History on Roma's Spinal Nephroblastoma

In mid September, 2013, Roma started to show some odd movement in her right hind leg. The mobility in that leg deteriorated very quickly over the next couple of days. Then she started to lose mobility in her left hind leg also. Within a week, she could not stand up on her own.

Roma was seen by a variety of vets with different specialty interests, but none of them seemed to be able to find a cause. When she could no longer stand on her own, her owner took her to the East Bay Veterinary Specialty hospital in Walnut Creek, CA. They have a neurologist on staff and Roma had an appointment to see him that week, but on Sunday night, when she no longer could walk, Shelley took her in and the neurologist, Dr. Filippo Adamo, saw her earlier than planned.

Dr. Adamo suspected that Roma had a spinal nephroblastoma and sent Shelley off to Redwood City to have an MRI done on her spine. Nephroblastoma is a pretty rare condition. It starts in the embryo when the kidneys are formed. When they drop, they leave a little tissue behind and it forms a tumor. It can be in the spine and in other locations in the body. It occurs in people as well as dogs. It is predominantly found in young female dogs. I have never heard of this in a Great Dane before.

The results of the MRI confirmed Dr. Adamo's suspicion and we were told that she needed surgery immediately if we were going to save her life. It was a very tough decision. None of the Internet sources we found for information on this type of tumor had encouraging information. We really wanted to give her a chance, but the prognosis seemed quite grim and the treatment extremely expensive. After a long night talking this over, we decided to give her the chance. Dr. Adamo did the surgery on September 24.

These pictures were taken on September 28, just a few days after her surgery.

Roma stayed at the hospital for a couple of weeks recovering from the surgery. She was unable to walk on her own, so they positioned her in the x-ray treatment room with a view of the area where the techs did procedures. Everyone there got to know and love her. She was right in the center of all the action. It was like having 24x7 live doggie TV. She was very happy there and never showed any signs of depression. They took amazing care of her during that time - keeping her comfortable after the surgery and doing physical therapy on her to help her regain sensation in her hind end.

This is the chronological sequence of the onset and treatment of her condition:

September 15: Shelley notices Roma moving a little strange in the rear while romping at a dog park
September 16: Roma stepping gingerly like she has sore feet. Shelley assumes she has sore pads from playing hard the day before
September 17: Roma showing signs of neurological impairment in the right hind leg
September 18: Roma sees vet who attributes the issue to arthritis and prescribes rimadyl
September 19: Roma continues to decline. She doesn't want to pee because she is so uncoordinated in the rear
September 20: Roma sees vet who does VOM manipulation on her and feels she will be fine with 4-5 more treatments
September 21: Continued decline - Shelley very concerned
September 22: Roma admitted to ER hospital unable to walk on her own and with urinary tract infection from holding her bladder for so long
September 23: Roma sees neurologist who suspects spinal nephroblastoma and then goes to Redwood City for an MRI that confirms the diagnosis
September 24: Roma has surgery
September 25-26: Roma pretty out of it from surgery and pain meds
September 27: Roma much more responsive and even showing slight tail wags
September 29: First bowel movement on her own and showing signs of pain reaction in hind feet indicating she is gaining sensation
September 30: Both rear feet showing signs of pain reaction.
October 2: During physical therapy, Roma is able to stand with assistance and places her left hind foot flat on the ground
October 3: Roma is able to pull herself up with her front legs. Rear legs are still immobile, but she is happy and seems to be comfortable
October 4: Roma showing signs of improvement on the left rear leg, but still not using the right rear leg
October 5: Roma is able to stand on the right rear leg while the left rear leg is being manipulated for physical therapy. The techs are able to get her to lay prone, which she would not do before. Right knee bending like the left. Pictures taken that day.

October 7: Roma comes home!
October 11: Roma develops gastroenteritis and is back at the hospital. Photo taken October 12

October 13: Roma comes back home
October 14: Roma trying to stand on her own. Legs are crossed and uncoordinated, but she is gaining strength
October 16: Roma has a CT Scan at UC Davis in preparation for radiation treatments. We talk to the Physical Therapy unit and start plans for physical therapy sessions while she is there for radiation. Put sod down on the driveway to give her a place to have physical therapy and increase tactile sensations in her hind feet. Took some video of her
October 18: Shelley goes to bring Roma her food and finds her standing. She got up on her own!
October 19: Roma is getting physical therapy at home. Here is video part 1 of 2. This is video part 2.
October 20: Noticing more ability to move the right rear leg when walking with sling. Showing signs of increased sensation in the right leg
October 23: Roma has the first of 20 radiation treatments. She will be having physical therapy 2-3 times per week while she is at UC Davis for radiation. Took some video of her
October 27: Roma is putting her right foot down correctly about every third step
November 1: Roma at UC Davis for radiation. Took some video

November 6: Roma at UC Davis for radiation and physical therapy and to star in a commercial for the new state-of-the art linear accelerator UC Davis put into service on the day Roma started her radiation treatment there. The first part of the shoot was taken with Roma and a UC Davis Veterinary Hospital student. The second part of the shoot was done in the treatment room. Here are a couple of pictures from the first part of the shoot.

November 16: Roma at Temescal State Park. Took some video and some pictures.

November 20: Roma has the last of 20 radiation treatments! She will continue to have physical therapy a couple times per week the next several weeks
November 25: Roma goes back to East Bay Vet Specialists where she had her surgery for a post-op visit with Dr. Adamo. She was really happy to see everyone there. Here is a 2-part video of Dr. Adamo's exam video part 1 and video part 2 and some pictures.

video

December 10: Roma is doing great in physical therapy at UC Davis. Here is a short video of her entering the facility

December 16: Roma was on prednizone during the last part of her radiation treatment for inflammation caused by the radiation. The dose was tapered off and she is finally off the pred. Unfortunately, she started showing increased weakness in the rear. We knew this could happen and she has had some setbacks during her treatment, so it wasn't a huge concern.

December 23: The weakness shown in the previous week progressed to her not wanting to get up and then showing signs of pain when she was helped up. She was taken back to Dr. Adamo who could not get a pain response on manipulation. She was put back on pred at 20mg 2x per day for 2 days, tapering off to 20mg once per day for a week and then once every other day for two weeks.

December 27: Roma responded well to the first two days of 2 doses of pred, but on the third day when only given one dose, she starts showing weakness and pain again. Dr. Adamo is out of the country until January 6. Roma has a physical therapy visit scheduled at UC Davis so we take her to see if they can do any manipulation that might help. We also contact Dr. Adamo's staff to see if he can be reached for consultation and try to get her into a neurologist at UC Davis. All this was going on simultaneously. I took some video of her to capture the loss of mobility. Dr. Adamo's office got back to us and said to put her back on 2 doses of pred per day for 4 days and then taper off the dosage as prescribed. He also prescribed 300mg of Gabopentin 3 x per day. We held off on getting her into neurology at UC Davis to give this treatment a chance.

December 28: Roma appears to be feeling much better on the increased dose of pred and pain meds. She is not back to the level she was before this all started, but much improved from the previous day.

December 30: 8am. Roma arrives for physical therapy at UC Davis and I'm alarmed at the neurological deficits she is showing since I saw her last Friday. She doesn't appear to be in pain but doesn't seem to feel very perky either.

9-10am. The physical therapist does some e-stimulation on her to see if that might help and she is very concerned with her condition. We are sent over to neurology to get her looked at. While in neurology, we are lifting her on to a gurney to take her for blood work and she lets out two gutteral yelps. We don't know where this pain is coming from, but now the vet staff has seen the evidence of it. They confer with the rehab people who have been seeing Roma regularly for a couple of months to get input. What we are seeing could be due to spinal damage done from the radiation, a reoccurence of the tumor or something completely unrelated.

2pm. We send her off for another MRI to see if there is any evidence the cause of this increase in inflammation.

6pm. They just finished the MRI and found two masses that are even larger than the first one was. We agreed that we would not wake her up from the anesthesia. The neurologist asked if they could do a necropsy. This is very different behavior than what they expect from this type of tumor. They want to learn as much as they can from this case to potentially help other dogs. We gave them our permission to do the necropsy. I will post a copy of it here when it arrives. This can take weeks, so it may not be for a some time.

January 14, 2014: Roma arrives home. Her ashes are in a lovely maplewood box. A placque with her name decorates the front of it.

We also received preliminary necropsy results: The preliminary results from Roma's necropsy confirmed the presence of several extradural masses along the lumbar spinal cord. The term extradural suggests that these masses are outside of the spinal cord's most outer protective layer (called the dura) rather than being within the spinal cord itself. A number of tumors, and even infection, can behave this way. There did not appear to be any other disease elsewhere in her body. The histopathology will of course tell us more, and samples from multiple organs have been taken for analysis

January 21, 2014: We receive word that the commercial that was shot at UC Davis with Roma as one of the "actors" is released. The Communications and Marketing Officer at UC Davis sent us two links. One to the commercial and another to a behind the scenes video.

Roma was a truly special and wonderful dog. She was beautiful and had an enormous spirit that charmed everyone she met. All the staff in the various areas of the different hospitals she visited over the last several months just loved her. And she loved them. She would literally drag us into these places and go up to all the people she knew there wagging her tail with a big happy smile on her face.

RIP
Affaire's Adventurous Gypsy
July 2, 2011 - December 30, 2013