Oncologist's are stumped

#1 · May 2, 2022, 4:28 pm

Hello everybody. I have a 5 year old cane corso named Vito. Over the course of this summer I noticed him losing muscle mass but his weight was the same. What's important to know that this was a slow process. Vito was filling with fluid in his chest and abdominal cavity. The vets drained 7 pounds of lymphomic fluid from his chest and 2lbs. from his abdomen cavity in January. He's had several ultrasounds and has been xray'd two times. No masses to be found. Blood proteins are normal, white cells normal, all of his tests on fluids are normal. The vet sent a lymph fluid sample to the University of Colorado to run a test whether Vito could have aggressive, non-aggressive lymphoma, or no lymphoma at all. No heart, kidney, liver, lymph node system, or lung issues ect... Now Vito has had to be drained of fluid 3 times, every 3 weeks. The issue is most likely cancer somewhere. As of now Vito takes two diuretics and 20mg of prednisone 2 times a day. We are treating him as if he has cancer. None of his issues are breed related. The next step would be an mri. That's very $$$. I've spent so much already, I can't justify putting Vito through anymore. If someone has remarkably (and sadly) had this sort of issue with their dog would you please tell me? Vito was drained this past weekend. He's not going through this again. That means if his medication doesn't work and he's fills up again...well hopefully he will not fill up again. Finally, I left this out till last...I've been blessed with some of sweetest dogs I will ever know. Vito and I have bonded so closely, rarely ever apart, his early passing will be crushing. (I've already lost a sweet dog to cancer when he was 5 years old already) Thank you to anyone who responds.

Sincerely,

Anthony and Vito

#2 · May 2, 2022, 4:30 pm

What a frustrating (and scary) ordeal you must be going through. Sounds like the vets and specialists already ruled out many issues and they came back with no diagnosis.

Did any vet ever offer to try an exploratory surgery?

Do they think he may be a good candidate for it?

#3 · May 2, 2022, 4:32 pm

Quote from Daisy on May 2, 2022, 4:30 pm

What a frustrating (and scary) ordeal you must be going through. Sounds like the vets and specialists already ruled out many issues and they came back with no diagnosis.

Did any vet ever offer to try an exploratory surgery?

Do they think he may be a good candidate for it?

Daisy, it's my belief than an exploratory is quite an invasive procedure, and if the OP mentioned debating on getting the MRI, the exploratory option may be out. I wonder if the ultrasounds were done when the dog had lots of fluid build-up and this may have clouded/obscured any possible growths? It's quite odd that nothing was found despite all the tests run.

#4 · May 2, 2022, 4:36 pm

Madmax, yes they have the ultrasounds both full and after draining. The Dr. did say they preferred to take the ultra sounds when Vito's full since the fluid helps them get more accurate results. They did do one xray initially while he was full (actually he's had 3 not 2 like I previously posted) and the other two after being drained. The same with the ultra sounds but a couple more. Daisy, I hadn't considered exploratory surgery. It really isn't a bad idea in general. I'd consider it only if we knew Vito would be "cured" of whatever is wrong. The line of what I want most and what is best for Vito is clear. I can't allow Vito to suffer. Thank you guys so much for giving me some different perspectives. It's where we are at this point so the more ideas or experiences you folks have please post away. Thank you again, Vito and Anthony.

ps. Vito's Dr's all say the same thing. Why isn't anything showing up? Even the fluid building up has nothing abnormal inside it.

#5 · May 2, 2022, 4:37 pm

I am so sorry to hear you are dealing with such a medical mystery. Just something worth pondering...You mention your oncologist is stumped. I am wondering if the oncologist is stumped because he/she hasn't found any trace of a tumor, which is what these specialists specialize in. So I am wondering if consulting with an internal medicine specialist would maybe help? In the medical field there's a saying "when you hear hooves, think horses not zebras" which means that when a doctor deals with certain symptoms he should think some common disorder. So if say, you are sneezing, he's most likely to think cold or allergies rather than some rare disease from the tropics affecting only 2 percent of people. So your oncologist may be simply looking for signs of cancer, the most common findings he deals with every day, which he has not yet found. It could be you dog is dealing with some other condition that is unusual, maybe rare or simply just not something an oncologist is used to seeing. An internal medicine specialist, on the other hand, may be looking for other issues which can be several when it comes to ascites (fluid accumulation in the abdomen) such as some intestinal disorder,heartworm disease, low blood protein levels (Protein losing enteropathy) etc.
Edited to add: I just saw you already mentioned having blood proteins already checked. I still think though that there may be something not commonly diagnosed going on that perhaps an internal medicine specialist may readily (or after excluding other conditions) point out. Also, wondering if a radiologist has looked at the ultrasounds? Sometimes vets may miss things a radiologist can see.

Former AAHA animal hospital employee, dog trainer and dog behavior consultant. Published dog author on several print and web publications.

#6 · May 2, 2022, 4:40 pm

alexadry, great points. Vito is currently seeing an internal medicine specialist. I left out a lot in my original post so it wouldn't take too long to read. From the specialist's report here's what she said in short. Vito is being treated for lymphangiectasia, a condition that occurs when the lymphatics dilate and leak protein rich fluid. Lymphangiectasia can also be secondary to inflammation caused by inflammatory bowel disease, fungal infection, or lymphoma. The chances of lymphoma are really small based on the the fact that he's "passed" all those tests, (my words there). BUT ALEXADRY, you have just caused me to call the vet. If Vito might have a fungal infection, shouldn't he be on antibiotics?? He's not. If that''s something that may help him I will get him on them tomorrow! So you are so correct about zebras and horses! Also as I read he notes, the internal spec also said they've reasonable ruled out chylothorax, (not sure what that even is), right-sided heart disease, and lymphoma. Vito had a rough night last night but is much better today. I would be simply so grateful if antibiotics could be the cure. Regardless, thank you Alexadry!! There is a small chance that you responding could lead to Vito maybe getting better and for that I will be forever grateful. He could still have undiagnosed cancer but not everything has to be cancer. thank you and sincerely, Vito and Anthony.

I forgot to say that I'm not sure a radiologist has checked his ultra sounds but I know for a fact his xrays have been. We'll be at the vets for the day again Sunday like we have been for nearly a month in a half. At lease we go to sleep tonight with a tinge of hope. Goodnight, Vito and Anthony.
Here's Vito about a year ago. He's a very good boy and I believe Vito has met more people in Maine where we live than I have lol! The second picture is Vito and his tiny pal Jade.

#7 · May 2, 2022, 4:41 pm

Quote from alexadry on May 2, 2022, 4:41 pm
Did they diagnose him with lymphangiectasia or are they tentatively treating him for that as they could not come up with any other diagnosis? Does he have a history of chronic diarrhea? Did they ever do a biopsy of the small intestine? I looked up more info on lymphangiectasia and found this info (you may already know about this, but I'll still post it) It looks like with this condition, the dog is losing protein through the intestine or stomach. One important protein that can be lost is albumin. Albumin is responsible for keeping water in the bloodstream, so when it is affected, it causes fluids to leaks out, causing fluid accumulation in the abdomen (ascites). Because the body relies on protein for many functions, when the levels get low, the body tries to extract it from other sources and muscles are one of them (which may explain the loss of muscle mass). So if your dog for sure has lymphangiectasia, what is causing it in the first place? This is the big piece of the puzzle missing. As the vets mention, it could be caused by a fungal condition, but also from Inflammatory bowel disease,
Intestinal lymphosarcoma (which hopefully was ruled out) and Intestinal lymphangiectasia. In the case of a fungal condition, these are often treated with antifungal meds, these are mostly drugs that end in "zole". Flucanazole, itraconazole. Histoplasmosis is more common along the Mississippi, Missouri and Ohio River valleys. There may be other fungal conditions though that may cause this. Did your vet recommend any supplements or a special diet to make up for the protein loss?

Here's a vet's thought on this condition:
http://www.justanswer.com/dog-health/1zk...tasia.html
A technical read on nutrition:
http://www.dvm360storage.com/cvc/proceed...losing.pdf
Another helpful read with more potential causes listed (primary and secondary):
http://www.epi4dogs.com/plelymphangiectasia.htm
The article above is from a group for dogs with exocrine pancreatic insufficiency, but the forum members there are very helpful if it turns out being something intestinal.
A complicated ordeal (quite similar to what you have been going through)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1288421/
I really hope that the vets get to the bottom of this and that it can be treated easily.

Former AAHA animal hospital employee, dog trainer and dog behavior consultant. Published dog author on several print and web publications.

Did they diagnose him with lymphangiectasia or are they tentatively treating him for that as they could not come up with any other diagnosis? Does he have a history of chronic diarrhea? Did they ever do a biopsy of the small intestine? I looked up more info on lymphangiectasia and found this info (you may already know about this, but I'll still post it) It looks like with this condition, the dog is losing protein through the intestine or stomach. One important protein that can be lost is albumin. Albumin is responsible for keeping water in the bloodstream, so when it is affected, it causes fluids to leaks out, causing fluid accumulation in the abdomen (ascites). Because the body relies on protein for many functions, when the levels get low, the body tries to extract it from other sources and muscles are one of them (which may explain the loss of muscle mass). So if your dog for sure has lymphangiectasia, what is causing it in the first place? This is the big piece of the puzzle missing. As the vets mention, it could be caused by a fungal condition, but also from Inflammatory bowel disease,
Intestinal lymphosarcoma (which hopefully was ruled out) and Intestinal lymphangiectasia. In the case of a fungal condition, these are often treated with antifungal meds, these are mostly drugs that end in "zole". Flucanazole, itraconazole. Histoplasmosis is more common along the Mississippi, Missouri and Ohio River valleys. There may be other fungal conditions though that may cause this. Did your vet recommend any supplements or a special diet to make up for the protein loss?

Here's a vet's thought on this condition:
http://www.justanswer.com/dog-health/1zk...tasia.html
A technical read on nutrition:
http://www.dvm360storage.com/cvc/proceed...losing.pdf
Another helpful read with more potential causes listed (primary and secondary):
http://www.epi4dogs.com/plelymphangiectasia.htm
The article above is from a group for dogs with exocrine pancreatic insufficiency, but the forum members there are very helpful if it turns out being something intestinal.
A complicated ordeal (quite similar to what you have been going through)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1288421/
I really hope that the vets get to the bottom of this and that it can be treated easily.

Former AAHA animal hospital employee, dog trainer and dog behavior consultant. Published dog author on several print and web publications.

#8 · May 2, 2022, 4:42 pm

I have been reading these posts and while I do not have much to add, I just wanted to applaud you for doing so much for your dog. He sure is lucky to have such a committed owner. I hope Vito fights this mysterious illness. Keeping you in my thoughts and prayers!