Wednesday 13 December 2017

Spleen just as important a part of the body for animals

Pete Wedderburn

MILLER IS a thirteen year old Lurcher who had always been fit and active. A couple of weeks ago, something odd happened. He stopped being as enthusiastic and energetic as usual, and he started to pant almost continuously.

At first, his owner wasn't sure if he needed to see the vet: he was eating normally, and he had no other signs of illness. No increased thirst, no coughing, no digestive upset. He was just a bit dull and he was panting. When he carried on being like this for a couple of days, she decided that a vet visit was needed: there was definitely something odd going on.

When I examined Miller, at first he seemed like a perfectly healthy individual, in good bodily condition with pink gums and a strong, regular heart. But when I palpated his abdomen, I could feel a large, firm object with the tips of my fingers, like a melon or a grapefruit. The diagnosis was clear: he had a large tumour growing in the centre of his abdomen.

I admitted him to our clinic for x-rays, and these confirmed what I feared: he had a big tumour on his spleen. It's impossible to know what Miller was feeling, but it was probably dragging down on him: can you imagine carrying two or three bags of sugar inside you? He would have been feeling tired, and it's also likely that the tumour was causing some discomfort, which might explain his panting.

The spleen is an important part of the body, storing blood that can be released into the circulation in a hurry if there's a crisis such as sudden blood loss. It also filters out old blood cells, breaking them down and using their contents to make new blood cells. The spleen plays an important role in the immune system, producing antibodies and helping to deal with challenges like viral and bacterial infections. Yet despite its importance, animals and humans can live normal lives without a spleen: it's one of the organs that can be removed without causing any obvious problem.

Tumours of the spleen are common, especially in older large breed dogs like Miller. As with most tumours, there are two types: benign (or harmless) and malignant. Around one-third of splenic tumours are benign, and two thirds are malignant. This was the big question for Miller: what type of tumour did he have?

If the tumour was benign, an operation to remove his spleen would cure him completely, forever. If the tumour was malignant, he might not even survive the operation, and if he did, he'd only live for a few weeks or months.

It's not always easy to tell the difference between benign and malignant tumours of the spleen: while our xrays showed that there was no evidence of malignancy (such as spread to his lungs or liver), the only way you can be certain is to send a sample of the tumour off to the laboratory for analysis. It just isn't possible to be certain of what's going on at the time of the operation to remove the spleen. This can be challenging: if it's malignant, is it right to put a dog through a major operation when they are only going to live for a few more weeks? On the other hand, if it's benign, it would definitely be wrong not to operate, given that this would provide a complete and permanent cure.

With Miller, as in many similar cases, we decided to go ahead with the operation without knowing. If we discovered during the operation that the tumour was malignant (e.g. if there were signs that it has spread to his liver), then we would not let him come round. Instead, we would quietly deepen the anaesthetic, letting him drift painlessly away to death: this would be better for him than waking up, only to die in the coming weeks. If we found no sign of malignancy during the operation, we would remove his spleen, and hopefully that would be the end of his problem. It was difficult for Miller's owner when she left him with us that day: she didn't know whether or not she'd be seeing her dog alive again.

Soon Miller was anaesthetised and on the operating table: the surgery was complex, taking over an hour. There was good news: no sign of any spread of the tumour to elsewhere in his body. The tumour was exactly as we'd expected: it weighed 3kg, taking up most of his spleen. His entire spleen was removed, which meant tying off around twenty large blood vessels. We had to use electrocautery to seal off the many smaller blood vessels too: the spleen must have one of the richest blood supplies of any organ in the body.

Once the job was done, Miller was sewn up again, and within a few hours, he was starting to wake up. We sent him home that same evening: he needed gentle nursing care from his owner and the comfort of his own home.

I checked him the following day, and I took his sutures out ten days later. He has healed up well, and as far as his owner can tell, he's completely back to his normal self. His usual energy has returned, and he has stopped panting. How much longer will he live for? Nobody knows the answer. But we do know that his immediate problem has been sorted, and Miller is a happy, healthy dog again today.


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