair loss in the tumor area.  The photo below was taken looking down over the top of her head.  There is a slight bump visible on her profile, but nothing like it was about 10 days ago.  The surface of the skin on her face actually looks worse now even though the tumor has decreased in size, but Dr. Rosen assures us everything that is happening is normal.  Tia continues on her liquid diet which she doesn't seem to mind at all.  The thing that she does mind terribly is that Rick doesn't give her treats while he is cooking!  She stands right by his side and looks up longingly, waiting for him to throw her something.  We can't give her anything solid yet, until the hole in her mouth begins to heal.  Poor Tia!

I went to Sweet Pea in South Windsor to buy more canned food for Tia last night.  Did you know that they actually make the equivalent of Ensure for dogs and cats?!  I've been kidding about making her Ensure meals by putting canned dog food and water through the food processor, and was quite amused to find that there is a special product just for them. 

Re-check

Tia and I took another trip up to NEVOG today for her first re-check visit since the radiation treatment ended.  Dr. Rosen checked her mouth and said it was nice and clean.  No food stuck in the hole.  That was music to my ears!  The process of rinsing Tia's mouth out after each meal is very cumbersome.  Picture trying to keep her mouth open with one hand while squirting the rinse in with the other AND making her stay on the grooming table at the same time!  As compliant as she is, it is still not easy.  I'm getting the hang of it, but won't mind one bit when we no longer have to go through this!  Tia is to remain on a liquid diet until our next appointment in 2 weeks.  We are going to start lowering her pain meds and cutting down the prednisone slowly. 

Dr. Rosen is pleased with the progress Tia is making.  The radiation side effects should now level off and begin to improve.  I've already noticed that she isn't drooling as much, and I'm pretty sure her tongue doesn't hurt as much because she was licking my hand earlier today; something she hasn't done in awhile.  Her tumor seems to get a little smaller every day.  The skin over the tumor site isn't quite as pink as it was, but it is beginning to look a bit dry and her fur is getting very thin.  No signs of a corneal abrasion, which is one side effect I've been praying she would not have.  Her eyes both look good.  No signs of dry eye.  All in all, Tia is doing very well!

A very special Christmas

Tia came home on Christmas Eve!  What  a WONDERFUL Christmas present.  She was obviously happy to be home, and so were we.  Her radiation treatments are finished and now we wait while she heals.  I was very excited to see that her tumor is smaller, even just 4 days after I had last seen her.  The fur around her tumor site has started to thin and the skin underneath is quite pink, like a bad sunburn.  Her tongue is very red too, which makes it painful for her to eat.  It doesn't stop her though!  We are feeding her wet food diluted in lots of water, because the Honest Kitchen food has many little food particles that cannot be ground down any smaller, and get stuck in the hole in the back of her mouth.  After her meals we have to use a special oral rinse, to help clean things out.  It is not easy to direct the squirt to the right place, and Tia hates it.  The vet told us that the next week or two would be messy, and she wasn't kidding!!  Tia will also continue to drool a thick saliva until things start to heal.  We've put a doggie shirt on her to try and keep her clean.  Otherwise her rough gets all gross.  She's a real trooper, and is handling things well, but during the healing process we are not supposed to let her rub her face on or in anything.  Tia has always LOVED the snow.  She loves to throw herself in it and make "Sheltie Angels", and she also loves to stick her face in it.  (This was before her radiation treatment!)  Now we have to be sure she doesn't rub, until the tumor site has healed.  She continues to take Prednisone, Baytril and Tramadol, and we return to NEVOG for a re-check on Monday afternoon.  Good thing we are nearing the end of the year, when vacation time starts from scratch.  I am all out of time for 2009!

We are so grateful to the NEVOG staff for the wonderful care they gave Tia during the 14 days she spent with them over the past 3 weeks.  If any of you ever find yourselves in need of a canine (or feline) oncologist I highly recommend them.

Almost done!

I'm excited to say that Tia's last radiation treatment is tomorrow morning.  I had a long chat with Dr. Rosen tonight and she reported that they have started hand feeding her small pieces of wet dog food, which they find doesn't get stuck in the hole in her mouth like her regular food.  They have increased her prednisone so she is hungrier than ever, if that is really possible!  Dr. Rosen said the next couple of weeks are going to be "messy".  Tia will continue to drool for awhile, which gets all over her fur.  She suggested that we put a T-shirt on her to keep her clean.  I have the perfect outfit ... something I bought for Emma a few years ago.  The radiation side effects will continue to increase over the next week or so, and then begin to subside.  There is still a chance that Tia will develop a corneal ulcer in the right eye, and this is something we need to watch for very closely.

Dr Rosen said Tia is an incredible patient.  They have really enjoyed having her around.  She has been extremely tolerant of all her treatment.  She is so well behaved that they don't even leash her when she is out of her kennel. 

Tia will have to return to NEVOG on Monday for a re-check.  They want to be sure her mouth is kept very clean and that she is still doing ok on her meds.  She will remain on the Tramadol, Baytril and Prednisone for now.

#12

Talked to Dr. Rosen today when I called for my daily update.  At first I was surprised that she took my call, because I usually talk to a technician.  Then I wondered if there was something wrong but I was happy and relieved to hear everything is fine.  Tia had her treatment this morning.  Her tumor is no bigger.  They have increased her Tramadol to 1/2 a tablet because she is having a harder time eating.  Her tongue must be really sore from the radiation.  They are thinking about switching her food because they are finding small bits of food stuck way back in her mouth, especially around the area where the infection is still draining.  They clean out her mouth daily while she is still anesthetized, but that is going to be much more difficult for me to manage once she comes home.  Tia eats a very healthy diet.  It is a dehydrated raw food made by The Honest Kitchen.  You just add water and let it soak for awhile.  There are lots of small bits and chunks, which easily get stuck in her mouth.  I wonder what food we can give her that won't cause the same problem... maybe a totally raw diet?  Dr. Rosen said they will figure out something and we'll talk again tomorrow.  Just a couple more days and she'll be home!!!

Counting down

Tia had her 11th radiation session this afternoon.  Only 4 more to go!  She still has some drainage from the infection, but it is much better.  Katie, the technician, told me that they noticed her tongue is red, which is a side effect from the radiation.  Her tongue is sunburned!  Can you imagine?!  I can only think of one thing that'll relieve that... ICE CREAM!  No doubt Tia would love that!  We'll have to get her some when she comes home on Thursday.

Week Three!

Tia is back at NEVOG for what we hope will be her third and final week of treatment.  Despite all the snow we had over the weekend, the drive up to Waltham was uneventful, and we got there 20 minutes before they opened.  Dr. Rosen was not in yet so I just dropped Tia off and returned to Hartford, to work. 

Dr. Rosen just called to say that she examined the tumor and it measures the same as it did last week.  She actually thinks it might be slightly smaller because some of the swelling from the infection has gone down a little.  They will continue with the radiation treatments, but will keep a close eye on the tumor.  If it gets bigger they will stop everything and we'll have to talk about the surgical debridement again.  Dr. Rosen said this is about the time when we should start seeing the tumor get a bit smaller. 

Tia was very quiet over the weekend.  She hardly barked at all, and spent a lot of time curled up on her ottoman.  She also started drooling from the same side of her mouth as the tumor is on.  I asked Dr. Rosen about that and she said it is a radiation side effect - thickening of the saliva.  Tia is still eating well, so I was surprised to see that her weight was a little down from last week.  Now that I think of it, that's probably because the hospital staff overfed her the first week she was there, and now that she's been eating her normal diet she is back to where she should be.  All in all, Tia was not her happy go lucky self, but we hope that will change once all her treatment is done.

Two down, One to go

Tia has completed 10 radiation treatments and is doing well.  I just spoke to Dr. Rosen, who said she got the culture results back.  The results show that she has a "sterile abscess".  It doesn't show any bacterial growth, which is good.  She is going to remain on the Baytril (antibiotic) as well as the Tramadol (for pain).  She has also just started taking Prednisone (a steroid) which will act as an anti-inflamatory.  Being that this is her second week of treatment, this is when they expect to start seeing some side-effects of the radiation.  I have also been instructed to do warm compresses on the tumor site 3-4 times a day over the weekend.  She still has a small hole in her mouth where we want the infection to continue to drain.  I asked if they have noticed any signs that she is in pain.  She said not really, because Tia is such a tough girl, but she asked the staff and they said they have noticed she isn't eating as fast.  Ok, THAT is DEFINITELY a sign that she is in some discomfort.  They said she still likes her meals though.  Duh!  That dog LIVES for food!

Dr. Rosen said if the tumor area is any bigger on Monday they may have to do a surgical debridement inside her mouth.  If it is the same size or smaller we will continue treatment as usual.  (Definitely hoping for the latter!)  She also said we may need to do another CT scan.  One day at a time!

Good news!

I spoke to Katie, one of the radiation technicians today.  She said Tia's infection seems to be under control with the antibiotic.  When she intubated her today for her radiation treatment she didn't see any evidence of puss or anything.  Her mouth was nice and clear.  I am happy and relieved by this news.  We will keep her on the current antibiotic until we get the biopsy results.  The Doctor will then determine if anything needs to be changed.

Treatment day #8

We are about half way thru Tia's treatments and she is doing well.  They have continued with radiation despite the infection.  The tumor has not gotten any bigger since Monday, and the Doctor feels this is a good thing.  It means the antibiotic is working.  (Then why isn't it getting smaller?!)  No biopsy results yet, but they are hoping to have them by Friday so we can get Tia on a new antibiotic, if necessary.

Infection

Talked to Dr. Rosen last night.  She found that Tia had puss draining into her mouth from a small fistula.  She shaved a small area on the tumor, drew some fluid, and found it was the same as the puss in her mouth.  We are clearly dealing with an infection.  She said the lymph node enlargement is all related.  This is a relief in a sense, since she was a bit concerned that we might be dealing with another cancer.  Tia had been on antibiotics since before her abscessed teeth were removed on 10/5/09, but we took her off around Thanksgiving because there didn't seem to be a need for them.  Apparently we shouldn't have done that.  This infection is all related to the original issue.  Dr. Rosen explained that the center of a tumor is an empty area where bacteria love to congregate.  In order to know how best to treat the infection we need to know what type of bacteria we are dealing with.  She did a biopsy but we won't know the results for another week or so.  Once the results are back we'll know what bacteria is involved and which antibiotic will be best to fight it.  For now Tia has been put on an 'all purpose' antibiotic.  She is still receiving her regular radiation treatments, but there is a chance they might have to be suspended if the infection can't be controlled.  I'm really hoping the antibiotic helps control the infection so we can complete the radiation treatments. 

Second week of treatment begins today

Another early morning ride to NEVOG with Tia.  This time traffic was a little heavier.  We got there at around 7:35.  I met with Dr. Rosen and told her we thought Tia's tumor looked bigger.  She measured it, which she does each week, and confirmed that it is a bit bigger, but that it seems to be from fluid.  If the lump were hard it would mean that the tumor might be growing bigger.  The fluid could mean there is an infection.  Dr. Rosen also said the lymph node on the same side as the tumor is a bit enlarged.  This could also be from fluid.  She is going to biopsy both.  Results won't be back until probably tomorrow.  The type of tumor Tia has does not spread, so seeing the lymph node enlarged is a bit of a concern.  But come to think of it, the tumor site started getting bigger when we took Tia off the antibiotics, so maybe this is an infection.  Hopefully that's all it is.

It sure was nice to have Tia home for the weekend.  When we picked her up Friday night she seemed a bit indifferent towards us.  She was probably mad that we 'deserted' her there for the week.  She got over that pretty quickly, and was SO excited when we pulled in the driveway later that night.  She spent the weekend following us around everywhere, running around outside with her friend Silvi, making sheltie angels in the snow, eating as much as possible.  She even came with us to get the Christmas tree yesterday.  It'll be another quiet week without her, but Silvi is there to keep us company.  Brian is picking Tia up on Friday, when he comes home for his Christmas break.

Day 3

Spoke with Liz at NEVOG.  Tia is doing great, and they love her.  She said she is such a cute little girl.  They want to keep her!  (Yeah, like that's gonna happen.)  Liz said they have been feeding her twice a day, which is what she is used to.  First they treat her and then they feed her.  Today they treated the dog in the kennel next to her, and then fed him.  Tia was NOT happy that he was fed before her, and barked her displeasure.  I asked if she stamped her feet too, like a skunk does before it sprays, but she said no.  She sure is an expressive dog.  I am glad they are enjoying her, but I can't wait to pick her up after work on Friday!

First treatment update

I just got off the phone with Dr. Rosen.  Tia was still on the table but they were just in the process of waking her up.  She did fine.  I asked if they ended up radiating from above the head, down over the right eye and into the tumor.  She said yes, but that they also are hitting it from below, with a sharper angle up so that there is no exposure to the left eye.  This way they can hit as much of the tumor as possible.  I asked about how Tia's vision in the right eye will be affected.  She said the loss of vision will be gradual over the next 6 months to a year.  She will basically form a cataract over the eye which will result in a gradual loss of vision.  She mentioned that depending on the extent of the damage to the right eye, there may be surgery to correct the vision, but I doubt we will pursue that, provided she still has good vision in the left eye.  Animals adjust much better to handicaps than we do, and I am sure Tia will do so as well.  Dr. Rosen even mentioned that the loss of vision shouldn't be too much of a problem in the immediate future, and doing agility is still in the cards for Tia!  I asked her about the probability of an oral/nasal fistula forming.  She consulted with the other doctors and was told that the probability of one forming is pretty remote.  Because her tumor is one that will go away gradually it will allow the radiated tissues to heal, and therefore a fistula should not be an issue.  I was very relieved to hear that.

Tia's treatment begins

Got up at 4:45am today to drive Tia to NEVOG.  Tia knew something was up, because even when we go to dog shows we don't usually leave so early!  She didn't want to get in the car, but once in she curled up and slept the whole way.  I was jealous!  We arrived at NEVOG at about 7:20, having hit just a little traffic on the Mass Pike - early Boston rush hour, I guess.  The hospital doesn't open until 7:30am, so it really wasn't a very long wait.  While we waited I took another picture of Tia's tumor.  I really think it is bigger than ever, and am relieved that her treatment is about to get underway. 

Dr. Rosen was there and we had a chance to talk a bit.  She asked how Tia has been doing.  I told her that she is still her crazy, happy, active self, but that her sneezing has increased, and that yesterday I noticed she was licking her lips a lot, which is something new.  Dr. Rosen thinks this might be a sign that she has some pain, and they will put her on pain meds if necessary.  They showed me the kennel where Tia will be staying.  It is very spaceous.  Her bed fits in just fine, with plenty of room for her to walk around.  I hear that the radiology staff spends a lot of time with the "in-patients".  They get daily walk and play sessions.  Tia didn't seem too eager to stay though.  She kept jumping in the chairs in the waiting room.  I told them they should put one in her kennel!  I was asked what tricks she knows, so they can keep her alert and occupied when they have time.  Sounds to me like she will get lots of attention.  We went over feeding instructions.  Poor T will only get one meal a day because she needs to be fasted before each radiation session.  Her first radiation treatment will be this afternoon.  Dr. Rosen explained that the size of her tumor will likely not change until after her treatments have finished, and that it will get smaller over time.  It is nice to know what to expect.  We will miss Tia so much while she is at NEVOG, but we have been encouraged to call daily for updates, and of course she will be home over the weekends.  Luckily we have Silvi at home, so we won't be entirely "dogless".  Silvi belongs to Kim Lappen, and I 'borrowed' her to breed.  She has a litter of puppies due right around Christmas.  So along with eagerly awaiting the end of Tia's treatments on December 24th, we also get to watch for puppies!  It will be an interesting, busy time.

Keep thinking happy, positive thoughts for Tia's full recovery!  

Second visit to NEVOG

Yesterday's visit was a bit of a shock.  First they took a pre-anesthesia chest x-ray.  The results were clear so they proceeded to put Tia under for the CT scan.  That procedure went well, but the results were startling.     Tia's tumor is much bigger than they had anticipated, so unfortunately, surgical removal is out of the question.  With this type of aggressive tumor they need to take a much bigger margin around it in order to ensure that they get it all.  Because of the tumor's proximity to Tia's eye this really isn't possible.  The tumor has also eaten away at more bone than we thought.  Our only option at this point is to radiate.  The good thing is that Tia's tumor will not spread to other parts of her body, and the rate of success with radiation is 80 to 90%.  They should be able to shrink the tumor considerably, and give Tia another 2 to 4 years of quality life.  Since she is 11 years old now, that is a very reasonable expectation.  The bad thing is that she will certainly lose total vision in her right eye because of the radiation.  She will also lose another tooth.  There are other risks and side effects as well, such as a possible oral/nasal fistula.  We'll deal with them as they happen (or hopefully not!).  We will begin radiation on Monday, Dec 7th.  She will stay at the hospital weekdays for 3 weeks and her last treatment date will be Dec 24th.  Thanks to Stephen's help I have attached a copy of a couple of Tia's scans.  You can really see the size of the tumor.  Very scary!

Some people may question why we would spend such considerable funds to fight Tia's tumor.  It's pretty simple.  First, she is in excellent health now.  If you saw her she doesn't act any differently that usual.  She is active and happy, and eating like she always does.  In fact, she had the best Thanksgiving day of her life, since she was allowed to run loose in the house with all our guests, and anything that fell on the floor was hers.  (Not to mention all the turkey that Rick gave her later on when we were cleaning up!)  Secondly, I've known Tia since the minute she was born.  She has been my constant companion.  We have thoroughly enjoyed the sport of agility together, and built a bond that can't be ignored.  She makes me laugh all the time, no matter how "bad" a dog she is.  If dogs have a sense of humor, Tia has a huge one!  Tia has done so much for me in so many ways.  How can I ignore that??  Treating her tumor is the least we can do for her.

Wish us luck as we continue our journey.  Lets hope for a good outcome.