Mammary abscess in senior dog

[Myka]

Hi all,

Two days ago I saw a red area on Roxy's belly near the last nipples, but didn't think much of it because she has allergies and gets red skin on her belly often. I spray 50/50 ACV/H2O on it and it usually heals up pretty quick.

Late last night I found a hard mammary lump about the size of a tennis ball cut in half on Roxy that was leaking some pus and a bit of blood. She's not bothering it and didn't have a fever, so I cleaned it up last night with some Hibitane soap, and waited until this morning to get a vet appointment. She has an appointment for this afternoon. The lump actually looks less mad than it did last night - if that's even possible.

I'm pretty sure she has had at least one litter of puppies as she has the hanging boobies syndrome (haha). I was told when I adopted her (age 6) that she was adopted from the SPCA at age 2, so she would have been spayed then if she wasn't already. However, who really knows, right?

Has anyone seen mastitis in a senior, spayed female? I'm really hoping it's mastitis and not breast cancer.

I took a photo last night before I cleaned it up, but the photo is *GRAPHIC*, so I will provide a link instead of posting it into the thread. If you don't want to see a draining abscess, don't click.

Monday Feb 16th 11 pm: http://i85.photobucket.com/albums/k4...216_225205.jpg

[Myka]

Well the vet appointment went ok I guess. Roxy saw a new, young vet. Fresh off the books I think!

The vet thinks the lump is a tumor, not an abscess because it is hard and a bit lumpy (it looks smooth to the eye). She said statistically, mammary tumors in female dogs are 50/50 cancerous, though she says she's seen more like 75% cancerous. So that's not good.

The prognosis for dog breast cancer (unlike humans) is very poor. The cost of mastectomy is quite significant, so I figured the first thing we need to do is try to figure out if it is cancer or not. If it is cancer, then mastectomy may or may not prolong her life. If it is not cancerous then mastectomy is a good option.

So, apparently when dog breast cancer metastasizes it usually goes to the lungs first (same in humans actually), so she x-rayed Roxy's lungs. The lungs came back as clear, but she noted that Roxy has an enlarged heart, but no heart murmur. This is almost certainly unrelated, but it's something else to keep in mind if Roxy's going to go under general anesthetic.

Next, we did a CBC, electrolytes, and chemical blood profile checking for abnormalities, particularly elevated calcium which could indicate cancer. The blood work came back all within normal range.

The vet said we could do a biopsy, but she said it is very difficult to tell the difference between malignant cells and normal cells. Biopsy is the normal step for humans, so I'm not sure why it would be different for dogs. I don't know if it is because dog doctors aren't as good as human doctors or because dog breast tissue is different than human breast tissue. Anyone know anything about this??

The vet was pushing towards mastectomy surgery rather than biopsy. Although she wanted to send me to a bigger clinic to get Roxy's heart ultrasound examined before putting her under anesthesia.

Anyone have any opinions or experiences?

I might go for a second opinion to a vet I used to frequent who has seen Roxy before. I switched because this old vet is the most expensive one (most recommended too), and also because the new vet is the only holistic center in the area.

[Myka]

I made an appointment for a second opinion tomorrow. I will take the x-ray and blood tests with me.

[Myka]

I just checked the lump. It hasn't been draining at all today except a small amount of clear fluid. The Metacam (assuming) has reduced the size of the lump significantly - about 1/3. I'm not sure what that means. I look forward to the second opinion tomorrow.

[hazelrunpack]

Hope you get good results tomorrow, Myka! Keeping my fingers crossed!

[Myka]

Thanks Hazel, I hope so too!

Here's a pic from Tuesday Feb 17th 10 am (18 hours after first Metacam dose): http://i85.photobucket.com/albums/k4...eb172015AM.jpg

[Myka]

Well, the second doctor didn't say anything different, but definitely did clear things up for me.

She explained to me that ALL tumors are cancerous. I didn't realize that. I thought benign meant non-cancer, and malignant meant cancer. That's not true; "tumor" is synonymous with "cancer". She said benign means non-invasive, local cancer. Malignant means invasive, and spreading throughout the body. So, in female dogs there is a 50/50 chance that a breast tumor is malignant or benign. There is also a small chance that the lump is ONLY an abscess, but she can't tell without cutting her open. She also agreed that biopsy is not a good route. She said because of the abscess around the assumed tumor, it could be very easy to miss the tumor and get a false negative on a biopsy, and for not even double the price we can just get the whole thing removed.

She said time is of the essence. She said if we want to do the surgery we need to get a move on as soon as possible. Although she also said that if we can shrink the abscess at all that would be really good because she needs 3 cm clean margins. That's a lot of tissue. Also, she's not concerned about Roxy's enlarged heart because she is asymptomatic.

So at this point Roxy is on Metacam daily and we started an antibiotic called Apo-Amoxi Clav today to see if we can shrink the lump one way or another. We also want to see the affect of the antibiotic just to cross off the small possibility that it is indeed just an infection. Oddly, our Chihuahua, Peewee likes to lick her nipples so there is an off chance he introduced bacteria from his mouth to a small cut she had on her nipple.

[Myka]

Here's a pic from half an hour ago; Wednesday Feb 18th 9 pm (29 hours after first dose, 5 hours after second dose Metacam, 5 hours after first dose Apo-Amoxi Clav). The spots are from her allergies. http://i85.photobucket.com/albums/k4...eb182015PM.jpg

[hazelrunpack]

Wow! It's looking tons better!

So how long does the vet think can you afford to wait for it to shrink before surgery, or, if it's just an infection, to heal?

[Myka]

Originally Posted by hazelrunpack

Wow! It's looking tons better!

So how long does the vet think can you afford to wait for it to shrink before surgery, or, if it's just an infection, to heal?

Yes, I'm surprised the Metacam did that much!

I actually sent an email to the 2nd vet last night to clarify your question, as I am a bit unclear too. I had so many questions. I do know that if the improvement platforms that we will either do the surgery at that point or try a different antibiotic. The vet said that if it is a tumor, the tumor could be very small and the lump could be mostly infection. So if it goes down 90%, and there is a tiny bit left then we still need to do surgery. She gave me 12 days of antibiotics, so I think as long as she continues to improve we will go the full 12 days.

My mom had breast cancer a number of years ago, and we were talking about it last night. Of course this situation brings back a lot of memories for her, and really caught her off guard when I told her! She had a biopsy, then a lumpectomy, and then a full mastectomy with removal of associated lymph nodes. There were 7 weeks between the lumpectomy and the mastectomy. I'm not sure if that experience could be correlated or not.

[MarianE]

I have been following this thread with a quaking heart. I'm so glad things are looking as good as they can. It's just wonderful. I must say also 'thank you' because I've learned so much. Warm thoughts to you both.

[Myka]

No changes today.

Originally Posted by MarianE

I have been following this thread with a quaking heart. I'm so glad things are looking as good as they can. It's just wonderful. I must say also 'thank you' because I've learned so much. Warm thoughts to you both.

Thanks Marian! I've learned a lot too!

[Myka]

Well, the mass went down in size a little more from the last photo, but it hasn't changed in the last couple days. I'm pretty sure the mass is NOT just an infection - I'm pretty sure there is a tumor in there too. I'm going to talk to the vet today about getting her booked in for surgery.

[hazelrunpack]

Oh, no. Keep us posted! Will keep her in my thoughts and prayers

[Myka]

Thanks Hazel.

The vet said to let the antibiotics go their full run (14 days). She said she wants to see no progress for 2-3 weeks before stopping, and going for the surgery. Last night was Roxy's last dose of Metacam, so we'll see what happens without that.

[MaxaLisa]

Just saw this. I'm sorry

You might want to look into something like Enzymatica Therapy IP6?
http://www.ncbi.nlm.nih.gov/pubmed/9042302

[Myka]

Thanks MaxaLisa, I will check that out. It sounds interesting.

I guess it's time for an update. The lump has continued to get smaller, and there is probably 75% reduction from the very first photo (when the abscess was leaking). I have no idea how much of that was swelling, how much was abscess, and how much was tumor (if there is tumor). If there is tumor, the tumor itself shouldn't be shrinking. There is no heat, swelling, or redness at this point. The lump itself now feels lumpy where it used to feel smoother. Roxy is at the end of her 14-day antibiotics today, and the vet is happy with the progress on the antibiotics, so she prescribed another 14 days. The vet said if the lump is only an abscess that it could take 6 or even 8 weeks for it to completely resolve. If it is a tumor, then there will be a point when there is no more progress in the reduction of the lump.

[SuperWanda]

That sounds encouraging I hope that Roxy makes a full recovery and it turns out not to be something more serious.

[hazelrunpack]

That does sound encouraging!

[MarianE]

That's wonderful news. I love updates like yours. Hopefully, while you're still concerned, of course, your heart has lightened a little. Has your vet mentioned that it might be a cyst that became infected?

[Myka]

The vet's office called yesterday and said they would really like to examine Roxy soon and see how she's progressing. So she was booked in today (one space left!).

The vet was very happy with Roxy's progress, and said she can't even say for certain that there is a lump there anymore. She said what she's feeling could easily be a fatty deposit or even just scar tissue from the abscess. There is only one area that she is still a bit concerned about and that's a small area directly behind the nipple (where the abscess was leaking from). The vet wants to do 2 more weeks of antibiotics from today and re-evaluate then.

I only feel the lump about twice a week so that it is clear to me if there is any progress or not. I look at it everyday just to make sure it isn't flaring up or something, but I don't thoroughly touch it. Today at the vet's office I felt it for the first time in 3 or 4 days and there was a significant difference in that time. Indeed, it does just kinda feel like fatty tissue, but there is a harder section about the size of a marble right behind her nipple.

Originally Posted by MarianE

Has your vet mentioned that it might be a cyst that became infected?

Yes, the trouble is that almost all cancers are able to produce cysts, so if it IS a cyst, that doesn't mean that it ISN'T a tumor.

[hazelrunpack]

Still keeping her in my thoughts and prayers, but that sounds very encouraging! that the lump is reduced even further in the next 2 wks!

[MarianE]

Originally Posted by Myka

Yes, the trouble is that almost all cancers are able to produce cysts, so if it IS a cyst, that doesn't mean that it ISN'T a tumor.

I didn't know cysts could be cancerous, thanks for the good info. I'm glad to hear it's going so well! It's really the best news possible.

[Myka]

UPDATE:

April 1st was the last day of Roxy's antibiotic treatment. She had a vet checkup on April 2nd. At this time the lump was down to about 0.5 cm - just a hard, slightly flattened nodule. The vet said she's still concerned about this nodule, and is not sure if it is scar tissue from the abscess or a tumor. We decided to take Roxy off the antibiotics and see what happens. By Tuesday April 7th it was obvious that there was some soft tissue expanding around the lump, so I figured let's just get this dealt with.

Roxy was booked for surgery on Friday (yesterday). The vet tech said she went through surgery very well. They removed all the breast tissue associated with that nipple including 3 cm margins of skin around the nipple. So she has an incision about 8 cm long. We did not send the lump to the university for examination - if it is cancer we will not be doing any chemo or anything like that, so it's a moot point for us to find out what it was. It will either come back (which is bad), or it won't (which is great) - statistically it's 50/50. The vet also removed two skin lumps (not suspected to be associated). The surgery was done at about 11:45 am yesterday, and I picked her up at 3 pm.

She's on Tramisol (opiate) and Prednisolone (steroid/anti-inflammatory) for pain for a few days and the same Apo-Amoxi Clav antibiotics for a week too. So now Roxy is recuperating. She was very alert when she woke up this morning even though she got up a bit slowly and I was a bit concerned about her being silly and popping stitches. She got her first round of meds and now she's obviously drugged, and relaxing, so I feel better about that!

[hazelrunpack]

It would have been nice if it would have resolved completely on its own but it's a relief to have it gone! Sending along good healing vibes for Roxy and praying the nodule doesn't return!

Heal quickly, big girl!

[Myka]

Thanks Hazel, yes it would have been nice, and maybe it would if we continued antibiotics or tried a different one. Who knows. Someone in my family just passed away prematurely from cancer on Tuesday, and I just didn't have the gumption to deal with this anymore, and figured I'd feel better if I just get it removed. I wanted to get those other two skin lumps removed anyway.

Now it's time to save some money and get Peewee's teeth done (dang Chihuahua's and their bad teeth!).

[hazelrunpack]

So sorry for the loss of your family member. It's been a rough year for it--my 39-yr-old nephew died last month of a brain tumor.

[Myka]

Sorry for your loss. You're right, it's been a tough year. I don't know what the statistics say, but it seems like we're seeing more and more people dying of cancers.

Roxy is doing well. She has a fair bit of bruising, but quite there was a good amount of tissue removed. She's acting like nothing ever happened, so that's good. She seems to be a bit sensitive to over-heating as she seems to get too hot easily (like snuggling), and is drinking SO much water (maybe the meds?). I'm not sure is it's any concern - I'll mention it to the vet tech when she calls tomorrow to check up.

I added up the bills today... $1541. Ouch. Two more check ups to go too. Good thing she's a good dog.

[hazelrunpack]

We stopped tallying up the bills long ago. Too distressing! But all dogs are good, and worth it, so we just keep paying our bills...

Sounds like she's doing very well! Pred will cause thirst and excessive urination--and our dogs seem to feel hotter when they're on it, too--so I suspect that's why she's a little 'off' in that regard. How long before you can wean her off the pred?

[Myka]

She has a week of Prednisolone. Good to know. I was thinking it was probably one of the meds, and figured the steroid would be the likely culprit. Is she supposed to be weaned off it? I'm giving her a caplet every 12 hours until they are gone, so no weaning. Should I ask the Vet Tech about that tomorrow?