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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.
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.