Hey guys! Summer is over, and now I have a little time to write. Sorry for the delay in posting. Frequent commenter “The Old Broad” requested I post more cases, so here’s one for you:
Little Ms. Izzy is a soon-to-be 7 year old red Dachshund (Her birthday is August 31, we should all wish her a happy bday!) Her human mama brought her in to see me early in July for sneezing and a swollen nose.
Sweet Izzy was sneezing like crazy and was affecting her owners quality of sleep with her snorting and assorted nasal shenanigans. Her owners reported that she was definitely a “hound” and had a strong history of sticking her nose where it doesn’t belong. Particularly sniffing around the copious rabbit poop deposits in the yard.
With Izzy being of the Dachshund persuasion, my first thought as to the cause of her nasal distress was a bad tooth. Dachshies have these long skinny noses and these big upper canine teeth that like to abscess and pop pus through the nasal cavity into the sinus. The resultant sneezing and nasal discharge is usually remedied by surgical removal of the offending tooth.
Other things to consider included: plain ol’ nasal allergies, sinusitis, foreign material ( Things like: grass, sticks, etc. Dr. Sharp even had a patient with a peanut lodged in his nose once) in the nose and cancer.
If I were to play the odds and rank the possibilities it would be teeth, allergies, sinusitis cancer and foreign body.
On physical exam, she had moderate to severe plaque, tartar and gum disease. I generally can’t evaluate for recession around the canines without anesthesia. Therefore, can’t rule in or out dental involvement yet. I couldn’t really appreciate nasal swelling, because what the owner saw was very subtle. She might have been moving slightly less air out of her right nostril, using the highly sensitive “piece of cotton stuck in front of each nostril and see how much it moves” test. However, when I did the even more sensitive, “put the stethoscope in front of each nostril and listen” test, the air flow seemed to sound the same.
The owner and I went over all the possibilities and decided to be conservative in light of the fact that she had only been showing symptoms for less than 24 hours. Izzie went home with a dose of allergy medicine and a recommendation to come back for further evaluation if the sneezing didn’t resolve.
About three weeks later, Izzie was back. Still sneezing. Dr. Brewer saw her and said the only way he could describe Izzie’s nose was that it looked like a “witches bump”. She had developed a large nodule on her nose and a mucoid nasal discharge. and even occasionally sneezed out frank blood.
At this point we are really concerned about “the big C”. Nasal tumors have a nasty habit of sitting there quietly until such time as they get big enough to physically cause symptoms: sneezing, discharge, etc. I consulted with Dr. Stephanie Cook, oncologist at Veterinary Specialists of North Texas about the sudden progression of Izzie’s symptoms. She said that once nasal tumors break through the top of the sinuses, they tend to be really aggressive and grow quickly.
Well, that wasn’t what I wanted to hear. I imagine Izzy’s owner wanted to hear it even less.
Her options were for us to blindly biopsy the lesion at our place, or to refer her to the oncologists for a CT evaluation and biopsy. My concern with us doing it was that Izzy’s problem started inside her nose and worked its way out to the skin. There was a chance that if we biopsy at the level of the skin (because we don’t have the tools to get all up inside the nose), that we would just get inflammatory cells, no cancer cells, and a big waste of money. Furthermore, we didn’t know how big and aggressive this mass was (These things can eat into the brain, eyeballs, etc. Extensive tumor spread might negate further treatment and evaluation).
The owners elected to have a CT done to look at the mass and for any possible metastasis. Prior to her visit to the oncologists, Izzie’s owner asks if we can put her on antibioitic in the off-chance it is some kind of infection. “Sure”, I say, it won’t hurt and it might help result in a cleaner biopsy sample.
I’ll be honest though, this case walks like cancer, it talks like cancer and the odds are it’s cancer. I’m not particularly hopeful the antibiotics will do much, but there is always a chance.
Izzy’s CT and needle aspirate of the mass are all consistent with possible carcinoma (cancer). She even had a lymph node enlarged in the area. Although the oncologist thought she saw cancer cells in the aspirate, she didn’t in the lymph node, so that was good. Biopsy samples were taken while Izzy was under and submitted for pathology review, with results expected in about a week.
Meanwhile, a strange thing was happening while we all waited for the biopsy results: Izzy’s lump was shrinking.
In case you were wondering: antibiotics don’t cure cancer, and that’s the only medicine she was on. Cancer generally laughs at antibiotics and keeps right on growing.
Then another strange thing happened: the biopsy report came back, no cancer. The mass contained a bunch of inflammation, bacteria and…this is the good part…a 2.5cm hunk of unidentifiable plant material.
That silly dog managed to snort some kind of plant part up into her nasal sinus which subsequently abscessed and broke out of the top of her nose!
This, my friends, is not a common presentation of a nasal foreign body. In our combined 80 years of practice, none of us have seen this. We’ve seen grass out the nose, between teeth, in eyeballs, down throats and the like, but never breaking out the top of the nose.
For all intents and purposes, it should have been cancer. However, in Izzy’s particular case it wasn’t, and that for her, is a pretty darn great birthday gift.
I’m hoping to get a picture or two of little Izzy as soon as her mom sends me some, so I’ll post when I can.