I had a call last Thursday evening from Dr. Fred Wininger, the neurologist at Washington State University’s veterinary teaching hospital, with some more answers about what happened to our blind Shepherd Pepper. It was exactly a week after Pepper died, and the information he gave us helped shed some more light on her disease. I took the photo above of Pepper in the MRI machine at WSU, and below you will see an image from the MRI that Dr. Wininger emailed me. I didn’t use these when I wrote about her death because, well, they seemed beside the point at the time.
After we made the decision to euthanize Pepper, Dr. Wininger asked me if we would give him permission to operate on Pepper the following day to further the research into the kind of tumor she had. (The fact that she would have been euthanized the previous day did not affect what they would learn.) Cases like Pepper’s are so rare that they had not done this surgery at WSU in two years. Moreover, Dr. Wininger said they were trying to determine if the MRI images could give the neurologists a better "signature" or reading on exactly what type of tumor it was before doing the brain surgery. As I reported on the day we lost Pepper, they suspected two possible types of tumors — a choroid plexus tumor and a meningioma.
Even after radiation therapy, which is the second step after surgery to remove the cancer, a choroid plexus tumor would come back in just a few months, while a meningioma might take up to a year to return. That information alone might make a difference to another family, trying to decide if surgery on their beloved animal was an option.
I told Dr. Wininger that we would definitely let him operate on Pepper, and that if her case helped advance veterinary medicine’s understanding of these terrible tumors, that would make us feel better about her tragic outcome.
When he called on Thursday evening, he had just come out of an hour-long meeting with WSU’s veterinary pathologists who had been studying Pepper’s biopsy for days. The pathologists told Dr. Wininger that they had "never seen anything like it before" … and that they still did not know what kind of cancer it was. It was in the choroid plexus region but was not the type of tumor they typically see there. So they were mystified by what they found.
Moreover, the tumor was "very infiltrative," meaning it had spread many small branches throughout her brain. Dr. Wininger said that they couldn’t fully detect this from the MRI images, and that the degree of infiltration meant "it would have been very difficult, if not impossible, to remove it all." And, he added, given the time it would have taken on the operating table to try and get the entire tumor out, it was even less likely she could have survived the surgery.
As if that wasn’t enough, because they don’t know what kind of tumor it was, Dr. Wininger said they would have no idea whether it would have responded to radiation therapy.
After reviewing all of this, Dr. Wininger told me he was convinced we made absolutely the right decision to let Pepper go. And that, of course, made Alayne and me feel a lot better. We hadn’t second-guessed this decision on Pepper — when I saw her on the gurney when they wheeled her in for the last time, I was sure she couldn’t survive the surgery and its aftermath — but it is a relief to have clinical evidence to reaffirm such a difficult decision.
Now, the question remained, why did Pepper’s symptoms — the seizures and the coma-like condition — happen so suddenly? Here’s one of the MRI scans of her head:
Her skull is at the top of the image, and you’ll see a dark horizontal-shaped space in the middle of her brain … it kind of looks like a water balloon being squeezed in the center. That’s the fluid-filled dilated ventricle inside her brain where the cerebral spinal fluid has backed up, creating the reservoir. As the tumor continued to block the spinal fluid from flowing out and down her spinal cord, it kept backing up inside the brain and expanding that reservoir, putting relentless pressure on her brain. Dr. Wininger said that ventricle is at least two to three times normal size — so you can imagine what this was doing to her brain.
The pathologists told Dr. Wininger that the reason her symptoms came on so fast is because the tumor had shut off the "valve" very acutely, or quickly. With the type of tumor they more typically see, this is a gradual process … which is why the dogs that come in have much more mild symptoms than Pepper did.
I hope you don’t mind all this detail, but Dr. Wininger’s update helped give us closure, both emotionally and clinically, and I wanted to share that with you. WSU is cremating Pepper’s body and we will be getting her ashes back soon. That will provide the final closure for us.
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