Tuesday, January 29, 2013

Walks Like A Splenic Tumor, Quacks Like A Splenic Tumor ... It Must Be A UTI?!?!

Mandy was about nine and a half years old, about the same age as Jasmine. She was showing some signs of aging but overall seemed to have been doing well enough.

German Shepherd Dogs are one of the breeds susceptible to
developing hemangiosarcoma
She had fallen very ill during the Christmas holiday.

She was very lethargic; didn't want to get up, didn't want to eat. She was drinking and urinating a lot and started having pee accidents at night.

The first business day after holidays, first thing, she was taken to the vet's.

Strangely, she seemed to have been feeling much better that day, even wanted to play. But because she looked so sick before, getting her checked out was the right thing to do.

The vet examined Mandy, checked her urine and diagnosed her with a urinary tract infection (UTI).

She was put on antibiotic, Deramaxx (apparently often used to decrease inflammation and discomfort), and a Phenylpropanolamine (PPA) for urinary incontinence.

It is true, that the meds seemed to have remedied the urinary accidents.

However, the next day, Mandy crashed hard again. She wouldn't get up, and when she did, she'd walk with extreme difficulties and looked very ill.

After a call to the vet, he took her off the PPA but didn't seem to have made any difference.

Meanwhile, there was another holiday. In desperation, Mandy's parents decided to lower her dose of antibiotics, convinced that must have been doing it to her. I warned them I didn't think it was a good idea to play around with antibiotics but it did seem to have bought Mandy another good day.

As Mandy resumed her full dose of antibiotics, she crashed once again.

By now convinced that the meds were making her ill, they took her off them. I did try to point out that Mandy's days of extreme lethargy were the original reason why they took her to the vet in the first place, so perhaps the meds are not to blame. If I was to pick a suspect, I would have picked the NSAIDs, having a horrible experience with that ourselves. It is true, that antibiotics can upset the digestive system, but I wasn't feeling it that they would cause such a havoc.

Either way, Mandy was now off the meds and seemed to have been doing much better again, even bringing toy to play with.

Her parents took Mandy back to the vet the moment they opened, to get the situation re-evaluated.

She was given a different antibiotic and was to remain on the Deramaxx. Overall, though, the vet admitted that he hasn't seen a case like this and didn't really understand what was going on.

Well, it's OK not to know. It is not OK not to find out.

As Mandy started her meds again, she crashed even harder then before. Her parents were devastated, because they felt that "they were doing this to her."

They were unable to convince her to get up at all for thirty six hours! She'd just lay there. She also hasn't urinated that whole time.

All else aside, the not peeing was now Mandy's biggest problem.

A dog should not be going longer than 24 hours without urinating. They needed to get her to pee or to the emergency vet. It was the first priority. I asked whether they'd be able to carry her outside to see if they might be able to get her to go.

Thankfully, even though with extreme difficulties and very unstable, they got Mandy to go out and urinate. 

With that emergency out of the way, I strongly suggested they see a different vet about all this. I appreciated that they liked their vet and trusted him, but this was not going anywhere good. The situation needed another pair of eyes.

In the light of the recent events, they agreed that getting a second opinion might be a good idea and made an appointment with another vet.

It was Friday evening, and the new vet examined Mandy and having a clear suspicion, ran some tests and took x-rays. She has seen this before.

Mandy had a splenic tumor!

The vet felt very strongly that this should have been recognized, she felt that Mandy was showing textbook signs.

Oh, and btw, Mandy DID NOT have a UTI at all, it was a contaminated sample!

She booked Mandy for surgery first thing Monday. 

The biggest concern was that the tumor could rupture in the meantime and cause rapid internal bleeding. It was a VERY LONG weekend ...

Mandy did make it till Monday and went in to have her surgery done, while her parents were waiting, filled with worries. Finally the vet came out.

"You still have a dog," she said.

That was the good news. The bad news was, that the spleen was already bleeding quite heavily when she went to remove it, and Mandy's abdomen was filled with "nodules."

Now there was the wait for the biopsy results.

The vet was talking about chemotherapy ... would the nodules mean it was a malignant tumor that had metastasize then?

However, after her surgery Mandy perked right up and seemed to have been feeling quite good. Unfortunately, it didn't take very long for the urinary accidents to return.

When the biopsy results came back the vet gave recommendation to oncology specialist, talking about a year or two that chemotherapy could buy.

I was confused—if it was hemangiosarcoma, this prognosis would not be adding up.

Perhaps it was something else? I never did succeed getting Mandy's parents to acquire what the biopsy results actually said. I was worried about false hopes, though.

Earlier last week, they had their appointment with veterinary oncologist.

They were told that with chemotherapy Mandy MIGHT have up to six months. Without, probably two weeks.

What happened to a year or two? 

This new prognosis, though, would have been consistent with the hemangiosarcoma diagnosis ...

Mandy's parents decided not to pursue the chemotherapy, since the benefit didn't seem that substantial...

Mandy took a turn for the worse and crossed the Rainbow Bridge later that week.

***

The nasty thing about hemangiosarcoma is that it typically develops slowly, with no signs of the disease at its early stages. 

By the time the dog is showing symptoms, the disease is already advanced.

Dogs with splenic tumors might develop a bloated abdomen, as the spleen enlarges. Mandy was a heavy girl, this wouldn't be something one would really notice on her. Other sighs might be lethargy and loss of appetite.

I believe that one can never be paranoid enough when their dog is lethargic or doesn't want to eat.

But the truth is, that with hemangiosarcoma, when you see a problem, it's usually already too late.

RIP Mandy.

Related articles:
Are Splenic Tumors Always Malignant? 
Veterinary Highlights: Can A Mushroom-Derived Compound Lengthen Survival in Dogs With Cancer? 

Further reading:
Cancer: Imagining the Worst, and the Best 
Hemangiosarcoma in Dogs
More on Hemangiosarcoma
Hemangiosarcoma
Canine Splenic Hemangiosarcoma: How a Simple Diagnostic Test May Save Lives

5 comments

  1. What a tragedy. I am so sorry for Mandy's poor humans. It sounds like it appeared to come on so swiftly and in no time at all, they were forced to say goodbye.

    AS you say, one can't be too paranoid about behaviour changes like these. In many cases, it is the only chance our animals have.

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    Replies
    1. Thank you, Kristine, on their behalf. It was about one month from the onset of symptoms to Mandy's passing. It was a very painful month. Splenic tumors tend to be very stealthy, unfortunately.

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  2. That is so sad. Mom's last dog stopped eating one day and was gone a week later - pancreatic cancer. The vet said that is another one that is rarely found until it is too late. She had lost weight but because she was part Newfie with lots of fur, no one really noticed.

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    Replies
    1. Sorry about your mom's dog. Yeah, the diseases that sneak up on you are the worst.

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  3. How sad! Poor Mandy and her parents, too. Traumatic, to be sure. R.I.P. dear Mandy.

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