The End

Tia's tumor returned around September.  There really wasn't much more we could do for her other than keep her comfortable.  Dr. Rosen at NEVOG recommended 2 or 3 short radiation treatments to try and arrest the growth further.  We did 2 treatments and it became evident that although the tumor stopped growing in one direction, it went in another instead.  Tia developed a bacterial infection in her sinuses and had a constant discharge from her right nostril.  It was quite bloody.  We tried many different antibiotics.  The only one that helped was Metronidazole.  Even at the end it seemed that had stopped working as well.  We had her on Prednisone to help with swelling.  It was a tough choice to put her on that because last summer we discovered she had developed kidney disease; common in older dogs.  The use of Prednisone was going to affect her kidneys.  But we chose the lesser of two evils in order to keep her comfortable.  It definitely worked.  Tia was much better once we introduced the Pred.  We also had her on Gabapentin for pain, which helped immensely.  The Tramadol had just made her groggy and listless.  Throughout the past few months Tia's appetite remained strong, but it took her a lot longer to eat and it was a very messy process.  It must have been hard with that tumor in her mouth.  When she drank from the water bowl it was obvious that she was having a hard time getting the water down because it almost looked like she had rinsed her mouth out.  The water was always dirty and a little bloody afterwards.  

Iin the end the tumor and the kidney disease won, and we lost our Tia on January 10, 2012 - a little over 2 years after she was diagnosed.  She was 13 years and 7 months old.  

To say that Tia was special would be a great understatement.  She was my heart dog, and there she will stay.  She had so much more living to do, but it was not meant to be.  I will miss her terribly, but know the wonderful memories of our time together will always remain.

Rest in Peace my Sweet T. 

Ding Dong the Tumor's Gone!!!

Here are three 'before' and 'after' CT scan views of Tia's tumor.  Before is on the left and after is on the right.  The differences are nothing short of miraculous!!  In the last 2 views you can actually see that Tia's eye is being pushed up by the tumor in the left view.  In the right view the eye is back to normal.  How wonderful that technology invented for use on humans is now regularly used on animals.  Without it Tia's tumor probably would have won.  Thank you Dr. Rosen and everyone at NEVOG for getting rid of Tia's horrible tumor and making her well again!!

Tia's treatment is not finished yet.  Dr. Rosen is consulting with a veterinary opthalmologist re: her eyes, because she still is experiencing lower tear production than normal.  Both eyes measured 15 yesterday, whereas normal is 20.  We are still using the GenTeal drops.  We are also continuing with the steroid ointment in the right eye.  Other than that she is off all meds!  The hole in Tia's mouth has not closed up at all, and Dr. Rosen was able to determine yesterday that it does actually open into the nasal cavity.  We will allow the mouth to heal awhile longer and then see what our options are.  We are not interested in putting Tia through reconstructive surgery, but Dr. Rosen says that a veterinary dentist can probably make a mold of the hole and create a sort of plug that can be inserted and removed easily.  I'd love to see how long that will stay in Tia's mouth!  Something tells me not long.  Maybe it gets attached with dental adhesive!  Hahaha... watch for Tia making a denture commercial!

THE NEWS WE'VE ALL BEEN WAITING FOR!!!

We went to NEVOG this afternoon and Tia had a follow-up CT scan.  It appears that the tumor has just about disappeared!!!  We are incredibly happy and relieved, and even Dr. Rosen was excited with the results.  She printed out a few of the CT scan views, and I will be posting them to the blog tomorrow.  You will be amazed at the difference between the beginning of December and now.  It is remarkable.  The hole in her mouth apparently does go all the way through to the sinus area.  I have done a really good job making sure it stays clean after Tia's meals.  For the time being we are to continue feeding her the liquefied meals.  We will discuss options re: the hole in the near future. 

Here is a photo showing the pigment returning to Tia's skin.  She has freckles!

Same ol' same ol'

I haven't updated the blog lately because there is nothing new to report.  This is a GOOD THING!!  Tia is completely off the prednisone now, and only has 2 more doses of the antibiotic left.  I am still using the steroid ointment in her eye, along with GenTeal eye drops.  Just as Dr. Rosen said, the pigment is beginning to return to the skin that was affected by the radiation.  No sign of any fur yet though.  Tia is obviously feeling a TON better.  She still has trouble getting up in the morning (don't we ALL!!!) but she is a bit more playful now, and even barks a little.  She has growled at the puppies through the x-pen a few times, but nothing bad.  She's the matriarch, and is only asserting her position as such!  The puppies will learn.  Next NEVOG visit is in 4 days.

Doing well

Recovery continues.  I've been giving Tia 1/2 prednisone pill a day, and tomorrow we will go to 1/2 pill every other day for 5 days, and then stop.  Her side effects have really lessened.  Hardly any drooling.  Her mouth has stayed nice and clean, and we rinse it after every meal.  Her right eye is doing better with the steroid ointment.  We see Dr. Leah at Ellington Vet on Monday for a quick recheck, to be sure her mouth and eye are ok.  I took a picture of her this morning.  She wasn't in the mood, can you tell?!  All in all, she is definitely feeling better than ever.  She has even started barking a little again, which is a sure sign.

3 weeks post radiation

Today was Tia's second follow-up visit at NEVOG since her radiation treatment ended.  Dr. Rosen checked her mouth, measured her tumor, tested tear production in both eyes and did another dye test in the right eye.  Good results all around.  Her mouth is clean and her tumor has gotten SO much smaller, both inside her mouth and outside. Tear production tested at '20' in both eyes, which is normal.  Last week her right eye tested 20 and her left eye was pretty much at 0 in 2 separate tests on 2 different days.  The dye test was normal as well but Tia keeps squinting and blinking the right eye despite using the eye ointment.  Dr. Rosen decided to change to an eye ointment containing steroids.  We are going to keep her on the Baytril until our next visit in 3 or 4 weeks.  Starting tomorrow I will taper the Prednisone to 1/2 tablet for 5 days and then 1/2 tablet every other day for another 5 days.

The skin on Tia's face where the tumor used to be is so light and incredibly soft - like silk.  Dr. Rosen says that is because it is brand new skin.  Over the next few weeks we should see some more pigmentation show through, and over the next few months the fur will come in.  As for the hole in her mouth, she does not think it opens into the sinus cavity, but it is hard to tell.  I told her I doubt it does, because if it did we would see her meals coming out her nose!  (She is still on a totally liquid diet.)  She agreed with this thought, but wants to repeat the CT scan when we return for our next visit.  The hole in her mouth appears to have gotten bigger (to me) and this is because it is taking up the space once occupied by the tumor.  We will see what happens over the next few weeks - if the mouth continues to heal and if the hole fills in at all.  I hope it does, because none of us wants to face surgical reconstruction of the area!

Lastly, we discussed the fatigue that Tia seems to have been experiencing over the past 3 or so days.  She doesn't lift her head off her bed when I come downstairs in the mornings and all around seems to be more tired than usual.  Dr. Rosen says Tia's body is still doing some major healing, after the radiation  and it could just be that it is causing her to be more tired than normal.  She had told me that this was a side effect to expect, but I thought it was strange that it appeared to be worse just in the past few days.  Of course there are also times when she has bursts of energy, especially when we get home from work, or at meal times.  We'll continue to watch things, I'll check in with Dr. Leah at Ellington Vet weekly and I'll report to Dr. Rosen next week so we can decide when our next visit at NEVOG will be.  If things are going well we won't need to return for another 4 weeks!

Hairless

Tia has lost even more hair on her face, which is to be expected.  I snapped a picture of her while she was napping a little while ago.  It's funny to see her white skin next to the black & brown fur on her face.  It is a stark contrast.  She doesn't seem to be feeling too well today, but she had a fairly big day yesterday, so maybe she is just tired.  Kim and I went to the sheltie club meeting yesterday afternoon, and I took Tia for a show and tell.  After the meeting I explained what Tia has been going through since September, and what an Acanthomatous Epulis tumor is all about. Hopefully nobody will have to deal with one, but if they do, they have an idea of what to expect.

After the meeting Kim came by the house and helped me clean out the hole in Tia's mouth.  Up until Thursday we were doing great keeping it clean, but I tried giving her some of the Honest Kitchen food mixed in with her liquid diet and she got a huge clump stuck in there.  I tried everything to remove it by myself.  Someone needed to hold Tia's upper and lower jaws, while I tended to the hole.  Since Kim has experience working at a veterinary clinic and knows how to handle animals she was invaluable in helping me get the job done.  We were amazed at what came out of that hole!!  Now it is all nice and clean, and I won't be experimenting with her food until I am told to by the vets!

The 'eyes' have it

Tia developed a sticky discharge from her right eye Wednesday afternoon.  Thursday morning she woke up and could hardly get her eye open.  It looked like some sort of conjunctivitis.  The vet just checked her eyes thoroughly on Tuesday and they were fine.  Go figure.  So off to see Dr. Leah again yesterday afternoon.  She did another tear test on both eyes and the results were unchanged.  Right eye is almost normal.  Left eye is dry as a bone.  We can't figure out why though.  The right eye should be the dry one.  She also did a dye test on the right eye.  Everything is fine.  No ulcerations.  She put Tia on an antibiotic ointment, which I am using in both eyes.  Maybe using it in the left eye will help with the dryness.  Dr. Leah gave poor "starving" Tia some treats because she was such a good girl, and so darned cute, of course.  She won't feed her from her hand anymore though.  Tia put an end to that on our visit earlier this week.  She really needs to learn not to bite the hand that feeds her, but at this point in her life I doubt she has much incentive to learn!

Last night is the first time in months that Tia has not had to take any meds, other than the eye ointment.  We have been tapering down her prednisone, so she only takes it in the mornings.  I decided not to give her any pain meds last night, as she didn't seem to need them.  She was fine without them.  Also, her last dose of Baytril was yesterday morning.  This morning Tia seemed almost back to her old self!  Barking and playing a bit, as she always has before I let her outside.  It's nice to see her making such progress.  I'm thinking of taking her to the LEAP agility club meeting and run thru's on Sunday.  Maybe we'll do a couple of runs at a very low jump height, if she's up to it. 

Update... just talked to Dr. Rosen at NEVOG, since they wanted an update on Tia's eye issues.  She wants me to start using Genteal eye ointment in Tia's left eye, as opposed to the antibiotic, since it is measuring so dry.  Also, since Dr. Leah mentioned that she thought the tumor area was looking a little puffy last night, she wants T back on the Baytril at least until she see's her again on Tuesday.  At least we've made progress by stopping the pain meds, and soon we'll be tapering down the prednisone to once every other day.

Tia visits Dr. Greenberger

We went to see Dr. Leah at Ellington Veterinary Center tonight.  We've been meaning to drop by since Tia's radiation treatment ended.  Everyone there was happy to see Miss T.  Dr. Leah checked her mouth and it was nice and clean.  Tia's weight was a little down, probably because of the liquid diet she has been on.  We also have not been giving her ANY treats for fear that they will get stuck in the hole.  While we were there Dr. Leah gave Tia a treat and she was so excited that she practically took the Doctor's hand off!  Yes, that's our Tia.  I forgot to warn Dr. Leah about that.  She also checked Tia's eyes for dryness and found that her right eye is almost normal, but her left is really dry.  That seemed strange, since we expected the dry eye to be on the side of the tumor, which was on the right.  We'll have Dr. Rosen check them again next week at our NEVOG follow-up and see if there has been any change.  We will continue to check in with Dr. Leah so she can monitor Tia's progress as well. 

While we were at Ellington Vet I took another photo of Tia's face.  This picture shows the fur loss and healing over the tumor site, and if you look closely you can also see an area of healing around her lip.  Tia continues to enjoy sticking her face in the snow whenever she goes outside.  It obviously feels good to her.  She doesn't seem to be doing any damage, and I haven't noticed that she rubs her face hard.  On New Year's Day I decreased Tia's prednisone from two tabs a day to one, but some of her side effects came back so I upped it to 1 1/2 tabs and she did better.  Today I decreased the pred to one tab a day.  We'll see how she does with that.  Tonight Tia seems more herself and Rick, Brian and I agree that she seems to be feeling better. 

We are so lucky to have such great veterinary care for Tia.  Everyone really cares about our T, and has gone above and beyond in providing her care.  We can't thank you enough!

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.