Following on from our dog blog post on November 1st Murphy went under the knife again to remove his rectal growth (for the third time). When Vicky at Whitstable Bay Veterinary Centre had him asleep and able to perform a more detailed examination it became clear the regrowth was more aggressive than previously and the mass was more widely attached to his rectum. This presented a problem in so far as a more invasive procedure would be needed to remove the bulk of the mass (leading to greater risk of post-operative issues but with the best chance of obtaining strong biopsy results) or a lower risk, more partial, removal that would likely not give strong results and would leave a large lump that Murphy would continue to ‘think’ he had to pass. We agreed to go for the more invasive removal stressing that minimal risk should be taken on future incontinence. Adam and Vicky did this together.
Whilst Murphy was under anaesthetic Vicky also cleaned a wound he had between his toes. This had the appearance of an imbedded grass seed (see earlier blog post) but Alan thought it an unlikely cause this late in the season. Vicky was not able to find any foreign body, so we assume the wound was caused by a thorn or similar on one of Murphy’s charges through the undergrowth in pursuit of squirrels (who are jumping through the trees anyway!).
Murphy quickly recovered from the procedure and was soon eating and ‘producing’ normally. On Vicky’s recommendation he now has a fibre additive to his food designed to help manage stool consistency and reduce friction on the remaining mass. This seems to have helped and Murphy’s first couple of motions in the morning are full but not too firm. Unfortunately, he to continues straining to pass what remains of the lump. Mercifully he is not passing blood when straining at present.
It took some time for full histopathology results to be achieved as multiple sections of the mass were processed. The final analysis by the pathologist is comforting as she said “I cannot see convincing evidence of invasive behaviour and therefore malignancy in the sections examined from Murphy. Therefore, this lesion is considered to represent a benign adenomatous polyp”.
Today, Alan was grateful for consultations with both Adam and Vicky. Adam gave him a detailed description of the mass he and Vicky removed (Murphy looked the other way!). Adam and Vicky were concerned by its appearance so are relieved by the test results. Adam explained that, even though the mass is so far benign, this may not continue to be the case when it regrows – as he is sure it will. The base of the polyp may widen and grow more aggressively even if it does not become cancerous. He went on to explain the difference between a rectal pull out procedure and a rectal pull through operation (that Alan had previously dismissed because of the complications associated with it). Adam recommends the pull out as the best chance of removing the whole of the mass and preventing re-growth whilst minimising the risk of future complications. He stressed this would be best done by a soft tissue surgery expert (and can recommend one), but agreed even this could not guarantee success.
An alternative to further surgery is to medically manage the symptoms and slow regrowth. Vicky explained the relative benefits and side effect risks of various anti-inflammatories and steroids. We also discussed a new drug, principally an anti-inflammatory, that has been shown to have positive effects on some cancerous growths and polyps. The study sample in dogs is so far very small but an oncology expert drew it to Vicky’s attention when she sought advice for Murphy. Alan has decided to give the new drug a go in the hope it reduces Murphy’s desire to strain and at least slows regrowth of his polyp. If it works, this will be the least impactful way of maintaining Murphy’s quality of life; if not we may have to go and see the soft tissue surgery expert (with a full wallet!).
Murphy’s quality of life is now almost fully restored. Only the straining to pass what’s not there interferes with his walks – and this is probably more an issue for Alan than him. He is eating well, has put some weight back on (he’s now about 30.5 kilos) and is enjoying running off after furry beasties on his walks. Let’s hope Murphy adds to evidence for the new drug in a positive way!