Last year we lost our Boxer to a meningioma.
It’s taken me a while to be able to write this up. We’d known since Kinglsey’s original diagnosis that it would eventually end his life, but it didn’t make it any easier to deal with. We managed to keep him alive with a decent quality of life for around 14 months. I hoped by writing about our experience, it might help anyone else facing the same prognosis with one of their animals.
What is a meningioma?
I simple terms, it’s a tumour that forms from the meninges, membrane layers around the brain. They are usually benign (non-cancerous) and slow growing, and generally cause problems due to putting pressure on the brain itself.
Depending on their location, symptoms can be different, but range from seizures, vision problems, motor control issues etc. They are a few methods of treatment with surgery seeming to be the most successful if it is possible, and radiotherapy if it isn’t.
A really simple, useful summary can be seen on the vetmed website here.
How did we discover the meningioma?
It happened very quickly and drastically. In June 2016 we had taken Kingsley to the vet for an ulcerated cornea. This is something he’d suffered from before and is quite common in boxers and quite a nasty condition in itself. I’ll probably write a seperate post about that sometime due to the complexity of the treatment.
When he returned from the vet, he had what looked like a small seizure where he began to chew as if he had something stuck on the roof of his mouth and drooled a lot. He was slightly shaking his head at the same time and this lasted for probably around 30 seconds, after which he looked a little disorientated.
My first thought, was that this must have been a reaction the the pain medication he’d just been given, or the intense pain of his ulcerated cornea. In the past this was the only pain I’d ever known to really make him miserable.
We called the vet immediately, and they recommended we observe him closely, and bring him back in if it happens again. Within what I think was a couple of hours, a more severe seizure happened. This one was quite alarming. He collapsed in the corner of the room, went rigid and let out a low howl. Again this lasted around 30 seconds, followed by approximately 2 mins of mild disorientation.
I’m still slightly shocked at how dramatically the issue escalated. In hindsight, we think it’s likely these weren’t his first seizures, and we suspect the ulcerated cornea was a result of damaging the eye during a seizure, so it’s possible that he’d had them in the past and we’d just never seen them.
We needed to understand what was going on
The immediate steps were some diagnostic checks at our local vets. They ran blood work to look for any obvious issues that could be causing the seizures. As an emergency measure, they also issued us with some Diazepam, a benzodiazepine that can be issued rectally (yes, in the bum) during a seizure to help the dog relax. They also prescribed a course of epilepsy medication called Levetiracetam, which is used to control seizures. The blood tests proved inconclusive, although the Levetiracetam did seem to be managing the seizures well which was positive.
The vet suspected a brain tumour, so the next step was to refer Kingsley to specialists to run further diagnostics. At this point we were referred over to the Animal Health Trust
Before I go further into the diagnosis, I want to take a moment to acknowledge the Animal Health Trust. I feel endebted to the teams at the centre, and I can’t thank them enough for the work they did, and how nice they were about it. Over the 14 months Kingsley lived after the diagnosis, I made numerous vists to the centre, at all hours of the day and night, and they couldn’t have been more helpful. I feel lucky to live near to them, and will forever be grateful for how they helped Kingsley. He eventually died there as well, in the most peaceful way I could have hoped for, under the trees, on a sunny day surrounded by his family.
The obvious next step was an MRI. Kingsley was booked in for a consultation where we discussed the full history and reviewed his notes. They tested his motor functions, and noticed he had some slight hesitation repositioning one of his rear feet which could be symptomatic of an issue in the brain or spine. From there he was booked in for the scan, which would require anesthesia. We left him there for the rest of the day, and returned later to see what they could find.
Unfortunately, the news wasn’t good. Well, I guess good or bad is relative at this point. We knew something was majorly wrong, so the news was already bad. It was really just a case of how bad it was. In this case, it was confirmed to be a meningioma. When I look for good news within that diagnosis, I saw it as follows:
- It was benign, and probably slow growing
- We knew exactly what was causing the seizures
- The prognosis seemed to suggest a fair amount of life remaining with treatment, and generally managable symptoms.
To give context, I’d already asked the vet to call me if they found anything immediately while he was under so we could consider not waking him up. I wasn’t expecting a positive outcome.
The really bad news was:
- It was terminal without question
- It was in a position that was inoperable
- Treatment was going to be intensive and expensive
The image below shows the actual tumour
It was quite a significant mass, and not in a position that was easily accessible. I struggle to remember the exact orientation of the scan, but the tumour was at he front of his brain. It would require accessing through the the roof of his mouth to treat it surgially. This wasnt an option.
We had two treatment options
We could simply medicate and make Kingsley as comfortable as possible until the tumour became too large to manage. Or we could try radiotherapy, which would involve repeatidly focusing radiation at he site of the tumour in an attempt to cause it to shrink.
My wife and I have always had the philosophy that we would be willing to do whatever we can to keep our animals alive, as long as it meant their quality of life was still good. This was a difficult one, as the treatment would mean Kingsley would need around 20 sessions of radiotherapy, and each session would mean general anaesthetic. As a fairly old dog, we worried this might be too much for him. Looking at him though he was still a very happy dog, and it only seemed right to give him as much of a chance as possible. It also wouldn’t be cheap. The original estimate was around £6,000. While this seems high, it would involve him staying at the centre five days a week for 3 weeks.
But before we could go ahead, we needed to get his heart checked out. The vet was a little concerned about a slight heart murmour Kingsley had which we’d already known about. Before putting him through multiple sessions of anaesthetic, they wanted to be sure we knew his heart could take it. That required another referral to a cardiologist over at Dick White Referrals.
He underwent an ECG there to check the underlying cause of the murmour. This meant him staying at the referral centre for the day and going through another general anaesthetic. The cost of this was just under £600, but it was an essential pre-requisite. The results of this were good. He had a slightly enlarged heart valve, but nothing too serious, and certainly nothing that should prevent his treatment. So with that news it was time to start the treatment.
I was really worried about the treatment for a number of reasons. I worried about Kinglsey being lonely stuck on his own for 5 days a week. I worried it would be physically very hard on him, and I worried it might make him worse in some way. In reality, none of those concerns materialised. Kingsley had a bomb-proof personality. My negative preconceptions of him having to be dragged away down the corridor were soon dismissed as he happily went in each Monday morning wagging his tail and didn’t miss us at all. In fact, the only issue we had was that when we picked him up on a Friday night our doberman, Junior seemed to not recognise his smell and got grumpy when he first saw him.
The three weeks of treatment went without a hitch. We had Kingsley back home and on a robust medication regime which he’d need to be on for the rest of his life. This was about all we could do, so we were hopefull it would help.
Life after treatment
Kingsley was on two types of medication.
- Epityl – a phenobarbital used to generally control epyleptic seizures.
- Levetiracetam – also used to treat tonc-clonic style seizures.
The timing of these was quite a challenge. The epityl was taken twice daily, and the levetiracetam once daily. The challenge with the epitly is to keep the blood saturation at a constant level for it to be effective, meaning it had to be given every 12 hours as accurately as possible. We also had to regularly take blood to check the levels were effective and adjust accordingly.
Needless to say, we saw a lot of out vet over the next year. At the same time, we kept a detailed seizure journal. It was expected the seizures would still happen occasionally, but that they would be few and far between. We kept a spreadsheet that detailed when they happened, how bad they were on a scale of 1 to 10, along with a description of the seizure. And that’s how we tackled the next year or so.
So did the treatment work?
This is a really hard question to answer. In my mind it was successful. For more that 1 year, we managed the keep the seizures relatively minor and infrequent, and Kinglsey was happy. In total, he had 23 individual seizures between October 2016 and August 2017. Most of them were mild and caused him little distress.
Over time it was apparent his condition was worsening. We needed to increase the medication as seizures recurred to maintain the status quo, so I knew at some point we would run out of runway, but until that happened, his life was good. The final seizure that killed him was fairly similar to the rest but just didn’t end. Under the vets instructions, we dosed him with Diazepan and took him in to the animal health trust for overnight observation. Sadly, his coordination deteriorated and he never recovered. We euthanized him the next day at the centre peacefully.
The argument for whether the radiotherapy made a difference or not his hard to determine. Towards the end, we took the step to undergo a second MRI to check on the tumour. Apparently this doesn’t ever happen as it doesn’t offer any options and is relatively expensive. I figured I’d like to know, and maybe it would be useful for the hospital or someone else who might benefit. As you can see in the second image below, the tumour is slightly increased in size, but not by a huge margin.
Ultimately, we will never know the alternative outcome of not performing the radiotherapy. Maybe the tumour would have doubled in size, maybe it would have happened sooner. Or maybe it would have been exactly the same and the medication was all that was needed. In the end, I just know that I did everything I could for Kingsley, and that at least allowed me some peace when he left us.
So what advice would I give?
My advice for anyone faced with a suspected meningioma in a pet, is at the vey least have it fully diagnosed. An MRI is likely to set you back around £600, but I can’t overstate how reassuring it is to know exactly what you are facing. Watching your dog go through seizures is a traumatic experience, but it is something you learn to deal with over time. The key is to remain calm, and reassure your dog. In our case, Kingsley was only disorientated for a short while, and was absolutely fine afterwards and back to his normal self.
As far as would I recommend radiotherapy treatment? I think it really depends on your personal circumstances. If you are insured and it’s covered, I’d recommend it without a doubt. The small studies that seem to have been done on outcomes suggest a life expectancy of between 12 to 24 months, which is about right in our case. If surgery is an option, it can be more optimistic.
To be brutally honest, if you are paying for treatment without insurance, I would seriously consider the impact on your personal finance before going ahead. It is a significant amount of money, and it will only buy you some time. It seems very unlikely to cure the condition completely. The full costs of treatment can be seen in my pet insurance post.
I hope that overview is useful. As always, if you have any questions, please feel free to leave a comment of get in touch.