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A Miracle for Hopnoodle
by Davida Kobler
 
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Hopnoodle's story, written in the spring of 2004, is an interesting journey with a rabbit diagnosed with thymoma, a tumor of the thymus, which is a gland in the upper chest.

It's been 18 months since my Syracuse veterinarian told me that Hopnoodle had only a few weeks, at most, to live. Despite my shock, I could not accept that pronouncement, nor accept that he would die painfully, suffocating or by heart failure, as the already massive thoracic tumor impinged on his heart and lungs.

This silly, lovely rex boy had been 5 weeks old in May of 1998, when he was being given away free for snake food. Just half a handful, he kissed my chin on his first day in foster care. Later that summer, after his neuter, he bonded with Fiver, an unwanted Easter bunny, and they were inseparable for 5 years. He protected her, nuzzled her, and comforted her during her almost 4 years in renal failure. They were serious interior redecorators, systematically destroying drapes and wallpaper despite the bunny proofing. Fiver was the strategist. Hopnoodle was usually the one left sitting amongst the piles of wallpaper shreds, looking innocent.

Late in summer 2002, Hopnoodle subtly began to slow down and wanted to run and exercise much less than before. He had always been an energetic bunny - when he was young to the point of launching himself into the most bizarre places, and at 5 1/2, this noticeable slowdown meant that a trip to the vet was in order. Our Syracuse vet did a physical, x-rays, and ultrasound, and then delivered the chilling news -- he had a large tumor in his chest, heart and lungs were seriously shifted out of normal position and compromised, and nothing could be done except to put him to sleep as he worsened. He had, at most, a few weeks.

My mind and heart rebelled at this; there had to be some way to help him. I posted to an internal HRS medical listserve seeking information, read the PetBunny Archives, scanned University of Pennsylvania School of Veterinary Medicine Oncolink, and finally realized that a veterinary oncologist was on board with the practice in Rochester. The referral was made, and armed with everything I found, pages from Biology of the Lab Rabbit, and contact information for Dr. Avery Bennett at the University of Pennsylvania's veterinary school, we went to the oncologist. The oncologist insisted on a tissue sample. With great trepidation, our Syracuse vet did an ultrasound-guided aspirate. The differential diagnosis: lymphoma, thymoma, or thymic hyperplasia. Whatever it was had a significant lymphatic component, and the oncologist thought that it might be radiation-responsive. Then he backed away and decided that the best option was simply prednisone.

Surgery was not an option. Dr. Bennett at Penn was possibly the only veterinary surgeon who would attempt it. It would be painful and fraught with post-operative possibilities such as infection.

The tumor was huge; it was wrapped around vital structures. How would prednisone by itself make any difference? I called our Syracuse vet back, and her colleague--a Cornell Vet graduate--was in. Dr. Zezule was willing to call Dr. Rodney Page, the veterinary oncologist at Cornell. She called me back the next day with news that Dr. Morrisey in Exotics would see Hopnoodle, as he had worked with rabbits with tumors during his years at AMC. Their linear accelerator had just come online.

And now, the first thank you -- to Jon Reiss. Thank you, Jon, for allowing me to rant hysterically when I called to make that first appointment, because I was terrified. I felt like Dorothy watching the sand stream through the hourglass, knowing that precious weeks had been wasted in Rochester. I was angry, numb, grief-stricken...and you calmed me and gave me some hope. Your competence and compassion gave me my first impression of what Cornell was to be all about.

Within days, we were there. Dr. Morrisey, chief of Exotics service, introduced Dr. Sara Childs, exotics resident, and Alice Vandemark, LVT. Jon had taken a comprehensive history, and they reviewed it and got to work. A biopsy would have provided a more diagnostic tissue sample, but Hopnoodle had been through enough, and I wanted to get started with treatment. The tumor, Dr. Morrisey acknowledged, was ‰¥þbig and ugly‰¥ÿ, prognosis was poor, anesthesia would be required for the initial CT scan (to map the field) and for all radiation treatments. There were no guarantees that anything would be effective. There were short-term and long-term radiation side effects, and Hopnoodle was already immunocompromised. Dr. Morrisey consulted with Dr. Margaret McEntee, chief of Radiation Oncology. The CT was done that afternoon. The treatments started the following week, 2 per week for 2 weeks. Each time, with the skill of the anesthesiologist, Hopnoodle awoke and headed straight for his dandelion greens.

With help from Marcy Moore Rosenfeld, responsible for the bicillin work with rabbits, we began Hopnoodle on every-other-day bicillin injections, as his body had to process necrotic material as the tumor cells died off. Hopnoodle also took prednisone to decrease the inflammatory reaction of the tissues irradiated.

After 4 treatments in the linear accelerator, another CT had to be done. There was too much risk, if the treatments had worked to any extent, of hitting vital functional organs with radiation, unless the field could be recalibrated. This CT told us that the tumor had shrunk an astounding 77%.

Four more treatments, at week intervals, were done. On the day before Thanksgiving, Hopnoodle graduated from his course of radiation therapy. These remarkable people gave him a party in the waiting room, complete with a plant with mylar ‰¥þCongratulations‰¥ÿ balloon, a bunch of organic carrots, and a card which simply said "Hooray" and was signed by them all. It was joyous, it was overwhelming, and it was bittersweet; Fiver had died in renal failure 2 weeks before, and Hopnoodle and I both grieved for her.

Hopnoodle was alone, and I worried if the stress of losing Fiver would be too much for him. In late summer, a co-worker had given me a little minirex who was underweight and had the worst respiratory infection imaginable. When it was discovered, after 10 weeks of antibiotics and nebulization, that this tiny bun also had molar problems from her previous 7 months on a junk diet, the coworker decided that she no longer wanted her. And that was fine by us, because Kushtie was a delight. When she was well, she was spayed, and she became the second Mrs. Hopnoodle. Now he has someone who nurtures him and kisses him endlessly. She even drapes herself over him when they ride together to Cornell for his rechecks.

Hopnoodle has had respiratory problems in the last year, from scarring because it was unavoidable that certain structures would be hit by the beam, but these problems have been managed expertly by Cornell䴜s Exotics team, and Dr. McEntee has been keeping an eye on the x-rays too. Cultures have been done, antibiotics prescribed, follow-up films done at regular intervals. He remained on an anti-inflammatory dose of prednisone for quite some time, and we continue the bicillin, multiple medications - both systemic and for nebulization to ease his breathing. At this writing, it is a year and a half out, and he is still in remission.

We thank the Exotics team : Dr. James Morrisey, Dr. Sara Childs, Dr. Elizabeth Bunting, Dr. Ricardo deMatos, Joao Orvalho (veterinary extern), Tina Clare, LVT, Alice Vandemark, LVT, and Jon Reiss..Dr. Casey Cadile of the Cornell ER..and the Veterinary Oncology Team, Dr. Margaret McEntee, Dr. Blaise Burke, and Laura Nicholson, LVT....and Dr. Dawn Zezule-Tornusciolo, for making that telephone call in October, 2002. And to our friends who supported us and gave us hope and love when we needed that strength, thank you.

We have had a precious year and a half that we never expected, because of you.


Epilogue 10/31/04
Hopnoodle's story was written in spring of 2004. Every hour, every day, every week, Kushtie and I loved him and cared for him and marveled at his strength and his will to live. Late in the spring, he developed mobility problems, and in the summer, sebaceous adenitis, which caused him to lose most of his fur. His gait grew awkward, and acupuncture treatments helped with that. As Hopnoodle approached 7 1/2 years old, he grew increasingly frail and lost much of his body muscle mass. In September, xrays told us that the tumor residual was still very tiny and his heart was working well. But he grew weaker, and in mid-October, his breathing became very labored and he was in distress. He had pulled through so much that I had a hard time accepting that he was suffering and ready to leave us. Even on his last weekend, he took a sunbath against the dining room window and enjoyed his carrots and dandelions, and kissed his lovely wife. With the help of a wonderful and supportive friend, Colette, we made the sad journey to Cornell. Dr. Morrisey's compassion will always be remembered as we eased Hopnoodle's pain for the last time.

We miss you, lovely boy.