Case #1: Venus
Venus was a 12-year-old, spayed female terrier lab mix five months ago presented to our clinic with a 1-day history of a firm, painful abdomen with occasional soft stools. Eating/drinking well, no medications other than probiotics. There are several reasons I would like to write about Venus (yes, internal medicine doctors, I am going out of order, don't have a heart attack).
Venus's owners have been fantastic with updates, consistent with follow-up appointments, and in general, have gone above and beyond for their pet (and are just nice people)
Venus's case was challenging, involving many doctors and staff but had a good outcome.
Venus is a good dog.
My colleague first saw Venus and, on physical exam, found a painful, tense abdomen. Other than being blind and deaf, the rest of the presentation was normal. (I would apologize again to the internists reading this. Hopefully, there aren't any because this isn't that kind of blog.) Radiographs (x-rays) and bloodwork were recommended. Bloodwork and radiographs are generally the first diagnostic steps a general practitioner can take with a sick patient. With a history and signalment like Venus's, we are worried about a foreign body, masses, and of course, the big K (cancer). My colleague saw a suspicious area around where the spleen was. The bloodwork showed mildly increased kidney values.
With this information, we could narrow our list of differentials (differentials are what we suspect the disease is) to a likely mass somewhere in the cranial (front) of the abdomen. Using ultrasound, we were able to find a mass that was inside the spleen.
The job of the spleen is to hold blood. It is essentially a large sack of blood that can be released in an emergency. When a mass is present in the spleen, it becomes more friable or easier to rupture. Having a giant bag of blood in your body that could break at any point is not ideal. To make matters worse, splenic masses have about a 50/50 chance of being benign (good) vs. malignant (bad). It is difficult to determine without having the spleen taken out and submitted for histopathology. The good news is you don't need a spleen to survive; pets can do very well without them.
There are many risks in performing a splenectomy. The spleen is attached by several blood vessels, which are tied off and cut. The spleen is also fragile, especially with a mass. Knowing the risks and potential that the mass was malignant, which would have a poor prognosis, we were given the go-ahead to remove the spleen. After a couple of hours, two doctors, several technicians, and a lot of swearing. The procedure was a success!
One of the aspects of veterinary medicine that is the most difficult to cope with is good news never lasts forever. Histopathology determined the mass was a malignant type of cancer called hemangiosarcoma. Hemangiosarcomas have a median survival time of 19-86 days. Venus was able to spend 153 days enjoying her life with her owners. She was placed on several supplements and transitioned to a Purina renal diet to help with the kidney values. She was still blind and deaf (we are doctors, not miracle workers) but continued to come in for routine blood tests, screening radiographs/ultrasound/bloodwork, and the occasional fluids. Her owner did a fantastic job of keeping her comfortable and treated every day they had with her as a gift.
Posted with permission by Venus’s owner.
