Questions?  

316-689-0202 

Case of the Month: The Dog and the Cantaloupe

Lucky is a 10 year old Chocolate Labrador Retriever that is a big part of the Hunsecker family, loved by Mom, Dad, and two kids.  He was adopted six years earlier and quickly became a fixture in the home. His muzzle and eyebrows are now noticeably grey giving Lucky a look of distinction and position, well deserved for his years of loyal companionship to the family.

 

 Lucky was brought to us on a recent Saturday morning for a wellness exam and to update his immunizations and routine lab tests. The owner commented that he had been just a little less active recently.  “Just getting older” we thought.  On close physical examination all systems seemed quite normal for Lucky, then I felt a cantaloupe sized mass deep in his abdomen.  This was serious.  I checked again, felt its surface and the extent of its involvement.  I was not mistaken. Now I had to turn around and carefully share the news with the Hunseckers.
 
Understandably, we all were caught very much off guard and their emotion shifted to nervousness and deep concern.  I needed to address the “elephant in the room” and talk about the risk of this being cancer, what treatment options are available and what costs might be involved, side effects of treatment, quality of life and Lucky’s age.  Additionally, we could be sitting on a powder keg because spontaneous and potentially fatal bleeding, possible at any time, is not uncommon with any large abdominal mass. The important questions hinged on knowing the origin of the mass and its specific diagnosis. Is it cancer or not, and if it is, how quickly does it spread? Lab testing and abdominal X-Rays or ultrasound were an appropriate initial step to better determine Lucky’s overall health status and to try to determine the origin of the mass, and the possibility of surgical removal. 
 
The family needed time to digest what had just been dropped in their lap. Nobody likes to hear bad news about a family member, and making treatment decisions on the spot makes things even more difficult.  They needed to balance the possible costs, what is best for the family, and what is best for Lucky.  Lucky’s overall condition seemed good and he didn’t seem to be very uncomfortable, so Lucky and his family were sent home with handouts and internet source material to study over the weekend, but a decision had to be made soon.
 
My impression was that the mass was growing from Lucky’s spleen which could be a big plus for everyone.  The spleen is one of the few “nonessential” organs of the body.  It can be removed and life goes on with little problem.  Also, when all of the cancer statistics and percentages are distilled down, masses found on the spleen quite predictably have close to a 50% chance of being totally cured if the spleen and tumor are removed when first discovered (1/3 of them being noncancerous, the rest being solitary cancers that have not yet spread outside the spleen). However, the flip side of the coin is that Lucky still has a significant chance for a cancer diagnosis, and the horses could already be out of the barn.  While some cancers respond well to therapy, treatment for cancer on the spleen is usually limited and unrewarding.
 
The family met me at the door Monday morning. Lucky was not doing well. He was very pale and breathing hard, his belly was somewhat distended but soft.  It was clear to me that his tumor had started bleeding into the abdomen and we needed to stop it as soon as possible before he became critically anemic.  They had already decided that surgery was an acceptable option, so he was given a whole blood transfusion collected from Dawn’s Boxer “Scout” and rushed into surgery.  I told the Hunsekers that I would contact them during surgery if we found anything that looked less than positive.  If the tumor could not be removed we all agreed that Lucky should not wake up from surgery.
 
After entering the abdomen and clamping off vessels of the spleen to stop the bleeding, my initial surgical exploration of the abdomen did not find any other additional masses on any other organs.  This improved our chances that the mass, which could still be cancer, was localized to the spleen giving us one more step toward a win.  I carefully continued the process of tying off splenic vessels, and then gingerly lifted the spleen and its fragile mass from the abdomen. With the big mass out of the way, the abdomen was again rechecked for other tumors. This yielded the same positive result and a quiet sigh of relief. Lucky was closed and had an uncomplicated recovery.  I was excited with the outcome and quickly called the family to share the good news, but also encouraged them to remain cautiously optimistic because we weren’t completely out of the woods. We could still have cancer cells “seeded” elsewhere.
 
After two days of hospitalization to give Lucky time to regain his strength and replenish his red blood cell count, he walked out of the hospital with his tail wagging briskly and was taken home. “He looks so much thinner” Mrs. Hunsecker remarked with surprise.  “We removed a cantaloupe” I replied.  He had survived the surgery, but that was only the first hurdle.  
 
To know that we had avoided cancer altogether we had to wait for the pathologist’s examination of the tumor tissue.  The report finally came four long days later by email.   No cancer found!  The mass was Splenic Hyperplasia, a nodular overgrowth of “normal” spleen tissue. The only risk with this type of disease was the uncontrolled potentially life threatening bleeding that Lucky had just experienced.  
 
The gamble paid off for Lucky and the Hunseckers. He is now at home continuing his duties as guardian, protector, and loyal companion.  He is still a 10 year old dog, but they are glad to have him.
 
Take home message:
1) Don’t be afraid to address serious diseases and things that might look like cancer.  Too many owners shut off their thought process when the possibility of these difficult diagnoses present themselves..  Listen to the information and the treatment options your veterinarian presents and determine what treatment is best for you and your pet.  Many of the most rewarding cases for pet owners and myself are those difficult cases with significant risk and uncertain outcome that yield better than anticipated results.  It can feel like scoring an inside the park home run.
 
2) Older pets are not less valuable pets.  Aging is not a disease in itself that lowers  their intrinsic value. It does bring with it an increased frequency of several common disease conditions that may need more of our help and attention to manage successfully.  Age is not a reason to stand back and reduce our pet’s level of care because our pets rely on us to maintain their quality of life.  At the very least they deserve proper pain management.
 
3) Pets hide their disease, especially cats.  When you notice that they just aren’t themselves, it is most probably affecting them more than we realize.  Give significance to small changes in behavior, daily routine, activity and attitude.
 
This article is the first in an ongoing monthly series to show what we do as a veterinary team.  We hope that you will enjoy them, learn from them as pet owners, and learn more about the heart of Village Animal Hospital.