Enlarged lymph node

[gooeydog]

Also known as "why getting old sucks"

Haley's had numerous lumps and bumps removed over the years, including a MCT (grade 2, small margins, but grew slowly and had 0 mitotic index- we opted to monitor for recurrance or other tumors) in '07. She's had a few cysts removed, has a few fatty type tumors we've decided just to monitor due to her age (newly 11, but she's also diabetic) and has about a billion skin tags.... all in all, she's a lumpy dog.

I noticed the Friday before last that Haley had two enlarged lymph nodes in her inguinal (lower belly) area, the right was about 1.5" long x 1" wide, the left smaller, but still clearly enlarged. She also had some skin pustules on her belly and hind legs. The vet who's seen her for her various lumps and bumps was away until tuesday, and she'd had another (different) node enlarged in conjuction with a skin infection a month or two before that had gone down with antibiotics, so I figured I'd start her on them again and wait for the usual vet unless her symptoms progressed. LNs seemed like they were getting a little smaller, so when we checked with the vet on Tuesday of last week, he said we could do a needle aspirate to know for sure what was going on, but that the enlarged LNs could be in response to the skin, and that if they were getting smaller, it would be fair to give it another couple days and see if they continued to shrink.

I opted to go the latter route, and over the next few days, her skin cleared, and the nodes seemed to be getting progressively, if slightly smaller. This Tuesday morning, the left LN was considerably smaller than when I had first noticed it, the right was still obviously enlarged, but smaller than it had previously been. I was hopeful. We went for our therapy visit at the senior center in the morning, where I noted she had picked up a flea (plucked it off, but she's got flea allergies, so it only takes one bite), she then became itchy and developed a few hives. After getting home, we hung out at home through the afternoon, then I dropped her off at my mom's for a bit while I went somewhere in the early evening. Later that night, I checked to see what the LNs looked like, and the right one was bigger than ever (egg sized area of the LN and inflamed area around it), the skin over it was red and inflamed. Yesterday I took her to work with me in the morning, the vet agreed that the left LN is much smaller, and that the right one was much bigger and inflamed looking. Sent out a needle aspirate, should have the results by tomorrow, but it wouldn't suprise me if they were in tonight. Not expecting good news, as I can't imagine anything good that would have caused that sort of blow up, and even the vet mentioned that it seemed sort of MCT-esque. Today the node is still about the same, so I guess we'll just wait and see. Haley, of course, is normal Haley, lazy at home, wild attention grubber in public.

[jamielvsaustin]

Very sorry to hear this. I hope you get the absolute best news possible and it was all just a scare. *Fingers crossed* Please give Haley a smooch for me!

[julie64]

Sending good thoughts to you and Haley.
Glad she is still acting normal.

[pblove]

Haley stop this LN shilt NOW (please stay well my crazy lil friend)

[Murfins]

Sending positive thoughts!

[Leslie H]

Haley is just trying to find ways to get you to take her to visit the vet's office. I hope this turns out to be something minor. Sending positive thoughts your way.

[gooeydog]

Well, two pathologist reviews of 3 different LN samples later, and we're still not sure what is in there. We sent the sample of the right LN, report back the next day said there wasn't any lymphoid tissue present, so we sent samples of both the right (again), and the left (which is almost normal size, but had at one point been quite large). Again the report said it looks like no lymphoid tissue, this time they suggested that the mass may be some sort of inflammatory lesion. Doesn't rule out things like lymphoma or spread of her previous MCT, but also doesn't rule it in, which I suppose is a good thing. Doesn't seem that they saw mast cells in the samples we sent, as it says there was no evidence of neoplasia in these samples, though a FNA only allows for a small sample to be tested, so anything is possible. They said it could be a granuloma, abscess, or nodular panniculitis/steatitis, among other things.

Recommending antibiotic and anti-inflammatory treatment, biopsy if it doesn't resolve with that. She already takes an NSAID for her legs, and has been on antibiotics and benadryl since I noticed the issue (can't give her pred because of her diabetes), and since the other "node" seemed to shrink up with that, we're going to give it a few days to a week and see if this one starts to do the same again, and if so, we'll continue that treatment as long as necessary. If it gets bigger/angrier looking, or she presents with any other symptoms, we'll biopsy it. If it stays the same, we may switch antibiotics next week, then consider the biopsy if still no significant response. I haven't looked at it yet this evening, as she stayed at my parents' while I worked today and was snoozing in her crate when I got home, but when I checked it before I left this AM, it was looking a little less firm, and maybe a little less inflamed around the swollen area. Guess we'll just have to see what happens over the next few days and go from there...

When I deposited her off at my Mom's this AM, I applied socks to both her back paws to make sure she wouldn't scratch, and the soft e-collar to be certain she wouldn't chew/lick that spot til my Mom was up to watch her... then put her in the crate when I left. She obviously felt totally demoralized and appalled by that treatment, judging by the look I was getting as I left I suspect I may be in for some sort of punishment in the near future

[Leslie H]

Well, I hope the meds do the trick. And yes, you are definitely owed some punishment.

[gooeydog]

The "egg" is definitely getting smaller, it's now about 1.25" long compared to the 3" or so it was last week, which is a little smaller than when I first noticed it 2 1/2 weeks ago. The left node is still not completely normal size, but hasn't gotten any bigger, either. Inflammation of her skin is gone, and the area around the "node"/lump feels normal. She has had some gross brown staining of her belly/inguinal skin over the last day or two, with a little odor, so I suspect she may be getting some yeast... unsure whether it's a side effect of the meds/lump, or was maybe even a contributing factor in all this happening. I don't work today, and it doesn't seem to be bothering her, so I'll have it checked tomorrow.

[gooeydog]

Lump is still there, it's stayed about the same size since the last update. Yeastiness was clearing up, but now she seems to be getting it back again, and once again the skin over the mass is getting angry looking red splotchiness about it. She's on antibiotic #2 (a week so far), and haven't really noticed any improvement since the switch. We sent out a tick panel yesterday to rule out one of the less well common tick diseases, and I find myself half hoping for a positive result, at least then we'd know what we're dealing with (also sent out a CBC/Chem, which was normal). I'm reluctant to have it biopsied, as she's not a great surgical candidate, and if it's a MCT, or even some other sort of tumor, cutting into it is not going to help matters at all.... on the other hand, if it's something else that can be treated, we won't know unless we send a piece out to have it tested. I think we'll try one more antibiotic after this one, then consider the biopsy if no significant improvement. It's hard to decide, but I'm reluctant to choose a more drastic approach, as other than the node, she seems perfectly normal, and she's tired of the increased poking and prodding already (I'm not planning to do chemo if there is a malignancy, so waiting won't make a difference in that case). Hoping we'll get some results from the tick panel Monday or Tuesday, and that maybe it'll be something simple for once!

[Leslie H]

There does seem to be an increase in some of the less common tick born ailments. Hopefully she needs nothing more than a round of different antibiotics. Sorry this isn't resolved yet.

[pblove]

did you send the tick panel to proteck?

[gooeydog]

It was a fastpanel PCR to Antech. We've had good results with it on a few dogs at the clinic I work at, though if it's negative, I may ask about sending out titers as well, just to rule out a more chronic, background level infection. With her currently "symptomatic" though, I guess I'd expect it to come back positive. I'll be vaguely surprised if she is positive for TBD, as she's not really at high risk for tick exposure, other than the population of them in our area, but you never know. There are other autoimmune diseases too which could be rule outs, so we'll have to decide which route to take after these results are back.

[gooeydog]

Tick panel is negative. Her vet was busy today, and since it's not really an urgent matter, I'll talk to him tomorrow or thursday about whether we should sent out the tick titer, and if there's anything else worth testing for that we may have overlooked. Short of that, guess we'll continue with the antibiotics, maybe switch to one more next week, and (hopefully won't need to) consider a biopsy after that.

[gooeydog]

Not good news, in any case. Two months later, and Haley's inguinal LNs are still enlarged. There was a period about 3-4 weeks ago where things seemed to really be looking up, we'd switched her to a different antibiotic, and both nodes shrunk up quite well, the right down to about the diameter of a quarter, and the left to almost "normal" size. Then I noticed that she had a couple lumps on the sides at the base of her neck, but not really symetrical, one a good bit higher than the other... she had a fatty type tumor on one side a few years ago that we never removed, so I considered that it could be that, they seemed too off kilter to be LNs, of course, no real way to know without biopsy. About a week ago, the first affected nodes got bigger again, and are now probably about the same size they were when I first noticed them. We discussed the risks and benefits of a biopsy again (the last time she was sedated, her heart rate became ridiculously slow, and didn't respond quickly to drugs to correct it- knowing what is going on with her LN does us no good if she dies finding out), along with the prospect of seeing an internal med specialist soon in hopes to get a diagnosis without surgery.

Had a different Dr look at her this evening because the area looked a little inflammed again, and she thinks lymphoma is the most likely possibility, despite the nodes varying size over time. It's been there as a possibility the whole time, but it still sucks to hear that it seems to most closely fit the bill. My parents don't want to do chemo, and I've also been leaning towards not, but it''s hard as hell to maintain that outlook when you're watching your dog merrily writhing around greeting everyone she encounters and thinking that there's a distinct possibility she'll be gone in just a few months. I had planned to schedule the int. med consult for this coming week, and still plan to at this point, but not really feeling optimistic about it at all.