Goldie's Story Goldie was an incredible animal. We received Goldie as a gift from good friends. Goldie's mother was a Great Dane and her father was a Doberman/Labrador mix. The litter was planned. Our friends wanted one litter out of the Dane because she was such a great dog so they bred her with another one of their beautiful dogs. She was taken from her litter at 3 1/2 weeks and weighing 9 pounds because there were nine fast growing puppies and the vet felt that the mother would have trouble feeding them all. Since one of us was home most of the day I was able to bring Goldie home. However, we made one important stop before going home and that was to Bay Cities Veterinary Hospital in Marina Del Rey, California and Dr. Sandi Milo. Dr. Milo along with Dr. Thomas Fitzpatrick, Dr. Mary Jane Brandt and staff of Bay Cities have been there for us in dealing with all sorts of problems both big and small. Another incredible source for care for Goldie had been and will be for all of our current and future pets is All-Care Animal Referral Center in Fountain Valley, California. All-Care is open 24 hours a day and provides Mayo-Clinic type of care for your pets. When your family vet is unavailable or unable to provide certain care for your pets All-Care is the place where we go and suggest the same to our family and friends. Goldie's 'puppydom' was pretty normal if you consider the chewing, jumping, running and the house training. The best chewing story and a strong reminder to leave your laundry secure was when she decided to eat a brand new suit my husband got in Italy - thank God for American Express. We had left the dry cleaning basket at the front door ready to be taken in the next day. Goldie took the opportunity that evening, after we went to bed, to take out the brand new suit and shred it. American express sent us a long form that needed to be filled out and reviewed before they could consider a refund. We filled out the form and decided to add a photo of our 80 pound puppy - we sent the form along with the shreds and the picture to Amex. In two days we received a phone call with laughter in the background - it was American Express. Amex wanted us to know that they just received their package and that we would be receiving a credit on our next statement (they loved the picture). Goldie with all her love and care still had a number of health problems in her life that we would like to share with you. While some of these health problems would be fatal for some Goldie had an incredible will to live and kept bouncing back such as: 5. Acupuncture 6. Hypothyroid 1. Proffessional Puppy Training? our biggest mistake! My husband and I were getting married when Goldie was just over 6 months old. We thought that while we were on our honeymoon it would be a good time for Goldie to be trained by a professional trainer - BIG MISTAKE!!!!! We used what we thought was a reputable trainer/kennel in Marina del Rey. We interviewed them and told them that we wanted Goldie to have lots of attention and lots of play time along with her training. We left her in their care for 3 weeks. Upon our return we immediately went to pick her up. I noticed that she seemed to be coughing. They told me she was clearing her throat - AND I BELIEVED THEM! Two days later she could not get out of her bed because she had kennel cough that had turned into pneumonia (in both of her lungs). Thanks to Dr. Sandi Milo at Bay Cities Veterinary Hospital and her diligent care, Goldie survived. We did call the trainer and he seemed to be totally unconcerned about her condition and did not offer to refund any of the fees that we paid him. I now caution anyone that puppy training is best conducted in your home or in a class enviroment with you there. Puppy's, even with their vaccinations up-to-date, are not completely protected. Also note that some dogs can not handle the stress of being in a kennel environment for any length of time. We have, from the time that Goldie had pneumonia, used pet sitters that stay in our home. It may cost more but the health of our pets is worth it! Note: Pneumonia is very hard on your pets heart and can cause problems later on - as it did in Goldie's case. 2. Ossifying Epulis When Goldie was three years old we noticed a growth in her upper jaw in her gums that resembled cauliflower. We took her to our family vet who felt it was important to remove it and have a biopsy performed. It came back as an Ossifying Epulis which was basically a tumor-like mass on the gingiva. The treatment would be to wait and see if it returned, which it did when she was 7 years old. When this happened our vet referred us to a surgical specialist to have the tooth in the area removed along with part of her jaw bone to prevent any regrowth. We went and meet with the surgeon and scheduled the surgery with the understanding that a tooth and part of her jaw would be removed. When we picked up Goldie after the surgery I noticed that no teeth were missing nor any of the jaw seemed to be affected. The surgeon was not available to speak with and called us the next day to tell us that she had an Ossifying Epulis (of all things!) and that he needed to perform another surgery and remove a tooth and part of her jaw. Well, we can tell you, we were a little taken aback - since we were referred to him to do just that and even had discussions in his office that that was what he would be doing. He very kindly offered to do the surgery and not charge us for the anesthesia. We very kindly declined. The Epulis recurred when Goldie was 9 years of age. This time our vet did not refer us to the same surgeon (we will not name him here - we will only mention those vets that we have and or had possitive experiences with). This time, because Goldie had developed a heart condition and needed to be properly monitered during anesthesia, we were referred to Dr. David Nielson of Animal Medial Group in Manhattan Beach who specialized in dental care for animals. He felt that because of her age and heart condition and since the growth was not invasive of the bone that he would do a Gingivectomy only (he did not want to be too invasive and put her under any undue stress). She came through the surgery with flying colors and the growth never reappeared. 3. Gastric Dilation - Volvulus ----- BLOAT!!!!!!!! Goldie was 5 years, 7 months old and we were getting ready to BBQ and I was feeding Goldie. When I put Goldie's food down she looked at it and walked away. Let me tell you from day one this dog had felt that each time she was fed it was like she had discoveed the cure for cancer. I felt her abdomen and found it slightly distended. I immediately yelled out to my husband to shut down the grill and that we had an emergency. Using the cell phone on the way to Bay Cities Veterinary Hospital we informed them that we had a possible bloat and we were on our way. Let me tell you folks this is a condition that if you even suspect it - do no wait - get to your vet or 24-hour emergency hospital and have your pet examined. As a matter of fact, Dr. Thomas Fitzpatrick of Bay Cities Veterinary Hospital, at first, thought that she may just have a little stomach upset - but erred on the side of caution and prepared surgery and took an x-ray. Goldie did not have many of the initial symtoms such as (and these are not all) hanging her head, graying gums, restlessness, attempts at vomiting, tongue hanging out or shock, but she did have the slight 'bloating' of her stomach. When Dr. Fitzpatrick returned with the x-rays he informed us that he needed to get her into surgery immediately! That is when Dr. Fitzpatrick took another look at Goldie and noticed that she started to hang her head and her gums had started graying - this was only 10 minutes from when he last saw her - and this was all of 30 minutes after I first notice something wrong at home. Goldie had engorged herself with at least a gallon of water. What caused her to do that we do not know - all I remember that day was that she seemed more thirsty than usual. My mistake was not monitoring the water intake more. Goldie came through the surgery fine that evening but there was still a risk of her stroking out so she needed to be closely monitored over the next 48 hours. She did great! within 36 hours after the surgery she was looking for kisses from the staff and us. Some preventive measures that we had taken since this episode was to feed Goldie not twice a day but three times a day (mini-meals) at an elevated eating station. Also we were mindful of limiting her exercise and water consumption just prior to, and following, eating. Always remember that our pets can not speak and we need to be observant of their behavior. We also feel it is important to have a vet that you can trust and is responsive when you say that something is wrong. Be aware of your vets hours of operation and also keep on hand the location and numbers of 24 emergeny veterinary hospitals - our favorite 24 emergency veterinary hospital in Southern California is All-Care Animal Referral Center in Fountain Valley, California (714) 963-0909. Note: As with pneumonia the Bloat can be stressful on the heart. 4. Incontinence and Bladder Infections Incontinence is not unusual for female dogs. It can occur at a younger age in spayed females and probably is more common in them. Which is what happened to Goldie. When Goldie was six years old she began urinating in her sleep. Our vet first ruled out a bladder infection before starting her Goldie on phenylpropanolamine (PPA) - it work great. Currently there is difficulty on getting PPA but be assured there are other options available for treatment including an estrogen supplement. Occasionally, Goldie also developed Bladder Infections. Bladder Infections (cystitis) is very common in dogs. It is usually caused by bacterial organisms that somehow get into the bladder and colonize in it (isn't that a nice way of putting it! yuck). Bladder infections are more common in females because the uretha is shorter. Goldie had the typical symptoms of having a bladder infection - she had to urinate often but only in small quantities, seemed to be uncomfortable or straining to urinate and there was traces of blood in her urine. The infections were treated with antibiotics which gave her seemingly immediate relief. Therefore, if you notice your pet straining or urinated more frequently, have them checked immediately. Please know that younger dogs are more likely to be affected than older dogs. Note: In July of 2001, Goldie got a bladder infection which we immediately began treating with antibiotics. After a couple of days, while still on the antibiotics, more blood appeared in her urine. As it turned out Goldie had developed Transitional Cell Carcinoma (TCC) - please see the section below. 5. Acupuncture - It WORKS!!!! Goldie at a number of times in her life seemed to be in pain. Dr. Mary Jane Brandt of Bay Cites Veterinary Hospital offers acupuncture. I was at first skeptical about using alternative medicine but Goldie was in pain and the other option was drugs that would mask the pain and possibly cause her more harm in the long run. Goldie mellowed out almost immediately after the first two needles were put in place. Her range of motion improved along with her energy level. Acupuncture was particularly helpful after surgery - speeding up the recovery time and minimizing post-operative pain. Acupuncture also help Goldie with her incontinence as an alternative to increasing her level of phenylpropanolamine (PPA). Because of Goldie's size we found that having the acupuncture done in the home was easier on her. Less stress in getting in and out of the car and remove the stress of just being in the doctor's office. In January of 2001, Goldie had to have a large growth removed from her leg that was causing her great pain and affecting her mobility. Because of Goldie's size and age, like many elderly people, her back 'went out' and she was in pain. To put her in the car in that condition would have been cruel and since she had a very severe heart condition we needed to be careful of the amount of pain meds that she was given. Dr. Rooks, of All-Care Animal Referral Center recommended that we get her some acupuncture ASAP. Luckily, we were able to get a house call. What a relief for Goldie (see photo below). As part of Goldie's regular care and at the advice of Dr. Rooks, Goldie was given acupuncture on a weekly basis. Dr. Kathleen Carson of the VCA Hospitals, in Los Angeles does house calls. She has been a savior. We believe that alternative medicine is an option. Like conventional medicine it may not have all the answers you are looking for. We always urge people to ask questions and make informed decisions for yourselves and your pets. What may work for our pets may not work for yours. This is where the 'practice of medicine' comes in. We always tell people that we are working on our Junior Vet Badge. Accupunture being performed 1 day post-op on 1/08/01 after removal of a large benign growth. 6. Hypothyroid Goldie was found to have a hypothyroid when she had a blood panel taken prior to her having surgery for cancer in January of 1999. She was put on Thyroxine and tested periodically to insure that her dosage was correct. Hypothyroidism is a common and serious genetic problem in dogs. There is virtually no breed of dog unaffected. The scope of the problem cannot be accurately defined because of a lack of complete statistical information; however, it is certain that veterinarians are seeing and treating a lot of thyroid cases. We believe that this problem seems to be more common because of improved pet care and testing capabilities. It is easily treatable and, with care, will help maintain the quality of life for your pet. Some of the clinical signs of Hypothyroidism include but are not limited to: Lethargy, obesity, mental dullness, cold intolerance, abnormally low heart rate (bradycardia), cardia arrythmias, weakness, seizures, ataxia, facial nerve paralysis, diarrhea, constipation, anemia, ellevated cholesteral levels, 'rat' tail, dry/brittle coat, poor wound healing, skin thickening, and or persistant infection. Please remember that while some of these symptoms may be signs of a hypothyroid condition in your pet only your vet can make that determination. These could also be signs of any number of other conditions. 7. Mast Cell Tumor and Spindle Cell Tumor Goldie had always had benign growths. At first, when she was younger, the only way to check on them was to have them surgically removed and a biopsy run. Later, we found that doing a needle aspirate was less invasive, gave us fairly accurate results and saved her from looking like the 'Bride of Frankenstein'. We were careful to have any new growths checked with a needle aspirate and any old growths re-checked if they changed in size or feel. Luckily we were diligent in doing this becuase in January of 1999 Dr. Mary Jane Brandt of Bay Cities Veterinary Hospital in Marina del Rey found that two new growths tested positive for cancer, one being a Mast Cell Tumor, the other being a Spindle Cell Tumor and they were within 2 inches of each other. We were given the names of two oncologist in Los Angeles, California and decided on Dr. Rodney Ayl of Animal Speciality Group. However, before we took Goldie to Animal Specialty Group a chest x-ray, ultrasound and a blood panel were run in preparation for surgery. As a result of these preliminary tests it was also discovered that Goldie had some problems with her heart. We were referred to Dr. Michael Lesser of Advanced Veterinary Care in Lawndale, California. The section titled The Heart of Goldie will overview the incredible and compassionate care that we received at Advanced Veterinary Care. Dr. Bilbrey of Animal Specialty Group did the surgery to remove the cancerous growths on Goldie. The growths were under her right front leg (in her 'arm pit'). Note, that not only were the growths removed but also about 1.25 inches of tissue in every direction around the tumors. We were very lucky to catch the cancer early because they were able to excise them completely and get clean margins and Dr. Ayl felt that neither chemotherapy nor radiation therapy would be required. Animal Specialty Group gave us a pager number so that we would be able call after hours to check on Goldie. Which of course we did. It was reassuring to have a doctor return the call. We have found that we are more comfortable leaving our animals overnight in a hospital environment have D.V.M.'s are on staff 24 hours a day, not only technicians. We have been amazed to find out that most veterinary hospitals do not have a D.V.M., a technician or anybody! in their hospitals after hours, even with animals in serious condition. We caution everyone to make an informed decision before leaving a pet overnight in any facility. We did some research on both Mast Cell Tumors and Spindle Cell Carcinoma. We have found that there is a way of classifying how far a maliganant tumor has spread prior to diagnosis. A 'Stage' and a 'Grade' classification is a way for the pathologist and/or oncologist to give thier impression of how aggressive a tumor is likely to be (how likely it is to spread to other tissues). Example of a mast cell tumor There are different staging schemes, but the standard is probably the World Health Organization (WHO) staging, even though it is geared more towards humans. A slightly simplified version of this is: Stage 1 --- Tumor is solitory, no sign that it has spread, tissue margins are clean on removal. Unlikely follow-on treatment will be suggested. Stage 2 --- The tumor has invaded regional lymph nodes - will probably require further treatment. Stage 3 --- The tumor is widely invasive, invaded past surgical excision and/or there are multiple tumors, even if the lymph nodes are not involved. Further treatment options should be discussed with your oncologist. Stage 4 --- The tumor has invaded tissue far from the original site. Grading of the malignancy of a tumor is somewhate subjective and is partially the pathologist's opinion, althought there are guidelines for grading, also. Grade 1 --- The tumors are the least likely to be highly maliganant. Grade 2 --- The tumor is malignant. Grade 3 --- The tumors are most likely to be highly malignant. The prognosis for a Grade 1, Stage 1 Mast cell tumor responding completely to surgical excision is good. In a review of mast cell tumors from 1988 (Vet Med, Paul Dean, 2/88), 44% of dogs with Grade 2 mast cell tumors survived more than 1500 days after surgical removal of the tumors, without additional treatment. A paper from the Animal Medical Center in Manhattan (Saraff, et al, 1996), of radiation therapy for the treatment of Grade 2 mast cell tumors in 32 dogs with Grade 2 tumors of the skin, had a better prognosis, with 86% of dogs treated with surgery and radiation making it to five years post treatment. Based on this, it seems like a good idea to consider radiation therapy, even when clean margins are obtained during surgical excision. Chemotherapy is an option but does not seem to be as effective as radiation therapy. However, radiation therapy is not as effective if the tumor has spread (Stage 2 or greater) --- so in this case, chemotherapy may have an edge. The oncologist will be able to help you decide which approach will be best. We are lucky to live in an area where we have a number of oncology specialists available to consult. We particularily respect the abilities of, because of our experiences with, both Dr. Rodney Ayl of Animal Specialty Group and Dr. Ravi S. Dhaliwal of All-Care Animal Referral Center in Fountain Valley, California (when Goldie developed Transitional Cell Carcinoma in 2001). 8. The Heart of Goldie In January of 1999 in preparation for cancer surgery, Goldie was given an ultrasound and had a blood panel done. As a result of the ultrasound and blood work it was found that Goldie's heart wasn't what it should be and her thyroid level was low. Dr. Mary Jane Brandt of Bay Cities Vetinary Hospital immediately started Goldie on Thyroxine and referred us to Dr. Michael Lesser of Advanced Veterinary Care in Lawndale, California. Dr. Lesser specializes in Cardiology. Dr. Lesser did a thorough examination by performing an Echocardiogram (Ultrasound of her heart) and an Electrocardiogram (to assess the electrical activity of the heart). The echocardiogram gives the most accurate determination of the size of each heart chamber and permits measurement of the thickness of the heart walls. The echo allows the doctor to see in actual time the contractions of the heart and can measure the contractions and compare them to the normal animal. The electrocardiogram assessed the electrical activity of the heart - or that is to determine the heart rate and to more accurately identify any arrhythmias which might be present. The combination of these tests resulted in Goldie being diagnosed with Dilated Cardiomyopathy with Ventricular and Supraventricular Arrhythmias. Arrhythmias are adnormal rhythms and can be, with the right medications, managed. Dilated Cardiomyopathy means that the heart muscle, espcially the thick muscle wall of the left ventricle, becomes much thinner than normal. The pressure of the blood inside the heart then allows this thinned wall to stretch, resulting in a much larger left ventrical chamber. Dilated Cardiomyopathy is the most common cause of heart failure in large breeds of dogs and can occur, less commonly, in all dogs in general. Dilated cardiomyopathy develops over many months or even years. Its effect on blood flow also develops slowly. As heart function declines, the body is able to compensate. However, at some point in time, the body's ability to compensate is no longer effective. At that point, dogs go into severe heart failure in what appears to be a matter of hours. Rapid, heavy breathing, a blue tongue, excessive drooling, coughing and/or gagging or collapse may be the first signs of problems or heart failure. We were lucky because the ultrasound performed at Bay Cities Veterinary Hospital found the problem fairly early so that Goldie could get treatment. Dr. Lesser prescribed Goldie Atenolol, Digoxin and Enalapril. Atenolol is a Beta Blocker. Digoxin (Digitalis or Lanoxin) is used to help the heart contract better and to slow the heart rate down if certain arrhythmias exist. Enalapril (or Vasotec, Enacard, Zestril, Prinavil and Lotensen) is a Diuretic that is used to help both to control and prevent accumulation of fluid in or around the lungs. Be aware that each patient is different and it takes care and time to get the right combination of drugs that works best. Usually long term prognosis for dialated cardiomyopathy varies considerably. Unfortunately, most dogs with signs of heart failure at the time of diagnosis die as a result of the disease within 6 months to two years. Some dogs, espcially certain breeds with a more severe form of the disease may survive only weeks to a couple of months. We got 2 years and 7 more months with her before she died peacefully in her sleep after an uneventful, painfree day. We have a second home in Mammoth, California. Because of Goldie's condition we were informed that she would not be able to go to that elevation again - too much stress on her heart (We are blessed with the best dog sitters!!!!!). Dr. Lesser had to be called on a number of times in the ongoing care of Goldie that did not specifically deal with her heart but could affect it. Dr. Lesser worked with Dr. Rodney Ayl at Animal Speciality Group in Los Angeles to insure that Goldie would go through her surgery to remove the Mast Cell Tumor and the Spindle Cell Carcinoma with the least amount of stress in January of 1999. Dr. Lesser then in August of 1999 worked with Dr. David Nielson at Animal Medical Group in Manhattan Beach, California to inform him of Goldie's condition and to insure that she was properly monitored during her oral surgery to remove an Ossifying Epulis, again to prevent any undue stress. Dr. Lesser, on two seperate occasions, then worked with Dr. Robert L. Rooks of All Care Animal Referral Center in Fountain Valley, California when Goldie had back surgery in July of 2000 and again in January of 2001 when Goldie had to have a large growth removed. As a matter of fact Dr. Rooks would not perform the surgeries unless Dr. Lesser gave the go ahead. Dr. Lesser's care and work with Goldie's various vets allowed Goldie to live comfortably and fairly event free during the last 2 years and 7 months of her life. Because of Goldie's condition, she did have some 'episodes''. These episodes, we believe, are not uncommon when a dog has this type of heart condition. Many times a simple adjustment of the medications is all that is needed. Dr. Lesser was always quick to respond to our needs and answer all our questions. At one point, when Goldie had an episode when we were out of town and our dog sitter was afraid to move Goldie herself, two of Dr. Lesser's staff came to our home to pick up Goldie and get her back to his office to be examined. We then were able to pick Goldie up from his office later in the day. He had put a monitor on her to wear for 24 hours to find out if there was something going on that we needed to be aware of. Luckily it was an episode that did not do any permanent damage to her heart and he was able to adjust the amount of her medications so that her heart would work more efficiently. 9. Back Pain and the Surgery In June of 2000 Goldie began experiencing alot of pain, was having difficulty getting up, much less getting comfortable and was not eating. We took her to our family vet, Bay Cities Veterinary Hospital in Marina del Rey, California. They saw that Goldie was in such a condition that they referred us to a vet at a 24 hour veterinary hospital in Los Angeles. We immediately took Goldie there. The vet that saw us said that we had a 10 year old great dane with a heart condition and there was nothing he could do for her. Over the next two days we took her to two more vets that were recommended by friends. They shrugged their respective shoulders and said that there was nothing that they could do. Not one of these vets even address the pain Goldie was in. One of our dog sitters then told us about Dr. Robert L. Rooks and All-Care Animal Referral Center in Fountain Valley, California. We called them and explained our situation and they found room in Dr. Rooks' schedule for us to see him that same day. Dr. Rooks did a thorough examination of Goldie and said "you have a dog in pain and I think I can do something about it". He wanted to do an MRI (folks they have their own MRI!) so that he could better diagnose Goldie's condition. Before the MRI was performed Dr. Rooks insisted on consulting with and getting the approval of Goldie's cardiologist, Dr. Michael Lesser of Advanced Veterinary Care in Lawndale, California. Dr. Lesser told Dr. Rooks to go ahead with the procedure. At this time Goldie had a hyperthyroid condtion and Dr. Lesser was treating Goldie for dilated cardiomyopathy with ventricular and supraventricular arrhythmias. The MRI showed that Goldie had two discs that were pinched in her lower back. Dr. Rooks recommended that the discs be fused. Again, before he went ahead with the surgery, Dr. Rooks spoke with Dr. Lesser to get his go ahead. The surgery was performed early on the morning of July 4th, 2000. Dr. Rooks called us as soon as the surgery was completed to tell us that everything went great and her heart held up just fine. He called again letter in the day to update us on her progress. Once Goldie was home and recouperating, Dr. Rooks and or his staff found the time to call us to check on Goldie's progress. Each time we were told to call them at any time if there were any questions or concerns. When we did have a question we were immediately called back by a D.V.M. who had Goldie's chart in front of them and got our answers. Please note that before the MRI and the surgery Dr. Rooks sat us down and explained that no procedure that requires anesthesia is without risk. We assured him that we were aware of the risks however her quality of life as it was was worth taking the risk. Goldie's surgery was a success. She immediately got her appetite back, was no longer in pain, regained her mobility and started to play with our english bulldog, Linda Louise. Without this surgery Goldie would probably have had to be put down because the pain was obviously so great. Not only was Dr. Lesser kept updated as to Goldie's progress but Dr. Rooks and All-Care sent progress reports to our family vet, Bay Cities Veterinary Hospital. If at any time your regular vet is unavailable or your pet needs special care we feel All-Care Animal Referral Center is the place to go. All-Care's philospophy is to provide the Mayo Clinic type of care for your pets. All-Care will gladly provide a tour of their facilities. Along with their own MRI, they do ultrasounds, perform arthoscopic surgery, treat hip dysplasia, do hip replacements, treat cancer (they have oncologists on staff), provide dental care, perform kidney transplants, provide physical therapy, etc! Just sitting in the waiting room at All-Care and talking to folks about their pets gives you an idea at the incredible things that All-Care can do there to improve the quality of life for your pet. 10. Growth Removal - Abscessed In January of 2001 we noticed that one of Goldie's many benign growths was getting rather large. It was in left rear leg. She was beginning to have problems getting around (she was tripping and had fallen on the stairs) and had problems defecating. The muscles in her leg were also beginning to atrophy. We took her to see Dr. Robert L. Rooks at All Care Animal Referral Center in Fountan Valley, California. Dr. Rooks saw all that and told us she was also in pain and it looked like the growth was pressing on her sciatica. At that point Goldie was 10 years and 8 months old with a severe heart condition. Dr. Rooks thought that she would benefit from surgery however, he wanted Dr. Michael Lesser of Advanced Veterinary Care, her cardiologist, to give his okay before the surgery. Goldie was examined by Dr. Lesser who said that Goldie could have the surgery however, she could be under anethesia for no more than one hour. Dr. Rooks went one step further and arranged for a board certified anesthesiologist to anethetize her. The surgery was scheduled to be performed on January 7, 2001. Dr. Rooks performs most of his surgeries very early in the morning - beginning as early as 3:00 a.m. Therefore the 'patient' needs to be at the hospital the night before for any lab work and preop. In consideration for Goldie's age and heart condition, Dr. Rooks wanted Goldie to have the least amount of stress, therefore we were allowed to bring Goldie in just prior to surgery (well before dawn). Dr. Rooks also sat us down before Goldie was taken into surgery. He reminded us that like all surgery, this one was not without risk, more so for her because of her heart. We all made the decision that if Goldie's heart were to stop during the surgery he was to let her go, or that is, to not resuscitate her. She did fine and luckily we did the surgery. As it turns out the growth was bigger than we thought and had actually grown up into her pelvic area and was around the sciatica and had abscessed. If we had not done the surgery Goldie would have been in increasing pain and would have had to be put down or suffered a very painful death when the abscess burst. After the surgery both the anesthesiologist and Dr. Rooks recommended that Goldie get acupuncture (see photo above) to assist with her healing. We are lucky to have an acupuncturist (who is also a D.V.M) that will come to our home. Dr. Rooks even took the time to call the acupuncturist and explained to them exactly what the procedure was and entailed and then reviewed her medical history, most specifically her heart condition. Within a month her muscles were coming back, she wasn't tripping and was having no problems defecating. All we can say is - thank you Dr. Robert L. Rooks and all of the staff at All-Care Animal Referral Center - another great moment in surgery!!!!! Not one 't' was left uncrossed, no 'i' was left undotted. All-Care allowed us to make an informed decision for our pet. We felt that she could get no better care anywhere else. 11. Transitional Cell Carcinoma - Treated with Feldan and Cytotec In July 2001 Goldie developed a bladder infection. She has had them before and we started her on a course of antibioics. Then two days later (on July 5th, 2001) she started urinated more frequently and blood reappeared in her urine. She usually responded quickly to antibiotics and never had this happened before. We knew immediately that something was not right. We called Dr. Robert L. Rooks at All-Care Animal Referral Center in Fountain Valley, California. Dr. Rooks called us back within the hour and asked that we come to All-Care immediately because he wanted to do an ultrasound to see if something else was going on. An ultrasound was conducted and a mass was found of which they got a sample of to biopsy. On the evening of July 6th, 2001 Dr. Rooks called to tell us that Goldie's biopsy came back and she had Transictional Cell Carcinoma (TCC) in the trigone area of her bladder. It was like being kicked in the stomach. He wanted to immediately start her on piroxicam (Feldan) and Cytotec and said he would be speaking with Dr. Ravi S. Dhaliwal of his staff, who is an oncologist, first thing the next morning. On Saturday, July 7th Dr. Rooks called 6:30 a.m. and said that he had spoken to Dr. Dhaliwal and told us to come into to speak with Dr. Dhaliwal that day. Dr. Dhaliwal took x-rays to make sure the cancer had not metastasized - it had not, however, Goldie was given 6 to 9 months to live. We reviewed the treatment options with both Dr. Dhaliwal and Dr. Rooks. Surgery, chemotherapy and radiation therapy were not going to extend her life any more then the drug therapy we decided upon. Also the drug therapy was the least invasive and had the least amount of side effects. This is the first time we ever felt defeated. Goldie had been through so much in her life to get this diagnosis. TCC is a cancer of skin cells, often the skins cells lining the bladder. It is classified as Stage 0 to Stage 4 depending upon how localized the tumor is: whether it is confined to the skin layer or penetrates surrounding muscle and/or tissue or whether it is metastatic (has formed new tumors in distant sites). There are currently four main options for treating TCC in dogs: 1. Drug Therapy with prioxicam (Feldan) 2. Chemotherapy 3. Radiation Therapy 4. Surgery As mentioned above we chose the Drug Therapy which we will go over last. Chemotherapy: Chemotherapy of dogs using Cisplatin has been studied by Dr. Wayne Shapiro of UC Davis School of Veterinary Medicine and by Dr. Deborah Knapp of Purdue. There have been no complete remissions of TCC docmented in dogs treated with Cisplatin chemotherapy. Partial remissions have occurred (1 in 6 at best) and stable disease has been observed for as few as 1 in 4 or as many as half of the dogs treated with an average survivial time of 180 days. The advantages is that it may prolong a dog's life and possibly improve it (reduce the tumor). Disadvantages include the fact that Cisplatin is a seriously toxic drug, that it may cause short-term effects such as nausea and vomiting and may have long-term effects such as renal toxicity. Complications include the fact that the drug must be administered intravenously. The dog must stay (at least) all day in the veterinary hospital. Treatment by a vet familiar with how to minimize or control side effects and what to monitor is essential. Treatment is expensive (several hundred dollars for the drug alone for a medium-sized dog - and Goldie was considered a giant breed) and the treatment must be repeated every 21 days. Radiation Therapy: There have been no reported remissions from radiation therapy. One study of radiation therapy done during surgery reported that the urinary bladder or ureter scarred and stiffened when irradiated, and that the tumor control was poor. The advantage is only that you can get a temporary alleviation of the symptoms. Surgery: Specifically this would mean removal of the bladder. Well it would be impossible to explain to a dog that the bag they are wearing must be kept clean and left alone. There have been surgeries done that after the bladder had been completely removed the ureters were then surgically attached to the large intestine so that urine flowed into the bowel. All of the dogs so treated developed high levels of nitrogen in the blood (azotemia). This causes nausea/vomiting and neurologic problems. The dogs lived one to five months. Dogs whose bladders were only partially removed did better; six of 11 dogs lived more than a year. The tumor was not completley removed, and after a time appeared to reoccur in most cases. Since Goldie's Tumor was in the Trigonal area (where the ureters enter from the kidneys, and the urethra exits) a partial removal was not an option. The advantages would only be if the tumor can be removed without disturbing the ureters and urethra, surgery could be a useful option and could make drug therapy with piroxicam and Cytotec more effective. The disadvantage of surgery comes into play if the ureters and urethra must be disturbed,surgery will then cause serious health problems. Complications of TCC are that they are extremely invasive turmors which spread rapidly and which can even be seeded (form new tumors) by surgery unless exquisite care is taken. If you choose surgery, find a really good surgical vet - also note surgery can be very expensive. Drug Thereapy with Piroxicam (Feldan): Feldan is a non-steroidal antiinflammatory drug (NSAID) primarily used to treat human arthritis. It has been studied in several species as a tumor suppressant drug. Dr. Deborah Knapp of Purdue Univeristy School of Veterinary Medicine studied the antitumor effects of Feldan in 34 dogs with TCC. 2 dogs achieved remission and 22 dogs partial remission or stable disease by defination of the study. 7 of the dogs lived for more than a year. These are the best results of any therapy for TCC to date. One of the advantages of Feldan is that it is a strong analgesic. So if it does nothing else, it will relieve the dog's pain. It is a relatively inexpensive drug. Most importantly this treatment is non-invasive. The main disadvantages of Feldan is that, like most NSAID, it irritates the gastrointestinal tract and may cause Gastro-Intestinal ('GI') bleeding. This is where the Cytotec is of use. The main complication is getting the correct dosage for both the therapeutic effect and to avoid GI irritation. The correct does is 0.3 mg Feldan per kg of dog per day. Once a day dosing is adequate and more drug will not work and only run you the risk of GI irritation. After reviewing the options with Drs. Rooks and Dhaliwal the drug therapy was the best option for us. We would bring Goldie in every two weeks for a re-check and found that the Feldan did in fact reduce the size of the tumor however, she did still get bladders infections. The bladder infections were treated with antibiotics. When she built up a tolerance to one antibiotic she was on all we had to do was to change to another antibiotic. Obviously quality of life was going to be our main concern. We told Drs. Rooks and Dhaliwal that we did not want Goldie to suffer and please to tell us if the time came to humanely put her down. One of the eventual side effects of having TCC was that Goldie was expected to become more and more incontinent. There are products out in the market to assist with this and we bought them to be prepared. However, the products were never required and the tough decision was never to be made. Goldie passed away quietly in her sleep sometime early in the morning of August 25, 2001. Her heart obviously stopped and she did not feel any pain. She looked beautiful and peaceful and painfree. Her last day was uneventful and there were no signs of trouble. Again we want to take the time to thank All-Care Animal Referral Center. We can not tell you the amount of compassion that was shown us from each and every member of the staff. Dr. Robert Rooks should be proud of the organization that he has created and each and every one of his employees need to realize how wonderful they are to make it all work the way it does. We will continue to go to All-Care when the need arises, as we are sure it will, because we will always have animals in our lives. Linda Louise's story includes the following topics: 1. Sarcoptic Mange 2 Foxtails 3. Canine Viral Papillomas 4. Scratched Cornea turning to Ulcers (Emergency Surgery) 5. Cherry Eye 6. Hypoplastic Trachea and Soft Palate Resection Surgery 7. Bilateral Stifle Arthritis 8. Bilateral Elbow Dysplasia and Elbow Arthoscopic Surgery 9. Laryngeal Saccules 10. Vaccinations - Are we over vaccinating our animals? Etc. This is a work in progress - come back and visit. We are probably just taking a break to play with the dogs. Please feel free to contact with any suggestions or comments at dougnora@aol.com hr7 |
our English Bulldog (also known as 'the pig') born on November 6, 1996 |
In Memory of Goldie May 7, 1990 - August 25, 2001 She is your friend, your partner, your defender, your dog. You are her life, her love, her leader. She will be yours faithful and true, to the last beat of her heart. You owe it to her to be worthy of such devotion. |
Welcome to Our Pets please laugh and learn with us and our experiences with our pets |
In Memory of Goldie May 7, 1990 - August 25, 2001 She is your friend, your partner, your defender, your dog. You are her life, her love, her leader. She will be yours faithful and true, to the last beat of her heart. You owe it to her to be worthy of such devotion. |
our English Bulldog (also known as 'the pig') born on November 6, 1996 |
Bobbie Lee our new addition - a Jack Russell 'terror' born on July 8, 2001 |
Some of our favorite people and Web pages for animal care |
This page was last updated on: January 31, 2002
Goldie's Story Goldie was an incredible animal. We received Goldie as a gift from good friends. Goldie's mother was a Great Dane and her father was a Doberman/Labrador mix. The litter was planned. Our friends wanted one litter out of the Dane because she was such a great dog so they bred her with another one of their beautiful dogs. She was taken from her litter at 3 1/2 weeks and weighing 9 pounds because there were nine fast growing puppies and the vet felt that the mother would have trouble feeding them all. Since one of us was home most of the day I was able to bring Goldie home. However, we made one important stop before going home and that was to Bay Cities Veterinary Hospital in Marina Del Rey, California and Dr. Sandi Milo. Dr. Milo along with Dr. Thomas Fitzpatrick, Dr. Mary Jane Brandt and staff of Bay Cities have been there for us in dealing with all sorts of problems both big and small. Another incredible source for care for Goldie had been and will be for all of our current and future pets is All-Care Animal Referral Center in Fountain Valley, California. All-Care is open 24 hours a day and provides Mayo-Clinic type of care for your pets. When your family vet is unavailable or unable to provide certain care for your pets All-Care is the place where we go and suggest the same to our family and friends. Goldie's 'puppydom' was pretty normal if you consider the chewing, jumping, running and the house training. The best chewing story and a strong reminder to leave your laundry secure was when she decided to eat a brand new suit my husband got in Italy - thank God for American Express. We had left the dry cleaning basket at the front door ready to be taken in the next day. Goldie took the opportunity that evening, after we went to bed, to take out the brand new suit and shred it. American express sent us a long form that needed to be filled out and reviewed before they could consider a refund. We filled out the form and decided to add a photo of our 80 pound puppy - we sent the form along with the shreds and the picture to Amex. In two days we received a phone call with laughter in the background - it was American Express. Amex wanted us to know that they just received their package and that we would be receiving a credit on our next statement (they loved the picture). Goldie with all her love and care still had a number of health problems in her life that we would like to share with you. While some of these health problems would be fatal for some Goldie had an incredible will to live and kept bouncing back such as: 5. Acupuncture 6. Hypothyroid 1. Proffessional Puppy Training? our biggest mistake! My husband and I were getting married when Goldie was just over 6 months old. We thought that while we were on our honeymoon it would be a good time for Goldie to be trained by a professional trainer - BIG MISTAKE!!!!! We used what we thought was a reputable trainer/kennel in Marina del Rey. We interviewed them and told them that we wanted Goldie to have lots of attention and lots of play time along with her training. We left her in their care for 3 weeks. Upon our return we immediately went to pick her up. I noticed that she seemed to be coughing. They told me she was clearing her throat - AND I BELIEVED THEM! Two days later she could not get out of her bed because she had kennel cough that had turned into pneumonia (in both of her lungs). Thanks to Dr. Sandi Milo at Bay Cities Veterinary Hospital and her diligent care, Goldie survived. We did call the trainer and he seemed to be totally unconcerned about her condition and did not offer to refund any of the fees that we paid him. I now caution anyone that puppy training is best conducted in your home or in a class enviroment with you there. Puppy's, even with their vaccinations up-to-date, are not completely protected. Also note that some dogs can not handle the stress of being in a kennel environment for any length of time. We have, from the time that Goldie had pneumonia, used pet sitters that stay in our home. It may cost more but the health of our pets is worth it! Note: Pneumonia is very hard on your pets heart and can cause problems later on - as it did in Goldie's case. 2. Ossifying Epulis When Goldie was three years old we noticed a growth in her upper jaw in her gums that resembled cauliflower. We took her to our family vet who felt it was important to remove it and have a biopsy performed. It came back as an Ossifying Epulis which was basically a tumor-like mass on the gingiva. The treatment would be to wait and see if it returned, which it did when she was 7 years old. When this happened our vet referred us to a surgical specialist to have the tooth in the area removed along with part of her jaw bone to prevent any regrowth. We went and meet with the surgeon and scheduled the surgery with the understanding that a tooth and part of her jaw would be removed. When we picked up Goldie after the surgery I noticed that no teeth were missing nor any of the jaw seemed to be affected. The surgeon was not available to speak with and called us the next day to tell us that she had an Ossifying Epulis (of all things!) and that he needed to perform another surgery and remove a tooth and part of her jaw. Well, we can tell you, we were a little taken aback - since we were referred to him to do just that and even had discussions in his office that that was what he would be doing. He very kindly offered to do the surgery and not charge us for the anesthesia. We very kindly declined. The Epulis recurred when Goldie was 9 years of age. This time our vet did not refer us to the same surgeon (we will not name him here - we will only mention those vets that we have and or had possitive experiences with). This time, because Goldie had developed a heart condition and needed to be properly monitered during anesthesia, we were referred to Dr. David Nielson of Animal Medial Group in Manhattan Beach who specialized in dental care for animals. He felt that because of her age and heart condition and since the growth was not invasive of the bone that he would do a Gingivectomy only (he did not want to be too invasive and put her under any undue stress). She came through the surgery with flying colors and the growth never reappeared. 3. Gastric Dilation - Volvulus ----- BLOAT!!!!!!!! Goldie was 5 years, 7 months old and we were getting ready to BBQ and I was feeding Goldie. When I put Goldie's food down she looked at it and walked away. Let me tell you from day one this dog had felt that each time she was fed it was like she had discoveed the cure for cancer. I felt her abdomen and found it slightly distended. I immediately yelled out to my husband to shut down the grill and that we had an emergency. Using the cell phone on the way to Bay Cities Veterinary Hospital we informed them that we had a possible bloat and we were on our way. Let me tell you folks this is a condition that if you even suspect it - do no wait - get to your vet or 24-hour emergency hospital and have your pet examined. As a matter of fact, Dr. Thomas Fitzpatrick of Bay Cities Veterinary Hospital, at first, thought that she may just have a little stomach upset - but erred on the side of caution and prepared surgery and took an x-ray. Goldie did not have many of the initial symtoms such as (and these are not all) hanging her head, graying gums, restlessness, attempts at vomiting, tongue hanging out or shock, but she did have the slight 'bloating' of her stomach. When Dr. Fitzpatrick returned with the x-rays he informed us that he needed to get her into surgery immediately! That is when Dr. Fitzpatrick took another look at Goldie and noticed that she started to hang her head and her gums had started graying - this was only 10 minutes from when he last saw her - and this was all of 30 minutes after I first notice something wrong at home. Goldie had engorged herself with at least a gallon of water. What caused her to do that we do not know - all I remember that day was that she seemed more thirsty than usual. My mistake was not monitoring the water intake more. Goldie came through the surgery fine that evening but there was still a risk of her stroking out so she needed to be closely monitored over the next 48 hours. She did great! within 36 hours after the surgery she was looking for kisses from the staff and us. Some preventive measures that we had taken since this episode was to feed Goldie not twice a day but three times a day (mini-meals) at an elevated eating station. Also we were mindful of limiting her exercise and water consumption just prior to, and following, eating. Always remember that our pets can not speak and we need to be observant of their behavior. We also feel it is important to have a vet that you can trust and is responsive when you say that something is wrong. Be aware of your vets hours of operation and also keep on hand the location and numbers of 24 emergeny veterinary hospitals - our favorite 24 emergency veterinary hospital in Southern California is All-Care Animal Referral Center in Fountain Valley, California (714) 963-0909. Note: As with pneumonia the Bloat can be stressful on the heart. 4. Incontinence and Bladder Infections Incontinence is not unusual for female dogs. It can occur at a younger age in spayed females and probably is more common in them. Which is what happened to Goldie. When Goldie was six years old she began urinating in her sleep. Our vet first ruled out a bladder infection before starting her Goldie on phenylpropanolamine (PPA) - it work great. Currently there is difficulty on getting PPA but be assured there are other options available for treatment including an estrogen supplement. Occasionally, Goldie also developed Bladder Infections. Bladder Infections (cystitis) is very common in dogs. It is usually caused by bacterial organisms that somehow get into the bladder and colonize in it (isn't that a nice way of putting it! yuck). Bladder infections are more common in females because the uretha is shorter. Goldie had the typical symptoms of having a bladder infection - she had to urinate often but only in small quantities, seemed to be uncomfortable or straining to urinate and there was traces of blood in her urine. The infections were treated with antibiotics which gave her seemingly immediate relief. Therefore, if you notice your pet straining or urinated more frequently, have them checked immediately. Please know that younger dogs are more likely to be affected than older dogs. Note: In July of 2001, Goldie got a bladder infection which we immediately began treating with antibiotics. After a couple of days, while still on the antibiotics, more blood appeared in her urine. As it turned out Goldie had developed Transitional Cell Carcinoma (TCC) - please see the section below. 5. Acupuncture - It WORKS!!!! Goldie at a number of times in her life seemed to be in pain. Dr. Mary Jane Brandt of Bay Cites Veterinary Hospital offers acupuncture. I was at first skeptical about using alternative medicine but Goldie was in pain and the other option was drugs that would mask the pain and possibly cause her more harm in the long run. Goldie mellowed out almost immediately after the first two needles were put in place. Her range of motion improved along with her energy level. Acupuncture was particularly helpful after surgery - speeding up the recovery time and minimizing post-operative pain. Acupuncture also help Goldie with her incontinence as an alternative to increasing her level of phenylpropanolamine (PPA). Because of Goldie's size we found that having the acupuncture done in the home was easier on her. Less stress in getting in and out of the car and remove the stress of just being in the doctor's office. In January of 2001, Goldie had to have a large growth removed from her leg that was causing her great pain and affecting her mobility. Because of Goldie's size and age, like many elderly people, her back 'went out' and she was in pain. To put her in the car in that condition would have been cruel and since she had a very severe heart condition we needed to be careful of the amount of pain meds that she was given. Dr. Rooks, of All-Care Animal Referral Center recommended that we get her some acupuncture ASAP. Luckily, we were able to get a house call. What a relief for Goldie (see photo below). As part of Goldie's regular care and at the advice of Dr. Rooks, Goldie was given acupuncture on a weekly basis. Dr. Kathleen Carson of the VCA Hospitals, in Los Angeles does house calls. She has been a savior. We believe that alternative medicine is an option. Like conventional medicine it may not have all the answers you are looking for. We always urge people to ask questions and make informed decisions for yourselves and your pets. What may work for our pets may not work for yours. This is where the 'practice of medicine' comes in. We always tell people that we are working on our Junior Vet Badge. Accupunture being performed 1 day post-op on 1/08/01 after removal of a large benign growth. 6. Hypothyroid Goldie was found to have a hypothyroid when she had a blood panel taken prior to her having surgery for cancer in January of 1999. She was put on Thyroxine and tested periodically to insure that her dosage was correct. Hypothyroidism is a common and serious genetic problem in dogs. There is virtually no breed of dog unaffected. The scope of the problem cannot be accurately defined because of a lack of complete statistical information; however, it is certain that veterinarians are seeing and treating a lot of thyroid cases. We believe that this problem seems to be more common because of improved pet care and testing capabilities. It is easily treatable and, with care, will help maintain the quality of life for your pet. Some of the clinical signs of Hypothyroidism include but are not limited to: Lethargy, obesity, mental dullness, cold intolerance, abnormally low heart rate (bradycardia), cardia arrythmias, weakness, seizures, ataxia, facial nerve paralysis, diarrhea, constipation, anemia, ellevated cholesteral levels, 'rat' tail, dry/brittle coat, poor wound healing, skin thickening, and or persistant infection. Please remember that while some of these symptoms may be signs of a hypothyroid condition in your pet only your vet can make that determination. These could also be signs of any number of other conditions. 7. Mast Cell Tumor and Spindle Cell Tumor Goldie had always had benign growths. At first, when she was younger, the only way to check on them was to have them surgically removed and a biopsy run. Later, we found that doing a needle aspirate was less invasive, gave us fairly accurate results and saved her from looking like the 'Bride of Frankenstein'. We were careful to have any new growths checked with a needle aspirate and any old growths re-checked if they changed in size or feel. Luckily we were diligent in doing this becuase in January of 1999 Dr. Mary Jane Brandt of Bay Cities Veterinary Hospital in Marina del Rey found that two new growths tested positive for cancer, one being a Mast Cell Tumor, the other being a Spindle Cell Tumor and they were within 2 inches of each other. We were given the names of two oncologist in Los Angeles, California and decided on Dr. Rodney Ayl of Animal Speciality Group. However, before we took Goldie to Animal Specialty Group a chest x-ray, ultrasound and a blood panel were run in preparation for surgery. As a result of these preliminary tests it was also discovered that Goldie had some problems with her heart. We were referred to Dr. Michael Lesser of Advanced Veterinary Care in Lawndale, California. The section titled The Heart of Goldie will overview the incredible and compassionate care that we received at Advanced Veterinary Care. Dr. Bilbrey of Animal Specialty Group did the surgery to remove the cancerous growths on Goldie. The growths were under her right front leg (in her 'arm pit'). Note, that not only were the growths removed but also about 1.25 inches of tissue in every direction around the tumors. We were very lucky to catch the cancer early because they were able to excise them completely and get clean margins and Dr. Ayl felt that neither chemotherapy nor radiation therapy would be required. Animal Specialty Group gave us a pager number so that we would be able call after hours to check on Goldie. Which of course we did. It was reassuring to have a doctor return the call. We have found that we are more comfortable leaving our animals overnight in a hospital environment have D.V.M.'s are on staff 24 hours a day, not only technicians. We have been amazed to find out that most veterinary hospitals do not have a D.V.M., a technician or anybody! in their hospitals after hours, even with animals in serious condition. We caution everyone to make an informed decision before leaving a pet overnight in any facility. We did some research on both Mast Cell Tumors and Spindle Cell Carcinoma. We have found that there is a way of classifying how far a maliganant tumor has spread prior to diagnosis. A 'Stage' and a 'Grade' classification is a way for the pathologist and/or oncologist to give thier impression of how aggressive a tumor is likely to be (how likely it is to spread to other tissues). Example of a mast cell tumor There are different staging schemes, but the standard is probably the World Health Organization (WHO) staging, even though it is geared more towards humans. A slightly simplified version of this is: Stage 1 --- Tumor is solitory, no sign that it has spread, tissue margins are clean on removal. Unlikely follow-on treatment will be suggested. Stage 2 --- The tumor has invaded regional lymph nodes - will probably require further treatment. Stage 3 --- The tumor is widely invasive, invaded past surgical excision and/or there are multiple tumors, even if the lymph nodes are not involved. Further treatment options should be discussed with your oncologist. Stage 4 --- The tumor has invaded tissue far from the original site. Grading of the malignancy of a tumor is somewhate subjective and is partially the pathologist's opinion, althought there are guidelines for grading, also. Grade 1 --- The tumors are the least likely to be highly maliganant. Grade 2 --- The tumor is malignant. Grade 3 --- The tumors are most likely to be highly malignant. The prognosis for a Grade 1, Stage 1 Mast cell tumor responding completely to surgical excision is good. In a review of mast cell tumors from 1988 (Vet Med, Paul Dean, 2/88), 44% of dogs with Grade 2 mast cell tumors survived more than 1500 days after surgical removal of the tumors, without additional treatment. A paper from the Animal Medical Center in Manhattan (Saraff, et al, 1996), of radiation therapy for the treatment of Grade 2 mast cell tumors in 32 dogs with Grade 2 tumors of the skin, had a better prognosis, with 86% of dogs treated with surgery and radiation making it to five years post treatment. Based on this, it seems like a good idea to consider radiation therapy, even when clean margins are obtained during surgical excision. Chemotherapy is an option but does not seem to be as effective as radiation therapy. However, radiation therapy is not as effective if the tumor has spread (Stage 2 or greater) --- so in this case, chemotherapy may have an edge. The oncologist will be able to help you decide which approach will be best. We are lucky to live in an area where we have a number of oncology specialists available to consult. We particularily respect the abilities of, because of our experiences with, both Dr. Rodney Ayl of Animal Specialty Group and Dr. Ravi S. Dhaliwal of All-Care Animal Referral Center in Fountain Valley, California (when Goldie developed Transitional Cell Carcinoma in 2001). 8. The Heart of Goldie In January of 1999 in preparation for cancer surgery, Goldie was given an ultrasound and had a blood panel done. As a result of the ultrasound and blood work it was found that Goldie's heart wasn't what it should be and her thyroid level was low. Dr. Mary Jane Brandt of Bay Cities Vetinary Hospital immediately started Goldie on Thyroxine and referred us to Dr. Michael Lesser of Advanced Veterinary Care in Lawndale, California. Dr. Lesser specializes in Cardiology. Dr. Lesser did a thorough examination by performing an Echocardiogram (Ultrasound of her heart) and an Electrocardiogram (to assess the electrical activity of the heart). The echocardiogram gives the most accurate determination of the size of each heart chamber and permits measurement of the thickness of the heart walls. The echo allows the doctor to see in actual time the contractions of the heart and can measure the contractions and compare them to the normal animal. The electrocardiogram assessed the electrical activity of the heart - or that is to determine the heart rate and to more accurately identify any arrhythmias which might be present. The combination of these tests resulted in Goldie being diagnosed with Dilated Cardiomyopathy with Ventricular and Supraventricular Arrhythmias. Arrhythmias are adnormal rhythms and can be, with the right medications, managed. Dilated Cardiomyopathy means that the heart muscle, espcially the thick muscle wall of the left ventricle, becomes much thinner than normal. The pressure of the blood inside the heart then allows this thinned wall to stretch, resulting in a much larger left ventrical chamber. Dilated Cardiomyopathy is the most common cause of heart failure in large breeds of dogs and can occur, less commonly, in all dogs in general. Dilated cardiomyopathy develops over many months or even years. Its effect on blood flow also develops slowly. As heart function declines, the body is able to compensate. However, at some point in time, the body's ability to compensate is no longer effective. At that point, dogs go into severe heart failure in what appears to be a matter of hours. Rapid, heavy breathing, a blue tongue, excessive drooling, coughing and/or gagging or collapse may be the first signs of problems or heart failure. We were lucky because the ultrasound performed at Bay Cities Veterinary Hospital found the problem fairly early so that Goldie could get treatment. Dr. Lesser prescribed Goldie Atenolol, Digoxin and Enalapril. Atenolol is a Beta Blocker. Digoxin (Digitalis or Lanoxin) is used to help the heart contract better and to slow the heart rate down if certain arrhythmias exist. Enalapril (or Vasotec, Enacard, Zestril, Prinavil and Lotensen) is a Diuretic that is used to help both to control and prevent accumulation of fluid in or around the lungs. Be aware that each patient is different and it takes care and time to get the right combination of drugs that works best. Usually long term prognosis for dialated cardiomyopathy varies considerably. Unfortunately, most dogs with signs of heart failure at the time of diagnosis die as a result of the disease within 6 months to two years. Some dogs, espcially certain breeds with a more severe form of the disease may survive only weeks to a couple of months. We got 2 years and 7 more months with her before she died peacefully in her sleep after an uneventful, painfree day. We have a second home in Mammoth, California. Because of Goldie's condition we were informed that she would not be able to go to that elevation again - too much stress on her heart (We are blessed with the best dog sitters!!!!!). Dr. Lesser had to be called on a number of times in the ongoing care of Goldie that did not specifically deal with her heart but could affect it. Dr. Lesser worked with Dr. Rodney Ayl at Animal Speciality Group in Los Angeles to insure that Goldie would go through her surgery to remove the Mast Cell Tumor and the Spindle Cell Carcinoma with the least amount of stress in January of 1999. Dr. Lesser then in August of 1999 worked with Dr. David Nielson at Animal Medical Group in Manhattan Beach, California to inform him of Goldie's condition and to insure that she was properly monitored during her oral surgery to remove an Ossifying Epulis, again to prevent any undue stress. Dr. Lesser, on two seperate occasions, then worked with Dr. Robert L. Rooks of All Care Animal Referral Center in Fountain Valley, California when Goldie had back surgery in July of 2000 and again in January of 2001 when Goldie had to have a large growth removed. As a matter of fact Dr. Rooks would not perform the surgeries unless Dr. Lesser gave the go ahead. Dr. Lesser's care and work with Goldie's various vets allowed Goldie to live comfortably and fairly event free during the last 2 years and 7 months of her life. Because of Goldie's condition, she did have some 'episodes''. These episodes, we believe, are not uncommon when a dog has this type of heart condition. Many times a simple adjustment of the medications is all that is needed. Dr. Lesser was always quick to respond to our needs and answer all our questions. At one point, when Goldie had an episode when we were out of town and our dog sitter was afraid to move Goldie herself, two of Dr. Lesser's staff came to our home to pick up Goldie and get her back to his office to be examined. We then were able to pick Goldie up from his office later in the day. He had put a monitor on her to wear for 24 hours to find out if there was something going on that we needed to be aware of. Luckily it was an episode that did not do any permanent damage to her heart and he was able to adjust the amount of her medications so that her heart would work more efficiently. 9. Back Pain and the Surgery In June of 2000 Goldie began experiencing alot of pain, was having difficulty getting up, much less getting comfortable and was not eating. We took her to our family vet, Bay Cities Veterinary Hospital in Marina del Rey, California. They saw that Goldie was in such a condition that they referred us to a vet at a 24 hour veterinary hospital in Los Angeles. We immediately took Goldie there. The vet that saw us said that we had a 10 year old great dane with a heart condition and there was nothing he could do for her. Over the next two days we took her to two more vets that were recommended by friends. They shrugged their respective shoulders and said that there was nothing that they could do. Not one of these vets even address the pain Goldie was in. One of our dog sitters then told us about Dr. Robert L. Rooks and All-Care Animal Referral Center in Fountain Valley, California. We called them and explained our situation and they found room in Dr. Rooks' schedule for us to see him that same day. Dr. Rooks did a thorough examination of Goldie and said "you have a dog in pain and I think I can do something about it". He wanted to do an MRI (folks they have their own MRI!) so that he could better diagnose Goldie's condition. Before the MRI was performed Dr. Rooks insisted on consulting with and getting the approval of Goldie's cardiologist, Dr. Michael Lesser of Advanced Veterinary Care in Lawndale, California. Dr. Lesser told Dr. Rooks to go ahead with the procedure. At this time Goldie had a hyperthyroid condtion and Dr. Lesser was treating Goldie for dilated cardiomyopathy with ventricular and supraventricular arrhythmias. The MRI showed that Goldie had two discs that were pinched in her lower back. Dr. Rooks recommended that the discs be fused. Again, before he went ahead with the surgery, Dr. Rooks spoke with Dr. Lesser to get his go ahead. The surgery was performed early on the morning of July 4th, 2000. Dr. Rooks called us as soon as the surgery was completed to tell us that everything went great and her heart held up just fine. He called again letter in the day to update us on her progress. Once Goldie was home and recouperating, Dr. Rooks and or his staff found the time to call us to check on Goldie's progress. Each time we were told to call them at any time if there were any questions or concerns. When we did have a question we were immediately called back by a D.V.M. who had Goldie's chart in front of them and got our answers. Please note that before the MRI and the surgery Dr. Rooks sat us down and explained that no procedure that requires anesthesia is without risk. We assured him that we were aware of the risks however her quality of life as it was was worth taking the risk. Goldie's surgery was a success. She immediately got her appetite back, was no longer in pain, regained her mobility and started to play with our english bulldog, Linda Louise. Without this surgery Goldie would probably have had to be put down because the pain was obviously so great. Not only was Dr. Lesser kept updated as to Goldie's progress but Dr. Rooks and All-Care sent progress reports to our family vet, Bay Cities Veterinary Hospital. If at any time your regular vet is unavailable or your pet needs special care we feel All-Care Animal Referral Center is the place to go. All-Care's philospophy is to provide the Mayo Clinic type of care for your pets. All-Care will gladly provide a tour of their facilities. Along with their own MRI, they do ultrasounds, perform arthoscopic surgery, treat hip dysplasia, do hip replacements, treat cancer (they have oncologists on staff), provide dental care, perform kidney transplants, provide physical therapy, etc! Just sitting in the waiting room at All-Care and talking to folks about their pets gives you an idea at the incredible things that All-Care can do there to improve the quality of life for your pet. 10. Growth Removal - Abscessed In January of 2001 we noticed that one of Goldie's many benign growths was getting rather large. It was in left rear leg. She was beginning to have problems getting around (she was tripping and had fallen on the stairs) and had problems defecating. The muscles in her leg were also beginning to atrophy. We took her to see Dr. Robert L. Rooks at All Care Animal Referral Center in Fountan Valley, California. Dr. Rooks saw all that and told us she was also in pain and it looked like the growth was pressing on her sciatica. At that point Goldie was 10 years and 8 months old with a severe heart condition. Dr. Rooks thought that she would benefit from surgery however, he wanted Dr. Michael Lesser of Advanced Veterinary Care, her cardiologist, to give his okay before the surgery. Goldie was examined by Dr. Lesser who said that Goldie could have the surgery however, she could be under anethesia for no more than one hour. Dr. Rooks went one step further and arranged for a board certified anesthesiologist to anethetize her. The surgery was scheduled to be performed on January 7, 2001. Dr. Rooks performs most of his surgeries very early in the morning - beginning as early as 3:00 a.m. Therefore the 'patient' needs to be at the hospital the night before for any lab work and preop. In consideration for Goldie's age and heart condition, Dr. Rooks wanted Goldie to have the least amount of stress, therefore we were allowed to bring Goldie in just prior to surgery (well before dawn). Dr. Rooks also sat us down before Goldie was taken into surgery. He reminded us that like all surgery, this one was not without risk, more so for her because of her heart. We all made the decision that if Goldie's heart were to stop during the surgery he was to let her go, or that is, to not resuscitate her. She did fine and luckily we did the surgery. As it turns out the growth was bigger than we thought and had actually grown up into her pelvic area and was around the sciatica and had abscessed. If we had not done the surgery Goldie would have been in increasing pain and would have had to be put down or suffered a very painful death when the abscess burst. After the surgery both the anesthesiologist and Dr. Rooks recommended that Goldie get acupuncture (see photo above) to assist with her healing. We are lucky to have an acupuncturist (who is also a D.V.M) that will come to our home. Dr. Rooks even took the time to call the acupuncturist and explained to them exactly what the procedure was and entailed and then reviewed her medical history, most specifically her heart condition. Within a month her muscles were coming back, she wasn't tripping and was having no problems defecating. All we can say is - thank you Dr. Robert L. Rooks and all of the staff at All-Care Animal Referral Center - another great moment in surgery!!!!! Not one 't' was left uncrossed, no 'i' was left undotted. All-Care allowed us to make an informed decision for our pet. We felt that she could get no better care anywhere else. 11. Transitional Cell Carcinoma - Treated with Feldan and Cytotec In July 2001 Goldie developed a bladder infection. She has had them before and we started her on a course of antibioics. Then two days later (on July 5th, 2001) she started urinated more frequently and blood reappeared in her urine. She usually responded quickly to antibiotics and never had this happened before. We knew immediately that something was not right. We called Dr. Robert L. Rooks at All-Care Animal Referral Center in Fountain Valley, California. Dr. Rooks called us back within the hour and asked that we come to All-Care immediately because he wanted to do an ultrasound to see if something else was going on. An ultrasound was conducted and a mass was found of which they got a sample of to biopsy. On the evening of July 6th, 2001 Dr. Rooks called to tell us that Goldie's biopsy came back and she had Transictional Cell Carcinoma (TCC) in the trigone area of her bladder. It was like being kicked in the stomach. He wanted to immediately start her on piroxicam (Feldan) and Cytotec and said he would be speaking with Dr. Ravi S. Dhaliwal of his staff, who is an oncologist, first thing the next morning. On Saturday, July 7th Dr. Rooks called 6:30 a.m. and said that he had spoken to Dr. Dhaliwal and told us to come into to speak with Dr. Dhaliwal that day. Dr. Dhaliwal took x-rays to make sure the cancer had not metastasized - it had not, however, Goldie was given 6 to 9 months to live. We reviewed the treatment options with both Dr. Dhaliwal and Dr. Rooks. Surgery, chemotherapy and radiation therapy were not going to extend her life any more then the drug therapy we decided upon. Also the drug therapy was the least invasive and had the least amount of side effects. This is the first time we ever felt defeated. Goldie had been through so much in her life to get this diagnosis. TCC is a cancer of skin cells, often the skins cells lining the bladder. It is classified as Stage 0 to Stage 4 depending upon how localized the tumor is: whether it is confined to the skin layer or penetrates surrounding muscle and/or tissue or whether it is metastatic (has formed new tumors in distant sites). There are currently four main options for treating TCC in dogs: 1. Drug Therapy with prioxicam (Feldan) 2. Chemotherapy 3. Radiation Therapy 4. Surgery As mentioned above we chose the Drug Therapy which we will go over last. Chemotherapy: Chemotherapy of dogs using Cisplatin has been studied by Dr. Wayne Shapiro of UC Davis School of Veterinary Medicine and by Dr. Deborah Knapp of Purdue. There have been no complete remissions of TCC docmented in dogs treated with Cisplatin chemotherapy. Partial remissions have occurred (1 in 6 at best) and stable disease has been observed for as few as 1 in 4 or as many as half of the dogs treated with an average survivial time of 180 days. The advantages is that it may prolong a dog's life and possibly improve it (reduce the tumor). Disadvantages include the fact that Cisplatin is a seriously toxic drug, that it may cause short-term effects such as nausea and vomiting and may have long-term effects such as renal toxicity. Complications include the fact that the drug must be administered intravenously. The dog must stay (at least) all day in the veterinary hospital. Treatment by a vet familiar with how to minimize or control side effects and what to monitor is essential. Treatment is expensive (several hundred dollars for the drug alone for a medium-sized dog - and Goldie was considered a giant breed) and the treatment must be repeated every 21 days. Radiation Therapy: There have been no reported remissions from radiation therapy. One study of radiation therapy done during surgery reported that the urinary bladder or ureter scarred and stiffened when irradiated, and that the tumor control was poor. The advantage is only that you can get a temporary alleviation of the symptoms. Surgery: Specifically this would mean removal of the bladder. Well it would be impossible to explain to a dog that the bag they are wearing must be kept clean and left alone. There have been surgeries done that after the bladder had been completely removed the ureters were then surgically attached to the large intestine so that urine flowed into the bowel. All of the dogs so treated developed high levels of nitrogen in the blood (azotemia). This causes nausea/vomiting and neurologic problems. The dogs lived one to five months. Dogs whose bladders were only partially removed did better; six of 11 dogs lived more than a year. The tumor was not completley removed, and after a time appeared to reoccur in most cases. Since Goldie's Tumor was in the Trigonal area (where the ureters enter from the kidneys, and the urethra exits) a partial removal was not an option. The advantages would only be if the tumor can be removed without disturbing the ureters and urethra, surgery could be a useful option and could make drug therapy with piroxicam and Cytotec more effective. The disadvantage of surgery comes into play if the ureters and urethra must be disturbed,surgery will then cause serious health problems. Complications of TCC are that they are extremely invasive turmors which spread rapidly and which can even be seeded (form new tumors) by surgery unless exquisite care is taken. If you choose surgery, find a really good surgical vet - also note surgery can be very expensive. Drug Thereapy with Piroxicam (Feldan): Feldan is a non-steroidal antiinflammatory drug (NSAID) primarily used to treat human arthritis. It has been studied in several species as a tumor suppressant drug. Dr. Deborah Knapp of Purdue Univeristy School of Veterinary Medicine studied the antitumor effects of Feldan in 34 dogs with TCC. 2 dogs achieved remission and 22 dogs partial remission or stable disease by defination of the study. 7 of the dogs lived for more than a year. These are the best results of any therapy for TCC to date. One of the advantages of Feldan is that it is a strong analgesic. So if it does nothing else, it will relieve the dog's pain. It is a relatively inexpensive drug. Most importantly this treatment is non-invasive. The main disadvantages of Feldan is that, like most NSAID, it irritates the gastrointestinal tract and may cause Gastro-Intestinal ('GI') bleeding. This is where the Cytotec is of use. The main complication is getting the correct dosage for both the therapeutic effect and to avoid GI irritation. The correct does is 0.3 mg Feldan per kg of dog per day. Once a day dosing is adequate and more drug will not work and only run you the risk of GI irritation. After reviewing the options with Drs. Rooks and Dhaliwal the drug therapy was the best option for us. We would bring Goldie in every two weeks for a re-check and found that the Feldan did in fact reduce the size of the tumor however, she did still get bladders infections. The bladder infections were treated with antibiotics. When she built up a tolerance to one antibiotic she was on all we had to do was to change to another antibiotic. Obviously quality of life was going to be our main concern. We told Drs. Rooks and Dhaliwal that we did not want Goldie to suffer and please to tell us if the time came to humanely put her down. One of the eventual side effects of having TCC was that Goldie was expected to become more and more incontinent. There are products out in the market to assist with this and we bought them to be prepared. However, the products were never required and the tough decision was never to be made. Goldie passed away quietly in her sleep sometime early in the morning of August 25, 2001. Her heart obviously stopped and she did not feel any pain. She looked beautiful and peaceful and painfree. Her last day was uneventful and there were no signs of trouble. Again we want to take the time to thank All-Care Animal Referral Center. We can not tell you the amount of compassion that was shown us from each and every member of the staff. Dr. Robert Rooks should be proud of the organization that he has created and each and every one of his employees need to realize how wonderful they are to make it all work the way it does. We will continue to go to All-Care when the need arises, as we are sure it will, because we will always have animals in our lives. Linda Louise's story includes the following topics: 1. Sarcoptic Mange 2 Foxtails 3. Canine Viral Papillomas 4. Scratched Cornea turning to Ulcers (Emergency Surgery) 5. Cherry Eye 6. Hypoplastic Trachea and Soft Palate Resection Surgery 7. Bilateral Stifle Arthritis 8. Bilateral Elbow Dysplasia and Elbow Arthoscopic Surgery 9. Laryngeal Saccules 10. Vaccinations - Are we over vaccinating our animals? Etc. This is a work in progress - come back and visit. We are probably just taking a break to play with the dogs. Please feel free to contact with any suggestions or comments at dougnora@aol.com hr7 |
Some more photos of Our Pets and some of Our Friends: |
