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Pre-cancer Dusty..... I've been a house rabbit mommy/rescuer for almost thirty years. In the past I had dealt with every breed of bun immaginable except Angoras but knew it was only a matter of time when a longhaired bunny would finally wander my way. Sure enough, on Valentine's Day, 1999, a languid bundle of gray wool quietly crept into my heart while turning my home into his personal English Angora Eden. Dust Bunny's parents had been abandoned at a local veterinary hospital. The "owners" didn't want the expense of keeping two English Angoras with upper respiratory infections any longer. They also failed to mention that the female was pregnant. Before long two became eight. There was one male who was tiny, on the thin side, thick furred, and very laid back. I was a bit apprehensive about dealing with a long-hair but he was just so very cute that I banished any negative thoughts and fell totally in love with this handsome hunk of fur now called Dust Bunny (Dusty, for short). Dust Bunny soon became known as "my little man in a fur suit". He had absolutely no fear of people and truly enjoyed participating in all kinds of social activities. He gained noteriety in the Norfolk/Virginia Beach area for his annual role in raising money for the Norfolk Society for the Prevention of Cruelty to Animals. Each fall he willingly wore a clown outfit, complete with ruffles, pom-poms, and pointed hat, while being pulled around Blair Middle School in a child's red wagon. Dusty would sit behind a plastic pumpkin and watch while middle school children dropped money into it. Each time coins are dropped in, Dusty wwould look inside. Toward the end of the day he would tip the pumpkin over and nose through the coins while pushing the cash under the blanket he sat on. He enjoyed all of the attention and relished receiving back pats as long as the kids didn't rub his fur the wrong way. Dust Bunny is very intuitive. He loves coming to school, happily spending his day lying by my computer desk in the library. One spring day we hosted a large group of children taking a standardized test. One of the boys became overwhelmed; silent tears streamed down his face. The proctor took him into a back room where the child simply sat and cried. Hearing the noise, Dusty leapt up, ran into the room, jumped into the boy's lap, sat up, and placed his head under the boy's chin. The boy cuddled Dusty for almost 20 minutes and, although reluctant to continue with the test, did so with the promise that Dusty would be waiting to comfort him. One of the local retirement homes allows Dusty to come in and socialize to his heart's content. He loves lying next to people who are bed-ridden and will gently smooch them before he moves on to the next room. Car rides are his favorite mode of transportation with shopping carts coming in a close second. He loves looking out the window as we whiz by and will actually stare at people when they pull up next to us. He proudly sits in his hamburger, a soft "doggie" bed that he selected while working at a Pet Smart rescue/adoption event. While I was talking to a group of people interested in adopting rabbits, Dusty was busy pulling his hamburger bed off of a shelf and into the shopping cart. Later on, as we wheeled through the checkout line there, under his "blankie", was the bed. I tried to return it to the clerk but Dusty sank his teeth into it. Twenty dollars later, it was his. Now, whenever we go to any pet store, I always empty the cart of all of Dusty's "buys" before we go through the line! The patience Dusty displays with humans is no less with his adopted brothers and sisters. Zoe, a Jersey Woolie whose former owner tried to drown and strangle, is extremely hyperactive. Dusty is the only bunny that will actually play with her. Once she frays his last nerve Dusty will run to the living room, hop into an old rocker, and rock himself to sleep. Now that he is going on eight Dusty has slowed down a bit. He loves to wrap himself up in an old blanket and sleep for a couple of hours. He enjoys playing with his plastic keys and his big blue ball. Lying in my lap while I am reading is still his main pleasure in life, not to mention one of mine as well! Unfortunately, our happy world came crashing down around us in August, 2006. Dusty began sneezing..
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The Diagnosis
Summer was coming to an end and the dreaded beginning of middle school was looming before me. I had just finished congratulating the bunnies on having an illness free month when Dusty let out a huge sneeze. A high-pitched squeal and a rapid shaking of his big gray head accompanied it. Knowing that "Rabbits can suffer from infections of the upper respiratory tract (the sinuses and other parts of the tract that are not actually parts of the lungs), and this is usually manifested as runny nose, runny eyes and sneezing." (Dana Krempels at http://www.bio.miami.edu/hare/sneezing.html) I checked him for any discharge but there wasn't any nor was there any change in his eating or bathroom habits. Everything seemed normal except for the occasional sneezing. Naturally, all of this occurred the week before the Labor Day weekend. I had returned to work but worried about Dusty the whole time. Five days later, on Saturday, I brought Dusty back to Pet Care. This time Dr. Peter G. Fisher (http://www.petcarevabeach.com/meetdoctors.html) saw him. After listening to his breathing using a stethoscope (just like Dr. Hulls had done), Dr. Fisher ordered a chest x-ray. The grim look on Dr. Fisher's face should have forewarned me that something was amiss……he placed the film on the wall reader and said one word, "cancer". He then pointed out the "mass" located next to Dusty's lungs. My heart literally stopped. Once I regained the ability to speak, the questions came rapidly. "Are you sure it's cancer?" "Could it be something else?" "Is it treatable?" "Is there something we can do?" Dr. Fisher said he could do an aspiration of the mass on Tuesday. He said he would also do some research on what it could be. In the meantime I could continue giving Dusty the Enrofloxacin just in case it was some kind of bacterial infection. After all, Dusty's sneezing had stopped……. Bright and early on Tuesday morning Dusty and I showed up for his aspiration. I was a basket case and asked Dr. Fisher to re-explain why Dusty needed to be aspirated. He thought the mass was a thymoma but to make a diagnosis requires getting a sample of the mass, using aspiration. He would perform the aspiration using a long, thin needle. It would be inserted into the mass and then some cells would be removed from the mass by suction. He further explained that some tumors, if that is what it was, do not release cells very well, so this may be non-diagnostic. However, this is less invasive than a biopsy, in which a small piece of the mass is removed either with surgery or using a special core needle biopsy. And, yes, Dusty must be anesthetized to avoid movement during the sample collection. I was so afraid that Dusty wouldn't wake up but Dr. Fisher assured me that the procedure would be quick. He was right; Dusty was back in my arms within an hour. Now, we had to wait for a pathologist to identify the cell collection. Finally, after a couple of days, we had a less than 100 percent identification: thymoma. I immediately ran to the computer and posted a query on Etherbun (a listserve for people with companion rabbits.http://www.bio.miami.edu/hare/etherbun.html), asking for any information on this disease. Sharon responded almost immediately, giving me much needed details and advice. She told me "the Thymus is a gland that we all have (yup, even us humans). In rabbits, it "shuts off" when they are babies since it is no longer needed into adult hood. For some reason, in some rabbits, this thymus gland kicks in again, and begins to grow...and grow. and grow." Her Sweety's "thymoma had grown and was actually taking up over 3/4 of her chest cavity. He (Dr. Hannon, Vet Pets Animal Hospital, http://www.vetpets.net/) told me to make a fist....that was the size of this behemoth in her chest (and Sweety was a little Netherland Dwarf.....how's that for a visual!) He said he didn't know how the little bun was living. " Sharon even sent me photos of her Sweety and told me how this little bunny continued to live and, eventually die, all on her terms. Click here to see Sweety's photos. In the meantime, Dr. Fisher researched the treatment options for thymoma. He gave me two handouts, one dealing with surgical removal and the other with radiation. Surgery would very invasive because the chest has to opened "by splitting the sternum using a reciprocating saw attachment on a Synthes mini-drill. Anesthesia has to be maintained by using manual intermittent positive pressure ventilation" (Harcourt-Brown, Frances, BVSC, MRCVS and Nigel H. Harcourt-Brown, BBVSC, FRCVS, Dipl. ECAMS. "Surgical Removal of a Mediastinal Mass in a Rabbit". Exotic DVM, Vol. 4.3. ( July 2002) pages 59 - 60). Neither of my bunny vets wanted to take on that challenge but would if I asked them to. Radiation therapy would be less invasive but would involve multiple anesthetic episodes and had to be done at a veterinarian hospital that specialized in this type of treatment. The nearest one, Veterinary Specialty Hospital (http://www.vetspechosp.com/index.html) in Cary, North Carolina, had never treated a rabbit before. Dr. Fisher did know Dr. Ruslander, president-elect of the Veterinary Cancer Society and currently on staff in the oncology department. After several phone conversations Dr. Ruslander said that he would treat Dust Bunny. The estimated cost would be somewhere around $1,500.00. Panic time. Where was I going to find $1,500.00? Outside of robbing a bank, my chances were slim. I teach public school and run a not-for-profit rabbit educational resource, Chesapeake Bay Bunnies, in addition to having 8 house rabbits of my own. I thought about getting a loan, mortgaging the house, anything to get Dusty the treatment he needed. Then, help arrived in the form of a living angel. John Doub, the director of Virginia Rabbit, Inc. (http://www.varabbit.com) knew that Dusty was ill and emailed me, offering to cover the cost of his radiation. Nirvana! With John's financial assistance and my trusty Toyota RAV4, Dusty and I set off for Cary, North Carolina at 6:00 am on Wednesday, September 20, 2006! |
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Road Trip
The road to Cary was certainly paved with great expectations. My father had passed away on September 17, 2006 and both my mother and I were still grieving. This trip was a chance for us to temporarily shelve our sorrows and concentrate on getting Dust Bunny's thymoma under control. After a quick side trip to Starbucks ("Mocha Frappuccino to go, please") we were on our way. Slowly. It took us 45 minutes to get out of Virginia Beach! Anyone who has ever visited our formerly bucolic little beach town has always been quite amazed at our citified traffic jams. We are now the 39th largest city in the US, with a total population of 447,000. Without a doubt, every one of those 447,000 people were on the road that morning. Once we were able to get onto Route 58 we breezed through rural Suffolk, Franklin, and Courtland. Crossing the state line found us forging ahead towards the city of Raleigh, North Carolina. Raleigh is part of the Research Triangle, a metropolitan region anchored by the cities of Raleigh, Durham, and the town of Chapel Hill. The major research universities of North Caolina State, Duke University, and the University of North Carolina are located in this area. By the way, the Research Triangle's population is the most educated in the United States, with the highest number of Ph.D's per capita. The North Carolina Animal Cancer Program (NCACP) is part of the Veterinary Teaching Hospital in the College of Veterinary Medicine, North Carolina State University. What can be done with animals that have cancer is amazing. To read more, go to NC State College of Veterinary Medicine at http://www.cvm.ncsu.edu/docs/onconcacp.html The hospital that agreed to treat Dusty is right in the center of this triangle. The trip down south took exactly three and one half hours. I refused to stop for bathroom breaks as our appointment was at 1 PM and I was terrified of being late. My mother and I were bathroom starved. Dusty, however, thoroughly enjoyed himself. There is nothing he loves more than riding whether it be in a shopping cart, wagon or car. See above photo. His spirits were excellent as we pulled into the parking lot and walked inside. We were met by a lovely receptionist who agreed to having her photo taken with the chubby boy.
After a short wait we were escorted to an examination room where the temperature had to be below 32 degrees. Dusty eagerly hopped everywhere, exploring every nook and crevice. He ran right up to Dr. Dave Ruslander, which made a huge impression. Dr. Ruslander remarked that he had never been around such a personable bunny!
Dr. Ruslander told us that the radiation therapy would shrink this solitary, albeit benign, cancer that could not be safely removed by surgery. During treatment, Dusty would be anesthetized and placed on a treatment table. A small area on his chest would be shaved and then marked with a colored marker so that the doctors would know where to aim the radiation. The radiation would come from a huge mechanical arm rotating around Dusty. The actual treatment would take 5-10 minutes and when it was done, no radioactivity would be in Dusty's body. After explaining the radiation procedure, Dr. Ruslander asked if I had any questions. The only thing I could think of was "will Dusty wake up?" Dr. Ruslander assured me that he would monitor my baby closely and that Dr. Fisher and he had arranged for an exotics anesthesiologist to work with the team. Dusty would be well taken care of….. Armed with all of this knowledge I still was a bit apprehensive but knew that Dusty's thymoma was growing with every passing day. It was already pressing on a nerve that caused his right eye to bulge and would soon be pressing on his lungs. My hugs and kisses were profuse and as the doctor slowly walked toward the treatment center, Dusty wrapped up in his favorite yellow towel, I tried desperately to banish all negative thoughts. I made a million promises to God. I wiped away tears and took my mother to lunch….. Sure enough, as soon as we re-entered the building, the receptionist called back to the treatment center. Out came a young male technician who told me that everything went extremely well. Dusty was waking up and would probably want some food. I quickly ran out to the car and brought in an entire bag of leafy green alfalfa. A few minutes later the tech returned to report that Dusty was awake and eating. The doctors wanted to monitor him for at least another hour, after which, Dusty could go home. I nervously knitted (made a trillion mistakes) while my mother read every magazine in the waiting room. 90 minutes later, a very tired Dust Bunny was placed in my arms and, after receiving both the doctor's and technicians cell phone numbers, we were on our way home! Dusty slept most of the way, curled up in my mother's arms while I drove like a maniac up Route 58. Big mistake. An unmarked car right outside of Courtland, Virginia, caught me. Yep, the nice policeman gave me a very expensive ticket for speeding. Crawled toward Virginia Beach after that little experience. Dusty had awakened by this time and was busily eating, boxing his towel and trying to look out of the window all at the same time. We arrived home around 8 pm, exhausted (the two humans, anyway). One treatment down, two more to go!
The End of the Road...
Dusty's next two radiation treatments were highly successful. He came home from each one stonger and full of energy. In November I brought him back to Pet Care for a follow-up chest xray. While waiting for Dr. Fisher Dusty spent his time exploring the office floor, something he hadn't been interested in doing for months. When Dr. Fisher came back into the examining room, he was smiling! The thymoma had shrunk! I was elated. Dusty behaved normally until the week before Christmas. He suddenly slowed down and didn't seem as lively as he had been. Worried, I carried him back to Pet Care but because there were few clinical signs to latch onto, nothing was found to be wrong. Suddenly, on Monday, January 8, 2007, Dusty stopped eating. I brought him over to Pet Care and he was diagnosed as being in stasis. We started him on Cisapride (http://www.medirabbit.com/Safe_medication/Safe_drugs_main.htm), Cyproheptadine (http://www.marvistavet.com/html/body_cyproheptadine.html), and Metacam but his appetite didn't come back. I began feeding him Critical Care and brought him back to Pet Care that Thursday due to his inability to hop. An x-ray showed that his back vertebrae had fused together. At home I began massaging him and held him with a heating pad wrapped around his back end in addition to giving him fluids and Critical Care. Unfortunately, the Metacam no longer kept Dusty from feeling the pain of what we now believe to be cancer somewhere else in his little body. So, Dr. Poutous gave me some Tramadol. Unfortuately, the Tramadol didn't seem to work as Dusty simply sat in one position and began to lose bladder control. By Saturday evening Dusty's breathing became labored and he was sitting in a corner of his cage. All of my attempts to get him to come out were rebuffed. His eyes were full of pain. With tears streaming down my face I quickly bundled him up and rushed him to the Veterinary Emergency Room where, on Sunday morning, January 14, my Dusty passed away. My grief was, and still is, overwhelming. I lost more than my precious bunny; I lost a huge piece of myself. Soon after, I received several emails from other bunny parents regarding Thymoma. I also began the most horrible downward spiral of my life....in March, I lost my 10 + year old feisty beauty, Savannah....June, my beloved Bailey (to something lung related) and then, in August, my precious Snowy left me. A huge, rapidly growing mass near his lungs.... and then, Sharon re-emailed me about Sandostatin and her darling Pippa. Click here to read about Pippa....
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