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Dr. Jo
Dr. Jo, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 2796
Experience:  DVM from Iowa State University in 1994; actively engaged in private regular and emergency practice since that time.
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Vets have suggested my dog has mystopathy. She is secreting

Customer Question

Vets have suggested my dog has mystopathy. She is secreting semi whitish fluid likely lymphatic fuild from her rear two teats. I did not give her immediate treatment hence the place is sore and now we are treating the wound around there. She has swelling in her hind legs and a vet told me to treat the wound before conducting treatment for cancer which will be through surgery and removal of mamary glands and uterus. We apply anti bacterial and anti fungal powder and a drying ayurvedic cream made out of neem tree leaves. She naturally has pain and therefore she pants. She keeps sitting on her hind legs and because of pressure the teats are pressed and they release the same semi whitish fluid in no time. I need to know what other options can I do to arrest this secretion and clear the soreness. She has been using elizabathen collar now. Her appitite is very good and she is always hungry. She drinks water regularly too. We gave her dirutic to ease the swelling in legs but not constantly. Can you help please.
JA: I'm sorry to hear that. This sounds like it might be serious. I'll let the Veterinarian know what's going on ASAP. Is there anything else important you think the Veterinarian should know about your dog?
Customer: She is 8 years ol. Samoyed breed. I had given her depo provera drug in her frist 2 years so that she doesnt concieve. Stopped immediately after. She isnt spayed and I know this could be a high reason of her present condition. I am told not to spay her now until her sore is arrested. She has never gotten pregnant but has mated and severally shown signs of false pregnancy.
JA: Our top Veterinarian is ready to take your case. Just pay the $5 fully refundable deposit and I'll fill the Veterinarian in on everything we've discussed. You can go back and forth with the Veterinarian until you're 100% satisfied. We guarantee it.
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Jo replied 1 year ago.

Hello,
I'm Dr. Jo and I'm a licensed veterinarian with more than twenty years of experience. I'm here to help with your question about your dog.

I'm so sorry you're having this problem, but glad you're looking for the information you need. You may join the conversation at any time by typing in what you want to say then clicking REPLY or SEND. Then we can chat back and forth until you're satisfied with the information I've provided.
So I may know we're properly connected and that you understand how the website works (including that I'll need to earn your good rating in order to receive any compensation for helping you), please type in a short response below. You may rest assured you'll have my full attention and will receive a complete response once I know you're there.

Customer: replied 1 year ago.
Thanks Dr Jo. You may go through the text I had inputed before paying for such service and advise me
Expert:  Dr. Jo replied 1 year ago.

Yes, I've read everything you've written. I'm so sorry you're going through this terrible ordeal with your dog.

(typing more)

Expert:  Dr. Jo replied 1 year ago.

I'm very worried that the current plan of waiting until the sores clear up to do surgery will be unsuccessful. I say this because the most likely cause for sores like this is an aggressive form of inflammatory mammary cancer, and - if that's the case - the sores will not clear up. The condition is very painful and progresses rapidly. I'm so sorry to let you know it is always fatal.

If it turns out to be the case that your dog has inflammatory mammary adenocarcinoma, it would be a shame to put her through additional treatment when she is already in pain and there is no hope for improvement.

That being said, it's also really important to emphasize that there are a lot of pain medications that can be used to try to keep her comfortable.

You mentioned she is on a diuretic. Please tell me all medications she is taking.

Customer: replied 1 year ago.
I have just added a picture of the wound of my dog as explained in earlier message.
Expert:  Dr. Jo replied 1 year ago.

I'm afraid the picture was not successfully uploaded. You may try again, using the paperclip icon to attach the file.

Customer: replied 1 year ago.
She is using ferosimide, she is using anti allergy piriton, she is using neomycine powder, she is also prescribed an anti inflammatory called tyfolone. Are you suggesting that surgery can happen when she is in this form.
Customer: replied 1 year ago.
Is there any other email address where I can send the pictures. I am trying to upload but it doesnt get through
Expert:  Dr. Jo replied 1 year ago.

Picture is here. Looking now...

Customer: replied 1 year ago.
The brown on the picture is the cream. Its an ayurvedic cream made up of neem leaves and its from the ayurvedic indian veterinery site ayurvet.com.
Expert:  Dr. Jo replied 1 year ago.

Am I suggesting that surgery can happen when she is in this form? That's a difficult question to answer. Based on what you've told me and what this photo looks like, I'm afraid you don't have any choice. She is not at all likely to improve with medications alone at this point, and the medications she is taking are not at all likely to solve the problem (they don't cure cancer).

The harsh reality of your situation is that even *with* surgery she is still not likely to survive. This looks like a very aggressive form of cancer.

I'll be frank with you... please don't misunderstand... I don't mean to sound harsh. Even with cultural and regional differences aside, I'm worried your dog has not been properly diagnosed and isn't receiving proper treatment.

This is a very complicated medical problem that oftentimes cannot be successfully treated even with aggressive surgery and medications. If she is to have any chance of surviving at all, she needs the best medical care available. That starts with a full workup and an accurate diagnosis.

Customer: replied 1 year ago.
I know there is pain as she pants is she has to walk though her walk has been reduced greatly. But she is eating very well and she passes stool and urine well too. This picture is uploaded is after applying the anti fungal and anti bacterial powder - cicatrin. But after a while if she sits up the pressure put on the lyphatic system by her sitting and pressing the leg will make the teats to bring out the liqui
Expert:  Dr. Jo replied 1 year ago.

Perhaps we have a language barrier... but mystopathy is not any type of diagnosis in English veterinary medicine.

Customer: replied 1 year ago.
Are there any pain killers that you can recommend in such situation.
Customer: replied 1 year ago.
The vet dr that comes to see is from Ukraine. She immediately said that this is cancer. However she said she can get the wound healed first and she said her breathing was hard and she feels (due to her years of experience) that her heart is weak hence giving aneasthesia for surgery may not work well now. She even gave an immune booster injection today
Expert:  Dr. Jo replied 1 year ago.

Yes. I will list pain killers that are typically used in dogs.

Again, please understand that pain killers will provide only temporary, palliative care at best. We stopped using Depo Provera in the US about thirty years ago because it causes terribly painful mammary cancer and death that cannot be successfully treated. I'm worried that's what is happening to your poor dog. Because your vet recommended using it (I assume), I'm doubly worried that she is not familiar with current standards of care for diagnosing and treating problems. That makes the situation even more severe. Even though I do not have the benefit of being able to examine your dog and make a professional opinion for myself, I will argue that a dog will pant for multiple reasons (including pain) and that I would not conclude it has a weak heart until I'd found evidence for heart disease on x-rays, ultrasound, and/or ECG. To claim otherwise without the benefit of diagnostic testing is not good care.

The bot***** *****ne is that sores caused by cancer WILL NOT HEAL with this type of medical and topical therapy. I hate to see your dog wait in pain for something that is not going to happen. If the sores would heal, after all, then she wouldn't need surgery. It makes no sense to me.

Pain relievers used in dogs coming up...

Pain medications

Expert:  Dr. Jo replied 1 year ago.
  • Acetominaphen (carefully)
  • Aspirin (carefully)
  • Tramadol
  • NSAIDS like carprofen, meloxicam, firocoxib
  • Gabapentin
  • Morphine
  • Hydromorphone

Never use ibuprofen for a dog, and use aspirin and acetaminophen only with extreme caution. These drugs can be very unsafe for dogs.

I'm so sorry you're stuck in this situation. I know you want what's best for your dog, and I'm sorry she's been given harmful medication (Depo Provera) and now most likely has incurable mammary cancer. It's a terrible situation all around. If this *is* inflammatory mammary adenocarcinoma, I'm afraid it will rapidly reach a point where no amount of pain medication will provide adequate relief. It's incurable. I'm so sorry.

Customer: replied 1 year ago.
Please see if there are any pain relievers that can be gotten in pharmacy for humans. Apprently the vet scene is bad here in Lagos, Nigeria. Also, I appreciate your replies even though they sound as if my dog is on last stage of cancer. We did her routine kidney and liver function test about 1 month back and it was absolutely normal. She is also eating very well. I am sure proper therapy can heal her or atleast give her quality remainder of life
Customer: replied 1 year ago.
One more thing Dr, are multivitamis for dogs (daily ones) bad if dog has cancer?
Expert:  Dr. Jo replied 1 year ago.

Everything I've listed above is available at human pharmacies... meloxicam is the only NSAID on the list that's used for people, but you would only use one anyway.

Yes, a multivitamin is a good idea.

Customer: replied 1 year ago.
What of piroxicam? Any other variant of such
Expert:  Dr. Jo replied 1 year ago.

Checking now... one moment...

Expert:  Dr. Jo replied 1 year ago.

Piroxicam is not commonly used as an anti-inflammatory in the US because it isn't labelled or approved for this use, but - interestingly - when it is used, it is used for situations like yours. People are currently studying it to see if it is particularly effective for tumor-based inflammation. While experimental, it could be a really good choice in your situation.

I'll attach the prescribing information below, in case your vet hasn't read this yet.

Piroxicam

  • (peer-ox-i-kam)
  • Feldene®
  • Non-Steroidal Antiinflammatory (NSAID), Anti-Tumor

Prescriber Highlights

  • NSAID primarily used for its antitumor (indirect) activity. There are safer and/or approved NSAIDs available for pain/inflammation for dogs & cats.
  • Low dose metronomic (continuous) therapy with cyclophosphamide shows promise for preventing sarcoma recurrence in dogs with fewer adverse effects then high dose treatment.
  • Contraindications: Hypersensitivity or severely allergic to aspirin or other NSAIDs. Extreme Caution: Active, or a history of GI ulcer disease or bleeding disorders. Caution: Severely compromised cardiac function.
  • Use in cats is controversial; use with caution.
  • Adverse Effects: GI ulceration & bleeding, renal papillary necrosis, & peritonitis.

Uses/Indications

In dogs and cats, piroxicam’s primary use is as adjunctive treatment of bladder transitional cell carcinoma. It may also be of benefit in squamous cell carcinomas, mammary adenocarcinoma, and transmissible venereal tumor (TVT). Piroxicam may be beneficial in reducing the pain and inflammation associated with degenerative joint disease, but there are safer alternatives available.

Pharmacology/Actions

Like other non-steroidal antiinflammatory agents, piroxicam has antiinflammatory, analgesic, and antipyretic activity. The drug’s antiinflammatory activity is thought to be primarily due to its inhibition of prostaglandin synthesis, but additional mechanisms (e.g., superoxide formation inhibition) may be important. As with other NSAIDs, piroxicam can affect renal function, cause GI mucosal damage, and inhibit platelet aggregation.

Piroxicam’s antitumor effects are believed to be due to its action on the immune system and not because of direct effects on tumor cells.

Pharmacokinetics

After oral administration, piroxicam is well absorbed from the gut. While the presence of food will decrease the rate of absorption, it will not decrease the amount absorbed. It is not believed that antacids significantly affect absorption.

In dogs, piroxicam has high oral bioavailability (100%) with peak plasma levels reached ≈ 3 hours after dosing. Volume of distribution is ≈ 0.3 L/kg; total body clearance is 0.066 L/hour and elimination half-life is ≈ 40 hours (Galbraith et al. 1991).

After single oral doses in cats, piroxicam is well absorbed with an oral bioavailability of ≈ 80%. Peak levels occur in ≈ 3 hours. Elimination half-life after intravenous or oral dosing is ≈ 12-13 hours.

Piroxicam is highly bound to plasma proteins. In humans, synovial levels are ≈ 40% of those found in plasma. Maternal milk concentrations are only ≈ 1% of plasma levels.

In humans, piroxicam has a very long plasma half-life (≈ 50 hours). The drug is principally excreted as metabolites in the urine after hepatic biotransformation.

Contraindications/Precautions/Warnings

Piroxicam is contraindicated in patients hypersensitive to it or that are severely allergic to aspirin or other NSAIDs. It should be used only when its potential benefits outweigh the risks in patients with active or history of GI ulcer disease or bleeding disorders. Because peripheral edema has been noted in some human patients, it should be used with caution in patients with severely compromised cardiac function.

Piroxicam has not been evaluated for use in cats. It must be used with extreme caution, if at all, in this species.

Do not confuse piroxicam with PARoxetine.

Adverse Effects

Like other NSAIDs used in dogs, piroxicam has the potential for causing significant GI ulceration and bleeding. The therapeutic window for the drug is very narrow, as doses as low as 1 mg/kg given daily have caused significant GI ulceration, renal papillary necrosis, and peritonitis. Other adverse effects reported in humans and potentially possible in dogs include: CNS effects (headache, dizziness, etc.), otic effects (tinnitus), elevations in hepatic function tests, pruritus and rash, and peripheral edema. Renal papillary necrosis has been seen in dogs at post-mortem but, apparently, clinical effects have not been noted with these occurrences.

In cats, GI effects (vomiting, anorexia, diarrhea) may be seen, particularly early in therapy. There are anecdotal reports of piroxicam decreasing hematocrits in cats when dosed daily for 7-14 days. Renal toxicity is possible if used for prolonged periods.

Reproductive/Nursing Safety

Animal studies have not demonstrated any teratogenic effects associated with piroxicam. The drug is excreted into milk in very low concentrations (≈ 1% found in maternal plasma). In humans, the FDA categorizes this drug as category C for use during pregnancy (Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in humans; or there are no animal reproduction studies and no adequate studies in humans.) If using in the third trimester or near delivery in humans, the FDA categorizes all NSAIDs as category D for use during pregnancy (There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks.)

Most NSAIDs are excreted in maternal milk; use with caution in nursing patients.

Overdosage/Acute Toxicity

There is limited information available, but dogs may be more sensitive to the drugs ulcerative effects than are humans.

There were 63 exposures to piroxicam reported to the ASPCA Animal Poison Control Center (APCC) during 2008-2009. In these cases 58 were dogs with 12 showing clinical signs and 5 were cats with 1 showing clinical signs. Common findings in dogs recorded in decreasing frequency included vomiting, and bloody vomitus.

As with any NSAID, overdosage can lead to gastrointestinal and renal effects. Decontamination with emetics and/or activated charcoal is appropriate. For doses where GI effects are expected, the use of gastrointestinal protectants is warranted. If renal effects are also expected, fluid diuresis is should be considered. Patients ingesting significant overdoses should be monitored carefully and treated supportively.

Drug Interactions

The following drug interactions have either been reported or are theoretical in humans or animals receiving piroxicam and may be of significance in veterinary patients. Unless otherwise noted, use together is not necessarily contraindicated, but weigh the potential risks and perform additional monitoring when appropriate.

  • Aminoglycosides (gentamicin, amikacin, etc.): Increased risk for nephrotoxicity.
  • Anticoagulants (heparin, LMWH, warfarin, etc.): Increased risk for bleeding possible.
  • Aspirin: When aspirin is used concurrently with piroxicam, plasma levels of piroxicam could decrease and an increased likelihood of GI adverse effects (blood loss) could occur. Concomitant administration of aspirin with piroxicam cannot be recommended.
  • Bisphosphonates (alendronate, etc.): May increase risk for GI ulceration.
  • Cisplatin: Piroxicam may potentiate the renal toxicity of cisplatin when used in combination.
  • Corticosteroids: Concomitant administration with NSAIDs may significantly increase the risks for GI adverse effects.
  • Furosemide: Piroxicam may reduce the saluretic and diuretic effects of furosemide.
  • Highly Protein Bound Drugs (e.g., phenytoin, oral anticoagulants, other antiinflammatory agents, salicylates, sulfonamides, and thesulfonylurea antidiabetic agents): Because piroxicam is highly bound to plasma proteins (99%), it potentially could displace other highly bound drugs; increased serum levels and duration of actions may occur. Although these interactions are usually of little clinical concern, use together with caution.
  • Methotrexate: Serious toxicity has occurred when NSAIDs have been used concomitantly with methotrexate; use together with extreme caution.

Laboratory Considerations

  • Piroxicam may cause falsely elevated blood glucose values when using the glucose oxidase and peroxidase method using ABTS as a chromogen.

Doses

Dogs:

  • As an adjunctive therapy of neoplastic diseases (extra-label): 0.3 mg/kg PO with food once a day (preferred, if tolerated) or once every other day (q48h). Adding misoprostol may be considered in dogs that do not tolerate NSAID’s GI effects.
  • For adjunctive treatment of idiopathic lymphoplasmacytic rhinitis (LPR): Long-term administration of antibiotics having immunomodulatory effects (doxycycline 3 – 5 mg/kg PO q12h; or azithromycin 5 mg/kg PO q24h) combined with NSAIDs can be helpful in some dogs. Piroxicam 0.3 mg/kg PO q24h is recommended. If clinical improvement is observed within 2 weeks, daily piroxicam therapy is continued but the frequency of administration of doxycycline is reduced to once daily or azithromycin reduced to twice weekly. Therapy will likely be required for a minimum of 6 months, if not indefinitely. (Kuehn 2007b)

Cats:

  • As adjunctive therapy for neoplasia (extra-label): For adjunctive therapy of transitional cell carcinomas: 0.3 mg/kg PO q24-72h. Most will use q48h (every other day) dosing interval.
  • As an antiinflammatory/analgesic (extra-label): 1 mg per cat PO q24h for a maximum of 7 days. (Note: After compounding, drug is stable for 10 days). (Gaynor 2008), (Rochette 2007)
  • Idiopathic chronic rhinosinusitis (extra-label): Some cats’ clinical signs can be reduced with piroxicam at 0.3 mg/kg PO once daily or every other day. (Kuehn 2007a)

Horses:

  • For neoplastic diseases (extra-label):
    1. From a case report treating mucocutaneous squamous cell carcinoma: 80 mg (per horse) PO once daily; lip lesion resolved completely over 3 months, but patient developed colic signs twice. Dose was eventually reduced to every other day or every third day. (Moore et al. 2003)
    2. From a case report treating a squamous cell carcinoma of the third eyelid after surgical excision: 80 mg (per horse) PO once daily. (Iwabe et al. 2009)

Rabbits, Rodents, Small Mammals:

  • Rabbits for fracture associated limb swelling (extra-label): 0.1 – 0.2 mg/kg PO q8h for 3 weeks. (Ivey et al. 2000)

Monitoring

  • Adverse Effects (particularly GI bleeding).
  • Liver function and renal function tests should be monitored occasionally with chronic use.

Client Information

  • Best given with food to reduce the chance for stomach upset.
  • Gastrointestinal (stomach) ulcers and bleeding and kidney problems (especially in cats) are possible.

Chemistry/Synonyms

An oxicam derivative non-steroidal antiinflammatory agent, piroxicam occurs as a white, crystalline solid. It is sparingly soluble in water. Piroxicam is structurally not related to other non-steroidal antiinflammatory agents.

Piroxicam may also be known as: CP-16171, piroxicamum or PIRO; many trade names are available.

Storage/Stability

Capsules should be stored at temperatures <30°C in tight, light-resistant containers. When stored as recommended, capsules have an expiration date of 36 months after manufacture.

Dosage Forms/Regulatory Status

Veterinary-Labeled Products: None.

The ARCI (Racing Commissioners International) has designated this drug as a class 4 substance. See the appendix for more information.

Human-Labeled Products:

Piroxicam Oral Capsules: 10 mg & 20 mg; Feldene®, generic; (Rx)

Revisions/References

Monograph revised/updated May 2014.

Customer: replied 1 year ago.
I have heard of feldene in this part of the world. My dog is 15kgs, can you recommend a dose for this weight. I thought feldene came in cream as well.
Expert:  Dr. Jo replied 1 year ago.

I also want to say how much I appreciate your clarity during our conversation, even though so much of what I am saying is bad news. I want to emphasize that it could be argued that I have no right to disagree with your vet... she's the only one who's had the opportunity to see and examine your dog and run the necessary diagnostic tests. I could be completely wrong with my assessment of the situation just because that can happen when we discuss things remotely like this. Our discussion and photos are no substitute for medical care.

I'm sorry you're stuck in a situation where access to veterinary medical care is difficult. Sounds like you're doing the best you can, though.

The piroxicam dose is provided above.

Expert:  Dr. Jo replied 1 year ago.

Dogs:

  • As an adjunctive therapy of neoplastic diseases (extra-label): 0.3 mg/kg PO with food once a day (preferred, if tolerated) or once every other day (q48h). Adding misoprostol may be considered in dogs that do not tolerate NSAID’s GI effects.
Expert:  Dr. Jo replied 1 year ago.

Is there anything else I can help you with at this time? I know it's a rough situation to be in.

Customer: replied 1 year ago.
Please give me few hours to revert and then will close this chat
Expert:  Dr. Jo replied 1 year ago.

Of course.

Please remember I am here for you and am happy to discuss your question until you are satisfied with the answer I've provided. You may return to this page at any time to review this information and/or post more. You may do so even after you've rated my response. I'll be notified of your response via email and will do my best to help you.
If you are satisfied with the information I've provided, please take a moment to rate my response. I've done my best to provide you with the most accurate, thorough and up-to-date information that is available, and your positive feedback is important to me. Without it, I receive no compensation for helping you.
If you are not satisfied, please let me know how else I may be of assistance.
Thank you for using our website.

Customer: replied 1 year ago.
If this inflammatory mamary cancer is true should i allow her to lick her sore - perhaps it will remain clean or is it that i should keep on with her elizabathen collar on? The discharge from her teats are they harmful for another dog or human. I have another samoyed male dog?
Expert:  Dr. Jo replied 1 year ago.

It is best to prevent licking, so please continue to use her E-collar.

Inflammatory mammary cancer does not spread through the fluid that drains, but it is still best to avoid contact between it and any other people in the household.

Customer: replied 1 year ago.
This morning condition. Its the sore thats red but watching closely the other sore areas are closing in. But yes the liquid is still draining through the rear left teat. It all started when she actually bit out her teat as you can see in all pictures.
Expert:  Dr. Jo replied 1 year ago.

Your picture came through just fine. That looks really painful. I'm so sorry you and your dear girl are going through this. I'm hopeful she can get some more aggressive pain management soon. Also, I want to clarify that the reason surgery can be done without the sores being healed up first include:

  • during surgery, ALL the unhealthy tissue is removed, so only healthy tissue remains to sew closed.
  • these sores simple are not going to heal. I'm afraid you're waiting for something that will never happen. The only way to get the skin to heal is to remove the sores and close healthy tissue.

I know you may not have a lot of choices, but what your dog needs is a second opinion. At the very least, please pursue more aggressive pain management with your current vet, and ask her for some straight answers on how long she thinks it will take for the sores to heal and if she's certain they will.

My heart goes out to you in this difficult situation.

Customer: replied 1 year ago.
Hello Dr, please see the latest picture of my Dog. The antibiotic powder and few drugs seems to be working as the wound is drying up. Does it seem so to you?
Customer: replied 1 year ago.
I just got feldene 20mg here (another name for piroxicam). As per the literature you forwarded, I will give my dog 1/4th of the tablet confining to 5mg since she is 15KGS.
Expert:  Dr. Jo replied 1 year ago.

Hello,

I'm sorry. I was offline for the last few days, but am back now. I apologize for the delay in my response.

It's encouraging you were able to find piroxicam for her. You've done your math correctly; the right dose for a 15kg dog is 1/4 of a 20mg tablet every 24 or 48 hours. Misoprostal can be used if this seems to cause GI side effects.

Looking at your new photos now...

Expert:  Dr. Jo replied 1 year ago.

Excellent! The photo of the feldene confirms you have the correct medication and your dosing is correct.

Unfortunately, the attachment from March 21 won't open.
If you're able, please send a new photo. If things are improving, we can hope the difference will be even more pronounced today. I'd absolutely *love* to be wrong about this and have her experience improvement.

Please take a new photo if you're able, and try uploading that with the paperclip icon. I'll be optimistic that there's some real improvement in the sores, even if the lumps are still there.

Customer: replied 1 year ago.
Hello Dr, are you there at all?
Expert:  Dr. Jo replied 1 year ago.

Hello,

I am online now. I'm sorry our time zone differences make it hard to be online at the same time. Were you able to read my replies from yesterday? How is your dog doing today? Please tell me her name...

Expert:  Dr. Jo replied 1 year ago.

Hello,

Just checking in to ask how things are going with your dog. Is she continuing to improve?

Thank you,

Dr. Jo