Possible spleen cancer.

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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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.

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.

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.

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.