The Dark Side of the Spleen

We’ve been experiencing a rash of splenectomies lately at our little animal hospital. 

Over the last month, I can think of 4 big spleens, 3 of  those dogs  had surgery, two of those survived.  The 4th dog still has his big spleen, and we’re deciding what to do with it (we think he has lymphoma).

This is a serious blog, but I have to digress a monent and observe:  “spleen” is a fun word to say.  There aren’t enough opportunities to use that word in a sentence.  It’s fun.  Try it.  Is that a spleen in your pocket or are you just happy to see me? 

Anyways, back  seriousness.  The speen is this deep-red almost maroon floppy little organ that sits in the abdomen, sort of adjacent to the stomach.  In a big dog it’s about the size of a flat banana.  It’s soft and squishy and limp and sort of slug shaped, but flat.  It’s job is to help out the immune system by housing a bunch of white blood cells that filter the blood of viruses, bacteria and other foreign invaders.  It’s also a backup location for red blood cell production when necessary.  If you get in a car wreck and have an acute bleed, your spleen will contract, releasing extra blood into your system.

The primary reasons humans get splenectomies are for trauma (that little floppy thing doesn’t stand up well to car wrecks or beatings), or blood disorders (sometimes the white cells in the spleen get too “grabby” and start removing the person’s own normal cells from circulation). 

In dogs, the spleens are usually removed because they are too big (that’s pretty simplistic, but that is what it boils down to).  The main causes of a big spleen (splenomegaly for those of you who need the technical terms), are (in my opinion):  hemangiosarcoma, hematoma (bruise), lymphoma, extramedullary hematopoesis (body making extra blood for some reason), chronic immune stimulation. 

You guys know I like to boil lots of information down to the bare minimum simplest terms, so…the most common causes of a big spleen that ends up needing surgery are:  hemangiosarcoma and hematoma. 

The other things usually get fixed or figured out with bloodwork and a physical exam.

The thing about big spleens, is that they, as I mentioned before are frail little floppy pathetic organs (I mean you can easily live without them for the most part), and they’re not amenable to stretching or moving around much.  Eventually they get so big they start to leak.  And they leak blood. And it doesn’t take long for that blood loss to become serious.

Hemangiosarcomas in humans are extremely rare.  If you Google the term, only a few entries pop up before it goes into discussions about dogs.  It’s really kind of scary if you think about it.  It’s one of the most common tumors we see in our patients.  Yet if a human turns up with one, the docs immediately start checking to see if the person was exposed to the harmful chemicals Thorotrast or Vinyl Chloride. 

So what are we exposing our dogs to that is causing all these hemangiosarcs?  I think the consensus is that there is a genetic component because certain breeds are overrepresented (German Shepherds, Labs, Goldens, Chows, Portugese Water Dogs  to name a few)…but I’ve seen them in MANY breeds.   Can’t help but wonder….

In doing some research on hemangiosarcs for this blog, I came upon this article written by one of my favorite teachers from vet school, Dr. Jaime Modiano.  Check it out if you want more detailed information on these tumors :  http://www.modianolab.org/cancer/cancer_hemangiosarcoma.shtml

He’s actually looking into the things I desperately need looked into:  an early detection test for the tumor, and a way to treat them.  AND he’s a super nice guy, so I sincerely hope he figures something out.

So, one of the more common presentations I see for this type of tumor is this:  8-year-old Golden Retriever was fine yesterday, but today he’s very weak and can’t get up.  Dog comes in, he’s on his side, panting, his gums are white.  I do a diagnostic abdominal tap where I get a sample of fluid from the abdomen and it’s straight blood.  Or worse, 8-year-old perfectly healthy Golden found dead in the yard.   When these tumors rupture, the dogs can bleed to death internally with astonishing speed. 

Chances of surviving surgery once they rupture seems to be around 50%.  IF they survive that initial 48 hours,  and it’s a hemangiosarc, the dog is only expected to live another 4-6 months. 

If we’re “lucky”, we find the tumor on abdominal palpation during an annual exam. 

Or, the patient is having intermittent episodes of weakness, and the client actually brings him in.  Bloodwork may show signs of recent blood loss.    X-rays or ultrasound shows the mass.  Sometimes bloodwork shows nothing, and we chalk it up to the dog getting older…until it finally ruptures.

“Lucky” is in parenthesis, because if it’s a hemangiosarc, even if we find it early and get it out– odds are it’s already spread and the dog still won’t live more than 6 months (assuming he survives the surgery). 

I know a vet who had a German Shepherd.  When that dog hit about 6 years of age, she started having the dog’s abdomen ultrasounded yearly to try and detect a hemangiosarc early.  Every year she did it. 

One day, the dog collapsed, and her gums turned white and she almost died. The tumor decided to show up on the right atrium of her heart (one of the other common spots for hemangiosarcs to show up, that and the liver).  Anyhow the tumor ruptured into her heart sac and caused compression of her heat.  Since the dog was in a hospital when it happened, they were able to save her, but she died a few months later. 

These are terrible, terrible tumors. Virtually undetectable until it’s too late. 

They affect some of the best dogs out there. 

I hate them (the tumors, not the dogs). 

Somebody out there needs to help us out a little. 

Researchers:  Help!  I’d like to place an order for an early detection test and some kind of treatment, please.

I’d appreciate it.

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