Advice please

Hello, To cut a long story short, our nearly 8 year old dog had been losing hair on body and tail for some time. Vet thought it could be allergy, so shampoo and anti-histamine prescribed. No great improvement. Dog was also less active, so vet then agreed to blood test for Hypothyroidism. These were inconclusive but he was started on thyroid meds anyway. Blood test showed anaemia and increased platelets, so vet suggested scan to check for growth/internal bleeding. Scan was abnormal, showing enlarged gallbladder and spleen. Exploratory surgery was scheduled. In the meantime, our dog gained a new lease of life -wanting to go on walks, leading the way instead of lagging behind, wanting to play, barking more (a downside!) - presumably through being on the Thyforon. It felt like we had our energetic, mischievous dog back and i was reluctant to put him through a major operation when he seemed so well and happy and was symptom-free. I contacted the vet and he seemed to have changed his view somewhat, saying he would not be averse to postponing surgery for a few weeks as he was not 'unduly concerned' at the moment, it wasn't an urgent matter. He said the gallbladder problem may have improved or disappeared (mucous?) and that the 'area' on the spleen wasn't that bog at the moment and was something 'of interest' rather than 'of concern'. He said that prior to the op, he woukd carry out another ultrasound scan. I'm wondering if the vet had revisited the scan results before moderating his opinion on the findings. Should I go ahead with the operation or leave things as they are, with our dog enjoying life, in the absence of any symptoms? The bottom line is, we want to do our best for him but are unclear what that is. Any advice would be welcome.  

Hello!  Obviously your vet knows far more about your dog than I do and - furthermore - they have responsibility for your dogs' treatment not I, and anything they say will always take precident over anything I might suggest regarding a particular case.  In my understanding splenic lumps are often matters of concern as a certain percentage of them (48-59 per cent, apparently) are likely to be cancerous and many may well, indeed, be heamangiosarcoma.  This may vary because of the size and lack of symptoms. Non cancerous lumps include Haematomas, cysts etc. Removing the whole spleen is major surgery and leaves the pet without a spleen, but if cancer than it is usually considered worth doing.   There are multiple options, including going ahead, not going ahead or attempting to stage the tumour in some way eg take aspirates and attempt to make predictions.  If I was in your position, I would want as much information as possible.  Questions for your vet (which they may need to make phone calls to answer; indeed, I have spent many minutes on the phone to pathologists) might include, How likely is it that this lump is cancerous, What are the chances of it being cured if the spleen is removed / what life expectancy might you predict?  I don't know the answer to this question and would have to be calling up the pathologist / looking up papers myself for the best answer, but it would make a huge difference to my decision and so it may be well worth persevering for the objective information that you require.

I have ready your post again and see that you report an enlarged spleen, as opposed to a mass.  Enlarged spleens can happen purely for physiological reasons e.g. if the spleen needs to release a lot of red blood cells - and can be normal.  It sounds as though the gall bladder change is only thought to be a problem if it persists.   If you feel that your vets' opinion is softening, it may because the severity of the situation appears to be less severe than it first presented  - which would be a good thing.  It's obviously optimal to avoid unnecessary surgery but important to deliver surgery if it is necessary, although only the vets can tell you what their thoughts were at the time.  Keep asking questions, especially of the vets who know the case best (we appreciate it when an owner wants to properly understand, but many owners don't, so we become  used to just giving instructions out to follow, and it sometimes requires a change of gear to explain fully) Best of luck!

Thank you very much for your very helpful replies. Much appreciated. Regards, Bill

Having reread your post for a third time, hypothyroidism is sometimes over-diagnosed and can often need multiple blood tests in order to diagnose it.   Sometimes inconclusive T4 tests need to be checked using a TSH test.  Because I do not know the patient or the bloods that were done - (not to mention that I have not been asked by your vet),  I am not really in a position to comment on this.  However, it may be well worth checking the situation with your vet, who might run this decision past a pathologist for a second opinion if they have any concerns.

I hope that this is more helpful.

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Very helpful. Thanks for taking the time. Much appreciated. Regards, Bill

Hello, Just to bring you up to date, our dog had a further scan as agreed and it showed the gallbladder was smaller and no longer appeared to be full of mucous and the 'area' on the spleen had gone, so surgery was 'put on the back burner'. The vet wanted to carry out a final scan to be on the safe side, and that was done a month later. This showed that the prostate was lightly enlarged, but no more than would be expected for a non-neutered male, there was a small cyst on a kidney, but nothing significant, the liver was normal and the spleen and the gallbladder were no longer enlarged. The vet (a different partner this time) felt that the spleen enlargement could have been due to the sedative/anaesthetic used in the first scan (none used for subsequent scans). This surprised me, as I had read a while ago that anaesthetic could cause enlargement and I'm not sure why the vet didn't consider this earlier. Finally, the vet did a further blood test to check the red blood cells. He said he'd contact me if there was a problem and I've heard nothing, so assume all is well. Our dog continues to have Thyforon daily and it continues to give him a new lease of life. It seems to have helped with his joints - he can jump onto chairs again and he is generally a lot more lively and keen to go for walks. The only downside is that some of his old reactivity, that we thought he'd grown out of, has returned, but I'll take that! I'd like to thank you for all your advice. It gave me the confidence and knowledge to question things with my vet and not simply accept that he needed an exploratory operation. Regards, Bill  

Hello again, I wonder if I could trouble you for some more advice. Our 10 year old dog has been on Thyforon since December 2021. He was initially on 200 mcg per day split into 2 doses, half a tablet in the morning and half in the evening. Healthwise, he has been fine but a few months ago, we noticed his hair thinning again, particularly on his chest and stomach. I consulted our vet, who recommended increasing the Thyforon dose to three quarters of a tablet twice daily.  He has been on this higher dose for just over 7 weeks. His hair does seem to be growing back, albeit very slowly, but we've noticed that particularly since the increased dosage, he's drinking more, and consequently, urinating more. When increasing his dosage, it was agreed that he'd have another blood test at the beginning of this month. The vet said at the time that his liver enzymes were slightly raised, so it was necessary to keep an eye on his thyroxin levels. This test was done and apparently his liver values are still up a bit. As far as the drinking is concerned, the vet said that  more than .75 litre of water per day for a dog of his size (around 7.7kg) would be regarded as excessive. I said I would monitor his intake but I don't think it is as high as that. We are also to get a urine sample to take in for analysis. This was all done over the telephone, but from what I've read, Thyforon, particularly when the dosage has been fairly recently increased, can cause a dog to drink more and the medication and thyroid issues can also affect liver enzymes. An ultrasound scan was suggested but I am reluctant to go down that path at the moment.  The reason for this is that in December 2021, a scan showed that the gallbladder and spleen were swollen and exploratory surgery was recommended. As our dog was, to all intents and purposes, well and active, with a good appetite, I questioned this and it was agreed to do a further scan in a couple of weeks. This scan showed that the swelling had gone down and the reason for the swelling was assumed to be the sedative used in the first scan (but not the second). It was also stated that at this stage, his liver was OK. This has knocked my confidence somewhat, as, but for my questioning the recommendation to operate (after receiving invaluable advice from Vet Help Direct), he would have had unnecessary surgery and the vet is aware of my reservations. It has therefore been agreed that we should try a liver supplement for a couple of months, then have a further blood test, to see if there is any improvement in his liver values. The 2 supplements recommended are Hepatosyl and Samilyn, although the vet didn't offer an opinion as to which is more effective. Both are quite expensive, even online, but we obviously, we want to do our best for our dog. Hepatosyl seems to be the best value, but I wondered if it was as effective as Samilyn. Online reviews for both seem generally favourable. Apologies for writing at such length. I would be really grateful to receive your thoughts and for any advice you can give me. Thank you, Bill        

Hi Bill This may be a complete coincidence and if so please overlook it, but are you a member of the veterinary industry I might have come across? - as this case reminded me of something. Either way, let me tell you what it reminded me of.  I think it may be important to find the reason for the hair thinning.  This is not common in canine hypothroidism, but can be common in Cushings and Addisons disease, and both diseases (they are opposite extremes of adrenaline levels) can be adversely affected by the thyroid medication.  They can also effect the amount of water consumed.   Fortunately they can readily be ruled out by getting that urine sample tested, as your vet has already proposed; we would reccommend hurrying this along if you haven't managed it yet. I know little about the supplements that you mention but would reccommend asking your vet directly before making decisions in this line. Please do let us know how you get on.  

Hmmm having fact checked that, normal water levels do not completely rule out adrenal imbalances, but never the less I strongly agree with your vet that it may prove a very useful thing to check.