By John Andersen, DVM
“Scout” is a 10- year-old Retriever mix who both ruined and made my day recently. For a 10-year-old, Scout has maintained a high activity level and has had no significant health problems. Scout also lives the good life. His owners are a wonderful couple in their mid-forties with no children—except Scout. He is their child in every way.
They are also incredibly in tune to Scout’s normal behavior and brought him in simply because he didn’t eat breakfast that morning and seemed a bit lethargic. That may not seem like a reason to pack the dog in the car and bring him to the vet, but Scout never misses a meal and every day for as long as they can remember he wakes up in a wonderful mood, so excited that it’s a brand new day.
These can be tough cases right off the bat because this could either be an over-worried owner with a normal dog, or there is a real problem. How we wish pets could just talk. I have learned to always listen to owners’ concerns because they truly are the experts about their pet’s normal behavior.
When I walked into the exam room, I could tell Scout was not quite himself. He usually jumps on me in excitement, but that day just managed a smile and a tail wag before plopping back down on the floor. His heart rate and breathing were a little faster than normal, and he seemed a little pale. When I palpated his abdomen (felt his belly), I became a little more concerned. I thought I could feel some fluid in his belly, but it was subtle because he was tense. Telling the owners as much, I recommended a quick ultrasound of the abdomen. It took about five seconds in ultrasound to confirm what I feared. Scout had a large tumor in his spleen that was bleeding into his abdomen.
Bleeding splenic masses (tumors of the spleen) are very common causes of disease and death in older dogs and usually have no clinical signs associated with them until things become urgent. The spleen is a large, red, tongue-shaped organ located in the middle of the abdomen that serves many functions relating to the blood and immune system. The spleen helps in red blood cell storage and production, removes old and damaged red blood cells, and also acts as a large lymph node for the immune system. In humans, our spleen is about the size of our fist. In a 60-pound dog, it’s about a foot in length.
Unfortunately, after many years of life, the spleen is a common site for tumors to develop—some benign, some cancerous. Initially there are no outward clinical signs. Dogs won’t tell us about some minor discomfort in their belly, and there is simply no way we can confidently feel even a baseball-sized mass in the spleen. There is simply too much other stuff in the abdomen.
As the tumor grows in this highly vascular organ (the spleen gets a lot of blood supply), it becomes more disorganized and eventually the blood vessels can spontaneously burst. Sometimes this happens within the inside of the spleen and the mass grows larger, filling with blood and blood clots while still contained within the spleen capsule. Eventually though, the spleen will burst and this is when blood starts freely pouring into the abdomen. These dogs can go from normal to collapse in an hour. They become very weak, pale, and start having labored breathing. Bleeding splenic tumors are so common that we can often predict them just from the classic phone calls: “My older retriever was fine this morning, but when I came home he can barely walk, his belly looks swollen, and he’s having a hard time breathing.”
Scout ruined my day because I had about a million things going on at the moment and I knew that everything else had to be put on hold or Scout wouldn’t be around too much longer. First came the difficult decision with the owners. “We need to do surgery immediately, or your dog is going to die. Unfortunately, this may be a cancer that has already spread to other parts of his body and he may only live a few more months even if he survives surgery. On the other hand, this may be a benign tumor that has ruptured, and as long as he survives surgery, he will have a good prognosis. Unfortunately there is no way I can tell until after surgery once we get the biopsy report back. Additionally, this surgery and the aftercare are fairly expensive and your dog is old and has lost blood…”
I admit this is a tough sell. Risky surgery. High expense. Potentially poor prognosis. Older dog. However, the majority of dogs survive surgery and many go on to live for many more years.
Scout’s owners quickly decided they wanted to try surgery. Scout’s “mom” had a worried smile that turned to tears as she told me, “We don’t have any children. Scout is our child. Please take good care of him.”
Fortunately I have removed so many spleens I have lost count. Scout was surprisingly stable under anesthesia, although it is always unnerving when we open the abdomen and large amounts of blood come pouring out. Scout’s spleen was the size of a soccer ball, irregular and oozing blood. I quickly clamped and cut the splenic vessels and rolled the huge tumor off the table into a container our tech was holding. It weighed 8 pounds! After inspecting Scout’s abdomen for any signs of cancer or bleeding, we closed him up.
Scout’s danger was not over yet. Many dogs can develop dangerous heart arrhythmias or fatal bleeding after surgery despite fluids and blood transfusions. Scout, however, was not that dog. After several hours of sleep, he was remarkably stable and alert. As our day neared an end, I got him out of his cage to walk up front and see his relieved owners. Scout pulled me the entire way and proceeded to eat a biscuit in the lobby. Scout had made my day.