Post Radiation Burn Care - Appointment #1

It is 4 days after the completion of Stella's radiation treatments and her first appointment for burn care.  Below are photos we took before her appointment and after.  In the before pics you will see areas that look scaly like crocodile flesh.  As I've said before we have been  careful not to touch the treatment area, other than applying the Silver Sulfadiazine Cream (SSD), so we were unsure if this was just hair that matted down with the cream or flesh that would need to be removed.  It turned out to be both.  Please be forewarned that the after photos are a bit shocking especially given that Stella's arm has had very little change in appearance from each daily post.

The radiation therapist cleaned and debrided the area of the dead tissue using Lidocaine topical anesthetic instead of putting Stella to sleep.  This procedure took about 15-20 minutes.  The radiation therapist also explained that the appearance of Stella's arm is completely normal and confirmed that while the cream is aiding in healing the wounds the dead tissue becomes more prominent; we just didn't notice it because the cream had matted down the hair.

While we waited we met with the Oncologist for follow-up.  Dr. F. stated that Stella did remarkably well during her treatments and that she was surprised that the burns developed so late and are relatively mild compared to her other patients.  She confirmed what the radiation therapist told us the other day that the way they will "know" they got all the residual microscopic cancer cells will be with time along with the knowledge they have of treating dogs with MCT's (and Pugs specifically) and with the location and grade of the tumor.  Just as with our initial appointment with Dr. F. 5 weeks ago she stated again that radiation therapy has a 90% effective rate that the cancer will not return in this same location. 

Stella will return to the hospital in 3 days for additional burn treatment.  At that time they will determine if she will need yet another appointment.  After burn treatments are complete she will see Dr. F. a few weeks later for a check-up and routine blood tests; because Stella had 20 rounds of anesthesia and is on medications they just want to be sure her bloodwork comes back normal.  Dr. F. said she would then like to see Stella every 3 months (for one year) for a check-up at which time she will carefully check Stella's body for any lumps/bumps.  After one year they will do an abdominal ultrasound to check the internal organs again.  Dr. F. said ultrasound should probably be performed once every year.

The report for today states: "We cleaned Stella's treatment site with dilute nolvasan soaked gauze to help remove any dead tissue and dried SSD cream.  The site looks great!  We have applied SSD cream to aid in healing".

We are to continue with the SSD cream 2-3  times a day and continue giving Stella the oral pain meds (Gabapentin & Tramadol) as needed.  We feel Stella has a little pain now as the treatment site is "raw" and definitely more sensitive so we will give her the pain meds.

First 3 pics are before cleaning and debridement:

3 Days Post Treatments

It is the day before Stella's first check-up; the appointment at which the radiation therapist said they would shave any dead tissue that developed.

We have been applying the Silver Sulfadiazine Cream 2-3 times a day as directed for the past 3 days.  Skin has already started to slough off by itself when Stella is laying down (as seen in the pics).  The burn areas do seem to be somewhat painful to her now so we are applying the cream with a very gentle dabbing motion as opposed to rubbing it.  

Other than not liking when we apply the cream to her wound area, Stella does not seem to be in much pain.  She continues to act like her usual self.  We are however continuing to give her the two oral pain meds (Gabapentin and Tramadol) just in case.

With flecks of skin that sloughed off on her blanket.



With cream applied.



Radiation Therapy Treatment #20 **LAST DAY**

We're finally here - the last day of Stella's radiation treatments!    We started this journey with so much fear of the unknown, questioning ourselves if we were doing the right thing, scared that Stella would be under too much stress and pain, all the while telling ourselves she could do it and so could we, we could make it through this crazy month of worrying, driving, and less sleep. 

One month, 20 treatments later and here we are.  It has been incredible.  The month has truly flown by and Stella has just sailed through her treatments without any complications.  As I wrote in yesterday's post she didn't develop burns until the last few days so she's had very little, if any, pain and very little stress (in our opinion).  Stella has been so adaptable, forgiving, trusting, and resilient and has remained her loving self throughout.

Today we asked the radiation therapist how they "know" if they got all the microscopic residual cancer cells.  The answer is that there really is no clear cut answer to that question. Success is based on historical data of dogs with MCT's, known data specific to the Pug breed (in Stella's case), and time.  

For now, the only thing we can think about is how grateful, fortunate and relieved we are.


Today we were given Silver Sulfadiazine Cream 1% to aid in healing.  We are to apply a small amount to Stella's burn areas and treatment site 2 to 3 times daily.  We will see the radiation therapist in 4 days for post radiation burn care; they said they will shave off any residual dead skin that may develop.  We are not to feed Stella 8 hours before her appointment in case they need to anesthetize her.

Stella's discharge summary for this last week states:  "There is slight evidence of radiation toxicity at the treatment site at this time.  Continue to give the Gabapentin and Tramadol as needed for pain".

Although the radiation treatments are over we will always have to keep a watchful eye out for signs of any new tumors developing.  We know this will be Stella's lifelong journey.  We hope it is a boring one. 

Our summary for Stella's radiation treatments:

• Mileage = 1372 miles
• Highway tolls = $35
• Trips to the hospital and back = 70
• Gas = (approx) $250

We are exhausted. 

Do we have any regrets? 

Absolutely not.

Time to rest...

...and heal.

Radiation Therapy Treatment #19

Spoke with the radiation therapist today.  She stated the redness on Stella's arm is indeed burns from the treatments. At least they developed towards the end of her treatments so she will recover quicker. 

The Gabapentin that was prescribed to Stella last week is for nerve pain.  Today we were given a secondary pain medication called Tramadol (50mg tablets).  They told us we should give it to Stella as needed (half a tablet every 6-12 hours) but said we could start giving it to her now as a preventive just as we are doing with the Gabapentin.  Again we are opting to do this instead of waiting for signs of pain (which she still has not exhibited).

On today's pics you will notice that although I said the redness on her arm looked better yesterday it definitely looks worse today.  Still not all that bad we think considering they anticipated burns would appear two weeks ago when she had many treatments to follow.  Having it look like this now with only one more treatment to go, Stella can definitely handle it.

One more treatment and last day of boarding tomorrow...

Radiation Therapy Treatment #18

Forgot to ask the radiation therapist about the redness on Stella's arm.  She is always so excited to see us and comes bounding into the waiting room for hugs and kisses and treats that we completely forget anything is wrong with her and our minds go blank.

Hard to tell in the pics but the redness looks a bit better today.

2 more days...

Stella likes to sit with her chin on the car hammock on the way home...





...except when she's being bad...



...or playing with cheesy burger.



Radiation Therapy Treatment #17

Didn't get a chance to ask the radiation therapist about the redness on Stella's arm - but it looks no worse today.

Baby Girl seems tired and somewhat reserved this evening.  We continue to give her the pain meds as a precaution and it does not appear she is in any pain.

3 more days...

Radiation Therapy Treatment #16

Last week of treatment - the countdown has begun.  4 more treatments and 3 days of boarding to go...

Today was uneventful as always. 

Radiation therapist said it is fine to give Stella the pain meds, "just in case",  even though she is not showing an outward signs of discomfort.

There appears to be more redness to the excision/scar area of her arm.  We will ask the radiation therapist tomorrow if these are "burns".

3rd Weekend Off

Our intention was to wait to give Stella any of the pain meds until we started to notice signs of discomfort.  We thought we would watch for signs like licking of the arm, not wanting to lay on that side, not wanting us to touch it in any way, not eating or playing, or any sort of personality change from her usual self.  But then we remembered what veterinarians have always told us in the past; because of their natural instinct to protect themselves against predators cats and dogs will always try to hide any pain or discomfort for as long as possible.  By the time one would notice any distress the cat/dog may possibly be in a great deal of pain at that point because they could no longer hide it.  We do not want Stella to have any discomfort so we are choosing not to wait until she exhibits any.  The hospital dispensed the pain meds and already stated they would have expected to see burns at this point so it seems to us that giving her the meds would not be detrimental to her health.  Just because we do not see anything does not mean she does not feel something. 

Our goal from day one was to do everything possible to assure that Stella stays as pain free as possible.  We started giving her the pain meds this morning and will let the radiation therapist know tomorrow that we are doing so prophylactically.

Last week of treatment starts tomorrow....Stella is rested and ready. 

Some random pics as Stella gears up for her final week of treatment.

Radiation Therapy Treatment #15

 15 of 20 treatments and 3 weeks completed!!  5 more treatments, just 1 week to go!!

Discharge summary for this week states once again "No evidence of radiation toxicity at the treatment site at this time".

We did notice today that the scar area of Stella's arm has turned reddish in parts (this is hard to see in the pictures).

The radiation therapist told us that because they would normally have expected burns to appear by now, as a precaution and because they will not see Stella for the next two days (her usual weekend rest days), they are dispensing a pain medication to us in case Stella should show signs of discomfort. 

As needed, she is to take Gabapentin 100mg, 1 tablet by mouth every 12 hours.  The hospital did not give her a dose today as Stella seemed fine.  We will watch her closely for any signs of discomfort.  Incidentally, Gabapentin was one of the pain meds prescribed to Stella after her herniated disk repair and MCT removal 6 weeks ago.

Radiation Therapy Treatment #14

Asked the radiation therapist today about the crust forming on Stella's arm.  She stated this was something they were aware of and had discovered a remnant piece of a stitch was still in her arm causing irritation which then caused oozing that dried to form a crust. 

Radiation Therapy Treatment #13

13 down, 7 more to go...

Will ask the radiation therapist about this "crust" formation we noticed the past two days.

Radiation Therapy Treatment #12

Hard to see in the pictures but in person it appears Stella's skin may be starting to have a reaction to treatment.  She doesn't seem to mind when we touch her arm but we're trying not to just in case.

We asked the radiation therapist if we could give Stella a bath if we were careful not to wash off the marker lines.  He said they preferred we did not as a bath may may cause irritation or dryness to the skin.  He said it's best that we wait until the treatments are completed and the skin is fully healed.

Radiation Therapy Treatment #11

Start of the third week - more than halfway there!

Smooth as usual.  Stella is acting like her normal self.  No fatigue today like there appeared to be the prior treatment day.

I kind of feel like we've hit a slump with this blog.  There hasn't been anything "big" to report this whole time.  But I'm happy it's been uneventful and I hope it offers some comfort to pet owners who are reading this whose pets are just starting the radiation process. 

  

Must guard cheesy burger at all times...

2nd Weekend Off

Getting plenty of rest...3rd week of treatments start tomorrow...

Radiation Therapy Treatment #10

10 of 20 treatments and second week completed!!!  Yahoo, halfway there!

Once again Stella's discharge summary for the week states:  "No evidence of radiation toxicity at the treatment site at this time".

In the car on the way home Stella seemed really fatigued.  We drove home wondering: are the treatments affecting her, making her tired?  Although we don't notice any change in her skin can she feel something?  Are these long boarding days (like today) starting to stress her?  Is she mad at us?

We arrived at home an hour later and she suddenly became her usual bouncy self; chasing her sister in the yard, carrying her beloved cheesyburger, and wanting to be fed.

Our summary for the halfway mark including initial surgery and Oncologist's consultation: 

• Mileage = 744.8 miles
• Highway tolls = $19
• Trips to the hospital and back = 38 (on the days she is not boarded it is one trip each way; on the days she is boarded, when we go to work, we make 4 trips total)

Stella has the weekend off again and then we start week #3. 

Radiation Therapy Treatment #9

After picking up Stella it seemed as though she was a little more tired than usual even though it wasn't one of her long 12 hour boarding days.  She seemed kind of punky but then again it was in the upper 80's here and smushed face dogs do not like warm weather so maybe it was just the heat.  Other than that, nothing out of the ordinary. 

 

Radiation Therapy Treatment #8

Stella's skin may look a bit odd in these pics but it appears it is just the healing from her MCT excision surgery and the scar that is starting to form. 

Still doing great as ever...