Acanthomatous Epulid - I don't want to remove half his jaw!
 

Hi! I'm a new member and am causing myself too many sleepless nights prowling the internet looking for info and advice on behalf of my deeply beloved Golden Retriever Teddy (8 years old). He had a biopsy on a small pink fleshy mass behind his lower left canine tooth which came back as acanthomatous ameloblastoma (a benign but locally invasive tumor that can invade bone). I went to an oncologist yesterday who admits that its small, but suggests radical surgical excision which would mean he would lose the lower canine and a chunk of his jaw because they have to use wide margins when they remove it (cost of $4-5K and two nights in hospital). I am devastated. I can't imagine him away from me for 2 nights as he was traumatized when he had to be away for 3 hours when he had a ear hematoma drained. The vet said he would win the award for most dramatic/tragic performance at the vet... The thought of leaving him for 2 nights makes me physically ill with worry to imagine it. I have read about radiation or bleomycin injections (which the oncologist doesn't do) and I was wondering if anyone has had any experience with this kind of tumor and what they have chosen to do and if they have any advice or recommendations.... Right now this mass isn't bothering him at all - it's not bleeding, not affecting his ability to eat or mood etc. and I am hesitant at taking off half his jaw for a benign tumor that isn't affecting his quality of life right now...

Can you get a second opinion, GoldenAngel? Maybe at a veterinary teaching hospital? It may give you no new options, but even that may help you in your decision. As for the two nights' stay, it might not be as traumatic for him as you fear. Procedures that require anesthetic leave the dog a bit out of it and more lethargic than usual for a day or two. Sometimes I think our dogs don't even remember having been gone.

I'm so sorry you're going through this. :grouphug: I wish you all the best with Teddy and I hope you'll keep us posted on his progress. :goodvibes:

Welcome to the forum, GoldenAngel and so sorry to hear about your boy Teddy. :grouphug:

I would also get a second opinion before making any decisions.

Good luck and please keep us updated. :fingerscr :goodvibes:

Thanks for the suggestions so far.... Unfortunately that is the only oncologist in Toronto. I will see if my vet can refer me to someone at University of Guelph as that is the only place in the province that does radiation for dogs. Very difficult decision making... I feel like it haunts all my thoughts all day and all night... hard to concentrate on work or even feeling social... =-(

I think because I don't see any negative effects of this tumor and the fact that its technically benign... its hard to feel motivated to rush such an extreme surgery....

It seems like a painful procedure, and afterwards his tongue will be hanging out on one side without the tooth/jaw to keep it inside the mouth. I have no idea about drooling and/or the top canine having nothing to counter it down below.

I'm sure the anesthesia will be heavier for this - but the oncologist said it will probably take less than an hour to perform surgery. When he had his hematoma drained, he was at the vet for 3 hours and they said he came around from anesthesia faster than expected and he was crying hysterically and I could come get him early if I was able to watch him... which I did.... Does nothing to settle the nerves... He is a particularly emotionally needy dog and we are both exceptionally attached to each other... (he's my only dog).

Would it be an option to simply remove the tumor as best as possible without damaging the jaw, and wait to see if it comes back? If it comes back then maybe you could do the radical surgery then? $4-5000 is a lot of money too, and as much as I would be loathe to put a price on my own dog's life, I wouldn't be able to pay [I]that[/I] big of a bill. With your dog already being a senior, maybe a less drastic approach as I suggested above may be a reasonable plan...

Thats really tough, i really hope everything works out, I dont know much about radiation and tumors but wouldnt it be possible to remove the tumor without the taking out part of the jaw. For example, my friend (not a dog) but still, had a small bump on his tounge, turned out to be a tumor(benign), and was removed without any major damage to his tounge. I know its like comparing apples to oranges but just a thought. Hope all turns out well.

From all the literature I've read online and from what the oncologist says, these specific kinds of tumors always grow back. I did read two posts on other sites from owners who said it grew back within 2 weeks and even larger! That's why they have to use a wide margin of healthy tissue and bone to be completely curative. Not good news...
Although the oncologist began our meeting with "it's good news..."... I guess in retrospect this is better than something malignant that will kill him. There is also no way to know how fast it will grow.
I felt pressured to proceed with surgery as he started saying "Well.. you never know the biopsy could always be wrong and maybe its something worse... and then 'you never know this might be the tip of the iceberg and while it seems small - it might have already grown extensively into the bone' and then 'you need to act quickly - getting it removed when it is smaller will mean less of his jaw will need to be removed'.... And of course the hefty price tag! Not sure how any of this is "good news" in his world...

My fear is that I am doing a radical surgery on something that is not causing the dog any problems so far and disfiguring him for his remaining years. I know they say dogs don't care and live 'in the moment', but I'm pretty sure he will notice half his lower jaw is gone!

As well... $5K for this benign tumor and what if something else goes wrong 6 months later... something more serious where $5K might be better spent... I know these are all 'what ifs' and impossible to see into the future...

I am taking him to his regular vet on Tuesday and while there I will ask her opinion on the oncologist's opinion....

Funny but I would gladly go into debt and pay the $5K to have him cured "magically" without the surgery, but I am just really concerned that I am traumatizing him with such aggressive treatment... =-(

Teddy's beautiful face....

I pm'd our good Dr. Lee to see if he has any suggestions. Teddy is very handsome. :cloud9:

Thank you for all your help.... (Teddy thanks you too)... I just spent $700 two weeks ago getting his ear hematoma drained (there wasn't even any ear infection so who knows how/why it happened)... and then just to consult with the oncologist was $195.00 ... but anyways... I am a single female on a single salary and the vet bills seem to be piling up all of a sudden!

Here are two recent pics of Teddy last week after his ear surgery... He is wearing the "Comfy Cone" (instead of the dreaded plastic elizabethan cone!). He much prefers it!

Teddy is gorgeous :lovestruck:. I am so sorry about his troubles. I have no advice but wanted to send some hugs of support :grouphug: :grouphug: :grouphug:.

There was an episode of dogtown (Season 3 - episode 9) with a similar situation where they removed most of a dog's lower jaw and the dog did very well. You might want to have a look at that :shrug:.[url]http://channel.nationalgeographic.com/series/dogtown/4098/Overview#tab-Videos/06580_00[/url]

OMG... I just watched that DogTown clip... that poor dog! Amazing what people will allow their dog to endure and then just leaving him at a shelter...
Wow!
Well... losing part of a jaw is not the worst thing in the world. The dog looked pretty happy after recovering. Teddy's tumour is the size of the nail on my pinky finger.

Once I get a bit more advice/opinions on all my options, I will do whatever I need to do... This has been a bit of a wake-up call to the reality of his mortality and its hard to come to terms with... He has really been my touchstone through much heartache over the past several years. I can't quite imagine life without him.

If I go through with this surgery, I am gearing myself up for staying at the VEC hospital for 2 days straight (bring a couple of books and some computer work) and just wait it out as I would if a loved one was in a human hospital.

Only wish they could anaesthetize me at the same time (!)... Even waiting for him to come home from minor hematoma surgery... the waiting was the worst...

I would also recommend getting another oncologist's opinion, if for no other reason that you do not seem comfortable with this one. I am not an oncologist but the general recommendation for acanthomatous ameloblastomas is surgery. A CT scan prior to surgery is also recommended in order to be able to better understand the extent of the tumor prior to surgery. This may help plan the surgery to help increase chances for proper margins as well as enhance cosmetic options. I hope this helps.

Hi GoldenAngel .... Just now saw your post. While not Toronto, there is an oncologist at Veterinary Emergency Hospital and Referral Group in Oakville. Our Bernese Mountain Dog Louie is undergoing chemo at the animal hospital and sees Dr. Gauthier. I will post the URL just in case you want to call them for a second opinion:

[url]http://www.vetemergency.ca/docs/vspecialtiesON.html[/url]

Take care,
Pat

GoldenAngel ..... While it says Oakville on their card, the animal hospital is actually just off Winston Churchill Blvd. in Mississauga.

Take care,
Pat

Thanks to everyone for your suggestions!! I will check with my vet and see if she can refer to a clinic that does radiation and see if that is an option for him... If not then I will go forward with surgery... I guess my real uncertainty on that is... since it doesn't appear to be growing - do I monitor to see if it grows and then schedule surgery or just move forward with it immediately. If it stayed as it was, I don't see that it affects him in any way. And if it never got larger he might be able to live out his life without any issues.
It's that difficult dilemma - do you be proactive and aggressive with therapy or do you take a moderate approach... the moderate approach of course also has its issues (as he ages, anesthesia/surgery increases risks).

This site has been wonderful in giving me much comfort as I try to make a difficult decision. I am humbled that there are so many wonderful people out there that care... thank you again...

Wow, what a scary ordeal for you...lots to consider :grouphug: You've got a gorgeous pup there :lovestruck:

A few things popped out at me that I thought I'd comment on...

[QUOTE=GoldenAngel;877158] When he had his hematoma drained, he was at the vet for 3 hours and they said he came around from anesthesia faster than expected and he was crying hysterically and I could come get him early if I was able to watch him... which I did.... Does nothing to settle the nerves... He is a particularly emotionally needy dog and we are both exceptionally attached to each other... (he's my only dog).[/QUOTE]

It's good to keep in mind that some dogs react really bizzarely to general anaesthetic...my special gal is one such dog. She recently had surgery (last week) and was an absolute basket case when she woke up at the vet, and really for the remainder of that day...I had to sleep on the floor with her that first night because she was so agitated and freaked out. She was much better the next day, after the anaesthetic had flushed out of her system. She reacted the same way after her last surgery too...lol we got a similar call "please come get your dog if you can, she's hysterical"...she was stoned and wigging out big time.

[QUOTE=GoldenAngel;877314]My fear is that I am doing a radical surgery on something that is not causing the dog any problems so far and disfiguring him for his remaining years. I know they say dogs don't care and live 'in the moment', but I'm pretty sure he will notice half his lower jaw is gone!
[/QUOTE]

This is the main thing I wanted to address. So the dog I was just talking about? We had her whole front right leg amputated when she was 7 months old. It was deformed and causing her discomfort and just generally getting in her way.

I can tell you this with certainty: your dog probably will "notice" that his mouth is different...but only in the physical sense. His thought process will basically be: "huh, that's weird"...followed by "well, that's life"..."now where's my ball?" There will be none of the grief, depression, or self-esteem issues that humans struggle with when they face disfiguring injuries. Dogs really truly DO just live for the day, and once the surgical injury is healed, he will adapt to any physical changes/limitations and then simply get on with his life. The only one likely to experience grief, depression, etc. are his human caretakers...but hopefully only in the short term as they realize that their canine pal is the same old dog, just a little different-looking. :grouphug:

Ahh thanks Bendyfoot! You gave me a much needed laugh. Yes, I think I internalized Teddy's hysterics after surgery... My childhood family dogs always came home from surgery looking tired and dopey. Teddy's reaction shocked me... it was like he was on amphetamines - unable to sit still, glassy and wild-eyed and crying hysterically - he was like a bull in a china shop, unable to calm down! The thought of that happening when he is stuck in a hospital clinic for two nights is extremely upsetting to me... which is why I will probably just drink coffee in their waiting room for two days or until I feel comfortable that he is ok... I know it sounds irrational, but I would do that if he was a human-baby, and it might be the only thing to calm me down.

And thanks for the perspective on amputations. Certainly I won't love him any less because he will still be perfect in my eyes. I have always had a tendency to "humanize him" and think of him as a human boy trapped in a dog's body... LOL

[QUOTE=GoldenAngel;877551]Ahh thanks Bendyfoot! You gave me a much needed laugh. Yes, I think I internalized Teddy's hysterics after surgery... My childhood family dogs always came home from surgery looking tired and dopey. Teddy's reaction shocked me... it was like he was on amphetamines - unable to sit still, glassy and wild-eyed and crying hysterically - he was like a bull in a china shop, unable to calm down! The thought of that happening when he is stuck in a hospital clinic for two nights is extremely upsetting to me... which is why I will probably just drink coffee in their waiting room for two days or until I feel comfortable that he is ok... I know it sounds irrational, but I would do that if he was a human-baby, and it might be the only thing to calm me down.

And thanks for the perspective on amputations. Certainly I won't love him any less because he will still be perfect in my eyes. I have always had a tendency to "humanize him" and think of him as a human boy trapped in a dog's body... LOL[/QUOTE]

LOL you described the "anaesthetic hangover" perfectly! I pretty much had to pin Jaida down on the floor with one leg and one arm (a modified spooning :laughing:) to keep her from flailing everywhere :rolleyes: Oh lordy, what a scene!!!

I totally understand about wanting to be close by...I'm a huge worry-wort, it takes all my self-control NOT to be on the phone every five seconds (Ring..."how is she now? OK? Alright, bye"...10 seconds later: Ring... "How about now? Still ok? Oh, alright"...repeat all day :loser::D)

I'll give you a tip, though (and this one comes from my five years of working in a vet clinic)...sometimes, if a dog is very attached to his/her person and vice-versa, the mere presence of mom/dad can be enough to cause hysterics.

I can't tell you how many times I would see a dog screaming and flailing and OH THE HUMANITY over some little procedure (a shot, nail trim, stethoscope:rolleyes:)...and that same dog, taken to the back treatment area away from mom/dad, just giving a big sigh and saying "well, alright then, if you must" and allowing whatever it was that needed to be done without a peep of fuss. And then that dog would go BACK to mom/dad in the waiting room and at the first sound of mom/dad's voice, the hysterics would begin again "OH MY GOD MOM THEY DID HORRIBLE, AWFUL THINGS TO ME, I CAN'T EVEN BEGIN TO TELL YOU!!!" :laughing::laughing::laughing::laughing: Some dogs are a liiiiittle more sensitive (theatrical) than others :D So, sometimes it's good to take a break from the clinic, put the vet's number on speed dial, and just call to get updates :D

Poor Jaida... she and Teddy are a matched pair for anaesthesia-delirium. It's always a shock because Teddy is always incredibly docile/relaxed by nature. Everyone who meets him wants a dog like him because even at 6 months old he was serene and almost "zen-like" in outlook. Anything else the vet has to do (nails, shots, rebandaging his ear, inspections, temperature-taking etc) he just freezes and stands very still and goes off into his own little world. His vets have always been amazed... so that's why seeing him post-surgery was such a shock!

The oncologist said they have to keep him for 2 days to ensure healing is ok and to feed him by IV until he is able to eat etc. I know it makes sense, but I will be in agony (!). I know it sounds crazy but I would even pay extra if I could just sleep on the floor beside him for those nights! They really should have special package deals at these clinics... I wouldn't mind bringing a sleepingbag! LOL

LOL you'll be ok (and trust me, it's pretty crowded in those hospital dog kennels...you CAN fit a human in there with a dog, but there's not much leg room!) :laughing:

And yeah, Jaida's like that too...when NOT under the influence, she is the world's easiest patient...go figure!

Acanthomatous
 

Hi Golden Angel,
Our mixed breed dog Nicki who is six years old, received the same diagnosis a few weeks ago. I too, did not want to have half of her jaw removed. We looked into radiation therapy (which is done in Pittsburgh), however, she would need to be there 5 days per week for 3-4 weeks. I did some research and found a chemotherapy called bleomycin. I discussed this with our vet and he called me today to say that he is willing to administer it. This is a relatively new therapy and the initial results are positive. It will require 4 weekly injections (into the tumor), but the cost is significantly less $1600 compared to approximately $10,000 for the surgery and as much as $3500 for the radiation (we would also have boarding costs and not be with our dog for 4 weeks). I am feeling hopeful for the first time in a few weeks. There are side effects with the drug, but comparatively speaking they seem to be worth the risk. We live in Western New York, and this seems to be the most viable option for us. I can keep you posted if you would like. I wish all the best for you and your dog.

I'm so sorry about your dog, sounds like a nasty benign tumor.

Golden Angel's posts were three years ago, I'm not sure what happened?

our dog Rusty is an almost eight year golden mix, also recently diagnosed with A. Ameloblastoma. He is very active, and we are torn between trying bleomycin and partial jaw removal. Of course the oncologist we saw wants 100% cure and wants remove a large portion of his jaw, insisting he will be just fine.

I would greatly appreciate learning what some of you decided to do, and what the outcome was. We have to make a decision very soon, because these things just continue to grow. There seems to be very minimal bone invasion at this point, but it won't stay that way for long. What did you do with Nicki, and how is she doing?

Dear Goldenangel, our almost 8 year old golden mix was decently diagnosed with the same thing and are facing the same dilemma. What ever became of Teddy? You seamed to stop posting before announcing your decision and outcome. I would really like to know what happened if you don't mind sharing. We need to make a decision very soon for Rusty, and would greatly appreciate your input. I really hope everything went well!

Thank you!
Zonker

Zonker, I know two people who have had this surgery performed on Shetland Sheepdogs. One dog I know is still really enjoying his life, can't enquire after the other just now because the breeder is holidaying overseas. I can find out if the other will talk to you about it if you like though? You could contact her by email or on Facebook. We are in Australia.

Thank you Goldfields,
It helps enough to just know that another dog is doing well after the surgery. I was really hoping to find information from someone who has tried a less drastic approach such as bleomycin.

Rusty's tumor is minimal (T1b) at this point, and we are hoping to either try bleomycin or possibly a more minimal surgery like remove two teeth and grind out some of the surrounding bone. Our thinking is that if it works, especially for a number of years before recurrence, then more could be removed later. Once it's gone, you can't put it back, you know?

Thanks!
Zonker

Alternative Remedies
 

I have a Great Pyrenees that has been similarly diagnosed. A week ago we began herbal treatments with two teaspoons of Cota mixed with yogurt taken twice per day. Our dog is a working farm dog. There is a related study where Cota reduced tobacco induced tumors on earth worms. I am interested in any other herbal remedies.

[QUOTE=Great Pyrenees;1059009]I have a Great Pyrenees that has been similarly diagnosed. A week ago we began herbal treatments with two teaspoons of Cota mixed with yogurt taken twice per day. Our dog is a working farm dog. There is a related study where Cota reduced tobacco induced tumors on earth worms. I am interested in any other herbal remedies.[/QUOTE]

I am so very sorry to hear this news :grouphug:

I do not know much about that specific cancer. I know that many of these cancers do respond to things like IP6 or curcumin.

There are about 3 posts in this thread here that talk about diet and misc supplements for cancer: [url]http://germanshepherdhome.net/forum/ubbthreads.php/topics/32999/Re_Cancer_General_and_Overview#Post32999[/url] This may or may not be helpful.

Of particular note, might be Sander's story there, who lived a very long time with a cancer in the jaw, though I believe it was a different type: [url]http://www.cinnamondog.com/[/url]

There are a few threads here that talk about different supplements, though it's a different type of cancer: [url]http://www.pets.ca/forum/showthread.php?t=44407&page=16[/url] (starting around 1/2013)

and here: [url]http://www.pets.ca/forum/showthread.php?t=82502[/url]

Please keep us posted....

Ran across this mast cell tumor protocol that says it also hrinks epuli. Same thing? I dunno, but it might help...

[url]http://www.bavariasboxers.com/cancer.htm[/url]