Chocolate lab with tumor
March 11, 2006 8:12 PM   Subscribe

I have an almost-14 year old chocolate lab, who collapsed about 6 weeks ago. They thought she had pancreatitis, but that was negative. In the course of events, they did an ultrasound and found an adrenal tumor, also a small nodule on her spleen.

They wanted to do surgery to do intestinal biopsies and take out the adrenal and spleen. I was reluctant because this was an emergency hospital, and I was not entirely comfortable with the surroundings.

They thought some of her intestinal problems might be due to allergies, so she went on prescription dog food and has been doing well- decently energetic, going for walks, etc.

2 weeks ago we repeated the ultrasound and it is different- the adrenal tumor is a bit larger (fractions of an inch), and her spleen now has multiple nodules. She also has some mammary lumps. Because the ultrasounds were done at two different places, it is unknown if maybe the first one just maybe wasn't performed the same way, and maybe these were there all along, and haven't changed.

I met with the surgeon, and she thought about 50-50 chance of malignancy on each one, with overall the index of suspicion high. She gives her 90-10 odds of coming out of the surgery, but there will be several obstacles. With the spleen, she might have heart irregularities for a couple of days, with the adrenal she will need to go on steroids "for a while," and with both, there is a risk of bleeding and need for transfusion. The last time she was on steroids she went nuts, but I am not sure if this is because her adrenal was overproducing. She was checked for Cushings disease but was negative. I trust the surgeon- she seems to really care, and was saying that she is such a wonderful dog, bright and alert. I feel that she would do all she could.

On the positive side, the spleen is easy to take out, and adrenal is the left one, which is easier for the surgeon to get to.

So now I have this big dilenmma. There are only 2 times in the next month where I can take the time needed to spend with her postop (extreme rest for 2 weeks). The best choice is in 3 days, but it seems so soon. But on the other hand I have had 6 weeks and all I am doing is letting these things grow if I don't do anything.

She has a pretty good quality of life now, and I don't want to mess with her....however these things look like they will grow and then things will be pretty bad with her. According to her regular vet, I can always "choose to stay in denial." She had pyometra (uterus burst) 4 years ago and I had to make an immediate decision and she did well, but that was 28 dog-years ago. I love her so much and want to do the right thing, but feel paralyzed. I wish I could ask her what she would want. Does anybody have any advice?
posted by marciabcd to Pets & Animals (11 answers total)
I suppose the golden rule might apply. What would you want for yourself, if you were in her situation.

For myself, "fix the problem before it spreads to another organ, and someone to take care of me after the op" would be the answer.
posted by Leon at 8:38 PM on March 11, 2006

I agree with Leon. Do for her, within reason, what you would want done for yourself. Just . . and this may sound a little harsh and I don't mean it that way at all -- but if it becomes apparent that she's in a lot of pain and isn't doing well, evaluate why you're taking the actions you're taking, and whether they're for you or for her. Having been in a similar situation in my past (with a horse, actually, not a dog) those are the hardest questions to ask yourself and act upon, but they're also the decisions that you won't regret later, because you've spent time on them. Good luck to you and your dog.
posted by Medieval Maven at 8:52 PM on March 11, 2006

If she's doing well enough otherwise (she's "bright and alert", right?) then I'd recommend the surgery. The surgeon and your vet seem to be in agreement, and in the end, I think however it comes out you'll feel better having done something. Besides, sitting around watching her slowly get sicker is likely to make you feel miserable and helpless.
posted by stefanie at 9:02 PM on March 11, 2006

I really have no advice but I just wanted to say that 14 is a grand old age for a lab and I don't think you can make a "wrong" decision here. If she were mine my major concern would be quality of life in the limited time remaining to her, whether she has this operation or not.

OK, I lied I do have a tiny bit of advice: don't let the vet guilt you in to making a decision you don't feel is right. I've gone through this many times with horses, dogs and cats and it's hard every time. Good luck.
posted by fshgrl at 9:03 PM on March 11, 2006

I'm very sorry to hear this story.

Your dog has lived to a ripe old age, any way you slice it. I can only extrapolate from what I know of humans, but from what you tell me, your dog has widely metastatic cancer. I can't see how a surgical operation could be curative; only palliative. That can mean suffering; your dog won't be able to understand why it's happening or why you can't fix it.

Here's a similar thread from a few years ago. It had a number of wise people posting a good, careful discussion of the topic.
posted by ikkyu2 at 9:06 PM on March 11, 2006

I agree with Medieval Maven. I completely understand your dilemma, at your dog's age, it's really hard to say what this surgery will buy her, it could be as little as a few weeks, or it could be a couple of years. I would say that if you're going to do it, do it now, do not make her wait, waiting makes it much more likely that you'll end up dealing with a debilitated dog with more involved tumours. But it would also be an entirely ethical decision to just treat this medically for as long as she is happy and comfortable. From a personal standpoint, I might be inclined to do the latter with a dog of this age, and I would definitely caution you to keep in mind that many veterinarians, especially surgeons, approach things from a "do something" standpoint, and may not always consider the long-term big picture (a successful surgery and good recovery is a good result, but this does not mean your dog will necessarily live all that much longer than she would have without the surgery, and she would have gone through the stress of surgery and hospitalization and recovery as well, which definitely raises the quality of life question). Good luck whatever you decide, your dog is lucky to have you.
posted by biscotti at 9:12 PM on March 11, 2006

marciabcd, the scenario you describe seems to be the metastatic cancer ikkyu2 describes. I can't imagine surgery to remove an adrenal gland and the spleen of a 14 year old dog, who also has mammary gland lumps, and perhaps other metastatic sites as yet undiagnosed, can be said to be truly therapeutic. Difficult as this may be, you signed up long ago to be the one to make the tough call, when it was time.

You know it is time, if not today, soon. I'm sorry for your pain.
posted by paulsc at 11:50 PM on March 11, 2006

I have had several labs, and know how you must feel at the moment. There is simply nothing better than a lab - they are indeed the best dogs on the planet.

However, as I have nursed a few labs into their old age... I must ask the following - when you say a "pretty good quality of life".....

How good is it? 14 for a lab is awfully old, and I would guess there have been a number of health problems in the past 4 years or so. If her health has been deteriorating lately, it may be time to face the facts about labs... they tend to fall apart rather early.
posted by bradth27 at 7:40 AM on March 12, 2006

As far as I understand it, the 'denial' should refer to the need to make a decision, not to the need for surgery. I.e. you're denying the need to make a choice. It's a hard dilemma - and remember that just a few years ago, it would not have existed as a dilemma.

If you don't want to treat this, you will make the rest of her life as comfortable as possible, and know when to make the call about putting her to sleep when the pain gets too bad.

If you do want to treat this, I would go for the surgery. Anything possibly malignant needs to be out of there ASAP. Any attempt to treat this just with meds, is going to involve multiple visits to vets, scans, med regimes, uncertainty, and so on. Vets may sound confident when they talk to you but I figure (from experience) they are guessing a lot; you may go onto one med regime, then be reading the medical/behavioural tea leaves and wondering whether it is working or not, then have more diagnostics, then be put on a different regime, for ever. As others have mentioned if it is widely metastatized, then surgery may not cure everything; but you could see it as being your 'best shot.'

Good luck.
posted by carter at 10:27 AM on March 12, 2006

Response by poster: The "denial" the vet meant was in the context of knowing something was wrong, and purposely ignoring it. She told a story of a puppy she had who appeared to have lung cancer, and for a month, she ignored it and gave him the best life possible. Then took him into surgery and he did have it and they euthanized him there.

By a pretty good quality of life, I meant she is pretty perky most of the day, follows me around, always wants to go out, actually gets so excited when she sees the leash that sometime she does a little dance. She sits next to me and comes over and rubs her nose. Wags her tail most of the time.

Overall, she has not had many physical problems since her pyometra surgery. Over the past 4 years, the worst thing I could say is that she sleeps more, and is stiffer getting up. One minute she will be moving around, and then she will curl up and sleep. However if she wakes up and I dangle food in front of her she will get up very fast. The only physical problems she has had are some anemia (gave her iron), a collar infection (antibiotics), ? mange (meds), and her recent collapse in January, treated with IVs/antibiotics. I don't think I was feeding her enough, combined with a ? food allergy. They wanted to do intestinal biopsies, but I wanted to take her home and see how she did with prescription dog food and "love therapy." She was 46 lbs, since then has gone up to 55 lbs and does look much better.

The only other recent problem of concern was two weeks ago, chills and temp of 103 day after an ultrasound (? this was something she picked up overnight at the vets, or a urinary tract infection.) Her ultrasound also shows a thickened bladder and she was losing control of urine before the antibiotics, so it seems like this is a chronic problem. They called this "fever of unknown origin," but I suspect it was bladder. Other than that, she has trouble holding her stools about half the time. This bothered me a lot a first, but it is part of life now. The vet says it's because her squatting muscles are weak, and she can't stay in that position for long.

Other than that, she is is pretty active walking around the house etc., but when she gets tired, she konks out for 5-6 hrs or so. She gets tired after a visit to the vet, but assume this is because she is pacing the whole time she is there. I never had an older dog before her, but assume this is normal for her age.

I am trying not to impose my people thinking on her, for instance I have heard dogs heal faster than humans, but if it was a 95-year old relative, I probably would not opt for surgery. My tendency (in general in life) is to try to figure out all the angles before deciding on something. In this case, it is paralyzing, and I am realizing I could be hurting her by waiting. As carter mentioned, what would happen if I don't? Another ultrasound in 2 weeks, just sitting there and watching the tumor overtake her.

I am trying very hard not to be in denial, but the ultrasound report is not overwhelmingly stating that there is malignancy. On the adrenal, "a central 4.6 mm hypoechoic focus was detected along with at least one small cyst. Left adrenal gland neoplasm should be considered." The spleen "appears more diffusely changed than on the previous study, and multiple hypoechoic foci/nodules are seen. These may represent regenerative nodules or extramedually hematapoesis, however the possibility of round cell tumor cannot be completely ruled out." On the mammaries, "two left caudal mammary masses were scanned and were comprised of irregular, imhomogenous, hypoechoic tissue and multiple minute cysts. The appearance of mammary massess is nonspecfic." I would think if this was overwhelming metastasis, it would say something like "strongly suspect," etc.

The other thing to consider is risk of blood loss with the surgery, as both the spleen and adrenal are "highly vascular organs," per the surgeon. The other thing is there is a risk of heart irregularity with surgery on the spleen, as it produces a substance that has to do with heart rhythm, i.e. need for defibrillation. The risky period is the surgery itself and several days after.

If it was me, I would have the surgery, but of course I don't know what it's like to be very old, and don't know if I would have a different opinion then. My grandfather had gall bladder surgery at 82, and lived to 92. I wish she could tell me what she would like. It seems her main happiness factors are eating (especially treats), being near me, and going for walks. I keep looking at her and asking her to somehow tell me- "I have a lot of life left, please do everything for me," or "I'm getting pretty tired, let nature take its course."
posted by marciabcd at 2:53 PM on March 12, 2006

It's hard. I guess the puppy story is not necessarily that helpful, as pups would have a much better post-op prognosis, I would have thought. I don't want to state the obvious or offer unnecessary advice, but have they run a thyroid function blood panel (you don't mention that)? Could explain the mange, and perhaps other things. Anyway, all the best.
posted by carter at 9:29 AM on March 13, 2006

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