H. Maximillian F. Hillgen

My most beloved Maximillian was under the care of two of your skilled specialists twice in his life. Maximillian was diagnosed with diabetes in February 2008, and after having difficulty getting his insulin levels regulated to a point where his glucose was under control it was discovered that he had a small mass in an adrenal gland. We live in Connecticut and an adrenalectomy was performed. It was successful and the mass was benign. We had believed that it was effecting his hormone levels and removal would allow him to better regulate his diabetes.

Within a week and half after surgery, probably from a combination of elevated tryglcerides and the surgery itself, Maximillian vomitted once and was rushed to the hospital and diagnosed with a most severe case of pancreatitis. He had surgery and a feeding tube and drain were put in. They were unsure if he would survive, but Max was a valiant fighter and spent 19 days in ICU and each time he came out to visit with us multiple times a day he just bounced out and seemed "to shake off" his pain.   

When he came home with feeding tube the calculated feeding levels were not determined properly for his needs and within 12 hours I rushed him back into the hospital believing he had a stroke as he was unable to walk properly and seemed to have deficits. At first glance they believed he had a stroke/tia; but later realized he in fact was in a diabetic hyperosmolar state. When fluid levels brought up he did just fine after a few more days in ICU. During this whole hospitalization he lost his vision to diabetic cataracts as his glucose levels were not his primary issue.After 4 months of a feeding tube, getting his tryglcerides to normal levels he was the best regulated he had ever been as a diabetic.

A few days before Christmas 2008, Dr. van der Woerdt agreed to to do a successful double cataract surgery. It was incredible to take a somewhat depressed dog who was completely blind in for surgery and to come back to visit him a few hours later as a completely sighted pup. It was a hard decision to put him through another surgery, but seeing him playing with our small child and 2 other Miniature Schnauzers and run into trees and trip over baby toys it seemed that he would be happiest with his vision.

He came home very happy and continued to be a regulated diabetic with small hiccups along his journey until August 1, 2009. That was our ill fated day. Maximillian woke up most normally and had just been in for full work up with ultrasound, blood work etc. no less than 3 days before. Although the day started normal enough, within a few hours our lives changed entirely. Max semi-stumbled/collapsed. Again I thought diabetic state or TIA and rushed him into the hospital. Within a few hours they discovered his abdominal pulses were "off." His skilled veterinarian (former AMC Intern) followed his veins/flows upstream and discovered a small mass on his right atrium and immediately suspected hemangiosarcoma and had realized there was fluid that had to be tapped off his pericardium and it was tamponade that made him "stumble." This was the most unexpected and devastating news we could have gotten. After all, Miniature Schnauzers are not prone to cancer, let alone cardiac.

We debated putting in pericardium window, we consulted with veterinarians in CT, NY, NJ, and MA. We had spoken to, e-mailed, and consulted with every specialist we could. We opted to start chemo right away, along with immune therapy. He was given a prognosis from the cardiologists of 3 weeks of life. This was not acceptible. I wanted to do everything possible to save my best friend and beloved family member.

He seemed to be doing  better than anyone anticipated and things were at bay until the week after his 12th birthday on October 13, 2009 - his heart filled with fluid 3 more times back to back and he needed several pericardium taps within a few day span. His symptoms were not as anyone suspected no lethargy, no trouble breathing - all the opposite from my little man that struggled and fought for life the Summer before. He was antsy and restless when his little heart filled with fluid. This was it, he needed an emergency pericardial window placed in, a biopsy of the mass if it seemed possible as everyone was beginning to wonder if it was truly hemangiosarcoma as they did not expect him to come so far and seem so fine. They were able to cut a large window in with yet another surgery and he recuperated quickly. We changed chemos yet again. The cancer spread to his lungs shortly before surgery and then after another chemo changed seemed to disappear entirely for a good long while. The biopsy came back and again confirmed our worst nightmare, hemangiosarcoma. The unimagineable silent killer! We had already been waging war with this beast for 2 months and nobody thought we could battle more than 3 weeks.

More determined than ever to beat this ugly cancer I continued research 24x7 with laptop in hand laying next to my companion as I refused to leave him alone at all as waged war with cancer. We decided that the only hope of prolonging Max's life was to explore radiation. Radiating the heart was a bit novel and new. But, we had no hope left it had been in his lungs and had grown enough now to require a pericardial sac to stop the bleeds and to give his atrium with now a chicken egg sized mass room.

I was able to contact Dr. Farrelly as we spoke to him early in our battle and discussed whether Max could be a candidate for radiation and learned you had a new piece of IMRT equipment that was set to be used in first trial in several weeks. In speaking to Dr. Farrelly and explaining our fears of waiting, he was able to move things along and after an MRI study Maximillian was your pilot patient for IMRT Radiation therapy. Not only a new and novel radiation, but certainly a new and novel area, radiating the heart.

We commuted in/out of NYC with Max twice a week for 4 weeks for a total of 8 sessions. Maximillian did great! He would come off the elevator after being anesthesized for each treatment and "shake it off" and be ready to go on his way with such great spirit. He continued the battle for his life and never seemed to quit, would come home from all his treatments and play with his sisters and enjoy life. Never showing pain or slowing down. 

A week or so after treatment, we knew the lung cancer had began to grow and start a new and unique nebulizer inhalent therapy and also noticed that he had the unfortunate side effect of radiation burn. Dr. Farrelly treated it 
immediately and we were all concerned between diabetes and chemotherapy if he would be able to heal or would this lead to his demise.

Within a week and a half he was completely healed and went into the holiday season seeming to feel great. He gave us a beautiful Christmas, played in the snow with us like he was a young puppy and seemed to be doing phenomenal nearly 5 months after his prognosis for 3 weeks of life. The good times, seemed to be short lived once again and on December 27th he began having seizures. Back to the hospital and a few days of seizures. He was home before New Years Eve and seemed to have a great 2 weeks seizure free and now with another new chemo that could break the blood brain barrier as we assumed the cancer had spread further as hemangiosarcoma is known to do. The heart mass had shrunk slightly and Max was doing well and seemed to be having the usual phenobarbitol side effects walking a little funny and being tired. I spent every moment attending to his needs. He had always been pretty inseperable from me as he want to work with me for years and I home cooked with the help of veterinary nutritionist (also former AMC intern) for his finnickiness and diabetes. But, since cancer he truly was with me 24x7.

January 13, 2010 Maximillian had a mini seizure and we were told to hold tight as the next morning we had another round of appointments with neurologist and cardiologist. In the middle of the night Maximillian lost the most valiant and courageous battle I have ever seen or been a part of. He slipped into a gentle coma and passed away in my arms at 5:40 a.m. on January 14, 2010. Max waged a 5 1/2 month war with hemangiosarcoma and I am so very proud of how he managed. He never seemed sick, if I didn't tell people what he had they would never have known as he ran about, played and seemed himself.

Maximillian faced death several times in life and was the strongest dog I have ever seen with the greatest will to live. We were confident that both Dr. Van der Woerdt and Dr. Farrelly improved Max's quality of life during two very seperate times of crisis. I also felt that since Max was your pilot patient for IMRT therapy you should know his story and what a medical marvel his doctors all believed him to be. I knew him to be my most handsome and loving little man that I will forever miss and be proud of. A huge part of my heart was lost when we lost this battle with heart cancer. May he have a well deserved rest in peace after the most valiant and courageous battle. October 13, 1997 - January 14, 2010.