Corneal ulcer and general thoughts on a long term cancer surving dog. (long)
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  • L

    So, Lion, our nearly 13 year old that is a cancer survivor for over 4 years now, **** (though it may be finally catching up with her), developed a corneal ulcer the other day. Sorry in advance if this is long.

    She had recently been on a course of cancer treatment that was Chlorambucil and Dexamethasone (corticosteroid) for about 3 weeks after having been on Melphalan and Prednisone for about 4 weeks prior to that (Melphalan and Pred had worked before for some jejuenal lymph node swelling, but did not this time). After the Chlorambucil+dexamethasone treatments also did not shrink her lymph nodes but the weeks of high dose steroids basically wasted about 75% of her muscle mass and made her almost too weak to walk, we stopped that treatment as the cure was worse than the disease at that point.

    After about 10 days being off the treatments she had started to make real increases in her strength and her demeanor was back to the dog we love. In fact, instead of lterally watching day by day as she got weaker and weaker, we were seeing her get stronger and stronger. I noticed Saturday AM, she had a fair amount of eye gunk in her left eye. I cleaned it but didn't think it was that unusual as both she and her brother seem to have more eye discharge this time of year, so they must have a mild allergy to something. We had a small gathering planned later in the afternoon so as I got ready I noticed maybe about 3 it was still getting gunky, but the eye seemed OK otherwise. We had about 12 people over for a while (friends and family she knows well) and she was fine with them, but had begun squinting some but seemed to be resting comfortably. I wiped her gunk off a few more times and by the time everyone had left at about 8:30, I noticed a spot in her eye. It was pretty small.

    I started wondering if we needed to take her to the vet at that point and we figured we would plan to take her in the next morning if she wasn't better. I just had a nagging feeling and kept checking and about 10:45 it seemed like the spot had gotten bigger and the area around her eye was swelling so I just decided to take her to the emergency vet while my wife stayed home with the other dogs. I called and explained and they said bring her on by. So, I talk to the Vet tech there and they took her back just to look her over, check temp, weight etc and when she brought her back she said, based on what we are seeing, there's nothing we can do for her and you need to take her to the Vet School NOW. (we are lucky enough here to have the NC State College of Veterinary Medicine about 20 minutes from the house.) She called them and I could hear the concern in her voice and they got the Ophthalmology resident to come from home to meet me and Lion there. Its now probably 11:45 and they take us back. The resident comes in at this point, does a quick check and started getting really concerned. She went ahead and did a full eye exam, dilated her, put in dye, tested the Ph with strips that she stuck under her eyelids, used three separate light colors, etc to check her. Now, the ER Vet on call wanted to check and at least one student also came from home to see her. (one thing I have found about going to the Vet School for the oncology is your dog will never have a shortage of people to check them out)

    So, she has a corneal ulcer that is part way through and in danger of perforating. Also, has some bad cells floating around in her eye and lots of inflammation (even since I had brought her it had increased.) The thought is all the immunosuppressive drugs she has been on along with the anti inflammatory corticosteroids caused her to not be able to fight off the bacteria and it got in on a scratch or foreign object that lodged in, but was gone by the time it was noticeable. They want to keep her overnight so they can give her drops every hour or so. She thinks there is a chance that she really might need surgery or else she is at risk of losing her eye. If that's the case, then we have a really tough decision to make as since her cancer status is not really known and we won't really be able to tell until she has an ultrasound Nov 6. We are just at the perfect time between the treatments and the ultrasound that they couldn't tell anything. So, we pretty much have to hope the medical therapy works as we don't want her last weeks to be in severe pain from losing the eye and with as much as we have done and spent so far, eye surgery just didn't seem like a good idea given her status, as much as we wished it were not so. So, I left here there at 2:30 Sunday AM knowing that we could be near the end with the sweetest loving dog you could imagine.

    Next morning they call and say the treatments seem to be working. Eye is no worse, they want to keep her another full day. The other two dogs are super restless and mopey without Lion there as she is the alpha of the dogs and sort of keeps it all together. Get a call Monday AM, and I can immediately tell the Vet is happy. She said the eye looked so much better and that if we were up for giving her the drops we could bring her home. So, we go to the exam room to go over her treatment and the exam table is half full of the supplies. She has a serum that was spun down from her own blood to extract cells (I guess white cells? I forgot to ask. We have to use a needle to extract it, then take the needle off and use that as an eye dropper, drops that are an antibiotic, drops to dilate her hey as it was really constricted and spasming. Several pills to take, including antibiotics, tramadol for pain (they are afraid to use NSAIDs due to her liver). This is all in addition to the Denamarin and Alpha Lipoic Acid she is taking for the liver. Although 4 pills is not too bad, at one point she was on 7 a day, some AM, some PM and some both. We had to buy a pill keeper to keep track of them all. Basically, during the day, she needs drops every hour and at night, she needs them at midnight, 3 am and 6am. She is a trooper through it all and we have been up the last couple of nights like we have a newborn to give her drops. Now she knows that after she gets a drop, she gets a treat. That only took about 6-7 iterations. Its way easier to accidentally train a Basenji than on purpose it seems ;) And, even in just the 36 hours when was away, she got stronger, even with the eye thing. She is improving each day now and even is going in and out of the dog door with the e-collar on her! She just can't be stopped.

    So, a lesson. If it has to do with the eye, don't delay treatment. They said that if I had waited until the next morning, we would probably be at a very different place.

    ****She had colon cancer and when they operated on her to remove 10cm of colon, they found a very small bump on her small intestine that never showed up on any of the scans or ultrasounds they had done, in fact they said they never would have found it if they hadn't just done some exploring "while they were in there". Turned out it was a plasma cell tumor. She had 4 rounds of IV chemo after the surgery and we gave her oral chemo for a while after that. She then went into remission, but eventually developed swelling in some lymph nodes and spots on her spleen and a couple of other things here and there. After more oral chemo for a few months, all that went away, then eventually, we got to where we are now, with two swollen nodes that are not responding to treatment, but have been pretty slow growing so far. Plus she has three liver values that are high, only one of which can be explained by the drugs, yet focused ultrasounds of the liver and biopsies show no cancer that is detectable. But, other than the initial recovery and up until this last month, she has been feeling great. No one would ever know she was sick and she runs around and plays with the other dogs like there is nothing wrong with her. We decided that as long as her quality of life was good, we would do what we could for her.

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  • boy, that is one tough little basenji! glad it sounds like she's on the upswing. the old pups are so dear.

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  • ?

    Glad the eye didn't end it for her as she sounds like she can keep going and going. Thanks for the advice about getting eyes checked out sooner than later, already met a dog that got a stick in its eye and ended up losing it, not nice.

    Jolanda and Kaiser

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  • My OJ had this, same as you…. hurry to the Vet! And Good to find a Ophth Vet for check ups, especially when they get older

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  • Eyes go bad fast, and the pain is unbelievable (suffered from recurring corneal abrasion for 2 yrs… put me in fetal position). I am glad you acted fast and that she is raring to go again!
    Four years out from cancer is truly remarkable.

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  • L

    Had her follow up appointment yesterday and they were genuinely super happy with her recovery. Actually, they were almost shocked it seems as they really thought she was going to need surgery at one point. They did cultures of the bacteria and while I forget the name, it was something especially tough to get rid of. So, now we just have to keep up with the antibiotic drops 3 times a day. E-collar off and she is still feeling great. In fact, she wasn't quite up to full out B-500 last night, but when Roo, the youngest wanted to play, my wife chased her around and Lion was running along with them at least. She is continuing to get visibly stronger every day. We are starting to add some cooked chicken for more protein to try to build what muscle we can back up.

    Coming off the corticosteroids has affected her appetite a little, but it is now starting to rebound. When she was taking them, she turned into a zombie dog who went back to puppy stage times about 5. We had to re-puppy proof and she even got on top of a table to drag down a leather messenger bad of mine I had put into the center of a dining room table. She would get up in the middle of the night and start to walk half dazed around the house, looking at all the closed doors, probably thinking, HMMM, there is toilet paper behind this one, shoes in here, a basket with onions in the pantry that I enjoyed eating the fabric liner of.

    I forgot to mention this before, but she actually started feeling really bad about a month ago when they checked her over, they found a ball of fabric strips in her stomach, some of which had been there for years, plus the leather pieces from the bag, which was making her sick it seems. Here was a dog, still eating and pooping, but had a half coke can of fabric in her stomach. She had always been a ripper, from toys to the occasional shoe or purse and can chew through a Lupine 1" wide leash in about 30 seconds, but I always found pieces in the poop when I picked up or we found tons of pieces on the ground at the scene of the crime, plus we would watch her toys and take them way once she got them apart, so we never realized a certain amount had been building up.

    When we had the first consultation in 2009 and they operated, I remember them saying that 18 months was typical with this diagnosis if things worked out and that 24 would be near miraculous, but of course they also said that there just wasn't that much research about dogs and certain types of cancer. At least Lion has allowed them to add about 7 inches worth of literature to the available information on file so far. ;)

    I will say that everyone at NCSU CVM have always been super good to work with. We have had students that worked on her that have now graduated and moved on. Some that have seen her on and off their entire time in Vet School and especially the "backroom" staff that does all the work. I found out that during the last ultrasound, when it was apparent that the second treatment protocol was not shrinking her lymph nodes, and seeing how weak Lion looked, the Radiological tech cried. (and honestly, she was so weak and frail that even I thought she would be gone in a week if the trend was not reversed). Everyone there is always excited when she comes in. I guess it helps to have a super cute and cool dog, though I am sure they are nice to everyone.

    Waiting room, Midnight Saturday/sunday

    Coming Home Monday (this was at a stoplight)

    Begging for a treat Tuesday night. The new clear E-collars are so much better than the old one we had!

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  • L

    Coming up on three weeks and her eye is doing super great. When I took her last Thursday, they were all super excited at how well it turned out for her. I guess they really did think they were going to have to operate.

    Now, she goes in for her ultrasound with Oncology 11-6 to see what the deal is with her lymph nodes. She has recovered pretty well from the prednisone and dexamethasone she had been on and while she is not quite as strong as she once was, she is now able to manage the stairs again with little issue, run around and at least do a full shake. There really was a time, right before they took her off that honestly, seeing her decline over a couple of weeks day by day that I could not imagine her being able to live through another week of it.

    Whatever is happening, at least for now, she is once again a happy dog and she will almost certainly live to be a lucky 13 on December 21. When I brought her to her last eye check, the receptionist saw her walk up and thought she was a puppy. Now, if I could only find a way to turn off the zombie dog need to chew bad stuff she still hasn't shaken from the corticosteroids. ;)

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  • Wonderful news, thanks for the happy update

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  • ?

    Well done Lion.

    Jolanda and Kaiser

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  • Q

    Well done - glad she is happy and enjoying life!

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  • L

    So, checkup was good. Lymph nodes are stable, so it will get her, but not too soon.

    When she is treated we get a summary each time with the findings and there is a summary of the major things she has been treated for there. This is what you get when you have a dog living 4 plus years with 2 major types of cancer.

    The keratin cysts are something she's had for a while and unless one happens to flare up like a zit they don't bother her. She has something like 25 now and they stick a first year student with measuring and counting them most of the times she is there. They have a map of her entire body with all the sizes.

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  • All i can say is just enjoy every day you have. And spoil the heck out of her.
    I cannot tell you how much i miss my Digital. It's never enough time.

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  • L

    So, we had the dogs in the kennel overnight Friday and when I picked them up Saturday, Lion's left eye was swollen all around the eye, though the actual eye looked fine. This is the same eye with the corneal ulcer 4 weeks ago, also on the day we picked them up from the Kennel.

    So, while in the past, I would have waited a while, I wasn't; about to this time. My normal Vet is open Saturday AM and I was about to go there but figure I would go to the Vet School since they had seen her so recently. Turned out it is nothing! At least nothing related to her previous issue, which they were again impressed with her healing. They think she probably bumped into something and gave use some anti-inflammatory drops and a few pills. Its kind of funny because my wife said it looks like someone punched her in the eye. Just swollen up all around like a boxer but you just can't see the black eye bruising.

    So, now I feel like the hypochondriac pet owner, but she is still fine! And she is getting so much stronger.

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  • I know what I am about to say is "hypochondriac talk" but that would make me feel funny or suspicious about the kennel.. Not saying they did anything but I know if feel funny taking her there if I thought she would come home with a swollen eye!! I don't blame you for worrying- she has been through a great deal..

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  • ?

    Goodness she is having more than her fair share of hardship, hoping she is going to get a break and have no problems and get even stronger.
    You would only be normal to start feeling like a hypochondriac owner after the two incidents, I know I would.

    Jolanda and Kaiser

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  • L

    Just an update. She had a recent checkup and the swollen lymph nodes continue to stay the same size or get slightly smaller. In spite of the fact that I honestly thought she was days from death twice last fall, she seems like a pretty normal almost 14 year old dog at this point. She never fully regained all her strength and she is a little hesitant to try and jump up on high things (though if we coax her, she still can, just has a lack of confidence), but she still runs the fence with the other dogs when a kid comes by the back and will occasionally still play with Roo or us around the house and loves to go for walks.

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  • Best that anyone can hope for, for a senior who has been through as much as her! Congrats and enjoy all the time!!

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  • L

    Just had a checkup yesterday and she again has swelling in most of her lymph nodes. She is going to undergo one more type of Chemo, it is a protocol used in dogs for other types of cancer and in humans for multiple myeloma, but there is not much research for use in dog on multiple myeloma. They typically would do this along with a corticosteroid, but with her past history that is not an option.

    She still seems healthy outside and no one would know she was sick, though we notice she has slowed down a little bit, but again, she will be 14 in December. So, we figured we would try this as essentially the last resort as the side effects are not expected to be too bad with this protocol.

    If it has no effect on the size, of the nodes then we know we have done all we possibly can and will just have to make sure she is comfortable. She is a good dog.

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  • It is so hard… my older gal is going to be 12. I know time is not on our side. You have obviously done everything, given her a good long happy life. I hope the new protocol buys you a lot more quality time.

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  • L

    So, the treatments for the Lymph nodes worked mostly. Reduced most of their swelling (except one that's always been the worst) and kept it stable. But, when we went in for the last dose of Chemo and they did an ultrasound about 2 weeks ago, they found another type of cancer was in her spleen. At this point, we are pretty much out of reasonable options and she has actually been declining in the last 7-10 days. I guess three different kinds of cancer was just too much!

    At this point we are just trying to keep her eating. Her staple of grilled chicken that we could always go to stopped working. She will pretty much only eat steak, pork and treats right now. Going to try Baby Food, but we have tried some stuff from Honest Kitchen that others have said worked great as well as Raw Goats milk and some kind of Fish liquid that was truly gross and she does not want. Just trying to decide the right time for her, but she still seems to be in decent shape when she looks at you and can walk around fine. Lots of cuddles and belly rubs, which she will always roll over for. We had some family over this past weekend and she got tired of being petted.

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  • It's so tough when you try hard and just keep getting bad news. My thoughts are with you.

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