Reagan

By Julie Tyger

April 16, 2011

Soon after Reagan, my Jack Russell Terrier, and I moved in with my mother in the winter of 2009, she had a couple of accidents in the house. I knew something wasn't right. The original vet said her age, recent stress, and being in another dog's house were the likely causes. Knowing Reagan as I do, this didn't seem right to me. After six months, changing vets, and my insistence on multiple tests, we finally and devastatingly diagnosed Reagan with Transitional Cell Carcinoma, also referred to as TCC, a cancer of the bladder.

TCC is a terrible cancer that can be very aggressive. The course of treatment traditionally varies from anti-inflammatory medication to chemotherapy, and, in extreme cases, surgery. At first, I was told there was nothing I could do and her prognosis was a couple of months. "Go home and enjoy your time with her," were my instructions. Being twelve, she was in perfect health and acted extremely young for her age. Moreover, she was my best friend and companion. All these reasons ensured my determination to do whatever I could to extend her life while making sure her quality of life was sustained. She had to be able to run, play, chase squirrels - in general be a Jack Russell.

Two months after starting chemotherapy the tumor in her bladder partially blocked both tubes from her kidneys to the bladder, the ureters. This would require a surgery to move the ureters to a different part of the bladder where the tumor was not growing. Just before her procedure, her surgeon suggested having her treated at Colorado State University Animal Cancer Center (CSU ACC) in Fort Collins, CO, where they had the capability to provide advanced treatment for Reagan's condition. Coincidentally, I had been considering relocating to Colorado and this provided the inspiration to move. With her appointment scheduled we were in Denver within a week.

Arriving at CSU, we learned that a new treatment called Intensity Modulated Radiation Therapy (IMRT) was showing promise as a treatment for TCC in dogs. As Dr. LaRue, the head of Radiation Oncology, explained, Reagan would have a CT scan to locate the tumor and create a 3-D tumor map of sorts. That map would be used to plan her treatment so the radiation would specifically target the tumor and spare the healthy tissue. She would have a custom made bed for her treatments to ensure she was in the same position for every treatment. Additional CT scans would be performed before each treatment to check the tumor size (which was hopefully shrinking) and to check, locate, and position the radiation beam thereby ensuring localized and precise treatment each time. While promising, this treatment needs time to shrink the tumor - which we were concerned we might not have given how quickly the tumor was growing.

We were in a catch 22 because Reagan's tumor had now spread so quickly that surgery was no longer an option and the tumor was causing urine to back-up into her kidneys, resulting in signs of kidney failure. This also meant the anesthesia that would be required for each radiation treatment would carry a higher degree of risk. The IMRT was the only treatment option - and we all knew it was a long shot because it might not work quickly enough and because of her concurrent kidney disease. We all understood the risks through a series of conversations. Dr. Barb Biller, her medical oncologist, and I agreed to monitor her blood for signs of kidney function knowing if it got worse, we would stop. She prescribed prednisone, a steroid, right away hoping its temporary tumor shrinking effects would be enough to help her kidney function and give the radiation time to do its job. After the first blood test taken after her second treatment, Dr. Biller called me and said that the values had unbelievably gone down to almost normal. She told me she was so surprised when she saw the results that she had tears in her eyes. She wasn't the only one tearing up; I almost couldn't talk.

For a time Reagan maintained positive results. I attribute the miracle of Reagan's improving prognosis to the competency and compassion of the staff at CSU, prayers from wonderful people all over the country, and a very strong little dog, Milo a Jack Russell Terrier with TCC and fellow patient at the ACC. Reagan and Milo became best friends during radiation where they played and cuddled. Reagan's beau is another amazing story of CSU as Milo was the pioneer of IMRT for bladder cancer in dogs as well as the only dog to have IMRT twice - once for his original tumor and again when it grew back. Milo forged the way to give other dogs quality time by helping the doctors learn about radiation therapy as a new treatment. Together they both completed radiation, Reagan with almost normal kidney function. The next week they started chemotherapy to attack any spread of the disease.

I wrote this article because I want people to know that with recent advances owners can have hope of more quality time with their buddies. I don't know what the future holds for us, but Reagan has already lived 5 good months post diagnosis. I'm hoping for a "Milo" who has survived 3 years after his initial diagnosis after finishing a second round of radiation for recurrence. Milo and Reagan don't know they are little dogs or that they are playing such a large role in making progress against TCC. Good thing no one tried to tell them to just go home and give up!

Everyone at CSU was wonderful, both with treating her cancer and trying to determine what was causing her kidney issues. Part of what made our experience at CSU unique is that Reagan was known throughout the hospital, bringing smiles to people's faces as she pranced down the hall, ears flopping and tail wagging, flopping over for belly rubs. Although as I reflect, I know other patients and owners also got this personalized care - it is just "how the oncology team rolls!" It shows how personal CSU makes any treatment experience.

Update written June 2011:
At the time we started chemo, Reagan's tumor was stable and her blood work was improved, all within the normal range. We were even discussing long term care. Even with such improvement, Reagan lost her courageous battle with cancer and kidney disease on April 8, 2011. She lived out her final days with the same tenacity and zest for life as she demonstrated all of her almost 13 years. I know Reagan is in a better place where she's again able to run, play, and chase with abandon. She is still greatly loved and is greatly missed. I am incredibly grateful for the additional quality time we had together and the all of the effort and compassion both Reagan and I received by everyone at CSU.

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