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 Over
the years, many of you have come to know Robbie, Dr. Henderson's
beautiful Irish Setter who is always wandering around the
hospital. Robbie is a very young twelve year old. He has been
very healthy through the years and his only chronic problem is
one of intermittent seizures.
A few weeks ago,
Robbie started sneezing and would occasionally sneeze out a bit
of blood. He had a small amount of drainage from his right
nostril which was mostly watery. Dr. Henderson reported that he
was sounding a bit congested in the evenings, but beyond that he
was eating, drinking and acting normally at home. As a doctor's
pet, Robbie has regular blood work performed and his latest
panel did not show any problems. He recently tested positive for
inhalant allergies, and our assumption was that the sneezing was
related to those allergies. Over the course of a few weeks, the
sneezing progressed a bit and Dr. Henderson tried Robbie on
antibiotics and decongestants which helped a little but did not
get rid of the problem.
To be on the safe
side, Dr. Henderson sent out tests to check to see if Robbie
might have a systemic fungal infection. Those tests were
negative. At this point, one has to be considering chronic
allergic sinusitis versus cancer of the nasal cavity in the
differential diagnosis.
The only way to
determine what was going on in Robbie's skull was to get some
x-rays and take a look. We anesthetized Robbie and took
radiographs of the skull. From the films below, you can see
that the sides of the head are different in appearance. The left
side has a more black and white image (more contrast) and the
right side is more grey, indicating the presence of fluid in
that side of the nose and sinus. If you look closely, the edges
of the bone are also less distinct on the right side.
 
Plain X-rays showing increased fluid on the right side of the
picture. This is the tumor in the nasal cavity. (double click
to enlarge)
While he was
anesthetized, we performed rhinoscopy. With the aid of a 4 mm
rhinoscope, we were able to look up into the nasal canal and
unfortunately, we found an angry looking mass growing in the
nasal canal near the bottom of the eyeball. We took a biopsy of
this mass and sent it to the lab. Robbie awoke without problem,
but we were left rather worried!
A few interminable
days passed and the biopsy results finally came in.
Surprisingly, they did not tell us what was wrong. The tissue
came back as inflamed mucosa (lining of the nasal canal).
Despite the negative
biopsy results, both Dr. Henderson and I were highly suspicious
of cancer and so Dr. Henderson took Robbie to a specialty center
in order to have a CT scan performed. The scan revealed tumor
eating away the nasal cavity and encroaching on the brain
chamber. At that time, Dr. Henderson took a more aggressive
biopsy and it confirmed that Robbie has cancer.
      
(Sequential CT images of Robbies skull, double click on images
to enlarge. Notice the grey fluid on left left side of each
shot. Also compare the detail of the bones in the same region on
the opposite side)
Tumors of the nasal
cavity tend to be aggressive and can spread to other parts of
the body rather quickly. Nasal tumors tend not to respond to
chemotherapy, however radiation therapy has been shown to slow
the tumor's growth and extend the life of the pet. This being
the case, Dr. Henderson and Robbie made the trek to Culver City
daily for 20 days to complete Robbie's treatment. Radiation
therapy affects the tissues near the tumor and we are nursing
Robbie's radiation burns on his face. These side effects should
pass in a few weeks and hopefully, he will not have any lasting
impairment from the treatment.
We are all hoping
that Dr. Henderson's loving attention along with the radiation
therapy will help Robbie will beat the odds and overcome his
cancer.
9-08 Update on
Robbie's Condition
Robbie did well after
the radiation therapy. His hair grew back (changed from red to
white) and he was asymptomatic. In April, during a
routine recheck CT scan, the nasal cavity and sinuses were
found to be clear of any disease. However, the radiologist
found another mass in the neck region on the right side which
measured approximately 2 x 6 inches. The mass was very
deep in the neck, next to the cervical vertebra. A needle
biopsy was performed on the mass and the pathology report showed
it to be a hemangiosarcoma. This is a tumor which arises
from the blood vessels. Hemangiosarcomas in this
location have a tendency to spread (metastasize) to internal
organs and can be fatal.
In hopes of giving
Robbie every chance at survival, the tumor was removed
surgically in April. After the wound had healed, Dr.
Henderson opted to take Robbie through another course of
radiation therapy for the hemangiosarcoma. She and Robbie
made the trek to Carslbad every day for 20 days for his
treatment. Once again, Robbie did well through the
radiation with only minor skin burns. Two weeks
after the radiation was completed, we began chemotherapy with a
drug called doxorubicin given every 3 weeks in hopes of stopping
any microscopic spread of the hemangiosarcoma.
Through the summer
Robbie was doing very well until mid August, he became suddenly
blind. On examination, we found that he had developed
cataracts (opacity of the lens) in both eyes as a result of the
radiation therapy (a common side effect). Considering he
was doing so well otherwise, Dr. Henderson took him to the
Ophthalmologist to be evaluated for cataract surgery.
Using sophisticated equipment (electroretinogram), the doctor
found that the left eye was completely blind due to damage to
the retina, but the right eye could still see if the cataract
was removed. Robbie underwent cataract surgery in late
August where the damaged lens was removed from the right eye and
a synthetic lens was put in its place. The surgery went
well, but Robbie developed glaucoma (increased pressure in the
eye) after the surgery and things were touch and go for a while.
With the aid of aggressive drug therapy, the glaucoma was
brought under control. Unfortunately, Robbie's eyesight
became impaired due to gross inflammation in the eye soon
thereafter. He began bumping into walls again and the
ophthalmologist thought he might have a brain tumor (spread from
one of his primary tumors) which might be affecting his sight.
Back to the
radiologist for a CT scan, and fortunately, the nasal cavity,
sinus and brain were found to be free of cancer! With more
aggressive anti-inflammatory therapy, sight slowly returned to
Robbie's right eye.
Here it is, mid
September, almost a year from his original diagnosis and Robbie
is still doing well. He and Dr. Henderson are enjoying
their time together and hopefully they will continue to do so
for some time to come.
December 10th Update:
Robbie continues to
do well. He is having some trouble walking which is
unrelated to his cancer, but probably more to do with his age.
Dr. Henderson has fitted him with a new walking assist cart,
which allows him to walk greater distances without fatiguing.
Robbie is beating all the odds on every front. Dr.
Henderson is ecstatic to be able to spend another holiday with
her beloved Robbie.
Robbie in his Cart
February 5th Update:
Robbie has been
having more trouble getting up and around and so Dr. Henderson
opted to try improving his spinal cord function by injected his
own stem cells into his spinal canal. There is evidence in
mice and rats that this therapy may lead to dramatic
improvements in spinal cord injury. The experiments in
mice did not have radiation induced damage to the spinal cord,
which is what Robbie is suffering from, so we don't really know
if it will work or not, but it is certainly worth a chance.
Over the past few months, Robbie has been having intermittent
pain and swelling in the back of his mouth on the right side.
Initially, we thought this was an abscess as it responded to
antibiotic therapy. While Robbie was getting his stem cell
treatment, this area was probed and it looks like there may be
another tumor growing in the pharyngeal area. The biopsy
results will be back in a few days and we are fearful that it
may be another cancer. For now Robbie is doing OK
and we are hoping that the stem cells will improve his ability
to get around.
3-09-09
It is a sad day here
at ARPH, for all of us and especially for Dr. Henderson as her
beloved dog, Robbie Eugene was put to sleep after a courageous
15 month battle against cancer. Robbie passed away peacefully
in Dr. Henderson's arms in her home on March 9th.
Despite 3 rounds of radiation therapy, chemotherapy and stem
cell therapy, we were unable to keep the cancer in check anymore
and it reared its ugly head in Robbie's right nasal canal and
sinuses (the opposite side from the original tumor). With his
deteriorating condition and poor prognosis, Dr. Henderson made
the heart wrenching decision to let him go as humanely as
possible.
She as asked me to extend her sincere thanks for the outpouring
of support and concern, which has been coming from all of you
over the past year or more.
We will all miss Robbie's presence, but we are grateful for the
extra time we were able to spend with him as a result of Dr.
Henderson's unfailing care.
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