To Biopsy Or Not? (long)

[Guest bigorangedog]

Hey guys,

Looking for some advice here... Let me give you the backstory.

 

In November 2008, our boy Crisco was limping on his right front leg and developed a good-sized lump in the "armpit" area. It's sort of under his leg, sort of back toward his ribs (you see it from the side, not the front). Pretty large, like the size of my cupped hand (I have small hands). It feels hard, but not bone-like. He doesn't fuss if you mess with it (and he's the type that would).

 

We had it x-rayed, and the vet said it could be a muscle injury or tumor. She aspirated it, and decided it seemed more like muscle than possible tumor. She told us that if it was a muscle injury, the lump would probably stay looking that way. In the meantime, his limping had subsided and he was moving around more or less normally, so we decided he was probably okay.

 

In the past few months he has seemed generally achey. In general it does not seem specific to that leg, and in fact more often than not it seems like his back end that is achey. We had to put a step up to the couch for him because he doesn't always make the jump all the way. Occasionally he will limp on that leg, but generally if he walks around on it for a while it seems to work itself out.

 

In May we went in for a checkup and had a full bloodwork done, all normal. She aspirated the lump again, and again said she couldn't tell us conclusively one way or the other whether it was muscle tissue or tumor tissue. Her gut feeling was that it was okay. (This was a different vet from the 1st time.)

 

It's hard for us to tell whether it has gotten any bigger or changed in any way, because we see it every day. My husband thinks it has gotten worse, but I don't think it has. But this week he does seem more achey than usual, and will limp on that leg some when he first gets up from sleeping.

 

The vet says that the next step would be to biopsy it. I don't know whether to do that or not. He'll be 14 in a few months, and it just makes me very nervous to put him under unless it is absolutely necessary. On the other hand, if it is a tumor, and there's something we can do for him, I need to know that.

 

(Oh, we've had him on 25-50mg of Deramaxx for the past few months, and he also gets the Springtime brand "Longevity" and "Joint" supplements. I just switched to those supplements about 2 months ago, and previously he got the Synflex glucosamine stuff. His spirits are otherwise quite good, and he'll even run a short distance occasionally. Still wants to go places, still excited about treats, still follows me around.)

 

We've lost 3 of our dogs in the last 6 months, two to osteo. Crisco is my best friend in the world, and want to give him a good life for a long time more.

Thanks for any advice!

Jen

[Jiffer]

If it were me, I wouldn't mess with it.

 

If anything, I would suppose that he's experiencing the aches and pains of old age, esp since the lump is still there and relatively unchanged since it first appeared.

[Guest Che_mar_Cody]

I'd take him to another vet for their opinion before I'd decide to do anything.

[Batmom]

If he's healthy, I'd just take it off.

[Guest budsmom]

Can your vet send the sample to OSU for them to look at? They're the experts and might be able to tell more than your vet can since they specialize in that.

[Guest Energy11]

If he were MY dog, I'd leave it alone! As you said, he is 14 ... just do love, lots and lots of it, good nutrition, and, of course pain management!

 

Hug that handsome senior man for us! Love, Dee and The Five!

 

p.s. LOVE his name!

[Guest kydie]

If he were mine, I leave it alone, at all most 14 I'm sure he has aches and pains, at almost 60 so do I, He he is in REAL pain then I would move on from there. I love the senior pups, one of mine is 10 and she moves a whole lot slower than ever I put her on a supplement with a high amount of MSM in it and it has help Good Luck

[Guest larock]

I would leave it alone. We had one taken off our 11yo and regretted it. It didn't go well, took 3.5 months to heal, two more re-stitches, a lot of open wound flushing and management, then another surgery - We finally took matters into our own hands and used every piece of advice that GT offered in order to get him healed.

 

2 weeks later we lost him to an unrelated complication, it was unexpected. To this day we have very much regretted putting the old man through all that and had we known, that it just woudn't matter in the big picture of things, we would have left it there and just enjoyed the last 4 months of his life without him going through all that pain and suffering.

Edited August 11, 2009 by larock

[EnzaFerrari]

I would go with leaving it alone. I removed a lump from my whippet who was 12 - and it took months to heal and she was miserable. She lived a bit longer, but I will never know if I had just left it alone if her last months would've been happier instead of miserable healing.

 

What heals fast when they are young takes so much longer when older.

[Burpdog]

Hmmm...tough call. I think I'd do a fine needle biopsy and send it off. I don't think they have to put him out for that.

[ahicks51]

I suppose the route to go would be to ask your vet- worst-case scenario, what do we do on a 13-turning-14 year old hound? I have a feeling management is going to be very similar to what you'd do if the hound were in pain: give painkillers, and hope for the best. I don't think chemo or surgery are appealing options at that age, although some might suggest management with artemisinin or similar.

 

Best wishes for you and your hound.

[Guest bigorangedog]

Hmmm...tough call. I think I'd do a fine needle biopsy and send it off. I don't think they have to put him out for that.

 

Sorry, is that different from needle aspiration? Thanks! Just putting things on my list of Qs for the vet...

[Guest lat41065]

IMHO at 14 how would knowing what it is change the way you address it ......... I also think that anesthesia can be horrible for a 14 yo. Id leave it be and keep his pain under control.

[Guest FordRacingRon]

Hmmm...tough call. I think I'd do a fine needle biopsy and send it off. I don't think they have to put him out for that.

 

I don't know anything aobut dogs and cancer,,haven't had to face that yet,,,but this is what they would do to a person and the person wouldn't be put under.

[GreyPoopon]

Given his age, I'd doubt I'd do anything. If I decided on a test that would involve anesthetic, I'd just remove it.

 

But just FYI: in other breeds, that location is a prime spot for lipomas (benign fatty tumours). Minnie has one on each side. We did a fine needle aspiration on one, and the vet rubbed a bit of the stuff between her fingers. It was clearly fat--even a non-vet (me) could see that. Perhaps neither of your vets thought it felt like a lipoma or saw fat.

Edited August 12, 2009 by GreyPoopon

[Wendie]

Jen, I have no words of advice, but just wanted to send you some :grouphug So sorry it's been such a rough last 6 months and you guys are in my thoughts

[macoduck]

Fine needle biopsy and fine needle aspiration are the same thing. A question you could ask your vet is how many samples will they take? I've heard of some dogs that did this without anesthesia, some with. Depends on your vet and Crisco's comfort level. Not sure if lidocaine could be administered first as it might skew the findings.

A lipoma can usually be left alone. Although we had a non-grey's lipoma develop "roots" that became invasive and though still benign,it had to be removed.

[Guest Greensleeves]

At nearly 14, I'd be inclined to leave it alone, and treat what sounds like old man aches and pains.

 

To this day we have very much regretted putting the old man through all that and had we known, that it just woudn't matter in the big picture of things, we would have left it there and just enjoyed the last 4 months of his life without him going through all that pain and suffering.

I VERY MUCH regret putting Nelly through ear surgery when she was 7. Obviously, we had no idea that she was going to die of (totally unrelated!) kidney failure a year later, but if we had, I would NEVER have made her spend five weeks in an e-collar, with a wound and forty stitches. It was absolutely horrible, and she was so unhappy during that whole time... I wish more than anything we hadn't stolen one of her last months from her like that.

 

Knowing that even in the BEST scenario, you have one or two years left, I would leave that lump alone unless it's clearly making life miserable for him.

[queenwinniesmom]

Oh, Jen, when I saw this post, I just knew it was going to be about Crisco! I knew he was getting up there in years, but had forgotten exactly how old he is. I don't think I have any advice, other than asking your vet about the fine needle biopsy, and if it is done without general anesthesia. I know you and Lloyd want to do everything for Crisco that you can, but I also know that you understand him very well, and would not put him through something if the negatives outweighed the positives.

I feel so bad that you've had so much heartache---I'm so sorry you lost your sweet Abby. I could sit here and cry thinking about Crisco being sick, so I'm going to assume that he is NOT!

And Lydia and I are going to send out many good thoughts (and telepathic nose kisses from her to her sweetie), and white light. And hugs to you.

Let us know how he's doing.

[Ragsysmum]

Personally if it isn't really bothering him much I'd leave it alone. I think sometimes just 'disturbing' things can trigger them off to start being active or developing and at his age you don't want to be doing that. Being realistic, you can't have more than a couple more years with him now so I would make every day count and not put him through anything which could be painful or lead to any invasive activity to spoil the rest of his time with you.

[Batmom]

Reason I suggest removal:

 

Our fragile, elderly whippet had a growth removed at 14 and healed as quickly as a younger dog. I will admit, due to location it was possible to remove it under local anaesthesia with a bit of valium to keep him quiet. Might not be possible in a location such as yours, but then again it might be. Might also be possible to remove it via laser surgery, which results in less trauma to surrounding tissues.

 

The reason we removed it is that it started growing to a size where it was bothersome for the dog. At that point, we wished we'd done it sooner, when it was smaller. We did not biopsy the growth.

[Guest KennelMom]

This is really a tough one. You have to consider the dog's personality and physical condition. If all is otherwise good/healthy, I'd lean more towards having it removed. Thirteen is just the beginning of "old" in this house...we've had dentals with major extractions and some other minor procedures done on 13 year olds. Our 13 year old Quilty has a rather large mammary tumor (we suspect) that we're going to have to make a decision on here shortly (she just came home to us a month ago and has been spending the month gaining some much needed weight). Q is a very spunky, strong 13 year old, so we're definitely leaning towards removing the mass if our vet is comfortable doing it and recommends it. We haven't really had a conversation about it yet b/c we've been dealing with some other issues with Quilty. Now that those are pretty much straightened out, we can focus on the tumors (there's also a small growth on her chin)

 

If a dog is "on the line" of us not being sure whether or not to procede, we have the "what will it change" discussion with our vet. If we put the dog through a surgery or other invasive diagnostic and it comes back with the worst possible scenario or any of the ones in between, what will that change? For example, our old girl Erin was going a little bit at 14. After discussing with our vet, one of our options was a MRI...not invasive but definitely pricey...the MRI would be to rule out a brain tumor and more definitively point towards the more benign diagnosis of cognitive dysfunction. Ultimately, we didn't do the MRI because if we found out she had a brain tumor, it wouldn't have really changed much. She was a very frail 14 and we would have just maintained her quailty of life as long as possible....the same as if she just had cognitive dysfunction (Erin lived for almost a year after...a little bit loopy, but happily. She didn't have a brain tumor, but passed from old age)

 

It really sucks to have to think and speak about these things practically and not from the heart...but a good vet should be able to have these very frank conversations with you so you can make the best decision for your dog and your family. Don't expect them to tell you what you should do...but they can educate you on all the possible outcomes and what may arise from each.

[Guest bigorangedog]

UPDATE:

 

We took Crisco to the vet today. We did another needle aspirate and another x-ray.

 

Good news: She does not see any signs of osteo on the x-ray. The mass appears to be pretty self-contained, without affecting surrounding structures such as irritating the shoulder bone, etc. What she saw of his lungs on the x-ray (it wasn't an x-ray of his lungs, since we don't really have any reason to suspect that yet) looked fine, and they also sound fine.

 

Not as good news: She does believe it has grown and changed some since the last time she saw it (which was Nov 08 -- another vet saw it in May). He does limp on it some, but she thinks it's likely that it sometimes presses on the nerves in that area. The cytology was inconclusive again -- it could be a benign growth, or it could be a hemangiosarcoma. There's no way to tell without a biopsy.

 

We're having the slides sent to OSU to see if they can tell any better than she can.

 

If it's a benign growth, there's not much of anything we can do to stop it getting bigger besides surgically remove it. Not the favorite option for an almost-14-yr-old hound. So in that sense, it doesn't matter a heck of a lot whether it is cancerous or not, because we're unlikely to do surgery in either case. (Of course, I still waver on that.) It appears to be slow-growing, so we'd mostly be worrying about metastases.

 

To address that, the vet thinks there is no harm in starting him on the OSU artimisinin protocol. She used this on her own dog last year and feels it is worth trying. (The vet's hound had hemangiosarcoma as well, but on the bone, and was not a good tripod candidate due to age/personality -- Crisco's potential tumor at least is in a better location, self-contained and outside his body cavity.)

 

So that's what I think we're going to do at this point, unless OSU tells us to do something different... Crisco is exhausted from his stressful day, even though he got Dairy Queen on his way home.

 

Jen

[Guest kydie]

[Guest Greensleeves]

Reading that, it all sounds mostly positive, really--and you have *something* you can try, to treat it. That's good news.