Sneezing (thymoma found as cause)

[Moonshadow]

Your other bunny is getting sick too?

 

[Ampee]

Your other bunny is getting sick too?

To be honest, I don't know.

He started visiting the litter box frequently and also producing chalky pee (every day).
I showed the vet a picture about this chalky stuff and also requested blood sampling. Result: No problem with any property of the blood.

For example today he peed like 5-10 times.
This has been ongoing for like 1 month now. (or so)

Of course: no blood, no wet legs nor belly. No moaning/yelling when peeing.

Also to best of my knowledge I dont give them anything "bad":
Hay, water, Oxbow Adult rabbit pellet (not much twice a day), oxbow digestive support (1 per day) and basil leafs (very few like 1-2 leafs per day )

 

[rabbit_friend]

Sorry I haven’t been on here recently, or I would have replied sooner. I have had two bunnies with thymomas, the first diagnosed in 2012 and the second in 2015. I treated the first one with radiation and the second with oral prednisolone (steroid). I did tons of research when the first one was diagnosed, reading all available studies and contacting 18 people to learn of their experiences with thymoma treatments. Based on that, surgery was out (I think there was only a 50% chance of survival past surgery, and even then, not much time would be gained and at quite agonizing cost to the bunny).

Based on the responses from the people I contacted, I opted to do radiation treatments with the first bunny. That was a 2-hour drive one way, once a week for 4 weeks, at an excellent teaching veterinary school where I was confident he would get his best shot at success. They had treated dogs with thymoma but he was their first rabbit. The cost was about what you were quoted. He had a lot of trouble after the first radiation treatment since his thymoma was already so large and his breathing so compromised, so the anesthesia was rough. But he pulled through and the next week the tumor had already shrunk and he did fine with the remaining treatments and anesthesia (they tweaked the anesthesia a little after the first time too). He was stable until he died 8 months later. Necropsy showed no sign of thymoma, but his lungs were very leathery, a side-effect of the radiation. He was a male Netherland Dwarf, so was very small, and I think targeting the radiation to avoid surrounding damage was more difficult than if he’d been larger.

His partner started sneezing and having a teary eye the year after he died, and she was treated for respiratory infection with numerous antibiotics and nebulizing until she was also diagnosed with thymoma in 2015. Hers was a fluid-filled thymoma, so they were able to remove a lot of the fluid with a needle to give her immediate breathing relief. She had to go through several more of these chest tap procedures and go on prednisolone before the tumor shrank enough to be stable, which took about 9 months. Then she was able to be off the prednisolone completely for 6 months before the tumor regrew and she had to go back on It. She lived almost 2 years after diagnosis before dying of an infection caused by the decreased immune function on prednisolone. Because of the effects of the steroid, she kept having respiratory infections and was on antibiotics a lot during those last 2 years.

Several things about the steroid:
-Prednisolone seems to be the best, from my research, for rabbits. Other steroids seem to be harder on them.
-Steroids will make them hungry and thirsty, so keep plenty of fresh water available. I had to give subcutaneous fluids routinely to keep her feeling her best. They will want to eat a lot, but getting too fat will make it harder to breathe, so you have to weigh regularly and watch her weight.
-Steroids suppress the immune system, which is probably why your vets won’t do RHDV2 vaccines. It also means if she has latent e.c. or pasteurella, that might become active. In other words, be even more on the lookout for any signs of infection or illness, and keep up with the best hygienic practices you possibly can. If they can do an e.c. titer on her and it comes back negative, that would at least give you a bit more peace of mind.

About the nebulizing:
-We also just held the tube very close to her nose (about 1 cm away) and she didn’t mind since it helped her breathing. She would have freaked out if we’d put her in an enclosed space. But she had congestion from respiratory infection, which your bunny doesn’t appear to have. If thymoma is the only problem, then nebulizing won’t help much, because as you saw on the xrays, it’s the trachea being pushed against the spine that causes lack of air. Then nebulizing will only make it harder for the bunny to get oxygen.
-We gave oxygen on several occasions when she was having a lot of trouble breathing and it calmed her down. So that might be something to ask about.

The outlook on either radiation or steroid depends a lot on the individual bunny—their size, their prior health, their weight (healthy weight with lots of muscle, or underweight and frail, or overweight and fatty). Back in 2012, none of my vets wanted to do steroids because “You never give steroids to a rabbit.” Now, vets have more experiences to know that some bunnies can take steroids with seemingly no problems, and that if the alternative is euthanasia, why not try it.

By the way, I’m pretty sure the second bunny cost more than the first for treatments, despite doing “just” the cheap steroid, since we had to do many radiographs, chest taps, antibiotics, nebulizing, and exams over those 2 years. Some people can give the steroid and only do occasional followup exams, but that wasn’t the case for us. With the radiation, we only had one follow up exam and no meds, although that could have gone differently as well, since radiation also suppresses the immune system (more temporarily) and may have other side effects too.

So the only thing you can do is read and research A LOT, and then go to the best clinic/vet you can afford that specializes in rabbits. We made the 2-hour trip to a specialist many, many, many times in those years, and since then with other problems, because it is worth it for peace of mind. But even then, it is luck of the draw whether your chosen treatment will work on YOUR bunny. And since we can’t try both treatments in parallel universes, there is always the question of what would have happened if we’d done the other treatment instead. You just have to do what will make you feel you’ve done your best, and learn from any regrets.

I would definitely get a head/teeth xray next time she is sedated, because she may have tooth issues in addition to the thymoma (the teary eye and strange broken tooth seem strong indicators).

I would also check the environment for any toxins that may have helped the thymoma to grow. My two bunnies were in a sunroom with vinyl tiles and I didn’t notice till very late that the tiles were offgassing chemical odors every time the sun hit them. I also used carpet remnants changed frequently which had odors (I now let carpet air out in our basement for 6 months before using them with bunnies). There was also some mold in the sunroom wall. Could any of those things have been the cause of my bunnies’ thymomas? I don’t know, but it’s my feeling that it’s worth checking the environment.

Hope your bunny does well on the steroid. I know how difficult it is to make decisions about what to do in this situation, and my heart is with you .

 

[Ampee]

Sorry I haven’t been on here recently, or I would have replied sooner. I have had two bunnies with thymomas, the first diagnosed in 2012 and the second in 2015. I treated the first one with radiation and the second with oral prednisolone (steroid). I did tons of research when the first one was diagnosed, reading all available studies and contacting 18 people to learn of their experiences with thymoma treatments. Based on that, surgery was out (I think there was only a 50% chance of survival past surgery, and even then, not much time would be gained and at quite agonizing cost to the bunny).

Based on the responses from the people I contacted, I opted to do radiation treatments with the first bunny. That was a 2-hour drive one way, once a week for 4 weeks, at an excellent teaching veterinary school where I was confident he would get his best shot at success. They had treated dogs with thymoma but he was their first rabbit. The cost was about what you were quoted. He had a lot of trouble after the first radiation treatment since his thymoma was already so large and his breathing so compromised, so the anesthesia was rough. But he pulled through and the next week the tumor had already shrunk and he did fine with the remaining treatments and anesthesia (they tweaked the anesthesia a little after the first time too). He was stable until he died 8 months later. Necropsy showed no sign of thymoma, but his lungs were very leathery, a side-effect of the radiation. He was a male Netherland Dwarf, so was very small, and I think targeting the radiation to avoid surrounding damage was more difficult than if he’d been larger.

His partner started sneezing and having a teary eye the year after he died, and she was treated for respiratory infection with numerous antibiotics and nebulizing until she was also diagnosed with thymoma in 2015. Hers was a fluid-filled thymoma, so they were able to remove a lot of the fluid with a needle to give her immediate breathing relief. She had to go through several more of these chest tap procedures and go on prednisolone before the tumor shrank enough to be stable, which took about 9 months. Then she was able to be off the prednisolone completely for 6 months before the tumor regrew and she had to go back on It. She lived almost 2 years after diagnosis before dying of an infection caused by the decreased immune function on prednisolone. Because of the effects of the steroid, she kept having respiratory infections and was on antibiotics a lot during those last 2 years.

Several things about the steroid:
-Prednisolone seems to be the best, from my research, for rabbits. Other steroids seem to be harder on them.
-Steroids will make them hungry and thirsty, so keep plenty of fresh water available. I had to give subcutaneous fluids routinely to keep her feeling her best. They will want to eat a lot, but getting too fat will make it harder to breathe, so you have to weigh regularly and watch her weight.
-Steroids suppress the immune system, which is probably why your vets won’t do RHDV2 vaccines. It also means if she has latent e.c. or pasteurella, that might become active. In other words, be even more on the lookout for any signs of infection or illness, and keep up with the best hygienic practices you possibly can. If they can do an e.c. titer on her and it comes back negative, that would at least give you a bit more peace of mind.

About the nebulizing:
-We also just held the tube very close to her nose (about 1 cm away) and she didn’t mind since it helped her breathing. She would have freaked out if we’d put her in an enclosed space. But she had congestion from respiratory infection, which your bunny doesn’t appear to have. If thymoma is the only problem, then nebulizing won’t help much, because as you saw on the xrays, it’s the trachea being pushed against the spine that causes lack of air. Then nebulizing will only make it harder for the bunny to get oxygen.
-We gave oxygen on several occasions when she was having a lot of trouble breathing and it calmed her down. So that might be something to ask about.

The outlook on either radiation or steroid depends a lot on the individual bunny—their size, their prior health, their weight (healthy weight with lots of muscle, or underweight and frail, or overweight and fatty). Back in 2012, none of my vets wanted to do steroids because “You never give steroids to a rabbit.” Now, vets have more experiences to know that some bunnies can take steroids with seemingly no problems, and that if the alternative is euthanasia, why not try it.

By the way, I’m pretty sure the second bunny cost more than the first for treatments, despite doing “just” the cheap steroid, since we had to do many radiographs, chest taps, antibiotics, nebulizing, and exams over those 2 years. Some people can give the steroid and only do occasional followup exams, but that wasn’t the case for us. With the radiation, we only had one follow up exam and no meds, although that could have gone differently as well, since radiation also suppresses the immune system (more temporarily) and may have other side effects too.

So the only thing you can do is read and research A LOT, and then go to the best clinic/vet you can afford that specializes in rabbits. We made the 2-hour trip to a specialist many, many, many times in those years, and since then with other problems, because it is worth it for peace of mind. But even then, it is luck of the draw whether your chosen treatment will work on YOUR bunny. And since we can’t try both treatments in parallel universes, there is always the question of what would have happened if we’d done the other treatment instead. You just have to do what will make you feel you’ve done your best, and learn from any regrets.

I would definitely get a head/teeth xray next time she is sedated, because she may have tooth issues in addition to the thymoma (the teary eye and strange broken tooth seem strong indicators).

I would also check the environment for any toxins that may have helped the thymoma to grow. My two bunnies were in a sunroom with vinyl tiles and I didn’t notice till very late that the tiles were offgassing chemical odors every time the sun hit them. I also used carpet remnants changed frequently which had odors (I now let carpet air out in our basement for 6 months before using them with bunnies). There was also some mold in the sunroom wall. Could any of those things have been the cause of my bunnies’ thymomas? I don’t know, but it’s my feeling that it’s worth checking the environment.

Hope your bunny does well on the steroid. I know how difficult it is to make decisions about what to do in this situation, and my heart is with you .

Thank you for your reply!

I'm already giving her immune booster (Vetri DMG, extra dosage 2ml per day), also Oxbow multivitamin.
We have just started the steroid (prednisolone) and could be that she is already hungry due to this (3rd day she is on it)? she is up to 1513 g (yesterday she was 1468 g), and eating like a "freak". (Knock on wood) (Before that her appetite was not that good).

Really appreciate your time writing this!

What do you think, can this steroid decrease the size of this cancer? My vet told me that it cannot.
Also "If they can do an e.c. titer on her" "E.C.", e cunculi? test her for E cunculi?

 

[rabbit_friend]

Yes, e. Cuniculi. A negative test would mean she doesn’t have it hiding in her system. A positive test will only say that she has been exposed at some time (estimates are that about 50% of rabbits have been) and won’t give as much information. Stress and immunosuppression can activate it if it is in the rabbit’s system.

Is the immune booster something your vet told you to give? Thymoma is a growth of the thymus gland, which is part of the rabbit’s immune system gone haywire. The point of giving prednisolone is that it suppresses the immune system, so I would be cautious about giving an immune booster since it might be working against the steroid’s effects. But I’m not familiar with how your booster works on the immune system, so can’t be sure.

Prednisolone can absolutely shrink the tumor, though there is of course no guarantee that it will. If your vet said it cannot, you might want to look around for a more experienced vet. As I mentioned, it shrunk my bunny’s tumor enough that she could be off it for 6 months before it regrew to a size that was causing her problems again. When I was deciding how to treat my bunnies, I spoke to several people who had used prednisolone, and to a vet in California who treated several of these bunnies, and some of them had dramatic shrinkage, with the bunnies getting a lot of relief in breathing.

Just for reference, my bunny weighed about the same as yours (1409 g) and was getting 1.25 mg of prednisolone once a day. It is a drug that you want to give the minimum effective amount of, though it is common to start at a higher dose and then taper down once the bunny gets some relief. (By the way, it must be tapered to get off it, never just discontinue it.)

I would suggest gradually adding more greens (romaine, parsley, fennel fronds were my bunnies’ favorites) so she doesn’t get dehydrated on the steroid, so her digestive tract can work smoothly, and so she gets more nutrition. With just a dry diet of pellets and hay, she may be more prone to stasis or tummy upsets while taking the steroid.

I would also suggest asking your vet about adding some meloxicam, maybe not every day, but it might make her more comfortable and there is some evidence it helps with tumors because it is anti-inflammatory. It is a balancing act, though, because both prednisolone and meloxicam can cause gastric ulceration.

 

[Ampee]

Yes, e. Cuniculi. A negative test would mean she doesn’t have it hiding in her system. A positive test will only say that she has been exposed at some time (estimates are that about 50% of rabbits have been) and won’t give as much information. Stress and immunosuppression can activate it if it is in the rabbit’s system.

Is the immune booster something your vet told you to give? Thymoma is a growth of the thymus gland, which is part of the rabbit’s immune system gone haywire. The point of giving prednisolone is that it suppresses the immune system, so I would be cautious about giving an immune booster since it might be working against the steroid’s effects. But I’m not familiar with how your booster works on the immune system, so can’t be sure.

Prednisolone can absolutely shrink the tumor, though there is of course no guarantee that it will. If your vet said it cannot, you might want to look around for a more experienced vet. As I mentioned, it shrunk my bunny’s tumor enough that she could be off it for 6 months before it regrew to a size that was causing her problems again. When I was deciding how to treat my bunnies, I spoke to several people who had used prednisolone, and to a vet in California who treated several of these bunnies, and some of them had dramatic shrinkage, with the bunnies getting a lot of relief in breathing.

Just for reference, my bunny weighed about the same as yours (1409 g) and was getting 1.25 mg of prednisolone once a day. It is a drug that you want to give the minimum effective amount of, though it is common to start at a higher dose and then taper down once the bunny gets some relief. (By the way, it must be tapered to get off it, never just discontinue it.)

I would suggest gradually adding more greens (romaine, parsley, fennel fronds were my bunnies’ favorites) so she doesn’t get dehydrated on the steroid, so her digestive tract can work smoothly, and so she gets more nutrition. With just a dry diet of pellets and hay, she may be more prone to stasis or tummy upsets while taking the steroid.

I would also suggest asking your vet about adding some meloxicam, maybe not every day, but it might make her more comfortable and there is some evidence it helps with tumors because it is anti-inflammatory. It is a balancing act, though, because both prednisolone and meloxicam can cause gastric ulceration.

Yes, it is something my vet recommended.
When I read about this steroid this was the same thing that puzzled me (Immune suppression vs imunne boosting) so I asked my vet about hey If we are suppressing the immune system then wont the immune booster counter that? She told me:
No! Thats not the property of the steroid we rely on. Immune suppression is another effect of the steroid we don't want, therefore we are countering that with Vetri. The thing we want from the steroid is to block cell reproduction hence the tumor's growth will slow down.

Also, on another note I think she is the best around. All the other Ive been to had some problems:
-One where they stung my Rabbit so she bled
-One where they were hesitant to investigate this runny eye/sneezing more.

 

[Ampee]

So I showed the piece of teeth to my vet via photo and it's probably an incisor (so not moral). How dangerous is that its broken off? Also how hard is it to "repair"?

 

[rabbit_friend]

Yes, it is something my vet recommended.
When I read about this steroid this was the same thing that puzzled me (Immune suppression vs imunne boosting) so I asked my vet about hey If we are suppressing the immune system then wont the immune booster counter that? She told me:
No! Thats not the property of the steroid we rely on. Immune suppression is another effect of the steroid we don't want, therefore we are countering that with Vetri. The thing we want from the steroid is to block cell reproduction hence the tumor's growth will slow down.

Also, on another note I think she is the best around. All the other Ive been to had some problems:
-One where they stung my Rabbit so she bled
-One where they were hesitant to investigate this runny eye/sneezing more.

Ah, I see. Yes, in that case, I can see how she would say the tumor won't shrink, as you are countering the immune suppression which I think does have a role in reducing tumor size. It sounds like you'd avoid some of the bad side effects of the pred by using the immune booster, though not the ones that deal with delayed wound healing and such. It might be interesting to search for steroid treatments in both rabbits and humans with thymoma - I'm pretty sure I saw some articles of it shrinking tumors in humans too.

I looked back at my notes and we actually had my bunny on prednisolone just 3 months before the tumor shrank enough that we could taper her off it (taking another 2 months to taper). Then she was off it for 9 months before it regrew enough to have to put her back on it. Most bunnies I've read about stay on it permanently, but because of her respiratory illness, it was better to have her off it a while so she wouldn’t have to be on antibiotics long-term.

From what you've said, I agree that your vet seems pretty knowledgeable. Just the fact that she is willing to try the prednisolone is a point (or several) in her favor!

 

[Ampee]

Ah, I see. Yes, in that case, I can see how she would say the tumor won't shrink, as you are countering the immune suppression which I think does have a role in reducing tumor size. It sounds like you'd avoid some of the bad side effects of the pred by using the immune booster, though not the ones that deal with delayed wound healing and such. It might be interesting to search for steroid treatments in both rabbits and humans with thymoma - I'm pretty sure I saw some articles of it shrinking tumors in humans too.

I looked back at my notes and we actually had my bunny on prednisolone just 3 months before the tumor shrank enough that we could taper her off it (taking another 2 months to taper). Then she was off it for 9 months before it regrew enough to have to put her back on it. Most bunnies I've read about stay on it permanently, but because of her respiratory illness, it was better to have her off it a while so she wouldn’t have to be on antibiotics long-term.

From what you've said, I agree that your vet seems pretty knowledgeable. Just the fact that she is willing to try the prednisolone is a point (or several) in her favor!

Maybe I should stop giving Vetri to have the size reduce?

Also on another note: Is the pred still effective if she eats it? Like not squshing it and then mix with water and then syrenge feed but just giving her while it's still a tablet and she chews it.
We were able to give her like this today. Basil leaf + pred inside . She ate it.

 

[rabbit_friend]

I always prefer to give meds as liquids so I can be sure the bunny swallows the whole amount. With a tablet, you never know if they have a piece under their tongue or stuck in their cheek and then spit it out later. We started out crushing tablets and mixing with water, but later our specialist vet gave us compounded prednisolone which was a yummy liquid that my bunny loved. The funny thing is that the vet said it was chicken-flavored

 

[rabbit_friend]

Another reason I prefer to give meds in liquid form (and I also always give with or after food unless it says not to) is that it is less likely to cause stomach issues. Since prednisolone can cause stomach ulceration, I would not just give the tablet and let it sit in the stomach to dissolve. It will be absorbed more easily and quickly if already crushed.

I would do some research first before skipping the Ventri, or ask if your vet can provide some research supporting its use during thymoma therapy. I only know that during chemotherapy for cancer, human patients are often told not to take vitamin C or other supplements to help the immune system because they can interfere with the action of the chemo. I have read several studies that say this, but it may depend on the type of cancer and chemo drug. Here is one:
https://www.breastcancer.org/research-news/supplements-before-and-during-chemo-risky
It could be that in the case of rabbit thymoma, just the very strong anti-inflammatory effects of prednisolone alone may be enough to shrink the tumor and the immune-suppressing effects aren't necessary. I just don't know since it's been over 5 years since I've looked into all that.

 

[Ampee]

Another reason I prefer to give meds in liquid form (and I also always give with or after food unless it says not to) is that it is less likely to cause stomach issues. Since prednisolone can cause stomach ulceration, I would not just give the tablet and let it sit in the stomach to dissolve. It will be absorbed more easily and quickly if already crushed.

I would do some research first before skipping the Ventri, or ask if your vet can provide some research supporting its use during thymoma therapy. I only know that during chemotherapy for cancer, human patients are often told not to take vitamin C or other supplements to help the immune system because they can interfere with the action of the chemo. I have read several studies that say this, but it may depend on the type of cancer and chemo drug. Here is one:
https://www.breastcancer.org/research-news/supplements-before-and-during-chemo-risky
It could be that in the case of rabbit thymoma, just the very strong anti-inflammatory effects of prednisolone alone may be enough to shrink the tumor and the immune-suppressing effects aren't necessary. I just don't know since it's been over 5 years since I've looked into all that.

For the stomach ulceration the vet told us to give Quamatel (a stomach protector stuff) so we are administering that as well.
Maybe is should mix it with vetri then? She loves that Vetri liquid. Even if a tiny amount spills on the floor she licks it all up

 

[rabbit_friend]

As far as your other bunny, it sounds like he may have bladder sludge. An xray from the side can easily tell (my vet can usually do that without sedation). I have a 10-year-old bunny who has had sludge problems for a long time. Make sure your bunny is jumping around a lot and is drinking lots of water (greens help).

 

[Ampee]

Today I learned that the hay I'm giving has "lucern" in it, so I will stop/give only a small amount.
With the movement: He doesn't move that much, the only thing he likes is that if I go to him and groom/cuddle him.
After that he always does flops like 2-3 in row.

 

[rabbit_friend]

My bunny doesn't move much either, since he is elderly and has spinal issues. So I put him on the counter every few days and just gently jiggle his lower abdomen to keep the sludge from just sitting at the bottom of the bladder. I also give him subcutaneous fluids to help flush out the sludge. Yes, the lucerne (called alfalfa here) is not recommended for adult bunnies because of the high calcium and protein. I do give my bunny some because at his age he can use the protein and he loves it. I would reduce yours gradually and make sure he keeps eating plenty of hay as you switch over to something else (mix old with new).

I had to look up quamatel to find out it's famotidine. I would be hesitant to give that long-term since it makes the stomach less acidic and an acid stomach is required for so many processes. Most of the bunny vets I've been to prefer sucralfate, though timing of doses is a little more difficult. It coats the stomach lining rather than suppressing stomach acid.

I can't think of any problems mixing the crushed tablet with the Ventri, though I don't know the ingredients and whether they might interact.

 

[Ampee]

My bunny doesn't move much either, since he is elderly and has spinal issues. So I put him on the counter every few days and just gently jiggle his lower abdomen to keep the sludge from just sitting at the bottom of the bladder. I also give him subcutaneous fluids to help flush out the sludge. Yes, the lucerne (called alfalfa here) is not recommended for adult bunnies because of the high calcium and protein. I do give my bunny some because at his age he can use the protein and he loves it. I would reduce yours gradually and make sure he keeps eating plenty of hay as you switch over to something else (mix old with new).

I had to look up quamatel to find out it's famotidine. I would be hesitant to give that long-term since it makes the stomach less acidic and an acid stomach is required for so many processes. Most of the bunny vets I've been to prefer sucralfate, though timing of doses is a little more difficult. It coats the stomach lining rather than suppressing stomach acid.

I can't think of any problems mixing the crushed tablet with the Ventri, though I don't know the ingredients and whether they might interact.

Dimethylglycine is the only thing Vetri DMG contains.

Hey, we think the same way! That's what I did with my male bunny for the past few days. "Jigge his lower abdomen"

 

[Ampee]

So an update:
It's been around 3 weeks since we started the steroid.
Just after 2 days of administering it, her condition got really better:
Active, eating a lot, eating pellets, drinking a lot, gained some weight.
No more sneezing.

However the fur got really hard under her eye (due to the runny eye I think)
How can I soften it up?

 

[JBun]

That's really wonderful to hear it's helping, and you're seeing improvement so quickly You must be feeling a lot more hopeful now.

With the hard fur around her eye, dampening the fur with warm water might help soften it up. Though I've found it's sometimes easier to just carefully pick it apart with my fingernails with it dry. It's kind of grainy, so once you start to get it separated, it will crumble out more easily.

 

[Moonshadow]

So glad your bun is improving!

 

[Ampee]

Yeah, also I can give the medicine in basil leafs, so she don't even notice it. She actually comes for the basil leafs every time.
Probably we won't go "the raditation therapy way" since it won't be this easy.