More Answers on Blind Pepper

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.

Comments

[Tryna Merriman]

I wonder if animals get headaches. From what you describe, it sounds like she should have been in a lot of pain, I sure would be!

[Margaret]

This is still SO painful, but it has been very courageous of you to follow up to potentially help someone else. We trust these results provide you comfort as well. Bless Pepper, and the WSU veterinary staff.

[Malinda, Littleton, CO]

Thank you for letting the medical community give Pepper an even more meaningful purpose - the discoveries and research that they are conducting would not be possible without you. I'm so proud of Rolling Dog Ranch - thank you for allowing me to continuously brag about all of the good things you do - for the current residents and future ones.

[Claire S. Moen]

What do you do with your beloved pets' ashes? I have to hand it to you, it must be difficult sometimes losing so many. But be comforted by all the good you have done for so many. Claire

[Linda]

Bless you, sweet Pepper. You really were one very sick girl, and I'm glad you are no longer suffering. And I'm glad for you, Steve and Alayne, to have this closure. The decision was hard but the right one, and you can rest easy knowing you did everything that had to be done for this darling girl.

[ginger & Tobias (the greythound)]

Thank you for sharing this information about Pepper. There is no doubt that you made the right decision.
Big hugs,
ginger, Tobias & Tlingit

[Carla Polastro-Nigro]

Dear Alayne & Steve, thank you for letting us learn more about Pepper's illness. I'm so glad Dr. Wininger's call has made you feel better, more at peace with your decision to let Pepper go.

Are you going to keep her ashes or will you scatter them in a place Pepper was particularly fond of?

[Andrew]

Thanks for writing that Steve! It has answered something I just didn't know how to ask you. I've always wanted to know if the loved ones you've lost come back to the Ranch. Of course I am sorry for your loss but I'm also happy to know that they do come home. I hope that makes sense.

[maggie]

Thank you so much for the update on Pepper. I certainly believe that you did the right thing in offering her body for medical research, and, while nothing can make you miss her less, knowing that it was her time and you made what was unequivocally the right decision does offer some peace of mind.
We also offered my dog's body after he passed from a brain tumor, but the clinic ultimately decided to leave him be as it was too emotional for all involved - including the vets, because Rocky was everybody's favorite golden dog. We will miss him always, as you will Pepper and all the others you have had to say goodbye to.

[Cora]

Never gets easy to lose one does it? I suppose if it ever does get easy, .. our human hearts and souls would have ceased to exist.

[Barbara Arenal]

Steve, Alayne-Thanks for sharing this medical info. The details may prove to help another pet owner in the future. And most importantly, Thank You for allowing the Drs to do a necropsy in the hopes of shedding more light on her unique condition. We know how hard it is to agree to this with a beloved pet, but it is sometimes necessary, to possibly save the lives of other animals. Similar to the decision for human organ donation. You have "honoured her life" by your selfless decision. We admire your courage and strength, through your love of these precious animals. 'Twas a FINE day in Dog Heaven when she walked through the gates to run and play with the others. God Bless them all. Hugs, Barbara & Joe

[Taylors on Olympic Peninsula in WA state]

Oh my goodness.Will wonders never cease?? Well, as difficult as the decision was to let her go , at least you now know WHY and as you said Steve, you knew it was the right thing to do.Poor little dog did't deserve to suffer anymore. I hope that when my time comes and it surely will, that the people closest to me will have the same compassion that you had for Pepper. Thank you so much for sharing the information about Pepper's case . hope the knowledge learned from her necropsy(hope i spelled that correctly) will help the good animal doctors in some future case. Thank you again for this wonderful (at times not so joyful) blog. As I have said before, Joe and I have learned so much, (in the year's time we have been reading your blog) about horses and all sorts of interesting things. YOU ARE AN AMAZING AND GIFTED TEACHER !!!!! Take care and have a good week

[Sonya Brooks]

Steve & Alayne, we all knew that you made the right decision for Pepper. It is absolutely amazing that even the clinical people can't explain her tumor. Hopefully, they will figure out something that will help to further the treatment for these kinds of tumors. When her ashes come to RDR, she will be home at last. She was a sweet girl and I imagine you both have good memories of her. God bless you all at RDR.

[Nina]

Thanks for the update re: Pepper. I also think that you did the right things from not allowing her to suffer any longer to letting Dr. Wininger operate and research the tumour. Pepper was truly loved and cared for at the ranch.

[Mary Ware]

Thank you for this information. I think it really helps to understand the whys and causes of such an event. Pepper was very brave and the decisions were the best to be made then and now. Also, though she has passed on, she has provided information that will help someone else down the road. I'm very proud of Pepper.
Mary Ware

[Smiley Faces]

Thank you for this post. Just this weekend I told my husband how much I learn from your blogs. You and Alayne are not only caring for your own "pack", but you are helping others by educating their parents. I know I am a more informed pet parent from reading the Rolling Dog blog.

Thank you for sharing this one final gift of love from Pepper. They always give us a great deal more than they take. Hopefully, one day, everyone will figure that out.

[Shirley & James, Portland, OR]

I understand the comfort it brings to get this type of medical diagnoses. I'm so glad you didn't allow Pepper to suffer for one more minute. It was her time but it's still so painful and difficult to say goodbye. We NEVER have them long enough. Thank you for the explanation on Pepper. My all the fond memories of Pepper be what you remember and cherish.