Definitive Radiation Therapy: Week 2
Chase is receiving definitive radiation therapy, which consists of 18 days (Monday-Friday) of small doses of radiation.
Radiation Week 2 – Monday, June 20, 2022
We didn’t see too many side effects the first week – we did notice that on the first day of each week, he is more tired. I suspect with the insertion of a new catheter and (probably) receiving a larger dose of radiation, Mondays will continue to be the worst day for him. He seemed to be a little sad the first Monday back, almost as if he realized this may be a new normal for him. This morning when I dropped him off, he actually refused to move for the vet tech.
It made me so sad to see him like that. I tried to mask my own sadness to make sure it didn’t make him more anxious. I walked with him and the vet tech to the back. But soon he realized I wasn’t going with him, and gave me a sad look as he was led into the back. This will probably be the worst part.
Since I had to go back to work this week, I headed into the office early after drop-off. I wasn’t sure when they were going to call me to let me know he was done. Last week it was around 9-10am. Before we agreed to radiation treatment, one of my fears was the logistics behind this whole process. When you don’t live near a major city, your options are very limited, the drives are long and the wear/tear of it all is that much more magnified. I don’t live TOO far outside of Boston, but it’s far enough that I had to mentally prepare myself to be extremely patient, prepared, and ready to power through it. But what I had to keep reminding myself about is that I wasn’t the one not eating breakfast, being dropped off with strangers all day, and then having to go through scary radiation treatment.
Throughout the week, he seemed to perk up by Friday. Although the mornings were tough because now he started to anticipate our daily routine, his appetite and energy otherwise have been great. I shifted his meals since he has to fast Monday-Friday in the morning. He now eats breakfast at 11:30-12pm, another smaller meal at 4pm, and another smaller meal at 8pm. This prevented him from being too hungry in the morning and less nauseous at night.
On Friday, June 25th, I picked him up from treatment and the radiation oncologists let me know that Chase had begun to experience colitis symptoms.
“Irritation of the colon (colitis) may develop near the end of the second week of treatment and may continue for 2-4 weeks after radiation is completed. You may see diarrhea which may contain mucous and/or small amounts of fresh blood.”
Chase had major bloody stool and even pooped small congealed pieces of blood right after radiation treatment. I could see he wasn’t feeling great. It didn’t help that it was getting hot out. So I got him into my office after letting him pass some blood and stool, drink some water, eat, and then got him comfortable. I wanted to make sure he could sleep in a cool, dark place where he wasn’t going to be bothered. After his nap, about two hours later, he seemed to be much happier and I even saw my happy old man dog again!
Since Chase is only doing radiation therapy Monday-Friday, it was onto the weekend! And it meant that he didn’t need a catheter in for two whole days, along with our routine walks, breakfasts, and lots of happy playtime. Week 2 is at a close, and that means we are that much closer to being done. I know my boy can do it – he’s strong. Even in his darkest moments, I still see that fighter in there.
Did you miss week 1? Read about it here!
——————
What is definitive radiation therapy?
Definitive radiation therapy traditionally consists of delivering small daily doses given Monday through Friday over 3-4 weeks (veterinary). Definitive intent radiation is employed when there is a potential for long-term control of a tumor. Stereotactic radiation is another definitive methodology that is highly specialized and typically delivered over 1-5 closely scheduled treatments. Read more here.
The type of radiation recommended is based on discussion with clients and the goals we aim to achieve. In general, there are 2 main intents of radiation therapy: palliative and definitive. Of course, there is an exception which is coarse fractionated radiation therapy which is a palliative schedule with definitive intent.
Definitive radiation therapy traditionally consists of delivering small daily doses given Monday through Friday over 3-4 weeks (veterinary). Definitive intent radiation is employed when there is a potential for long-term control of a tumor. Stereotactic radiation is another definitive methodology that is highly specialized and typically delivered over 1-5 closely scheduled treatments.
Coarse fractionated radiation therapy is a protocol that is between definitive and palliative by means of definition. Course fractionated radiation therapy uses larger doses per fraction, as in palliative therapy, however, the goal is curative. There are certain tumors that respond better to this type of protocol. Malignant melanoma is an example of such a tumor.
Palliative radiation therapy consists of fewer, larger fractions of radiation therapy with the intent to alleviate pain and clinical signs associated with the tumor. This is different from stereotactic radiation which also uses large doses per fraction, however, it is typically used for curative intent. Palliative radiation therapy is used to improve the patient’s quality of life and typically does not have long-term control. This protocol is less intensive and less expensive.
I cried the first day I left Chase to start his first treatment of radiation. I sobbed in my car before I drove away, even though it was a beautiful morning, even though he didn’t appear nervous or anxious. I cried second-guessing myself, asking out loud if I was doing the right thing by putting a 12-year-old through 18 consecutive days of radiation, general anesthesia, and a complete change to his schedule. Was I doing this just for me? Was I being selfish? What if he didn’t want to do this? What if the side effects are worse than we planned for?
But now that we just completed day 3 of radiation, we’ve gotten into a great routine. The oncology and radiation team have completely dialed his anesthesia in, to the point where he isn’t even groggy when I pick him up 4 hours later!
—————
Chase’s Radiation Schedule:
4:45 am
We get up, get ready for the day, and try to keep Chase in bed for as long as possible. He cannot eat until after his treatment, so he fasts in the morning.
5:30 am
We need to be out the door!
6:30 am
It’s a smooth check-in process because I’ve already pre-paid for the 18 weeks of radiation (using Care Credit, highly recommend it!) – so the daily check-in is smooth and quick. Chase is getting more comfortable there, although some days are better than others.
10:00 am
Usually, he is done with treatment by 9am and is ready for pick up an hour later. They like to keep him for observation for an hour after just to monitor side effects and post-anesthesia.
12:30 pm
He is usually at my office or with his grandma by now – we try to get him to eat, use the bathroom, and then right to a comfortable, cool spot so he can sleep off the rest of the anesthesia. Typically he is completely normal a couple of hours later, but if they need to give him anti-anxiety meds, he’s pretty groggy the remainder of the day. These are the toughest days. I hate seeing him so spacey and off. It makes him look so much older.
What are the side effects of radiation on a dog?
There are both acute and long-term and potentially permanent side effects when it comes to radiation therapy – the short answer is “depends”. It all depends on the location or area of the body where radiation is being administered, the dose/length of time, the type of approach, the type of radiation, and more.
I am not a veterinarian, so I’m going to refer to my source of radiation knowledge, MSPCA Angell in Boston, MA. Read here
But what I can elaborate on, are the side effects that Chase has experienced so far:
1. GI Upset: Chase is getting radiation delivered to his abdomen, there is a good chance this symptom will continue throughout his treatment plan. Right now, his first bowel movement of the day is pretty normal (solid, full, complete). He has been experiencing more diarrhea later on in the day, particularly after exercise/small walks, or after radiation treatment. This is TMI, so stop reading now if this grosses you out, but it’s watery. It’s usually after a small solid bowel movement too – which I found interesting. It’s almost as if he feels he needs to strain because of the skin irritation, which may be producing a feeling that “he has to go”, but in reality, he doesn’t.
2. Skin Irritation: Chase is also getting radiation delivered to his anal glands, which is a very delicate spot. Of course, I think part of his bathroom issue, is also because of the direct impact the radiation is having on his anus. I can’t imagine it is the most comfortable feeling. His skin is slightly agitated around the anus, and he has been trying to lick at it for self-soothing, but this has been curbed because of the potential for self-mutilation in an attempt to make himself feel better.
3. Limping: Chase has a catheter put in for the week of radiation, they typically rotate the leg, but depending on how he sleeps on it, he can be pretty sore. Some days are better than others. I try to get him up every hour or so to get some blood flow and for him to get some steps in. It’s important to keep him moving as much as possible (but obviously not forcing him if hes in pain!).
I do post daily updates of Chase, and note some information about the day. If you’re looking for more bite-sized information and daily accounts of Chase and his radiation treatment, check out his Instagram >> Click here
Here are some of my favorite pics from last week June 19-June 25
* Please note that the following information provided is based purely on personal experience. Any discussion of treatments, evaluation, and prognosis is specific to Chase and should not be used as advice or guidance on treating your animal. Please consult your pet’s veterinarian to discuss all information provided.