Spleen Problems in Dogs

Question: On February 12, 2001 our trusted vet did emergency surgery for a mass on our 11 year old female vizsla's spleen. When showing me the spleen and the "mass" (my husband and I are both have medical backgrounds), our vet described it as hemangioscarcoma.

Today the pathology report came back and our doctor called to say the report says the mass was a nodular hyperplasia. Naturally I am happy about the news that our beloved dog has a benign tumor. Star still seems quite weak (she had a 7 pound weight loss over the past few weeks and literally screams if our other dog bumps into her when walking or lays down too close to her. The only other thing our vet found wrong with her was osteoarthritis of her hip for which we have EtoGesic(etodolac). She's had lab work, x-rays, the surgery, etc. We have recently turned the corner on the weight loss, by adding tuna or chicken soup to her dry dog food, but the screaming seems so out of character for her.

I had looked up the hemaniosarcoma on your site and sort of resigned myself to the fact that maybe she just hurt all over from the metastasis.

We'd appreciate your thoughts and would like to thank you for having such a great web site.

Sincerely, Lynn

Lynn

Splenic tumors are hard to make any certain statements about. In studies in which spleens that have been removed are examined for cancer (Spangler 1997, Johnson 1989), between 33 and 41% of spleens removed due to enlargement did not have cancer. This is a much higher percentage than our clinical impression of the situation, at least in our older patients. Our impression, not validated at all by studies, is that the rate of cancer is higher than this. A partial explanation for this may be the difficulty in choosing the sample of the spleen to send in, since there are often hematomas and cystic structures in spleens that result from tumors such as hemangiosarcoma. If a sample is taken from one of these areas, the tumor may not be found. However, there are benign conditions that cause splenic enlargement so there is good reason to be hopeful that the pathology report is accurate and that this will mean that the outcome for your vizsla will be good. I certainly hope that is the case.

We have had three or four patients over the time I have been in practice who exhibited signs of significantly more pain than our usual surgery patients. I am not sure why this is the case but all did go on and recover within a few days and seemed to be normal in the years afterward. We operated on one of these dogs twice and she seemed to have just as bad an experience the second time as she did the first time, except that we were better prepared and had used preoperative pain killers and then kept them up postsurgically as well.

In looking back over your note, I think you were actually saying that she was in pain prior to the surgery. We see this occasionally with large splenic tumors. I think that they pull on the internal ligamental structures pretty hard when they move about and that this can be quite painful. I think that this is more likely than pain from a metastasis.

I hope that she is better now and that the pathologist's evaluation of the tumor is completely correct.

Mike Richards, DVM 3/10/2001

Enlarged spleen

Question: Hello, I am the director of an animal shelter in Costa Rica. We have two veterinarians working for us and they would like to keep up to date with all the new developments. One question, what causes the spleen to become enlarged?

What can you see on X-Rays according if there is cancer in the spleen? What is the best way to detect cancer in the spleen? Thank you, Lilian

Answer: Lilian-

Lot of things make spleens enlarge, unfortunately. Splenic enlargement occurs when pets are anesthetized with some anesthetics, in stressful or shock inducing situations, when blood parasites are present, if there is bruising (hematomas) affecting the spleen, if there is splenic cancer (particularly hemangiosarcoma), when the stomach torses (twists) and for other reasons, as well. By itself, splenic enlargment is a pretty non-specific sign and doesn't match up well with any particular disorder. A lumpy enlarged spleen, or one that obviously contains a lump in it, is a different story. In this instance, it cancer or hematomas are much more likely. Often, the only way to tell these apart is to biopsy the spleen or to remove it and have a pathologist determine what the disease process is. Hematomas of the spleen and hemangiosarcoma tumors are very hard to tell apart when doing surgery, even after good visualization of the spleen.

X-rays are really only useful, to me, when there is a pretty large lump in the spleen but that may be partly due to an inability on my part to interpret X-rays until they show an obvious problem. Usually by the time I can find a lump on the X-ray I can palpate it (feel it) easily. The X-rays are still useful in determining if it has spread to other areas of the abdomen and in getting a little better idea of size, as well as sometimes confirming that the lump is in the spleen and not in some neighboring organ. X-rays of the lungs are a good idea, too --- to make sure that there is not a spread of a tumor from the spleen or abdominal region to the lungs.

Tumors affecting the spleen are most common in middle-aged or older dogs and in our practice, golden retrievers and Labrador retrievers seem to have more problems with this than other breeds.

Hope this helps some. If you have a more specific question about a particular patient or particular problem, I will try to find some information for you if you send another question.

Mike Richards, DVM 6/14/2000

Spleen removal

Question: On a Sunday morning 4/18 I woke up to find my 13 yr old golden retreiver wouldn't eat breakfast and would not sit or lay down. I took her to the emergency vet and xrays showed her spleen bulging and they recommended immediate surgery to remove her spleen, which was done. There were no growths on the spleen, it had swelled for some reason, and a biopsy showed no cancer. They believed her other organs looked good, x rays of her chest were clear. After surgery her temp was up to 106.9 and it took about 24 hrs to come down. Her WBC was very high and her RBC was very low for about a week, now both are near normal range. Since the operation she he was on Baytril for 10 days and Prednisone (20 mg/day). She couldn't stand on her own for about 72 hrs and would only eat cooked meat for about a week. She now has a good appetite (the pred has helped that I suppose). Since the operation she has been panting heavily much of the time, especially at night and drinks a lot of water. Her glucose level is in the normal range.

For the past couple of weeks prior to the operation she had a little difficulty getting up (rear legs), but once up walked and ran as normal. Since the operation she has a LOT of difficulty trying to stand up, and once up walks quite slowly and carefully. Stairs are a problem, getting into a car is a major chore as is trying to stand up on a tile floor. Her stools are very soft but not runny, borderline diarriah. Her weight went from 78 at the time of the operation down to 70 in a week. At the end of week two it is back up to 75.

The biggest problem now seems to be her rear legs. My vet prefers a slow, cautious approach. He "guesses" there is probably some arthritus and that the pred should help. I have also started giving Cartilage Factors (Chondroitin, Glucosamine, etc. made by Pure Encapsulations) though he said this takes a good 30 days to begin to have an affect.

She received the Baytril for 14 days, 2 days after it ran out her temp went up to 104 so they gave me 10 day supply of Amoxi-tabs. I took her back to the vet and instructed them to xray her legs, hips and spine and do more blood analysis. The blood test results showed normal for kidney function but elavated enzyme counts indicating a liver problem. The vet said the pred could be responsible for the high enzyme level.

The xrays showed that at the end of her spine the last 2 vertabrae had very narrow spaces and that was probably causing the problem with the rear legs, perhaps they were fusing together or a pinched nerve. The hips looked good. The xrays also showed a lot of gas throughout her G/I system. She has always eaten feces of her own or my other Golden and has passed gas frequently for quite a while now.

So the bottom line it appears there is a potential liver problem and arthritic problem. The vet said we could take her off the pred and check her blood in another week or 2 to see if the enzyme level improves but he is concerned about taking her off the pred so soon as it probably helps the other probs. He discussed possible use of Rimadyl but said that could be a problem for the liver to handle. I don't have a clear sense of how to proceed and he seems to just want to maintain the staus quo. Meanwhile, I have a dog in pain just toughing it out.

Should any additional tests be done on the liver? I don't like the thought of a liver biopsy so soon after the spleen surgery.

I am concerned about the pred usage without a clearer understanding of what other things could be wrong. He doesn't know why the spleen swelled, suggested an auto immune disorder. If she has arthritus and its an immune mediated arthritus would Pred be a mistake?

Could a problem with the liver have caused the spleen problem?

Can anything be done about the spinal problem?

Do ypu think acupuncture might help?

Is this a hopeless situation with recovery unlikely?

I'd just like some help and another opinion with a prognosis and where to go from here. Two years ago my other Golden who was 10 died of bone cancer. I couldn't bare to put her to sleep and let her hang on a little too long I think and suffer longer than she should have. I don't want to make that mistake again. I don't mind spending the money to do what needs to be done if I can get her quality of life back closer to the way it was. Being in pain and barely able to stand and walk is not a quality way to live.

Thank you, RTV

Answer: RTV-

I can't offer much help with what may have been wrong with your golden retriever's spleen. Many different illnesses and disorders can lead to splenic enlargement.

The fever post-operatively may indicate that there was an infectious cause of the spleen enlargement, though. Surgery is enough stress to enable a hidden infection to become a major problem and removal of the spleen may make this situation worse since part of its job is to aid in the immune response. There is a lot less evidence of post-splenectomy immunosuppression in dogs than there is in people, though. The major infections to worry about with this scenario are the tick borne diseases, especially ehrlichia and babesiosis. It is probably not all that likely that your dog actually has one of these infections but they are worth considering.

Prednisone often causes panting as a side effect. It tends to selectively raise the serum alkaline phosphatase level, which is one of the enzymes that rises when liver disease is present. If this is the sole indication of liver disease in your dog after the administration of prednisone it is very hard to judge the significance of it. If other liver enzymes are elevated or bile acid response testing indicates a deficiency in liver function, then you would have to take the rise in alkaline phosphatase levels more seriously. It would not surprise me if the soft stools are associated with the use of prednisone, too. That sometimes happens in our patients, although it is not a really common side effect.

Any surgery in which the incision is big enough to remove the spleen through is going to be painful for awhile. This is a very long time for it to hurt but different patients have different recovery times and it is conceivable that the surgery may be partially responsible for the increase in lameness. Even without the surgical incision, the positioning for surgery (legs extended and tied to the table in most cases) is enough to really exacerbate arthritis in some dogs. It can take a while to recover from this.

On the other hand, the narrowing of the spinal segments and pressure on the nerve roots exiting from the spine (cauda equina syndrome, lumbosacral instability) is often enough to lead to neurologically induced weakness in the rear limbs. Many dogs with this problem do not have strong use of their tail, many have poor anal tone (their anus doesn't pucker strongly when touched), toe dragging or improper placement of the feet. If these signs are present it helps in making a diagnosis. They are not always present, though. Our experience has been that prednisone works a lot better than carprofen (Rimadyl Rx) in this circumstance. So I wouldn't be too worried about not being able to use Rimadyl while trying to figure out if the liver enzyme level increases are due to prednisone or not.

Surgery is supposed to be pretty helpful for cauda equina syndrome. We have very limited experience with this surgery but our patients have done much better in 2 out of 3 cases that I can remember. Prednisone works pretty well for us and many of our patients do well enough not to have to have surgery. Our thinking has been that surgery is a better option in younger dogs in which the long term effects of prednisone usage seem to be more of a problem but you may feel differently about the risk/benefit situation for your dog.

It is possible that a liver problem could lead to splenic enlargement but I think this is low on the list of possible problems if only the alkaline phosphatase levels are up -- and a little more likely if the ALT is also high or bile acid response testing indicates liver dysfunction. I would definitely advise doing the bile acid testing prior to considering a liver biopsy. And also definitely have blood clotting testing done prior to considering a liver biopsy, too.

Several of my clients really think that acupuncture has helped their dogs with arthritic conditions. I can't see any reason not to try it if you want to.

Hope this helps. If I missed a question, just let me know.