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Could it be something else besides lymphosarcoma?
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Could it be something else besides lymphosarcoma?

We have a 10 year old female black lab who was diagnosed with lymphosarcoma based on a test done on fluid or tissue drawn from her lymph node.  The reason I took her to the vet was because her whole back leg was swollen.  She didn't appear to be in any pain, her appetite was fine, no vomitting or really any other symptoms.  The vet took a sample from her lymph and called a day or two later to say it she has lymphosarcoma.  This was around October 1, 2009.  We opted to just treat her with antibiotics and prednizone.  She has been on both since October because if we stop either, the swelling in her leg gets worse.  At one point in late October, she was actually oozing foul smelling lymph fluid from the inside of the hip area.  Her leg still looks swollen, but doesn't seem to bother her.  She is over-weight still and has an enormous appetite still (in part from the prednizone, I think).  She will actually bark at us while we are eating because she want's our food now too.. even if she just ate a whole bowl of her own food.  She poops and pees normally.  The only real sign that she's not herself is that she is not energetic, sleeping most of the time.  Also, she is panting a lot more, but it's winter here and we run a coal stove to heat the house which keeps it pretty warm inside.  We think she may just be panting because she's hot because she seems to pant less if we open the sliding glass door a bit to allow the kitchen to stay cooler. (She mostly hangs out in the kitchen).  She was diagnosed almost 6 months ago and happily is still with us, without treatment.  Now, finally to my question, since everything I've read says the life expectancy for an untreated dog with lymphosarcoma is about 60 days, is it possible she doesn't really have it and that she may have something else causing the swelled leg?  Should we be taking her back to the vet for new tests?
Type of Animal
:  
Dog
Age of Animal
:  
10
Sex of Animal
:  
Female
Breed of Animal
:  
Black Lab
Last date your pet was examined by a vet?
:  
October 01, 2009
City
:  
ShermansDale
State/Province
:  
PA
Blood Test Results
:  
Lymphosarcoma
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931217_tn?1283484935
Dear Katballew,

Lymphosarcoma, aka "malignant lymphoma" often presents as enlarged lymph nodes in multiple locations. An aspirate, as your dog had [diagnosed with lymphosarcoma based on a test done on fluid or tissue drawn from her lymph node.], is frequently suggestive and even diagnostic, however because other disease processes (various infections or chronic inflammation) may alter the cytology (cells) in a lymph node, the diagnosis is usually confirmed with a lymph node biopsy (cutting the skin and removing all or part of a lymph node).

Certainly your dog could well have lymphosarcoma, however, if just one lymph node is affected and the dog is otherwise well, I would be looking to rule out another problem which is secondarily affecting a lymph node.

As far as treatment for lymphosarcoma, what you have had to date [We opted to just treat her with antibiotics and prednizone.] is at best minimally palliative. The course of the illness [if we stop either, the swelling in her leg gets worse.] while still possibly being lymphosarcoma, also suggests the possibility of a local infection in the limb.
[At one point in late October, she was actually oozing foul smelling lymph fluid from the inside of the hip area.]

Dogs on prednisone will be restless, pant, overeat, gain weight, drink and urinate more.

As "She was diagnosed almost 6 months ago and happily is still with us, without treatment." you may want to get another opinion to address what may well be a problem other than lymphosarcoma,  perhaps a resolvable one.  

" is it possible she doesn't really have it and that she may have something else causing the swelled leg?  Should we be taking her back to the vet for new tests?"
YES and YES

Tests to include: blood work (CBC and biochem profile), urinalysis,  xray images of limb and pelvic area, xray images of chest and abdomen. Biopsy lymph node if still present and enlarged. If a draining wound present that should be probed, cultured, biopsied and a drain placed if indicated.

In short, i would pursue this to get a definitive diagnosis.

Good luck and let us know how it turns out.

Sincerely,

Arnold L. Goldman DVM, MS
MedHelp & PDC
3 Comments
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Thank you for the quick reply.  I will take her back to the vet for additional tests.  I am also concerned about the affect 6 straight months of prednizone and antibiotics might have on her, specifically stomach, liver, kidneys.  If she has something else that is resolvable, I would hate to realize we damaged her digestive track in some way because we unneccesarily had her on those meds for an extended time period.  I hope we do find out that it's something else... we had initially resolved ourselves to losing her in a short time.
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931217_tn?1283484935
Thank you for the opportunity to comment.

As far as long term consequences of medication, it depends on why a medication is chosen, duration, dose and the pets condition.

There are pets that have conditions which require these medications for control and long term use is taken for granted. Indeed a good number of the conditions we treat are controlled, not cured. Generally speaking in and of themselves and when properly used for an appropriate indication, antibiotics are not harmful to organs. Certain classes of antibiotics must be used cautiously in certain conditions (For example: aminoglycosides like gentamicin when kidney disease already exists) but in an otherwise healthy animal with a particular infection they are essential.

Corticosteroids like prednisone are generally not used in pure infections, but are useful for inflammation and for inappropriate immune system related diseases. They can cause adverse effects its true, particularly in the liver if used in high doses for long periods, but in and of themselves when properly used should not be feared or avoided when indicated.

We hope that pet owners will trust the medical judgment of the licensed veterinarian they have chosen to work with when a diagnosis is made and a course of therapy decided upon. The public cannot be expected to grasp all the nuance of disease and the various medication choices available and should seek a professional they can trust to make treatment judgments in concert with them.The variables are just too numerous to second guess. If one finds oneself second-guessing, its time for a second opinion.

Very best regards,

Dr G
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American Animal Hospital
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