Dr. Marie replied:

I can understand that this can be frustrating! It's often very difficult to interpret xrays and accurately determine what is going on.

"Old dog lung" has very small (like 2-3 mm) white spots on the lungs. There can be many of them. We don't know what causes these but it's possible that there are areas that calcify. If this is old dog lung then the lungs are likely nothing to worry about. However, it can sometimes be difficult to tell if this is old dog lung or actually small metastatic tumors. This is indeed an area where having a radiologist look at the xrays could make a big difference.

So I went back and re-read your previous question and I'm trying to put things together for you.

It sounds like what the new vet is saying is that he feels that there is a mass in the spleen. There are a few things that could cause this. Some dogs will have very benign growths in the spleen. When we do surgery to remove these growths they can do extremely well. However, my experience is that dogs who have this condition rarely have any other symptoms. You have described that Mara was really struggling to breathe and had difficulty moving around.

Now, I have seen dogs have symptoms like this if they had a ruptured tumor in the spleen. Sometimes there can be a large pocket of blood in the spleen. If it ruptures then there can be massive bleeding into the abdomen. Because blood carries oxygen, if there is a sudden rush of blood from the bloodstream into the abdomen then a dog can definitely have trouble breathing. Also, we can see extreme weakness, especially in the hind quarters.

However, in most cases like this we can see significant changes in the red blood cells on blood work. We should see significant anemia (low red cells), and we should also be seeing odd changes in the shapes and sizes of the red cells. Your previous question didn't mention any lab abnormalities when it comes to red blood cells.

The next possibility is that there is a serious cancer affecting the spleen. If the liver is enlarged then it may have spread to the liver. In cases like this, we can do surgery and chemotherapy, but most dogs do not live long if we have liver involvement.

It's often hard for me to advise in a case like this because I don't know all of the details. However, let me see if I can lay things out logically for you:

First of all, I do think that an ultrasound could be a good idea. An ultrasound should be able to tell us if there is just a fluid filled area on the spleen or if there is evidence of liver involvement as well. If the liver is involved then we really have to think hard about how much further we want to go here. Surgery to remove tumors from the liver is really not done. Some chemotherapies can buy us some time but are not likely to cure the problem.

So, let's say that the vet feels that this is confined to the spleen. Then we have a hard decision. One option is to do an exploratory surgery. When the vet is in the abdomen, if they see that there is obvious cancer that is spreading and affecting other organs then you could decide to euthanize on the operating table.

However, if there is no other organ involvement then the spleen could be removed. The spleen would be sent off to a pathologist and they would tell you whether or not it is cancerous. If it is not cancer, then she could potentially live for quite some time. My main concern, again though, is that if this is not cancerous, then why is she feeling so sick?

If the vet is able to have a radiologist look at the lung xrays this really would help because if the radiologist does feel that cancer is possible then it makes the idea of surgery less attractive.

If the radiologist agrees that these are old dog changes then I think it is worthwhile to go ahead with the ultrasound. You may find that the answer is obvious if there is significant evidence of spread to the liver or other organs.

But where it will be a hard decision is if it looks like a localized disease in the spleen. If this seems to be the case then I would ask the vet if they have an explanation as to why she feels so sick. If they feel that they can cure her with surgery it may be worth a try....but the problem is that it is pricey to do so. You could easily be looking at a couple of thousand to do surgery.

I'm not sure if I've helped or confused you more. I hope this helps somewhat though.

I will only be online for a few minutes more tonight but will check in on you tomorrow morning.

Dr. Marie.

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Dr. Marie replied:

I think that's a good idea.