Symptoms can point to several problems

1/12/2014

Dear Dr. Thompson,

I have a golden retriever that I rescued from Golden Retriever Rescue about five years ago. Last year he developed the symptoms that you related in your column Dec. 29. (“Dog’s lymphoma can be treated”) I took my dog to the vet and he did a biopsy and it came back negative. In addition to the symptoms you mentioned, he always has a drippy nose and runny eyes. The dog was given steroids for six months and the swelling went down, though not completely. Then the vet told me that keeping him on that wouldn’t be good because of the side effects. I give the dog Benadryl and it helps keep some of the swelling down and stops the nose and eye problem, but I know it is difficult for him to swallow. The doctor told me when I was there in November that in his entire career he has never seen anything like this and is stumped. He also said that if it were cancerous the dog would not be here today. Is there an option for him?

I am sorry to hear that he has such a tough road the past year. Without knowing the specifics of his case I can only offer some broad advice about what has transpired and what I might suggest as the next step.

Enlarged lymph nodes are a symptom of certain types of cancers, but they can also be a symptom associated with a number of other conditions. The swollen glands are a result of something triggering the immune system. That can be caused by some infections, cancers, or his immune system gone awry. 

A needle biopsy can be a noninvasive method of establishing a diagnosis in many cases, but not all. For cases like his, more extensive testing is often needed. Laboratory testing, ultrasound, and surgical biopsies can all be part of the process of establishing an accurate diagnosis.

The steroid medication he was given does have profound adverse side effects if given long-term, and without an accurate diagnosis this class of medications can interfere with biopsy results. I agree that if he had lymphoma the disease would have progressed by this time, but other types of cancer can’t be eliminated. Some chronic infections can result in the symptoms you are seeing as well. Many of these can be extremely difficult to diagnose without very specific testing.

Diseases of the immune system mimic many other conditions and can sometimes be what we call a diagnosis of exclusion. This means that every possible source has been eliminated before coming to the conclusion of an immune-mediated condition.

It sounds like you are dealing with a challenging case and your veterinarian has taken appropriate steps to this point. 

Sometimes a referral to a board-certified specialist can shed new light and offer you further diagnostic options.

Ask your veterinarian whom he might recommend, and good luck with what sounds like a very difficult situation.

Questions for Dr. Gary Thompson can be emailed to askthevet@theblade.com or mailed to The Blade, Attn. Ask the Vet, 541 N. Superior St., Toledo, OH 43660. Dr. Thompson regrets that he cannot answer individual letters.