Last week was one of the hardest weeks of my career thus far, and I wasn’t online much. Back on track now, and will hopefully stay that way for awhile yet! Another week like that might send me to the loony bin. . .This post has nothing to do with what happened last week, as I actually wrote it last Monday before the shit hit the fan, and just never posted it until today!
The spleen is a handy little abdominal organ which filters red blood cells, acts as a bit of a reservoir of blood, and participates in your immune system. It’s a good organ to have. Unless it turns on you. . .
A surgery I definitely do not enjoy, because it never happens for a good reason, and often it’s a life prolonger and not a life saver… Splenectomy. In other words, the removal of a spleen.
Why do we remove the spleen? Well, generally because it has a tumour. There are many different kinds of splenic tumours, both primary tumours and metastatic tumours. You can get hemangioma, hemangiosarcomas, fibrosarcoma, lymphoma, osteosarcoma. . . just to name a few.
Worst case scenario is when one of these tumours is bleeding into the abdomen, making the animal ill, weak, and usually they present because they’ve collapsed. You suspect a belly full of fluid, you stick a needle in the belly to see that it is indeed blood. In these cases we offer the client the option of emergency surgery to stop the bleeding, remove the spleen, and follow up with a blood transfusion. Often, either because of the large cost associated with this, or the poor prognosis of surviving the surgery, or the combination of both, the clients chose to euthanize rather than go through surgery.
Sometimes a dog presents who is ill, and you’re not sure why, and either you can palpate a mass in the abdomen, or you can see a mass on an xray, and you strongly suspect spleen. Then you recommend going in and removing the whole spleen. Or, if you’re not sure, you recommend an ultrasound to verify the organ involvement, or an exploratory with the agreement that if it is indeed attached to the spleen you will be removing the spleen.
Then there’s the SURPRISE! SPLENECTOMY TIME! Situations. These don’t happen often, thank goodness, but I’ve had it happen once.
Now, I read once that every time you remove the spleen you should take a liver biopsy to check for metastasis. And so I always do. And in that last case, with the rock? The splenic mass came back as noncancerous. The liver biopsy came back as significant liver failure eminent. So, if you’re dog has a splenic mass and you go for surgical removal. . . if you’re given the option of liver biopsy, take it! (I don’t give an option – the cost of histopathology is the same if I send a splenic lump alone, or with a liver sample, so why not include it? And if you remove a spleen you should ALWAYS send it for histopathology. The look of it alone will never a confident diagnosis give you.)
More than just the typically grim prognosis associated with splenectomies, I don’t like them because they are fiddly surgeries. I hear there are some new fangled ways of removing them with fancy pants new tools that make it simpler, but I don’t have that stuff. I have to do it the old fashioned way. Tieing off the vessels to the spleen one, by one, by one, by one, by fifty million and one… and each vessel gets at least 2, if not 3, ligatures, depending on its size. And these spleens are usually large and difficult to manage. Totally a 2 surgeon job – both to share the load of tying all those ligatures, and to help hold the spleen itself out of the way. And some of these tumoured spleens are HEFTY. Long as your arm and twice as thick, at times. Maybe even larger.
I will always remember my first splenectomy. It was one of those cases where a dog presented because he wasn’t doing well and I saw the mass on radiograph. The owner elected to go to surgery, and Ollie, my own precious superstar blood donor, came in to donate blood just in case. Ollie even got to meet his potential recipient, they shared a little bum sniff. The surgery went well, my boss assisted me, and we did end up giving a blood transfusion (even if the tumour wasn’t bleeding, removing the spleen removes a lot of blood.) Sadly, the histopathology came back as the worst case scenario splenic tumour, and the dog was given at most 4 months to live. However, I never let the dog read the report so he didn’t know that and went 6 months before he started to go downhill. I like to think it was because of Ollie’s super blood.
It is a difficult decision to make – to go to surgery or not. That dog surely would not have lived 6 months the way he was before surgery, as he was quite sick already and it was a very aggressive tumour. However I recently euthanized a dog that was diagnosed with a splenic tumour 6 months ago and the owners chose not to put him through surgery. His was obviously, in hindsight, not as serious a tumour as the one I removed on the other dog. . . but we had no way of knowing that when the owners decided not to do surgery. It’s a gamble. We have no way of reliably knowing what kind of tumour it is until we remove it – you can’t just take a biopsy, you need to have the whole spleen examined and several sections checked under the microscope to really be sure about a diagnosis. We always send a piece of spleen that “looks” normal, and as much of the mass as we can (depending on size, if we have to section it to send it, we try to get edge of tumour, and a good chunk of obvious tumour)
It is always preferable to operate on a stable dog, rather than a dog who is in crisis because of a ruptured tumour, but it’s never an easy decision to make no matter how ill the dog is. Typically these are older dogs, and no matter how healthy they are aside from the tumour there are significant risks associated with this surgery. Your vet gets that. And if he or she doesn’t, you need a new vet. Just saying.