Stetson's ASAC

2012

On November 12th, my vet found a tumor in my dog Stetson's right anal gland during a rectal exam. He was at the vet with our other dog for his yearly vaccines and she discovered a pea-sized lump while checking to see if his anal glands were draining (they were). Stetson had exhibited no symptoms; his anal glands were actually being checked because our hound was smelling stinkier than usual on the ride over and the tech was meant to check the hound's glands instead. Luckily (or not) the mix-up resulted in our vet finding Stetson's tumor. Due to the fact that almost all of the lumps found in neutered dogs in this area are malignant, our vet recommended a fine needle aspirate of the lump to be send to pathology immediately.

On November 16th the aspirate came back positive for anal sac adenocarcinoma (ASAC). Being the over-analyzer that I am, I had already spent all week looking up information on anal sac tumors in dogs. Some of the readings were positive while most of them were negative (less common form of cancer, quick growing, high rates of metastasis, etc). I had prepared myself for the worst so when our vet called that day, I already knew what was coming. We decided to go ahead and schedule Stetson for an ultrasound, x-rays, and aspiration of the sublumbar lymph nodes (usually the first place these tumors spread to).

The US/XR/aspirates were done on November 23rd and there were no [obvious] signs of metastasis at that time. The lymph nodes were still incredibly small and the radiologist said she had a hard time even getting an aspirate from them. Our vet suggested we schedule Stetson for surgery so that an outside surgeon could remove the anal sac and tumor (anal sacculectomy) and send it for a biopsy. After the tumor biopsy is done she plans on referring us to an oncologist to further manage the cancer. According to her, and my research, ASAC almost always comes back and tends to micro metastasize despite no diagnostic signs of spread.

AB and I have talked about what steps we would take to treat Stetson, and while we've agreed on the initial surgery, we've completely ruled our radiation (it requires a lot of $, stays at the vet, and repeated anesthesia) and are questionable about chemotherapy (to be decided with an oncologist). Stetson is 11 years old and while he has no signs of cancer, he is a geriatric dog and I have no desire to put him through anything that may lower his quality of life. At this point we're aiming for quality and not quantity.

The surgery for the tumor removal is scheduled for tomorrow, Dec. 6. I will update after it's over, and have to admit, I'm fairly nervous. While Stetson has been through general anesthesia more than once, I'm more worried about the risks from the surgery itself- the main one being fecal incontinence. Stetson has pottied in the house once in the 11 years he's been with me, and it upset him more than most dogs I've met. Hopefully we can avoid that issue, but will deal with it if it occurs. In the meantime I've been reading several books- "The Dog Cancer Survival Guide" by Dr. Dressler and "42 Rules to Fight Dog Cancer" by Aimee Quemuel among others. They both have some useful info for our situation so I'll definitely be hanging on to both of them.

While I haven't changed much about Stetson's diet (he already gets grain-free dog food due to allergies), I have added BLUE canned foods, K-9 Immunity Plus tabs, and 4000mg of Omega-3 capsules a day. I'm also more lenient about giving him people food- hey, he has cancer, he might as well enjoy some turkey and steak!

Surgery update to follow...

So on Thursday December 6th, Stetson underwent his anal sacculectomy surgery. The surgeon wasn't able to start until that afternoon, but I ended up bringing him home around 6:30pm that evening. He was incredibly drowsy and had a bare behind, but seemed to be doing okay. He did want some food and water when we got home so that was hopeful. When I spoke to the surgeon on the phone, he said it looked like the tumor had spread locally, and he was concerned he didn't get it all- but I was going to have to wait for the path report anyways. As for medications, the vet had prescribed cefpodoxine for antibiotics, carprofen for his anti-inflammatory, and tramadol for pain. I had already planned on sleeping downstairs with him for several nights, as he was on strict activity limitations and we were unsure how incontinent he may be. That same evening, he had an uncontrolled bowel movement but was able to get a little sleep.

Post-Op Day 0
The next morning was the beginning of the roughest time Stetson and I have ever had to endure. Looking back, I don't know if I would have done the surgery had I known how hard it would be (on both of us).
**As of March 16, I can say that we WOULD go through it again given how well he's done**
Stetson started out the day eating and voiding, and took his meds without issue. I kept him confined in the living room unless I went outside with him and he slept on and off for most of the day. That evening, the loose stool started leaking. By leaking, I mean liquid brown poop constantly ran out of his butt, and he had absolutely no control over it. Every 10-15 minutes I would clean him up, switch out the towels underneath him, and start over. He looked miserable- he's always been neurotic and going to the bathroom in the house seemed to stress him out more than most dogs. AB was working half a night shift, and on his way home he stopped at WalMart and got me some betadine and eucerin ointment. I diluted the betadine with water, put it in a squirt bottle, and used it to wash his bottom every few hours. Although the vet said not to put any ointment on the incision site, I wanted to protect it from the constantly leaking stool, so I rubbed a little on it in hopes of protecting it some. I spent most of that night cleaning up his diarrhea and trying to get him comfortable (night 2 of very little sleep!).

Post-Op Day 1- more swelling
The morning of Day 2, I called the vet because Stetson was still leaking stool. I was concerned about dehydration even though he still had an appetite. He was still taking all of his scheduled meds around the clock. The vet prescribed an anti-diarrheal, pro-biotics, and a sedative to help him sleep. Despite the sedatives, Stetson continued to be restless, leak stool, and by that evening, also had some mucus and blood coming from his rectum. When he finally laid down to rest, I was hopeful that the sedatives had finally kicked in. However, he became so lethargic he wouldn't move, and when he started shivering all over the panic set in. I called my vet who recommended we take him to the emergency vet right away. AB and I loaded him up in the car (at this point he wasn't walking) and drove across town to the specialty hospital. Once there they took him in the back, did some exams and bloodwork, and gave him a bolus of fluid. The vet there thought is was a combination of dehydration, colitis from the diarrhea, diarrhea from the post-op meds, and not enough pain control. I felt like a shitty mom! The vet there took him off the cefpodoxime and carprofen and put him on metronidazole for antibiotics and gabapentin/fentanyl for pain. We headed home around 2am in the morning with hopes that things would improve. I ended up spending the rest of the night cleaning up leaking stool and not sleeping.

On Day 3, Stetson ate some food, had a few controlled bowel movements outside, and then STOPPED THE STOOL LEAKING! I was exhausted (as was he) yet so relieved. He did continue to leak small amounts of bloody mucus (colitis) but at least the diarrhea had stopped.

Post-Op Day 3- resting with with fentanyl patch on
Day 4 brought Stetson refusing to eat and looking like he really needed to poop but wouldn't. I called the vet who said to give him one more day on the new meds, and that after all the diarrhea it wouldn't be abnormal for him to not poop for a while. She also told me the pathology report on the tumor was back and that the margins were clear! What this means is that the edges of tissue contained no cancer cells however, this type of cancer tends to micrometastasize so even then I didn't feel in the clear. That night, I let Stetson go up the steps to sleep in our room. He was still leaking some mucus but every night had stood at the steps waiting to go up to bed; we figured it was time to give him that after everything he'd been through.

On Day 5, I took him into the vet just to check the sutures, make sure he wasn't constipated, and get some canned bland food. I had to go back to work the next day and needed to do so with less concerns. The vet said Stetson's sutures were beautiful, he was not constipated, and he just needed a little time (and the fentanyl patch off).

Post-Op Day 5
Day 6 my mom stayed with him all day while I went to work and said he did fine. He seemed much more rested and alert when I got home, and on Day 7, he had a solid controlled bowel movement! YAY!!! He was also starting to eat again and his meds were finishing up. The mucus stopped leaking out and his behind finally started to look close to normal again (sans hair).

Days 7-12 were spent keeping his activity restricted (for the most part) and making sure he ate and used the bathroom regularly. I had bought a Comfy Cone in case he started licking at his incision, but he never did. Shocking.

Healing nicely

On Day 13, I took Stetson to the vet where they sedated him and removed his sutures. His activity restrictions were lifted and most of his meds were completed.

Today (December 21st) I took him to the Vet Specialty Hospital to have a consult with an oncologist. Both her and her techs were incredibly nice, and after talking to her about his diagnosis and everything thereafter, I agreed to try 4 rounds of chemo with a drug called carboplatin, given IV once every 3 weeks for 4 total treatments. In addition to each treatment, the oncologist does a rectal exam, CBC to check his blood chemistry, and prescribes some prophylactic meds for diarrhea, nausea, and vomiting (which I'll probably give due to Stetson's overly sensitive GI tract). She also checked his ionized calcium level, which was normal (it can be high with these types of cancers). We went ahead and did the first treatment today, and when I went to pick Stetson up he was alert, tail wagging, and wearing a bandanna that said "Hug Me I got chemo today". The tech said he didn't need sedation, he just laid on the mat while they did the treatment. He's required to get a follow-up CBC in a week with our regular vet, and then he returns in January for his second treatment. I'm crossing my fingers that everything goes smoothly with this chemo; that surgery was hell and put a toll on all of us. Once home, we went on a walk and he promptly ate a bowl of food, drank a good amount of water, and chewed on one of his bones.


More to follow...

Today (December 29th) Stetson had his 8 day post-chemo blood work drawn and the vet just called to say that everything looked great. I spent most of the past week expecting the worst, but for the most part his appetite hardly changed- he definitely kept begging, he got a little tired a few days in but still wanted to go for walks, and did not have any vomiting or diarrhea. He did take anti-nausea meds on days 1-4 and is on Bactrim for days 3-12. I have a script for Flagyl but so far no diarrhea anyways. The oncologist said most side effects occur in the first week so I'm keeping my fingers crossed that this is how he manages the last 3 treatments! When I took Stetson to the vet this morning the tech came to get him and he tried to climb up on the bench beside me; I'm sure the pup is tired of being stuck but if I can give him another healthy year we will handle the temporary discomfort together. His next chemo treatment is January 11th...I'll update again then unless anything changes.

For those who are wondering, Stetson still gets a mixed diet- mainly canned food (Blue Buffalo or Prescription EN), a little grain-free dry, and people food (chicken and turkey mainly). He takes K9 Immunity tabs once a day and 2000mg Omega 3 oil.

2013

Chemo Update (January 4): Stetson is now 14 days post-chemo treatment #1 and for the most part has not had many issues. He took the anti-nausea meds for 4 days and recently finished his 10 days of Bactrim. We ended up going to the primary vet earlier this week because he became lethargy one morning and had a fever >103 (normal for a dog is ~101-102). The vet didn't really know what was wrong and thought he may just be having a delayed reaction to the chemo or all the stress. She told me to start giving him the Flagyl the oncologist had prescribed in case it was diarrhea related. He's supposed to go for treatment #2 this coming Friday and I plan on talking to the onco about the crazy amount of antibiotics he always seems to be on; it seems like his immune system needs a break! Stetson has had a decreased appetite, but most of his life he's been picky and finicky so it was kind of expected. He's still begging for people food so I know he's at least hungry!

Yesterday (January 11th) Stetson went for his second chemo treatment. I had a chance to talk to the oncologist about how he had been doing, so she'd know what to adjust (or not). Due to his slight loss of appetite and reaction to the Bactrim, she decided to lower the dose of carboplatin only a little and not put him on the Bactrim this time around (it was to prevent diarrhea and infection but luckily his WBC counts have stayed fine and the Flagyl works great for diarrhea). She said given his health (aside from the cancer) that Stetson should be able to get chemo without having many side effects at all, which is why a few things got adjusted. Hopefully this time through is a little easier (although honestly he's handled it really well) especially since Stetson gets to spend a little time with my dad next week!

My husband and I went on vacation over the past week and Stetson stayed with my Dad. Right before we left (January 18) Stetson went to the vet for his follow up CBC and to have his random hot spot-looking areas checked. His blood work was fine but the vet started him on some low dose antibiotics for the skin infection. She didn't know if the spots were related to allergies or the chemo but with me going out of town, we wanted to treat them as simply as possible for my Dad. While we were gone, Stetson managed to woo my Dad into feeding him ground beef, ribeye, and chicken breasts in addition to getting a walk every evening. Stetson also took all of his medicine although he decided the can food wasn't for him anymore (it happens occasionally), which makes sense considering he was getting fed some good human food! By the time we came home, Stetson was off of Flagyl (diarrhea) and was on his last day of antibiotics for his skin. His appetite hasn't been great but he's still begging. He also has plenty of energy for walks so I'm not too concerned. Today (January 28) I'll take him to Petco for a bath in hopes of getting the extra skin off from his healing hot spots.

Chemo treatment #3 is next week...

Stetson had his 3rd chemo treatment today (February 4th) and his labs were all looking good- the oncologist's only concern was this skin infection he's had on and off for years, but has become more constant during chemotherapy. There's a chance it has developed into an antibiotic-resistant one. Fabulous. As long as the cancer is [mostly] gone then I'll tackle the skin. Luckily the limping is going away with the NSAID's and he came right home, went on a walk, and gobbled down a LOT of food. We stuck with the dosage from the previous treatment since he did so well with it. His last one is in 3 weeks, and the vet will do a followup ultrasound and x-rays to make sure there's no OBVIOUS metastasis. There might still be some micro but at that point nature will just take it's course; I think the pup has been through enough!

Yesterday (February 6th) I started Stetson on probiotics- Fortiflora by Purina. I tried giving it to him back when he had his surgery and he refused to eat anything I sprinkled it on (it's a powder). After researching I realized it's one of the only FDA approved probiotics for dogs and he was going to need to take it somehow given that he's on antibiotics all of the time now for his skin. I tried wrapping it up in cheese. He tried to spit it out but I persisted. I then had a dream that I opened the toilet lid and Stetson had spit the ball of probiotic laced cheese into the bowl. Last night I sprinkled a little at a time into some thin sliced turkey and wrapped it up in a little ball. He ate those but after the first one (it took several) I noticed he was catching on. I'm heading to WalMart today to find some other sliced deli meats; maybe if I mix it up he'll stay naive to me. Otherwise, his energy and appetite are fine. The limp has almost disappeared; I'm going to keep him on the Previcox a few more days and if it's not better, I'll have the vet check it when he goes next week for his follow up CBC.

Stetson went in for his CBC today (February 11th) and I'm waiting for the vet to call and say whether or not the results were normal (they have been up until now). Otherwise he seems to be doing well; his appetite hasn't really changed (and he weighed 61.8 pounds today so he's definitely not starving), his activity level is no different, and luckily the skin infection isn't getting any worse. The limp has pretty much disappeared and the probiotics seem to be helping with his belly issues (his gas is way better at the very least).

Stetson had his 4th and last (yay!) chemo treatment yesterday (February 25th)at the specialty hospital. The oncologist did an exam, bloodwork, and an ultrasound prior to the chemo and everything looked good! That's not to say that there aren't small cancer cells wandering around in his body (most likely) but for now he has a clean bill of health and hopefully another good year of quality life. His skin infection cleared up although I am having to treat him for a yeast infection in both ears (poor guy). Otherwise, he has tolerated everything fairly well and I'm hoping for the best! He has a follow up CBC next week and then we're just back to regular senior exams.

Stetson had his final CBC last week and his counts looked good. Our regular vet had to treat him with something for the ear infection but as of today (March 16th) they seem to be cleared up. I ended up starting him on a dose of Flagyl last week for some colitis-looking diarrhea but otherwise he seems to be doing well. His appetite has been good and all things considered, so has his energy. Our vet does think that most of his hearing is now gone (age, not cancer related) but it doesn't seem to bother him; he sleeps better at the very least. Now Stetson will just get check-ups every 6 months and we'll hope that the chemo and surgery gave him some more time!

2014

The vet found a pea-sized tumor in Stetson's left anal gland (the only remaining one) on May 13. We've decided to pass on surgery and chemo this time since he's lived a long and (hopefully) happy 13 years. I do have him on multiple "holistic" treatments including K9 Immunity Plus, Fish Oil, Probiotics, CoQ10, Milk Thistle, Inositol, and Turmeric. I'll post a little more when I'm better managing the depressing diagnosis.

July 27- So far Stetson seems to be doing fine. We are battling with recurring skin infections but he's had that issue his entire life. I've kept him on all of the supplements listed above and he hasn't had an issues having bowel movements. I just pray that the cancer hasn't metastasized elsewhere and will suddenly pop up without warning.

Sept 23- Stetson continues to be doing ok. He went to see the vet a few weeks ago and when she felt the tumor she said it felt much smaller (cross fingers). He's staying on his huge load of supplements and aside from some tramadol/neurontin daily for arthritis he still seems quite happy and ready to run. His deafness doesn't even seem as bad- he'll react to me clapping my hands loudly now but I think the old age has led to some pacing-type senility.

Nov 12- Stetson has hit his 2 YEARS POST-CANCER ANNIVERSARY!!! So far there are no new signs of cancer but his arthritis is kicking in. He's on really strong pain meds but there's just some wobbliness going on. I think it bothers me more than him. He's also still having regular skin infections as always but otherwise seems to be enjoying life still. The vet and I decided to forego some of his vaccines this year due to age and his tired immune system. He did have a little bit of a cough a few weeks ago, but chest x-rays didn't seem to detect any tumors so keeping my fingers crossed.

2015

Stetson crossed the Rainbow Bridge on May 27, 2015 surrounded by loved ones at home. His death was not due to cancer, but to old age, arthritis, and mobility issues. He will be greatly missed, never forgotten, and always loved. Rest in peace sweet boy.