Lung Torsion or Lobe Torsion

Good news....I have a twisted lung, but we think this is not lung cancer!

I was very unwell after my operation to remove the twisted lobe. We really thought this tumour was cancer, After the operation my legs started to swell up and I was crying because I could not move around and bend my legs. But walking around slowly was the best way of getting the fluid moving. Daddy did some lymphatic massage on me, to try and get the fluid moving nearer the heart and pumped away. However, once it was pushed past the shoulder, I just kept producing more and more fluid and I had like a small balloon on my chest but it was not seeping out of my chest wound. I started having all the same symptoms of not being able to lie down, scraping the carpet, not able to breathe or rest...I had to be propped up on lots of cushions in a semi sit position.

Anyway, Daddy took me to the vets at Animal Ark because I was in so much pain from the fluid and swelling that I was not eating, and not drinking and I was gaining weight from the  fluid but wasting away a bit underneath. Anyway, Daddy had the biggest and best news. I do not have cancer, the bit they removed is not a cancerous tumour. It is formed by a massively engorged and twisted lung lobe. Here is some information that Mummy gave me about my condition, and I have written down some of the symptoms I had.

Lung Torsion or Lobe Torsion (twisted lung)

Some deep chested dogs, for example Afghan hounds or a greyhound can be more susceptible to suffering from a twisted lung. AKA lung torsion, or lobe torsion.

Sometimes, one of the lobes of a dog''s lungs can become twisted. If it twists in such a way that blood is pumped in by an artery, but not pumped out because the vein is blocked then that lobe can become horribly distended and the lobe becomes necrotic. Basically that just means dying off and rotting away internally. it causes pleural effusion (which means fluid in the chest cavity which can be thick and full of mucous, or it can be pink and blood filled)

I wanted to post about this, because at some point in the future it could your owners who have similar problems with a similar chest condition.

I have found out that this particular condition although reasonably rare, is becoming more common amongst sighthounds, especially Afghan hounds, but this condition occurs more commonly in all deep chested breeds inc greyhounds. It can go undiagnosed, or like me be diagnosed as a mass or even cancer. Mummy and Daddy knew there was a mass, but they felt and the vet felt it was not fair to euthanize me unless we knew 100% what this was.

Our boy 9 yrs old has had breathing difficulties since Feb and was diagnosed with cancer after needle biopsy, with a teeny tiny % chance it could be a condition mimicking cancer 
I had xrays, needle biopsy, fluid drained off the chest repeatedly as well as chemo Vincristine but it made not a difference to the mass, although fluid draining relieved his pain and symptoms.

I went into a crisis last week and I have posted this under the thymoma, as we thought I had some sort of lung or thymus gland cancer, but after surgery the ‘tumour’ turns out not to be cancer at all. It is a lung lobe that has died off and twisted and become engorged, necrotic.

Here is a pic of what it looked like

My biggest problem has been the fluid building up in the chest cavity. I do have complications of lymph draining into my legs and they are horribly swollen at the moment.
Mummy and Daddy know exactly what sort of pain or problem I am getting now by my behaviour. I start sticking my neck right out and panting fast and hard, then I can't like down, and I start groaning in pain and standing all the time...and my belly is tight with my ribs pushed out.

So what wre my symptoms of pleural effusion (fluid building up in the chest) that is indicative of either this, or another chest problem?

Watch out for:

• Uncharacteristically going off my solid food (i.e. not on chemo) even if it is cheese or meat and my fave stuff, or only wanting to slurp up liquids but not dry biccies or kibble
• Difficulty swallowing, slight choking when swallowing
• Distinctive, crowing straining single cough….coughs get closer together depending on how much fluid has built up. Here is me at the very mild beginning stages of this, I have been coughing like this for 6 mths and they get closer together. To see this cough on the vid, just start it at about 40 secs (unedited vid sorry!).

• Not wanting to lie flat and only lying in Sphinx position. Eventually if much worse, not able to lie down at all. 
• Groaning and kicking of legs grumpily when lying flat. 
• Groaning or low growl of discomfort when trying to lie down.
• Coughing up spots of blood, or blood coming from nose (without any chemo).
• Pleural Effusion (fluid on the chest) which shows up normally as opaque milky areas on xray. The twisted lobe often looks opaque as it becomes engorged with blood that has no exit.
• Sticky mucous at the back of my throat
• Mesothelial, or other ‘thelial’ type tissues on needle biopsy. If fluid is drained off the chest, it can be characteristically pink and lab results do show evidence of cells dividing rapidly but often cannot confirm without a proper slice of the affected organ or tumour. We were told the cell results showed it was cancer like with only a tiny chance it was not cancer but could be a condition mimicking it.
• Fluid build up anywhere else in the body. Swollen legs/joints with fluid. When pressed with a finger, leaves a depression that slowly fills up.
• If lying down, holding myneck out straight and his head tilted up.
• Pulling lips back to take in gasps of air (a bit like Popeye’s mouth).
• Walking really slowly, needing to drag him along on the lead
• Really tight abdomen, feels like a drum and if you tap it, it sort of resounds like a balloon filled with water.
• Dipping spine….look at his normal posture and remember it, if the chest gets full of fluid, then the curve of the spine makes a camel hump at shoulders, then dips right down between shoulder and back end before coming up again, and the stomach bows down as well.
• Becoming clingy….uncharacteristically sticking to you like velcro, not wanting to sneak up on the bed or sofa like normal.
• Standing and doing a lot of vacant staring, especially with head facing a wall.
• Digging, scratching or going to front door or back door to want to escape;
• Hangdog expression. You might find that he doesn’t whine or vocalise apart from some groaning as if from indigestion.
• Rapid fast breathing, panting hard and not stopping for hours.
• Bad hot breath (more than usual) and sometimes a clicking or bubbling sound in the chest.

Treatment for lobe torsion

Normally it is surgical, and required the twisted lobe to be removed carefully (not untwisted in situ, as this releases toxins). This is called a lobectomy.

Normally there is a fairly long scar, or it might need a square section with a rib removed. My scar is quite neat on my side but fluid built up around it. There can be complications in surgery,my heart stopped and I died but was revived, but that could have been down to anaesthesia, age or condition as I was quite poorly…or it could be a release of toxins from the necrotic lobe flooding my heart or chest.

Post surgery complications can happen, I am having a few, but once over that hurdle (a couple of weeks after surgery) then prognosis is fair to guarded.

Sometimes the lobe twist can be present with other conditions, sometimes it is just ideopathic (no definitive cause seen) or could be from trauma.

There are conditions like chylothrax (milky fatty fluid in chest cavity) and I am not sure if it is that.....Mummy and Daddy pick me up from the vets today, so then we will know.

Dizzy had his surgery

Hello, this is Lily here....Dizzy is a little bit busy recovering from major lung surgery.

Last night, he was a bit annoying as I was trying to get some Princessy sleep and my companion hound was just standing, panting and staring, making loud honking noises and then digging up the carpet. He could not lie down he said, there was too much fluid and he was in a lot of pain and could not breathe. He had lost a lot of weight over the past two days. Anyway, Mummy and Daddy called the vet at about 3.30 am, and got him out of bed (sorry Uncle Lyndon, but you are our hero!). We took Dizzy in, and he needed to have major surgery to find out what was going on. Mummy and Daddy knew it was risky.

Anyway, apparently Dizzy has had his major surgery and is recovering but the next 24-48 hours are critical. We are not going to visit him or pick him up as he needs to rest and be monitored. Our vet managed to remove a massive hard tumour from the lung, and has done a lobectomy....that piece of diseased lung or tumour will now be analysed. There were complications in surgery, and Dizzy's heart stopped, but they had a full team and were able to get it going again with heart massage....so no damage done there but it is worrying how much stress his poor body is under. Of course, if he came home and laid eyes on my Royal person he might just have another heart attack, that is the sort of effect my exquisite beauty has on common hounds like him.

We are all just waiting now, for tomorrow, so that we can go and pick Dizzy up. I know I moan about him and he can be a nuisance to me and keep me awake but things are a bit quiet here now he is not with us and I sort of miss him.....for example, where has that box of fresh lamb gone? And the cheese? And the chicken? And rice? Mummy and Daddy have been spoiling him something rotten and I was next in line to receive Dizzy's refusals at meal times. Now that seems to have disappeared and boring kibble has turned up in my bowl. Come home soon Dizzy, I sort of miss you! And I might even love you? Just a tiny bit? I am not admitting any more than that of course.

Lily

My Chest

Well, after my 3rd lot of chemo Mummy and Daddy gave me a little break of 10 days and the sores did clear up. Then I had my 4th lof of chemo. I was quite sick afterwards and not able to eat and I got very skinny. Then at the point when the nausea should have worn off, Daddy could not get me to eat at all but Mummy could only feed me tiny bit by tiny bit. About a week after my last chemo, I started making those horrible honking, straining, crowing retching noises. Very loud choking sort of sounds but it was just me trying to clear my chest. I got to the stage where I could not lie down at all and so something had to be done as I was very very tired.

I went back to my vet and he drained a lot of fluid off me. I weighed about 32.5 kilos in before, and then when reweighed I was 31.33. My chest was full of fluid so I could not breathe, could not swallow and my ribs were pushed out...it was horrible. Mummy and Daddy made a video of it to show our vet.
When I got home, I was so tired, I snoozed like a pup on my brand new bed and was much more comfortable. I had a reasonably comfy night, only a few groans and honks....so a dramatic difference from when the fluid has built up.

It looks like the chemo so far has not made a lot of difference to the problems coming back, and that surgery to remove the mass is the only option. We are all very frightened because the surgery is risky, and we don't know what we might find if it is opened up. Hopefully it will be something my vet can take out really easily which would be good.
If not, then at least we can know exactly what it is, get it biopsied, and then treat it with specific  treatment.

The other thing I overheard Mummy and Daddy talking about is the insurance. I was insured for one condition for up to £2,500 treatment and it looks like I am a good few hundred pounds over that. If there is more surgery, and more treatment then we might double that figure above. I heard Daddy talking to a man in the park whose friend spent £30,000 on cancer treatments, but it didn't work. Mummy and Daddy promised me that we would not make a decision on whether to go ahead based on finances. They will make sure I am very comfortable and that they won't choose something that will make me very uncomfortable unless there is a chance of it working.

So, looks like I will be getting my chest opened up next week sometime, possibly after Tues as Mummy has to go to hospital herself on Monday. If I am too sick or unwell to post, then Lily is going to have to (reluctantly) put a post up for me to tell you how I am.

Dandruff

Well it is Dandruff City in our house, everybody's sores seem to be clearing up and I am all flaky and peeling. Daddy took me to the vets for my usual weekly check up, and he made the decision that because I was a little bit perkier, and the sores needed a break, he would delay my last lot of chemo for about 4 days...so I had my last lot of Vincristine last Sunday.

On my scans, it looks as if there is still that big old mass but the good news is that the fluid is down from usual, and it looks like this mass has not metastasized anywhere else...this looks like it has not spread and is local. The problems with breathing are still there because the trachea and lungs are diverted, but I can now lie down comfortably and I am back onto the sofas. In fact, some of my annoying habits have come back so I must be feeling better.

I overheard Mummy and Daddy talking though, and they are worried because the insurance company only cover up to £3,000 and they are now at their limit. Neither is working, Daddy was made redundant and Mummy is sick and not working at the moment and is lame and not able to walk on her left foot. I am doing well, and it seems a shame not to proceed with treatment that is working....so they will probably be running up credit card bills just for my treatment! They can't stop now....can they? Also, I am a bit of an elderly gent for a greyhound and cannot believe I will be 10 next March, so it is difficult to persuade a charity to help out if the treatment only gives me a tiny chance of improvement or a short remission.....

Oh dear, I am doing my best to try and appear normal. 
I am doing the odd retching and chundering noises and breathing problems occasionally and I am off my food since my last Vincristine, but no more sores breaking open.
I look a bit tired and grey from normal, but hopefully will bounce back after this last treatment. The plan is to break from that and do a scan/xray in 10 days. Then what...we don't know. At some point, my vet might want to open up my chest and take out that big old lump....especially as it has not spread. I don't like the sound of that idea, but Mummy and Daddy will do their best....and I am loving the walks and attention.
I am still refusing nice food though, I feel entitled to get a bit fussy!

Dizzy

Dee Dee the Service Dog

Oh no, Mummy has found this wonderful, saintly and useful greyhound to compare me against, and its going to be hard. Dee started life as a racer, and a fast one at that. Then she retired and went into foster care, and then got adopted by a new Mum who trained her to be a companion and petting service dog, which I know I could do if I was not so afraid of people. Then Dee Dee's Mum got sick, you can read about her on this blog http://aroundwiththehound.com/.

Dee Dee learned to become more than just a constant companion to her Mum, she was trained to be an official service dog and helps her do day to day tasks. She can pull the covers over her Mum, open and close doors and pick up things and fetch them. Here is her story:

Now this puts extra pressure on me. Everybody knows I have been intelligent enough to manipulate people into thinking I am royalty, everything in life goes my way....and I am quite selfish really.....so please, nobody send me off to train to pick up Mummy's laundry and do the washing....and I really couldn't cook, but I can eat!

Lily

Good News & Bad News

I will start with the slightly bad news first. I had a small sore on my toe which Mummy and Daddy thought was just my knuckles rubbing and me being run down. After about 3 weeks it seemed to heal. Then last weekend, Daddy found a very big sore breaking out on my leg, this was followed by both ears having sores, both eyes.....and then it even spread to Lily. It was crusty so Mummy thought it might be ringworm and started using an antifungal cream.

On Tues I went in to have my chemo as normal and at first the vet thought my sores looked like they were cancerous and that the cancer was at a much later stage than we hoped. But, that did not explain why Lily had two. Even Mummy had one sore on her mouth, others on her face and a rash on her arms. The inside of her mouth was sore and has now started bleeding.

When we went into the vets Tues morning, Lily had one and a half sores and I had about 4, and then by the end of the evening Lily had 5 sores and I had 10 even though we were both on antibiotics and antifungal creams. We are wating for results of skin scrape tests, and its a bit worrying and obviously contagious.

Here are some amusing diagrams Mummy has been drawing. It is the only way she can remember where the sores are and keep a count of whether the patches are getting better or worse.

Now for the Good News....there was less fluid on my chest and on x-ray the vets could see much more clearly in the chest. I still have a mass and still have displacement of my trachea, lungs etc but it looks like that mass has not metastasised (that just means spread out like little satellites) anywhere else.  So whatever is happening with the chemo, my fluidy chest has got better rather than worse. I still have coughing, honking and breathing difficulties and I don't feel like eating. That is partly the chemo though so its not surprising.

So we are waiting for the skin test results to come back....and in the meantime it is scary and hard work for Mummy and Daddy who are bathing, adding lots of cream to us, and then having to supervise us so we do not lick it off again.

My Treatment

I have had a couple of episodes of being very unwell. A couple of weeks ago I was doing what Mummy and Daddy call 'Cuddle Tennis' where I was a bit too miserable and uncomfortable to lie down and just kept walking from one person to another and cuddling while standing and laying my head in their lap. I did try to have a cuddle with Mummy on the sofa but as soon as I lay down I started honking and straining with a really noisy and horrible distressed type breathing. 

They took me to see my Uncle Lyndon (my only and favourite vet in the World) at Animal Ark, which is the base for my biggest fan club and entourage.  Apparently that veterinary practice was set up for the sole purpose of worshipping me with biccies and attention. It can be a bit tiring keeping up all that ''roo rooing'' and cuddling with my many fans, but I try to share out the attention amongst them all as best I can. I am obviously doing a good job as they have nicknamed me ''Noisy''. I went into the doggie ward immediately to drain fluid and have more x-rays. It was still not easy to see what was going on in x-ray but at least I could breathe again. I had more biopsies and the fluid analysed and it is still is looking like a lymphoma in the chest.

So my carers decided to presume this is a lymphoma type cancer as all the tests indicate that (with a small percentage that it is something else giving those results) and they started my chemotherapy. Nobody wants to open me up at the moment, which is what would probably happen if I was referred to an oncologist, so I went onto a drug called Vincristine. When I came home I was really tired and floppy for a day or two, then a bit sick for a day or two and off my food again, but then back to normal and quite perky. I did have a couple of nosebleeds, which was a bit scary. It seemed to happen if I got excited...especially about going out for a walk.

I have had two treatments now. The second dose was 20% more than the first one, and I did feel more nauseous and grumpy for a day or two but I have perked up a bit now. Whatever happens, I have to keep this lovely food they keep giving me, so I will have to keep looking a bit miserable if I am offered anything less. Lily is driven wild with jealousy when I have my breakfast. She knows I am getting things in my food that she isn't, even though she is shut in another room to have her brekkie. Afterwards she comes and sniffs me all over and then licks my ear vigorously to tell me she is still in charge but we all know that isn't the case any more and I get first pickings from the best of the food going.

This is what I have been eating mainly....Mummy has spent a fortune on this, but I love it.

I will let you know how my next treatment goes, but don't tell Mummy and Daddy about the plan I have for keeping my yummy food.

Dizzy

I Need Sympathy Too.....

All this time Lily has been ill with her claws and immune disorder, I have been growing a mass around the thymus area. Well I had never heard of the Thymus either, but it is a gland that is part of the immune system. I have been very run down for a couple of months, hacking intermittent cough, blood in my wee and gasping for breath and loping along very slowly.I couldn't swallow my food or hard biscuits and started losing weight and looking a bit cancerous. Mummy and Daddy thought I was off my food due to antibiotics, so they changed it, about 4 or 5 times at least, and then thought I was being fussy and demanding human food. I also had gooey stuff in the back of my throat, I was in pain and a couple of times I actually forgot myself and snapped at Mummy as I thought it was whoever happened to be sitting next to me causing the pain. I kept lying there, staring into space and panting hard even when resting and could not get that comfortable a lot of the time.

I finally was well enough after weeks of antibiotics to have a small sedative and x-ray with a needle biopsy on Monday. The news was not that good, it was very cloudy and the heart and lungs were pushed right back in the chest cavity, and the trachea pushed up and displaced...no wonder I could not breathe properly. That trachea is right up by the spine and displaced. 

Anyway, the cells in the needle biopsy did not give a 100% definitive answer. There were cells dividing, rapidly into 2 and 3 and that indicates a fast developing malignancy, but still cannot be 100% certain without a full tissue biopsy and as I am a little bit more perky on antibiotics, the feeling is to continue antibiotics to see if perhaps all of that mass was just a huge enlargement of the thymus, or could be swollen due to abscess or infection.  Look at how the position of my windpipe drops in the neck ever so slightly on my 2nd x-ray...nearer normal than before...but the end of it is still pushed up with lungs and heart pushed back and out the way...

So for the next 18 days I am on antibiotics and painkillers, then will have another x-ray to see if that is making a difference. If it is not, then I can start chemo to try and shrink the chemo, or if critical open up the chest and take a decent sample for analysis. But I am a senior boy now, so all surgery is risky and its not a nice job. I am too well and bright today to consider that option.

We are going forward as if this is 100% malignancy,but carry a tiny hope that this could be swelling due to infection. All the tell-tale signs of a serious illness are there, but we have to be positive and work towards the tiny window of chance.

Symptoms of Thymus Gland Problems

I had a persistant cough. Hacking and bronchial sounding, with a sort of intermittent sneeze as if trying to move an obstruction or huffing up mucus, but no mucus present.
I had some sticky substance in the throat, either that was fluid from the tumour/mass draining off, or I was producing lots of saliva to make it easier to swallow. It was white (not green), odourless, and stringy and gel like but fairly wet. I was very run down, reluctant to run, gasping for breath with a sort of grimace and lips pulled back at the sides (think of Popeye's mouth) as I was gasping for more oxygen. When I walked, trotted or tried to run, my head was leaning to one side as if stiff. I had blood in my wee, high bilirubin and proteins and on one test high sugar. I was very thirsty all the time but would often choke. I could not eat solid food but could manage soft food.

My Diagnosis

Please note I am not a vet, I am just a greyhound with thymoma related problems and this is what happened to me. Always get advice from your own doctor and get your owner to find out as much as possible about all the possible diseases and causes that give those symptoms.

Thymoma cancer is very rare in dogs, and problems with the gland are not that common. Initially an x-ray will show abnormal placement of lungs and heart and can show a mass in front of the heart and around trachea and neck and there may be a lot of cloudiness in the chest obscuring a clear view. If this is shown then a vet will take a needle biopsy while the dog is sedated and might try to draw off as much fluid as possible. About 3 days later, it is possible in the lab to see which cells are dividing and mutating, and are abnormal and the rate at which they are doing this. A needle biopsy is quite often not enough of a sample to give a 100% definitive answer, but gives an indication of whether it is likely or not to be malignant and may advise on the probability of that type of malignancy. The vet may proceed with a presumptive diagnosis, which is to assume it is the most severe of the possible outcomes and proceed with the treatment as if it is. if the dog is extremely unwell and in distress at the time of the results, then he may go ahead and open up the chest anyway and malignant tissue can be diagnosed and removed. However opening up the chest to do this is quite a serious thing to do, so if the dog appears to be well and responding to antibiotic treatment and painkillers, he may proceed with that to see if the mass reduces when not infected.

My Treatment

Initial treatment is antibiotic and anti-inflammatory drugs until the mass is clearly seen and diagnosed. If a presumptive diagnosis of lymphoma or thymoma is given, some chemotherapy can be given via weekly or fortnightly injections to try and shrink the mass. Even if it is benign, or low malignancy, the mass can obstruct airways and make it difficult to eat and cause pressure and pain as it takes up the chest and neck cavity. As the Thymus gland is necessary for the immune system, anything wrong there can cause a break down in immunity and give illnesses and a run down condition like me. For example, I have had chronic bladder infection and flu like symptoms. It was as if I had suddenly aged overnight and lost all my zest.

Well...it has been all drama lately in our household, two people unemployed, one off sick, one redundancy recently, one person with two broken metacarpals/broken hand. One person with numbness down left side and completely numb, one dog losing all her claws, one dog with an immune disorder and bleeding paws.