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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 ( 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 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

Stan is 10!
October 8th '07 and celebrating Stan's 10th Birthday

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