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Possible spleen cancer.

Species: Dog
Breed: English Labrador
Age: 11-15 years
About 2 wks ago noticed lack of appetite and lethargy. Took her to the vet who said she had a UTI and tapeworm. Put her on Clavamox and tapeworm meds. 2 days later, she had a nosebleed. Appetite and lethargy still present. Vet did more thorough check up and said her spleen was bumpy looking. Opted for steroids since she has responded well to this in the past (a yr ago had a cancer scare and the steroids seemed to work). Steroids made her feel better, more energy and better appetite. Vet aspirated spleen and said that it was not cancer, however, the steroids could be masking the cancer - lymphoma. She wants to aspirate again, but take her off of the steroids. I'm in a double bind because if it is lymphoma, this will spread quick and will die. However the aspiration may show it is a tick related infection and she may live a little more. Vet is not being helpful and after spending more than 3k on these tests I need a second opinion, Should i go through and take her off the steroids and aspirate again, or just keep her happy on steroids and see how far we can get? Vet said she has an elevated white cell count in her spleen. I have the results of the tests if you need them. Miss Tiger and I Thank you!

Online vet, Dr. Marie

Dr. Marie replied:

Oh, this is a tough situation. I'm sorry that you and Tiger are going through this.

Before I answer, can you tell me what her platelet level was? It should be a number like 150, or possibly lower if she has a low platelet count.

Also, has she had any tick bloodwork done such as a lyme test and tests for ehrlichia, babesiosis and rocky mountain spotted fever?

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Customer reply:

I assume Platelets would be abbreviated as plt? in that case the initial test, 2 days after we first took her in says 130(L)

Customer reply:

I can't see in any of her records the above mentioned tests for lyme, ehrlichia or rocky mountain...

Online vet, Dr. Marie

Dr. Marie replied:

OK, thanks.

Whenever I see a nosebleed in a dog I worry about low platelets. Although 130 is low, it's not low enough to cause nosebleeds.

One cause of low platelets is if the spleen is destroying platelets. This could be due to cancer or it could be due to something called immune mediated thrombocytopenia.

Another cause of low platelets is a tick borne diseaes like ehrlichia or babesia or rocky mountain spotted fever. These diseases are only common in certain parts of the country so your vet may not have tested for them if they are not commonly found in your area.

You are in a conundrum though and it's going to be hard to advise you on what to do! Let's see if I can process for you some of the different options.

Let's say that this is immune mediated thrombocytopenia. If this is the case, then if we take her off of steroids then the immune system will continue to destroy platelets. If it is an immune mediated problem then likely the aspirate of the spleen will not tell us much. So, if this was her diagnosis, then keeping her on the steroids is the best plan.

On the other hand, let's say that this is a spleen tumor such as splenic lymphoma. This could cause the "bumpiness" on the spleen. (It should be noted though that some dogs will have benign bumps on the spleen that we don't worry about.) There are other tumors as well. A much more common one is splenic hemangiosarcoma.

So, let's say this is a tumor. If it is there is a possibility that Tiger could be cured with surgery. Some dogs with splenic lymphoma will make a full recovery if the spleen is removed. But, if it is a splenic hemangiosarcoma, then even with surgery dogs only tend to live for a few months.

So, if you had a diagnosis of cancer in the spleen, would you be willing to have surgery done? Or, would you be willing to talk to a cancer specialist about possible chemotherapy? Either of these options would likely be expensive and there are no guarantees of success.

If you answer yes to the above question then I think it is a good idea to stop the steroids as suggested by your vet and go ahead with the aspirate.

If, on the other hand your philosophy is to recognize that she is older and that there is a decent possibility that this is something that could be an "end of life issue", then I think a good plan is to keep giving the steroids until they are no longer working for her and at that point to talk about euthanasia. No one can say how long this period of time may be. And, if this is an immune mediated problem then there is a chance for a cure.

I am always REALLY cautious about going against another vet's plan though...if your vet has recommended this plan of action it is probably the right thing to do.

The best advice I could give you is to ask your vet for a referral to a veterinary oncologist or at least an internal medicine specialist. They can look at what has been done so far, and look at Tiger and help you to decide what would be the best step to take next.

I'm not sure if I have actually answered your question or made things more confusing! Feel free to respond if you need more clarification. I'll be online for about another 10-15 minutes tonight.

Dr. Marie.

Customer reply:

Thank you. We live in Houston, TX so Rocky mountain is likely out. Ticks on the other hand - she has come home a couple of times with ticks and we treated her for it.
I've done my homework on the spleen surgery and chemo and that is just not for us (bad prior experiences).
The consult noted the same as you regarding the bumpiness of the spleen (that it's not unsual for some breeds, etc) but the results still talk about a mild hepatosplenomegaly and mild perintoneal fluids being concerning for neoplastic infiltrations (is this lymphoma?).
The ultrasound said the same and included evidence of cystisis and the spleen has illdefined hypoechoic nodules (??).
So after all this, I guess taking her off the steroids and seeing if it is autoimmune related while doing another aspiration might be a bit more conclusive?
Thank you for all your help!

Online vet, Dr. Marie

Dr. Marie replied:

Here is some explanation of the medical terminology for you:

mild hepatosplenomegaly - the liver and spleen are a little bigger than they should be.

mild peritoneal fluid - some fluid in the abdomen (this is not normal and often means that there is a cancer present). (Neoplastic = cancerous).

cystitis - the bladder wall is thickened - this may not even be related to the spleen issue.

hypoechoic nodules in the spleen - there are little pockets (likely of fluid) in the spleen. These can be normal but could also be cancer.

So, to answer your question, the aspiration, done without steroids may be more conclusive. But, from what you have described I'm really concerned about cancer. I think it would be good to talk to your vet and let them know how you feel about treating cancer.

If your feeling is that you are not willing to do chemotherapy or surgery then I personally think that just staying on steroids is best. Steroids will help to fight inflammation associated with cancer and will help her, but only for a short time.

The whole idea of taking her off steroids is to get a diagnosis. But, if the diagnosis is immune mediated disease then the treatment is steroids. If it's cancer, and you don't want to do surgery or chemo then the treatment is steroids.

Unfortunately I am heading offline now as it is bedtime for me. I'll be back online tomorrow, so if you have more questions I'll check in on you then.

Dr. Marie.

Customer reply:

I took her to the vet again today and got a tick serology done. I wont have the results for another couple of days, but in the meantime they gave her a rx for doxycycline. My question is, she only has 2 more of the clavamox left (tonight and tomorrow morning). Should I start her on the new antibiotic, or just wait until tomorrow night to give her the new pills. I don't think the vet realized that she had 2 more clavamoxes left. I don't want to hurt her, since it seems that the doxycyline is a heavy duty antibiotic...any advice?

Online vet, Dr. Marie

Dr. Marie replied:

I think the doxycycline is a great idea. It is safe to give doxy and clavamox at the same time, so I would finish out the clavamox as directed and start the doxycycline tonight as well.

Most dogs I treat with doxy handle it really well - I wouldn't say it is any more "heavy duty" than another. It just tends to treat different things. Many of the tick borne conditions can be treated nicely with doxycycline.

Customer reply:

The vet is now entertaining the idea of continuing treatment with the prednisone. Rather than doing the aspiration, I had her go down a laundry list of other possible causes for the inflammation. I guess I'm just going by process of elimination, since I don't want her to be uncomfortable and at least the prednisone seems to keep her spirits up and her appetite healthy. The first test was for the tick related diseases, but I wonder if you could help me with other non invasive (or minimally invasive that won't require taking her off the prednisone) tests that I could have done to her in this quest to figure out what is ailing her.
I truly thank you for your time, it has been a comfort to have you available.

Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome. I'm not sure what else I could suggest though. Really the only way to know if there is cancer in the spleen is to do an aspirate or a biopsy. It's not that the aspirate is dangerous when she's on steroids, but the problem is that if there is cancer there the steroids will shrink the tumors and make it difficult for us to get a diagnosis.

I think you're doing all of the right things. I know how hard it is to keep going without knowing exactly what is going on.

It sounds like your vet is doing all of the same things I would.

I hope she continues to do well!

FYI...I'm heading offline for the night now.

Dr. Marie.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.