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Susie's eccrine adenocarcinoma & front leg amputation--pain meds?
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Member Since:
11 January 2016
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13 January 2016 - 12:40 pm
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I'm a brand-new Tripawd member, and originally posted this in another forum, but another member advised me to post it here, as I have a question about the surgeon taking my dog off all meds so just a week after surgery:

My little 10-year-old Westie, Susie, was diagnosed with eccrine andenocarcinoma (she had two different biopsies at two different times, as I guess it's hard to diagnose) of the paw pad on her right front leg. Apparently, there is also apocrine adenocarcinoma, too, which is not quite as rare as the eccrine and maybe not quite as aggressive. I can't find much of anything online about the eccrine type, as apparently it's so rare that many vets have never seen a case.

 My ten-year Susie presented with a limp back in early October. Another family member was outside with her and she ran around the shed in the backyard--when she came back, she was limping.

We (and our local vet) thought she'd stepped on something in the backyard and cut her paw and then it had gotten infected, or that she still had a foreign body in the paw pad. (The vet tried cutting it out with a scissors at one point, but couldn't find anything.) Through the next few months, Susie was treated with four different oral antibiotics (one of them so strong that I had to wear rubber gloves in order to handle the pills so I didn't get aplastic anemia), plus an antibiotic ointment. (Susie had to wear a little sock on the affected paw all the time, so she didn't lick the paw and also so the ointment would stay on.)

So, three months and five antibiotics (counting the topical one) later, Susie was still limping and in pain (even crying and whimpering in her sleep), and the paw pad area had ulcerated and gotten much redder and bigger. I had been taking her in to see our local vet every single week since early October, and it was now late December! I asked the vet to do a culture to see what antibiotic the "infection" might respond to, so under general anesthesia, the local vet did the culture and the first biopsy. Susie was due for a dental cleaning, so the tech did that, too, and also pulled one of her teeth. While she was under anesthesia, they also probed once more for a foreign body, but again, didn't find one.

After the biopsy, she had to wear a splint for several days, but it rubbed pressure sores on her leg and she was in even more pain.

The culture came back first, and showed which antibiotic would work best for her infection (at this point, she apparently DID also have an infection or two), so we got yet another antibiotic to give her, but we were told that it would finally heal her, so everyone was relieved and happy.

Then, just a few days later, the biopsy came back (I had completely forgotten they'd even done a biopsy, and the vet said she felt as if she were robbing us by even doing it, as the prospect of that type of cancer was so rare that she'd only seen one other case in all her 30+ years of being a vet). I had an appointment for Susie that day, anyway (my twelfth in about as many weeks), and I'll never forget the look on the vet's face as she ushered us in. Blissfully unaware, I was joking around about how Susie resisted going into the vet's office, as she'd had so many bad experiences there over the past three months. I remember telling the vet, "I love you, Dr. ___, but I wish I didn't have to see you so much!" But neither the vet nor her tech cracked a smile. Instead, the vet told me, "The biopsy came back this morning. She has eccrine adenocarcinoma, a really nasty and severely aggressive form of cancer. The best case scenario is that her leg would be amputated, and even then the cancer could metastasize to her lungs or lymph nodes. She's an older dog, so you might want to think about euthanasia."

I had to turn around and face the wall to get control of my emotions. I didn't cry, as I was reeling from shock. For a solid minute, I believe my heart just stopped beating. That's what it felt like.

Then I blurted out, "Ten years old doesn't seem old to me, especially for a little terrier! Susie is a very young ten!" She has never really been sick (except for allergies, which nearly all Westies seem to have), and has been the healthiest dog I've ever had, with no real chronic health conditions. So I had expected her to live about 16 years.

The vet readily agreed with my decision to try to treat the cancer, and recommended specialists. She said she wished she'd done the biopsy sooner, rather than let the cancer keep growing for three months.

Anyway, I made an appointment with veterinary oncologists at the University about two hours' drive from my house. They "staged" Susie's cancer by taking chest X-rays, lymph node aspirations, and an abdominal ultrasound--all without any kind of anesthesia whatsoever. They didn't even let her have her regular pain med--Meloxidyl, which she'd been on since early October for the pain from the "infection." She wasn't allowed to eat all day.

But she was a little trouper, and the tests came back negative for any more cancer, although they weren't able to get anything from the aspiration of the lymph nodes closest to that leg.
Because of the Christmas and New Year's Day holidays, I couldn't get Susie in to see the soft tissue surgeons for two more weeks. It was hard celebrating the holidays, when Susie was whimpering and holding her paw up, and also constantly licking it. I thought she seemed very depressed. I knew she couldn't go on much longer, in so much pain. The Meloxidyl didn't seem to be helping much at all anymore.
We were told we could have the surgery done by our local vet at a much lower cost than having it done at the University veterinary medicine teaching hospital, but I didn't want Susie staying overnight all alone the first night after her surgery. We decided to have it done at the University facility, and we stayed at the Holiday Inn Express there during the four nights that Susie was in the hospital, so that we'd be close by, and also we could visit her twice a day on the two days following surgery, at times dictated by the veterinary student's convenience.

I took her in to see the surgeon who would oversee the resident performing the surgery (I really liked her) and the veterinary student in charge of Susie's case, who was fabulous. They decided to run liver and kidney function tests on Susie the first day she was in the hospital (the day and night before surgery) to make sure she didn't have anything bad going on because of being on a daily dose of Meloxidyl for so long. (Her functions tested fine.)

She had her surgery on Wednesday, and the supervising surgeon told me she was a "rock star" and didn't need any blood transfusions. The next day she was in Intensive Care, but we were still able to see her for fifteen minutes at a time twice that day. The bad news was that her IV blocked up almost immediately after surgery, so she was no longer able to get fentanyl and fluids by continuous infusion. They tried one of the rear legs, and the vein collapsed. (Both legs are still very bruised and swollen.) She has been on oral codeine and Meloxidyl ever since the IV catheter got blocked after surgery, but they only want her on pain meds for the week immediately following surgery, so that means tomorrow is her last day. That kind of scares me, as I can tell she's still in pain, and she is also experiencing phantom limb pain. They are worried about the side effects of long-term use of the Meloxidyl, as she's been on it since October, and actually wanted her off it as of today.

They also biopsied the lymph node closest to her leg, and it did show a small amount of cancer. So that's scary.

Also they kept her an extra day in the hospital, since they didn't like the look of her incision, as part of it appears to have lost its blood supply. I was told they could eventually debride the tissue to get new skin growing in that area. That sounds painful to me!

We checked out of the Holiday Inn Express near the veterinary hospital after she was discharged on Saturday, and life has been very stressful and intense since then. I'm concerned that her pain is not under control, and concerned that she is too stressed-out by the E-collar to wear it. (We found a Comfy Cone collar to substitute for the hard rigid collar they sent her home in, but she went into a panic attack just minutes after my putting it on her. I think she got claustrophobic over the lack of peripheral vision.) She's a super-sensitive dog. So I feel as if I have to watch her every minute. I've cancelled all my work-related trips for January and February so that I can work at home and take care of her. I got rid of my Queen-sized bed and am using a twin-sized thin mattress (from Aldi!) on the living room floor. I bought her an orthopedic dog bed, but she seems to prefer my camp bed, so I was worried I'd be sleeping on the dog bed! (However, we can both somehow squeeze onto the very narrow mattress.)

She's wearing a Thundershirt (that I originally bought for her because she developed a fear of thunderstorms), and so far, has shown no interest in chewing on the incision area underneath the Thundershirt. However, she's been sedated from the codeine (and all pain meds end after tomorrow, because they felt she only needed them for a week following surgery). I did see her possibly licking the shirt at one point, but she stopped quickly (and the shirt didn't even feel wet). I'm still scared that she'll get more interested in her stitches once she's off all meds the day after tomorrow.

She is also licking the paw of her remaining front leg, and that paw looks red to me, so I'm scared to death she's developed cancer in it, too.

I asked the veterinary student about the inflatable donut e-collars, and she told me the one she bought for her own dog popped! We bought a less hard e-Collar while Susie was still in the hospital and showed it to the veterinary student, but she thought it might be too flimsy. So we had to take it back to the pet store in the area.

I'm having trouble getting her to eat and to drink water. She prefers to just lie in my bed on the floor of the living room most of the day. I feel stressed-out just taking my eyes off her to do anything at all, since she gets so freaked out by the hard plastic cone and also the Comfy Cone, so she isn't wearing them.

Any suggestions?

Also, the oncologist wants us to bring Susie back to the veterinary hospital (two hours' drive away) every three months for more chest X-rays, abdominal ultrasounds and lymph node biopsies. But the oncologist told me that chemo and radiation don't seem to be effective on this type of cancer. She did admit that, since it's so extremely rare, they can't offer any prognosis. I am wondering if all these tests are necessary (they would definitely not help with Susie's quality of life, as she was so desperate to get away from that hospital and would be scared to death we'd leave her there again each time we brought her in), since treating the cancer if it did spread to the lungs or lymph nodes would not seem to make any difference, anyway, or might not even be an option. It would be very traumatic for Susie, as she didn't even like the fact that her stomach was shaved for the ultrasound. (Of course, she is now shaved all over.)
Any ideas?

And is there anyone else out there whose dog was diagnosed with eccrine adenocarcinoma or is Susie the only tripawd with it in this group?

Virginia







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22 February 2013
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13 January 2016 - 12:48 pm
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Good, glad you posted here too. Our beloved "volunteer vet" will see it and provide insight if she's familiar with this type.

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!


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13 January 2016 - 6:21 pm
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I have heard of this but never seen one.  Adenocarcinoma in general is malignant and locally invasive so amputation was a good idea.  Since it was in the local lymph node I would suspect it may in time travel to other locations (such as the lungs) but that does not always happen or may not occur for several months/years.

As far as pain meds go small dogs do seem to get on their feet faster than large dogs although I usually at least do an NSAID for 2 weeks.

Pam

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11 January 2016
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13 January 2016 - 7:25 pm
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Thank you so much, Pam! I really appreciate it. Even the oncologists at K-State had never seen a case of it before, as it's so rare. It's no wonder that my local vet treated Susie for three months for an "infection." She said she'd read about eccrine adenocarcinoma, but had never heard of any vet she knew in this area coming across it.

So, even if the codeine were discontinued a week after surgery (today), you would still give the Meloxicam for a couple of days longer? I've still got some left, so I will probably keep giving it to her until it runs out, as it probably wouldn't hurt. I can tell she's in more pain right before she's scheduled to have her next dose of codeine.

On The Road


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13 January 2016 - 8:50 pm
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Pam you are the BEST, thank you!

Susie's Mom, tomorrow I would ask your vet about continuing the meloxicam in case Pam doesn't see your response.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

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11 January 2016
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13 January 2016 - 11:57 pm
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I will do that, Jerry. Thanks so much! Maybe I'll see how she fares off the codeine, though, before asking for it to continue past the one-week-past-surgery mark.

I think the reason they wanted her off the Meloxicam is because she's been on it since October, and apparently it can cause liver or kidney damage or even stomach ulcers (although I think there's at least a small risk of all NSAIDs doing that). But, in my opinion, just one more week on it would be worth that risk if it means that Susie isn't crying in pain.

On The Road


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14 January 2016 - 10:22 am
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Yes, NSAIDs can definitely do that, it happened to us once so I don't blame them for being cautious. Just check with them before changing up her meds, you'll feel better about it and she will too.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet


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14 January 2016 - 8:54 pm
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I would ask your vet but 1 more week of meloxicam should not hurt.  It is pretty safe.

Pam

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11 January 2016
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14 January 2016 - 10:12 pm
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Thank you so much, Pam! I really appreciate it.

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