GOING BEYOND THE EXPECTED
Beloved pet unites human, veterinary surgeons in the OR and offers vet med a new treatment option for nasal tumor in dogs
Medicine is a science and as such works best when emotion is absent, but emotion is the very thing that sparked an innovation in the way the University of Georgia’s Veterinary Teaching Hospital treats nasal tumors in dogs.
It all started with a tearful phone call between Erin Brill and her father, Dr. Patrick McLear. Brill’s beloved four-year-old French bulldog, Criquette, was diagnosed with a vascular tumor of the sinus cavity that was impeding her breathing.
Brill was referred to the VTH, where she learned that the standard treatment for nasal tumors in dogs was radiation. Although carefully targeted to the tumor, radiation can damage nearby healthy tissue. Multiple treatments would also be needed, and animals must be anesthetized for each treatment, which takes a toll on the kidneys and other organs.
For Brill, who’d waited all her life for Criquette, the potential side effects were devastating. “I remember leaving the hospital. I was so distraught,” Brill says. “I pull over to the side of the road. Criquette’s in the front seat with me. I call my dad and I’m like, ‘Dad, I think Criquette’s gonna die.’”
Criquette with her extended family.
(L to R) Patrick McLear, Jack Brill, Michael Brill , Erin Brill with Criquette, Melissa McLear, Dr. Patrick McLear, Caitlin Dennison with Louis, Parker Dennison, Ryan McLear
Criquette with Michael, Jack, and Erin Brill.
Criquette and her "brother," Jack Brill.
McLear the father heard despair. McLear the physician heard hope. A human ear, nose and throat surgeon for more than 30 years, McLear has treated similar tumors in children where radiation is not indicated. The nasal anatomy of a small dog is not unlike that of a small child, and McLear saw the possibility for applying the same treatment used in humans – endoscopic radiofrequency ablation – to Criquette’s tumor.
Combined with cauterization, which uses heat or cold to seal severed blood vessels and stop bleeding, this technique destroys the tumor without harming surrounding tissue. McLear employs this two-pronged approach to treating benign tumors using a machine marketed as the Coblator II.
Prior to Criquette’s surgery, radiofrequency ablation was not a considered form of treatment in dogs, let alone accepted or approved. But that didn’t stop McLear from asking his daughter to connect him with Dr. Rochelle Prudic, the oncology resident who evaluated Criquette. He asked Prudic for the name of the veterinarian most likely to entertain a proposal for this alternative treatment with an open mind.
Prudic connected McLear with Dr. Joe Bartges, a specialist in internal medicine, interventional radiology, and nutrition, and veterinarian to the Uga line of English bulldogs who serve as UGA’s football mascot. “I talked to Joe, and he was fearless,” McLear says. “He said, ‘Yeah, let’s go ahead and try it.’”
Brill was six the first of two times in her life that she asked for a dog. One of four children of McLear and wife Melissa, Brill was part of a busy household with a menagerie of low maintenance animals – lizards, turtles, bunnies. A dog wasn’t in the cards, McLear recalls telling her.
“I sat her down and said, ‘When you get to a point when you have your own place and such, I’ll help you get a dog.’ I never heard another word from her about it until she was out of school for about a year. She was working, she had her apartment, and she goes, ‘Hey Dad, remember we talked about a dog?’”
McLear and Melissa are now grandparents to two dogs, but Criquette “is definitely the queen,” McLear says. “She is part of the family.”
That’s a common refrain at the VTH, and one that clinicians take to heart. Dr. Mandy Wallace, an associate professor of small animal surgery at the VTH, was early in her career in 2017 when Criquette presented at the hospital. She says the case taught her early to think outside the box when offering treatment options to clients with sick family members.
It took four months to get the approval of the hospital’s administration and board of directors and to put the necessary pieces in place for Criquette’s surgery. McLear received a Coblator on loan from the manufacturer. He also acquired a medical model of a canine skull the size of Criquette’s to ensure the scope would fit, thus improving the team’s chances of success with minimal side effects.
Criquette’s tumor was originally thought to be an angiofibroma, essentially a tangle of blood vessels and fibrous tissue that grows in the nasal cavity. Upon resection, the diagnosis was revised to nasal adenomatoid hamartoma, a benign tumor with excessive and progressive growth of glandular tissue. Rare in humans and rarer still in dogs, there was only one case report in veterinary medical literature at the time of Criquette’s diagnosis.
Criquette came through surgery with flying colors and even got a little nose job that flared her small nostrils a bit and improved her breathing. Criquette is now 11 and doing well, Brill says.
“She got a second chance so we’re not squandering it, that’s for sure,” she says. “She goes to day care a couple times a week. She goes on hikes every couple of days. She has a whole fitness schedule because we’re trying to keep her in shape even though she’s getting older.”
The canine skull model McLear used to test out the scope.
The surgical team operating on Criquette at the UGA Veterinary Teaching Hospital
Criquette recovering post-op, wearing an Elizabethan collar to prevent her from irritating any healing surgical sites
Since Criquette’s surgery, the VTH has acquired its own equipment and consulted with other veterinary schools in its use. Wallace says a surgery resident who was on Criquette’s care team is now on the faculty at Texas A&M University. When confronted with a case similar to Criquette’s, she reached out to Wallace for consultation.
McLear also sat in with Wallace and Bartges on a second procedure performed on a Weimaraner named Isabella. Isabella’s Virginia family read a scientific paper the surgical team published in the Journal of the American Veterinary Medical Association after Criquette’s surgery and brought her to Georgia for treatment.
Isabella’s nasal tumor turned out to be malignant and therefore recurred after treatment, but her family were nonetheless grateful for the extra time it gave for them to enjoy her. “They were, and still are, in a lot of ways, our biggest cheerleaders,” Wallace says. “They were actually on a Facebook group for dogs with nasal tumors and they put their story out there. We had a big rush after that where we were reviewing medical records all the way from California of people who said, ‘If this will work for my dog, I will come.’”
Isabella’s case taught the team to widen their focus when looking at patients who might benefit from ablation. Malignant tumors are more destructive than benign ones, eroding bone and growing aggressively with a high probability of recurrence. Even though Isabella’s cancer returned, the team gave her family a healthy year with her that they wouldn’t have had without the option of ablation. As they become more proficient with small benign growths the team is keeping an eye on the possible applications of ablation in treating malignant growths caught early.
“We may get to a point of deciding if it’s malignant but it’s not overly aggressive, maybe that’s still a good candidate, realizing it’s going to come back, but maybe we can slow it down,” Wallace says. “The other option would be if you go in this way and remove as much as you can and then follow it up with radiation therapy. Would that give you a better response? Those are all things you don’t know. We certainly don’t know right now.”
McLear still consults with the VTH team to evaluate and execute ablation to treat nasal tumors in dogs. He praises the staff and administration of the VTH for their willingness to step outside their comfort zone and work with his family to cure Criquette.
“You can’t get that everywhere. People aren’t always willing to take the chance when you’re busy and you know what you do, and you do well,” he says.
Bartges says the fact that the procedure was proven to work well in humans with similar diagnoses made the ask an easy sell.
“I don’t know that I had a preconceived notion of how successful this was going to be in either of these patients, but it was more a matter of what can we do that’s different than what we’re already doing, and do we get a different outcome than what we usually get,” Bartges says. “That sounds like a very general statement, but if you do what you’ve always done, you always get what you always got. And so, trying to look at other ways of managing things beyond the way we’ve always done it, can you get better? Well, you don’t know until you start doing them. It’s easy to say we’re doing fine and not change, and it’s a whole different thing to say well let’s try something different and see what happens.”
