Yes, Roscoe, Miracles Do Happen

An appointment about a month ago looked simple enough on the calendar-check cough. I was presented with Roscoe, a bouncy, happy 2 1/2 year old Boxer, full of life and very much loved by his human family. And yes, he was coughing-a harsh, dry cough, almost a honking sound that came from deep within his chest. He looked exhausted-as did his humans. No one could sleep with all that coughing going on. Now, "kennel cough" certainly can present this way, as can a myriad of other conditions and diseases. Simple rest and cough suppressants usually do the trick. But Roscoe was a sick dog-he was losing weight and this cough had been going on for some time and it was only worsening. I thought it would be best to take some radiographs of his chest to be sure we weren't dealing with one of the more serious conditions right off-and his owners agreed.

No one expected what we found. He was only 2 1/2 years old after all! Roscoe had masses throughout his lung fields-and one giant one on the right side of his chest. Because of his breed (Boxers, unfortunately, have a very high incidence) and the sudden onset-and now this terrible finding in his lungs, lung cancer had to be high on our list of differentials, or rule-outs, as the cause of Roscoe's cough. Understandably, his owners were just devastated when they saw the films and the news sunk in. Remember how I wrote about "It Is A Whole Family's Diagnosis?" This was certainly the case for Roscoe. He had some young children in the family, too, who just wouldn't understand this horrible news. We set about making a plan for confirming what we suspected and getting him any help we could.

First, we decided to do some blood work-it looked really good. That could mean there was a lower chance that this aggressive looking disease had metastasized or spread to other organs of his body-although blood work is not definitive in this regard. Next, we attempted to take a fine needle aspirate or sample of the cells of that large mass in the right lung field. We took several samples-and got several different cell types back! It was frustrating. The pathologist couldn't commit to a single disease, saying that the different cells were indicative of several conditions. Finally, we decided to send Roscoe to the veterinary oncology specialists and have them evaluate him.

The oncologists were quite pessimistic as well. They took some follow up chest x-rays and the mass in his chest had actually doubled from the time when I had seen him-in just a week! They suspected primary lung cancer and as ill as he was during his visit to them, didn't expect him to live longer than 1 to 2 weeks. Roscoe's owners were distraught. They asked if there was any chance this could be something else-he was such a young dog! The oncologists explained that Boxers were a "special" breed when it came to cancer, and we can actually see it in any breed, but in a 2 1/2 year old Boxer it wasn't as surprising. Tragic, yes. But they did say that there was another disease that, although very rare, could manifest in a similar way as Roscoe's disease had. This condition is called pulmonary infiltrates with eosinophilia-or PIE for short.

I had never heard of this kind of PIE, so did what research I could. There wasn't much out there, but we did find that if Roscoe had this condition, he would respond very quickly and very dramatically to a simple drug called prednisone. No need for the more advanced (and costly) chemotherapeutic medications, just this antiinflammatory drug. We had absolutely nothing to lose, so Roscoe was started on the pred. Well, you guessed it-he got better! His owners were hesitant to get their hopes up after such a dismal prognosis from both me, their primary care giver, and from the specialists. We called them a few times over the week and each time they reported decreased coughing, better energy, more sleeping through the night-everything he needed to be doing.

Just to be sure, we had Roscoe in this week for some follow up radiographs of his chest. We figured they couldn't "lie" to us. We could see if those masses were decreasing in size or if it was just false hope as his owners feared. Look at that picture! The big mass is almost gone! I couldn't find all those little ones at all. It really was a miracle! I rushed to show the films to Roscoe's owner in the exam room-she was so excited she had tears of joy and gave me a big hug. Oh, it felt so good, especially after the terrible time that family went through.

Roscoe was one of the fortunate ones, for sure. He'll have to be on the medication for quite a while, but that's OK. He seems to be handling it fine-the alternative is unthinkable. We can't expect things like this to happen all the time-that's what makes miracles, well, miraculous! I am very thankful for this one case turning out as it has, and will do my best to pursue all options for my patients, even when the eveidence seems seems overwhelmingly bad. Miracles do happen.

Peace,
DrReneigh