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