Hope did not prevail in the end. Our little blind Shepherd, the girl with the "perpetual puppy" look, died this afternoon. We made the decision to let her go gently and with dignity.
The MRI images showed that a tumor at the base of her brain had obstructed the flow of the fluid that normally bathes the spinal cord. With nowhere to go, the fluid had backed up inside her brain, creating a large reservoir and causing intercranial pressure to rise dramatically. Although the neurologists have seen this type of tumor before, they have not seen a dog in as bad a condition as Pepper. Usually the dog is showing much milder symptoms. In Pepper’s case, she had somehow been able to compensate incredibly well while her brain was being flooded. Yet when her brain finally was tipped over the edge, she had nothing left to give … which is why, even today, she had yet to come out of her coma-like condition.
Dr. Wininger explained that while it would be possible to do surgery and remove the tumor, we had only a 20% chance of her surviving the operation. Those are terrible odds but one we’d be willing to take if she could beat this thing … but Dr. Wininger said the tumor would, in fact, come back. Even if she survived surgery and then completed a month-long radiation therapy, the tumor would still come back — in a year at the outside. And at that point we would have no other treatment options — a second surgery is not feasible — and Pepper would be right back where she is today.
There are two possible types of tumor causing the obstruction — a choroid plexus tumor or a meningioma. The first one, the choroid plexus, is the worst of the two, and after surgery and radiation it would be back within months. The meningioma is the "nicer" tumor that might allow a survival time of up to a year, but it too would still come back to kill her.
That one-year time frame is a median survival rate, so if you imagine a bell curve, a year would be at the top or center of the curve. A few survive longer and would be on the right side of the bell curve, and a few die sooner, putting them on the left side of the bell curve. In Pepper’s case, given the severity of her symptoms, Dr. Wininger said she would already be starting out on the left side of the curve … if she could survive surgery.
And that was only if it was a meningioma. It was more likely — in fact, a 50% to 70% greater likelihood — to be the choroid plexus tumor, meaning the survival time is measured in only a few months.
I talked through all this several times with Dr. Wininger this afternoon after reviewing the MRI images. Then I called Alayne to tell her everything I had learned. After three long, painful and tearful conversations, Alayne and I finally decided we wouldn’t put Pepper through this. We don’t mind the 20% chance of surviving the surgery, but then only to have the tumor come back … we just couldn’t see doing that to her.
Dr. Wininger said the surgery, intensive post-operative care, and month-long radiation therapy would have cost between $8,000 and $10,000 … but I can tell you that the cost did not factor into the decision. Had it been a $2,000 operation, we would have reached the same conclusion. Because of the sanctuary’s compassionate and generous donors, we are blessed that we don’t have to make medical decisions like this based on cost — only on what is best for the animal.
I told Dr. Wininger that we would let Pepper go. He left me alone in an exam room to cry while they went to get Pepper and wheel her in. When I saw her on the gurney, I knew we had made the right decision. She was still comatose, and more than two hours after the MRI, she still had not recovered from the anesthesia. In fact, she was unable to breathe on her own. I don’t know if she knew I was there, but I stroked her face and held her paws in my hands while I cried over our little blind girl. And then I told her how sorry we were. I was still holding her paws when she slipped away.
Goodbye, Pepper. We love you, honey.
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