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Stan's story of his fight with
intestinal lymphoma
This is Stan's story of pre diagnosis of intestinal lymphoma
to now 11months later
Stan started having diarrhoea in March 06 and I guess he's
always been a softish firm poop sort of guy! The kind that you could
pick up with bag but not the formed easy pick up poo (sorry...am I
being too graphic?)
Few things I noticed about Stan even before March 06 was that
he was always a fussy eater (you'd never guess now that he's Stan
the non- stop eating machine!) He use to be fed dry kibble but would
take ages to eat a small cupful (would go and graze at it throughout
the day and take a few hrs to eat it....even though I tried changing
his kibble. Now ...he'll eat anything including kibble (and skewers
and anything else!)
Other things that I notice before March would that he would
eat a LOT of grass. He'd go and strim the long grass from the edges
of my garden and going on walks, he'd always take a chomp of grass
and have it hanging out from his mouth (unfortunately it didn't
always get digested and may come out/get stuck the other end!)
He also used to sit in his bed and use his front paw to rub his
chest to belly....seriously I thought he was being a rude boy and
wanted to rub something else but he use to keep doing that. He also
used to be very sensitive to any food changes or treats and could
easily get a few days of looser stools.
Then in March 06 (after he had to withdraw from a tv show in
UK called Britains Top Dog -he was one of 16 dogs chosen nationwide
to go on the show and only one of 4 dogs in the South West/Wales
area but that's another story)...then in March he started having
loose stools with urgency after any sort of exercise. It was
guaranteed that after he'd played ball in the park then few mins
after stopping, he'd get urgency and have a loose motion.
So he ended up being investigated....initially stools showed
campylobacter, so we treated that with abiotics for weeks and weeks,
then we tried changing foods to sensitive/intstestinal dry kibble,
no improvement. bloods were normal though looking back now -in July
06 his lymphocyte percentage was >30% and a blood film was
advised but not done (so I wonder if things were getting out of hand
then) So we tried foods, wormer, stool cultures and very little
improvement but his stools were still soft formed not runny.
Then in July 06, Stan went on holiday with me and nearly
drowned. It was awful seeing my boy sink and worse still seeing his
breathing be erratic and him "out of it" then, breathing
stopped, he went blue and I gave him mouth to nose. He spluttered
and was then sick then had oxygen from the lifeguard until we
located the nearest vets and took him there.
At the vets who saw him after he nearly drowned, he had a shot
of dexametasone (strong steroids intravenously) to prevent secondary
drowning. He was already on antibiotics for his stools and also
given diuretics (120mg!! which is a huge dose for a 18kg dog
compared to in adult humans we use max 80-120mg and that's for an
adult human!) Poor Stan was weeing for Britain!
The day after the steroids (so this was July 06) his stools
were nearly normal (the first time since March 06) so when we got
back home, the loose stools started again after a few days (after
steroids) and so we started treating him for inflammatory bowel
disease. He had prednisolone 5mg every other day for few wks, then
tried antibiotics, then sulfasalazine but all didn't make much
difference. Then his bloods showed folate was really high so they
diagnosed SIBO (bacterial overgrowth) so gave him more
antibiotics/probiotics.
Throughout all of this Stan was well in terms of being active,
though appetite was always fussy as it always has been. His wt did
drop a bit but we put it down to the diarrhoea -his wt dropped to
about 16.5kg
Eventually in Oct 06, I spoke to the vets about referring him
for further investigations. The vets were initially a little
reluctant as they were still working on the food sensitivity thing
as a cause but I insisted although at that stage I didn't want Stan
to have to have an endoscopy/camera test as that seemed drastic for
a "well" dog.
Funny that sometime in those months -possibly about July time,
I noticed his submand nodes were enlarged and remember pointing it
to my vet and they weren't concerned. Stan's got missing teeth and
worn down teeth (again from his past). Looking back now, I would
have been more worried.
So we got referred to our specialist and they took a history
and were keeping Stan for the day to do bloods, scans. They knew I
was a bit reluctant to do anything "invasive" as Stan's
probably 9-10 yo but not sure as he was a stray .
Well bloods were ok but his abdominal ultrasound showed
thickened gut lining (from memory I think 8mm although normal is I
think less than 4mm). He also had some enlarged gut nodes-
mesenteric lymph nodes were 2-3cm big and also ileo-caecal nodes.
When we had a chat to the specialist, he said the next stage
would be to do a camera test as it could be just severe inflamm
bowel disease or it could be other causes including lymphoma. I
asked him about giving him treatment with steroids first (at a
higher dose than he had previously) and other treatment for inflamm
bowel disease as I didn't want Stan to have an anaesthetic/invasive
procedure. The vet told me that if it was cancer, then dogs would
not respond so well to chemotherapy if they'd been on the
steroids...so reluctantly I took his advice and Stan stayed another
day to have the camera text -down his mouth and up his bottie!
They then phoned me to say the gut lining was all very very
very inflammed and bleeding and could be due to inflamm bowel
disease or something like intestinal lymphoma. They took gut
biopsies and also took some samples from the enlarged gut nodes.
Well, the results from the gut nodes came back reactive rather
than cancerous, so when I went to pick up Stan on that Friday
afternoon we were all thinking it was a case of very severe inflamm
bowel disease. His bowels were so so bad that he was recruiited into
a trial they were doing (and the vet doing that is now one of my
friends as she's good friends with one of my friends but didnt
realise at time! small world!)
So that weekend we were happy that it was likely severe inflam
bowel disase, recruited into trial but we knew we had to wait for
the bowel biopsy results.
Then on the 13 Nov, (I had started a new job on the Monday) I
got the call from the specialist to say the biopsies came back as
lymphoma. I couldn't believe it and the prognosis was those awful
figures 4-6wks with no treatment (so would have been xmas by then)
or 2-3months with steroids alone, or 4-6months with chemotherapy.
I was a mess and crying (very attractive !!) and remember
saying to the vet about chemo, was it worth it, the side
effects/pros and cons. Whereas he didn't push me either way, he did
say as Stan is well it wouldn't be a bad idea to try the chemo.
So we started the chemotherapy -COP protocol . Initially
vincristine weekly for few wks with the prednisolone, then we
introduced the cyclophosphamide but Stan didn't get on with that so
we swapped to melphalan (which isn't classed as a usual tablet for
lymphomas but more so for myelomas/ovarian cancers...but as I've
found out Melphalan is the drug of choice for treating lymphomas in
ferrets!!)
So Stan was on weekly vincristine till about 3m post diagnosis
, then we dropped to fortnightly then at 6months post diagnosis he
dropped to 3wkly vincristine. Throughout all of this Stan had abdo
scans to check progress every 2nd treatment and gradually the nodes
shrunk in his gut and his gut thickness went back to normal.
It was difficult for the first 3-4months as Stan was already
having loose motions and before his diagnosis it was very runny, but
with the chemotherapy it made the diarrhoea worse and he had
increased frequency/urgency/some accidents and I had many sleepless
nights! I live alone and work as a doctor so it was awful leaving
him home alone especially if I'd had little sleep in the night.
Surprisingly Stan's grass eating (which he'd always done from
the first time I'd had him) seemed to stop/decrease, the funny tummy
rub he used to do completely stopped and his appetite after the
first few months of chemo gradually picked up and he now eats his
dinner (and everything else!) within a few minutes!
As you may have read, his last scan on Monday was normal and
his stools grew salmonella . His poops are improving and near
normal, he's back on his normal food (rather than home made
chicken/rice) and we're back for more chemo on Monday when it's
Stan's birthday (it'll be the 6th yr I've had him!)
Unfortunately it's the last time we'll see his specialist as
he's moving to a new post and I will be so sorry to see him go as
he's been there from day one.
I'm not too worried about the hyperechoic area on the spleen as
it hasn't changed from his scan back in Nov 06 and we can get
shadows like that. I guess the alternative would be for Stan to have
his spleen out and I don't want him to have an operation such as
he's so well and his bloods are ok. I'm happy just monitoring it.
So there you have it and anyone else who's not fallen
asleep reading this! That's Stan's story and he's now 11months post
diagnosis which is brilliant.
He was back for chemo (vincristine) y'day) and his bloods were
fine. They even said that if it wasn't for his external lymph nodes
being up , then they would wondering if his diagnosis on the
pathology of his gut biopsy of intestinal lymphoma was correct and
we were dealing more with a very severe inflam bowel disease. He did
also say that often they treat severe IBD with chemo. I don't doubt
Stan has lymphoma because hisexternal nodes do vary a litttle with
vincrisine.
Stan the nonstop eating machine and his Salmonella belly is
still here eating, drinking, burping, occasionally farting but he's
such a wonderful happy cheeky character and I love him to bits. You
probably know that since Stan's diagnosis in Nov 06 he has worried
me with his appetite for all things inappropriate like the BBQ
skewers, sachets of dessicated beads and all sorts! That's probably
why he's had campylobacter again and now has Salmon Ella and her
millions of mates in his gut!
I'm going to try him with a few treats tomorrow cos birthday
boy's belly needs treats on Monday!
Carol and Stan and his soon to be enemies Salmon Ella and her
mates
October 8th '07 and celebrating Stan's 10th Birthday
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