those darned lipomas scare us

For about six months we've been worried about a lipoma in Penny's neck. We tried to be optimistic about it, but our local vet thought he should take it out. However, he decided that because it was so close to her carotid artery, he should stop the operation and we should wait and see what it did.

It's been simmering in our minds as a generalised anxiety, and when I took her to the vet yesterday to talk about her cough, of course he also re-examined her lipoma and thought it was time to consult a specialist surgeon. (We've been going to our local vet each month, BTW, to keep a check on it.)  I was concerned that it might be pressing on something in her neck and making her cough.

We were fortunate to get a specialist appointment for today.

Off we went, Penny most concerned that her worst fears had finally come true and her humans had forgotten to feed her. Of course, it was only because the specialist centre told us not to give  her food in case they operated.

Well, they did. And it was great news. The lump was a simple lipoma, not invasive, as everyone who examined it previously thought was possible.

And now she's home, having got rid of this worrisome growth. She has four more lumps that we know of,  but the surgeon examined them and said it should be okay to leave them alone.

When she arrived home, she was tuckered out, but managed to make her way to the kitchen when she heard dinner being prepared.

I cooked up a nice bowl of soft-boiled rice, carrot and chicken, and we gave her a small serving.
(Yes, you'll notice I burned the pot in all the stress of the moment, but her meal was not burnt.)

She tucked into the delicious meal and even had the energy to check around the outside of the bowl to make sure she hadn't spilled any.

During the evening we fed her the rest of the meal, in two separate serves. She certainly hasn't lost her appetite so far.

Now it's a matter of keeping her comfortable and checking she doesn't scratch at the stitches. She didn't after the last operation on this lipoma, so here's hoping.

Oh, and the cough... well, she had so many (expensive!) preparatory checks today that we now know there is some bronchitis, so she'll continue on the doxycycline and we'll hope the bronchitis will clear up.

lipoma in Penny's neck

We're keeping an eye on Penny's lipoma. The vet was unable to remove it, because it's so close to important parts of her throat, so we have to check it each month. He told us not to feel it too frequently, because we might become accustomed to it and not notice it changing in size.

It's hard to resist checking it all the time, but so far we've been strong with ourselves and only felt it yesterday, because we've decided the first day of the month might be an auspicious day to do this monthly task. It's about as big as a marble.

We have to look out for a swelling on Penny's neck, which might mean the lipoma is blocking a gland. Or if we notice she cannot turn her head comfortably, that would be a signal to do something about it. Or if we notice her coughing a lot.

All this is a worry, of course, but the vet is advising a wait-and-see plan.

Because I like to be prepared, I've been reading up on lipomas, and discovered they are very common in older dogs, especially females. On most of the sites I visited, vets said they would not remove a lipoma for cosmetic reasons. They are only removed if they are causing problems for the dog. Here's an article that I thought was good.


So, if we have to do something, I've looked at a few suggestions:
1. Help her lose weight, because lipomas are made of fat.

2. Liposuction might work, and I've seen a few technical articles about this, but I think they're mainly dealing with huge lipomas on accessible places. And I don't see references to many in Australia using this technique.

Quoting from the article mentioned above:

Liposuction, the same procedure that vacuums fat out of humans in cosmetic surgery, is in many cases less invasive, less painful, and faster healing than surgical removal.
In 2006, a 12-year-old Kelpie-cross named Patch made headlines in Sydney, Australia, for being the first Australian dog to undergo liposuction. Patch had several lipomas, one of which, on his hind leg, threatened to cripple him within months. Remembering a European veterinarian who performed liposuction on a dog using the suction tool normally used to clean up fluids during surgery, an Australian vet suggested trying this approach on Patch. The hour-long procedure removed six fatty tumors weighing two kilograms (4.4 pounds, or 10 percent of Patch’s body weight). He was soon happy and playful again.
In January 2007, the Journal of Small Animal Practice reported the liposuction removal of three giant lipomas from a dog in Leipzig, Germany. The extremely obese patient suffered from arthritis and hind-leg lameness, plus irritation caused by an armpit lipoma. Previous treatment involving dietary weight loss and non-steroidal anti-inflammatory drugs had failed. Liposuction of the three lipomas resulted in a three-kilogram weight loss (6.6 pounds, or 10 percent of the dog’s body weight).
In a retrospective study published in July 2011, the Journal of Small Animal Practice reviewed the use of liposection on multiple lipomas from 20 dogs. The treatment successfully removed 73 of 76 lipomas (96 percent). Simple, encapsulated lipomas measuring less than 6 inches in diameter were the easiest to remove and resulted in minimal risk of complication. Giant lipomas contained fibrous material that interfered with the removal of fat and had a high risk of bruising, hematoma, and seroma (fluid-filled swelling), especially in the groin area. Regrowth occurred nine months to three years later in 28 percent of the lipomas. Liposuction is not recommended for infiltrative lipomas.

I was interested to come across the abstract of the above-menioned veterinary article on liposuction in dogs:

To review the success rates for liposuction of lipomas in dogs, report early complications and medium-term outcomes and formulate recommendations on the most appropriate candidates for liposuction.
METHODS:
Retrospective study of 20 dogs with 76 lipomas diagnosed by cytology, in which dry liposuction was attempted. Case records were reviewed for number and size of the lipomas, efficacy of liposuction, frequency and types of complication and likelihood of recurrence.
RESULTS:
Liposuction was successful in removing 73 of 76 lipomas (96%). Simple, encapsulated lipomas less than 15 cm in diameter were most easily removed, with minimal risk of complication. Giant lipomas contained fibrous trabeculae that hindered liposuction and resulted in poor fat retrieval. Giant lipomas were also associated with a high risk of bruising, haematoma and seroma, especially when inguinal in location. Regrowth was noted at follow-up between 9 and 36 months in 28% of lipomas.

CLINICAL SIGNIFICANCE: Liposuction may be less invasive and more attractive to owners than conventional surgery for lipomas up to 15 cm in diameter. Liposuction is not recommended for infiltrative or giant inguinal lipomas. Regrowth can be expected in a high proportion of lipomas, which should be considered when choosing liposuction over conventional excision.

3. Another technique is:

The newest lipoma treatment for dogs and humans is the injection of collagenase, an enzyme that breaks the peptide bonds in collagen, the fibrous protein that connects body tissues. Developed by BioSpecifics Technologies Corporation and marketed as XIAFLEX® in the U.S. and XIAPEX® in Europe and Eurasia, collagenase is being tested in clinical trials.
One preliminary trial tested three healthy dogs with multiple subcutaneous lipomas that were benign, superficial, and easily measurable. One lipoma on each dog was injected with collagenase and another was left untreated for use as a control. Ninety days after injection, a CT scan showed that the treated lipomas on two of the dogs had disappeared completely and the third dog’s treated lipoma was only 7 percent of its original size. By contrast, the control lipomas had grown. Altogether, the treated lipomas showed a 97-percent reduction in size while the untreated controls increased by 23 percent.
BioSpecifics has initiated a placebo-controlled, single-injection randomized Phase II clinical trial to evaluate the efficacy of XIAFLEX for treatment of benign subcutaneous lipomas in 32 canines in a study to be completed in 2013. This will be followed by a Phase III clinical trial before the product becomes commercially available. 

However,  the warnings about side-effects seem scary. There's a forum for discussion of its potential use in dogs on their website, but only two people have entered comments.

There are different types of lipomas (quoting from the same article I found helpful):

Most lipomas are subcutaneous (occurring just beneath the skin's surface) and are moveable, not attached to skin or underlying muscle or tissue. They are usually small and either round or oval, the size of a marble or marshmallow, and soft or rubbery to the touch. A few feel more solid due to fibrous tissue or inflammation. Some grow to golf-ball size, and very large lipomas can resemble baseballs. A few grow long and wide.

Occasionally lipomas invade connective tissue between muscles, tendons, bones, nerves, or joint capsules. Called infiltrative lipomas, these usually occur in the legs but can affect the chest, head, abdominal body wall, or perianal region. Infiltrative lipomas can cause pain, muscle atrophy, and lameness by interfering with movement. Unlike normal lipomas, infiltrative lipomas can be difficult to remove completely and often regrow.  

Some lipomas grow so rapidly that they might be something else, such as a liposarcoma. This rare, malignant fatty tumor usually does not metastasize (spread to other parts of the body) although it can be aggressive and fast-growing. 

terrifying lumps and worrying times

I haven't had the heart to blog recently, because we've been frightfully worried about a lump in Penny's neck. But we've just had good news. Well, sort of good...

When we noticed the lump, we thought it might be yet another lipoma. (She has three or more, now, but we don't intend to put her through the trauma of surgery unless necessary, so we're simply observing them.) There are lots of sites on the internet with information about how common lipomas are in older dogs. This is one site, and it suggests that all lumps need to be investigated before deciding on a watch-and-wait approach.

However, we - and the vet - thought this lump felt strange, so even though a needle aspiration seemed to indicate it was a cyst with some infection in it, he suggested surgery to remove it. We agreed.

Penny started on antibiotics to settle the infection and duly had her surgery. On the day, we waited for the phone call to say she was fine. But when the phone call came, the vet nurse suggested we make an appointment to talk to the vet as we collected her. Little alarm bells went off, so both her humans went together, to give each other moral support.

The long and the short of it was that the vet had found the lump sitting around a major blood vessel, so he stopped the surgery, having taken a piece off the lump. It was sent off for a biopsy and we waited...

We kept Penny beside us every moment of the first couple of days, to check she didn't scratch at the stitches, which pretty much she didn't.

She even got to sleep beside one of her humans, which doesn't normally happen. Like the Princess and the Pea, she reclined on a tower of soft mats.

Today we've learned that the part biopsied is a lipoma, and, to use the vet's words in the reassuring phone message he left for us, basically 'harmless' and 'benign'.

But it's still beside that blood vessel - the jugular - and it showed two different results in testing, lipoma and cyst.

I called in to discuss it with the vet, and was impressed with the amount of time he spent explaining to me what the situation is. We'll be keeping an eye on it, checking it every month to see if it is growing. I asked if it might grow inside where we can't check it, but the vet said it will grow out, if at all. He said not to check it more frequently than once a month, because we might become too accustomed to it and not notice a change.

Here's hoping all will be well.

two lipomas on Penny's shoulders

Good Friday - just the day to spend sitting in the waiting room of the Animal Emergency Centre. We certainly weren't complaining that we had to wait, because when families rushed in with unconscious dogs, or dogs who couldn't stand, we knew they had to go first.

It all began yesterday evening, when we noticed not one, but two, lumps on Penny's shoulders. We reacted the usual way, first shock, then the worried internet search, and the reassuring decision that they were - probably - lipomas.

What a terrifying word that is...probably.

We decided we just couldn't wait for the end of the Easter holidays and the opportunity to see our own vet. We would go to the Emergency Hospital straight away.

I rang to see whether it would be appropriate to come in with this problem, because we wondered if on Good Friday (when nothing is open in Australia, generally speaking), they might only deal with life threatening emergencies. But we were reassured that we would be seen.

So off we went, and the vet examined Penny carefully and gave us the good news that she would do a needle biopsy immediately, because otherwise we'd have to wait four days until our own vet clinic was open.

She asked us whether we thought Penny could be distracted while she inserted the needles into the two lumps. Since I had a packet of the little dried fish that Penny has come to love, the answer was a resounding 'yes!' I think Penny didn't even realise she had the two little procedures.

The vet then gave us the even better news that, yes, they were lipomas. Whew!

I've read that most older dogs have at least one lipoma.

Next week we'll go to our own vet to follow up, because sometimes it's better to take lipomas out, in case they distress the dog as they get bigger, or in case they do change into something more dangerous.

Thank goodness for modern medical procedures and good vet hospitals!

After the stitches came out

Sue, from the Portuguese Water Blog, added a comment on my last post saying that Penny's swelling was probably fluid. That's what our vet said, also. He said it would be mostly gone by yesterday - which it was. Aren't vets amazing? I would have said it would take another week for such a big swelling to go down.

Here's a picture of it yesterday, after our first proper walk in more than two weeks:

It's a little swollen, but basically gone. And, hooray, the stitches are out at last.

We had a lovely short walk at Clifton Hill, in the winter sunshine. We used to walk about an hour a day at least, briskly, but for this first outing we simply strolled around for half an hour.

swelling after lipoma surgery

I'm glad Penny is going back to the vet tomorrow morning, because the stitches around her lipoma surgery don't look too good. (If our vet were open on a Sunday, I'd have taken her there today.)

For a couple of days now we've thought the spot was swelling, but today it's more obvious than it was.

Penny lying on her back, the swelling obvious after her lipoma surgery.

The swelling after the lipoma surgery looks horrible when she's standing.

A couple of things are reassuring, and help us to keep the worry at bay (until tomorrow morning!). One is the fact that Penny seems fine. Here she has taken herself outside this morning to enjoy the winter sunshine, the first we've seen in days.

Secondly, a look around the internet seems to show that this kind of swelling is not unusual, in humans or in dogs, after a lipoma is removed.  Most sites say it will resolve, even if it takes a long time. (I sure hope hot.) One recommends hot compresses.

Here's a short clip of a similar swelling on a man's back. 

I got brave and watched a video of a lipoma surgery. I only gagged once! It was amazing to see the surgeon lift out the lipoma in its own little sack of skin. Now I understand what my vet meant when he said they got it all and it was intact. 

Here's another vet talking on YouTube about fatty lipomas. Very informative and interesting, but if you watch, be warned that suddenly you might be watching him standing with a huge ball of fat in his hand and cutting it off a dog! 

clipper causes skin rash after surgery for lipoma

I hope you'll forgive me for yet another post about Penny's surgery, but I thought our experience might be useful information for other people deciding whether to go for this option if their dog has a lump.

We visited the vet for a check-up today, four days after the surgery, and the wound looked swollen around the stitches, which the vet said was 'serum' around the wound. It might have been the result of Penny's activity since the operation. We'll take it even more quietly for a few days until the wound is not swollen-looking. On the other hand, Penny has mostly been resting and we only go out to toilet a few times a day, on lead.

The ghastly-looking redness around the wound was most likely a rash from the clippers used to remove her coat around the site for surgery. Here's the photo from a few days ago:

 and today it is much less sore-looking:

In this photo you can see that there is no stitch at one end of the cut. The vet said he left this open in case the wound needed to drain.

Whilst reading up  for this post, I've come across a really good article at The Kerry Blue Terrier Foundation, dealing with the question of whether or not to have surgery for a lipoma.

The article discusses the pros and  cons, gives lots of case studies, and talks about other possibilities than surgery, including:
watch and wait
no treatment
liposuction
injection of collagenaze
weight loss, diet and exercise
acupressure
herbal medicines
homeopathy (not much success reported)
aromatherapy

One thing I was glad to read was that modern anaesthesia means that it should be safe for even an older dog to undergo surgery for a lipoma. I must admit this was highest in my list of worries when  we opted for surgery.

post surgery for the lipoma

Penny's operation to remove a lipoma has given us peace of mind, and she appears to have bounced back from the anaesthetic, but these photos show there's still a price to pay.

I'll be glad when we've been back to the vet to check it is all healing okay. Two days to wait.

Penny is home again after her surgery

Hooray! Penny is home and resting after surgery to remove a lump on her chest. Thank goodness it was only a lipoma.

It's a pity Penny now has to recover from an anaesthetic, but while she was under, the vet also cleaned her teeth and took off another lump from the top of her head, so I guess it was worth it.

Now we'll have to nurse her back to her usual energetic self.

Many thanks for the encouraging comments. It's great to know that others are thinking of us, and great to hear how other families cope with these sorts of things.

I think this is one of the terrific advantages of the internet. We are not alone.

Penny has a lump

It's a bad, bad moment when you're grooming your dog and you feel a lump. You say to yourself, 'No, I just imagined that.'

You call Human Number Two and she feels the spot and looks at you and says, 'Yes. I can feel it."

Just when you've had this scare, the grandmother of all thunderstorms rolls across the city.

I wouldn't have had a good night's sleep anyway, but the thought of Penny with a lump and the sight of her sitting frightened in the doorway of the bedroom led to her first night ever sleeping on the bed. In the past, she has occasionally been allowed to jump on the bed around dawn, but this was her first all-night sleepover.

First thing in the morning, we rang our vet (Saturday), but had to wait until today for an appointment.

What a worry!

He first tried to get some fluid out of the lump, with the thought that it would be a lipoma. When that did not work, we discussed the situation and he said we could simply wait a while and see what the lump did. But there's the drawback that it might grow quickly, which would be dangerous if it is a 'bad' lump. (Notice I'm a bit scared of writing the 'C' word.)

So tomorrow Penny won't have any breakfast and the vet will take off her lump. It's not the first lump our vet has removed from Penny's chest. I

I hope she will have a quick and full recovery and the lump will turn out to be something that is just a natural part of aging.