Monday, March 28, 2016

Canine with Distended Belly; Splenectomy. Costs, Advice, Tips, and Why Immediate Surgical Intervention Is Critical.


This is Buddy. 

He is like most of the Jack Russell Terriers that we see in rural Maryland. He is fierce, brave, obstinate, and incorrigible. He is also unapologetic about all of this. He is a big personality in a small football sized package. He is the quintessential JRT. There are a few breeds that follow the breed specific personality test to the  letter; JRT's are that breed. They go full tilt full time and they want, need, or desire few things. It is a short list of "likes" and a long list of unmatched indifference. To love one you have to own one, to understand one you have to live with one.

Buddy is a fit muscular pup.
Can you appreciate the "roundness" to his belly?

Rather suddenly his parents noted that his belly was getting mysteriously bigger rather quickly. 

Should this happen to your dog you should go your vet as quickly as possible, OR, you could visit me at Pawbly.com and ask me what might be going on?

At Pawbly.com I am first going to tell you to head directly and immediately to the vet. Any vet, anywhere as this can certainly be a life threatening emergency.

Then I am going to answer as follows;
There are a few things you need to be worried about..

1. Something is leaking. Maybe blood? Maybe fluid. All are bad.

2. Something is expanding. Maybe the stomach (gastric) is inflating like a balloon? This is called dilatation. If that balloon twists it is called volvulus. If this happens these organs can become strangulated, this is like placing a string that is too tight around your finger. If not treated and relieved quickly this tissue dies. We all need a stomach. GDV can kill your dog in minutes to hours.

3. Something inside is growing. After adulthood is reached your organs aren't supposed to keep growing. In almost all cases that growing thing inside is not supposed to happen. Cancer is the most common cause of abnormal growth.

4. The abdominal wall can be stretching due to muscle loss,, but this is usually a slow gradual process. Think diabetes, Cushing's disease, hypothyroidism.

Now some of these cases these pets are simply getting fat. But fat is not a round basketball just got inflated in the belly.

Buddy is not fat.. Buddy is in crisis for something else.. Where do you go after the examination ($50 at Jarrettsville Vet) confirms your burgeoning belly suspicion?

A radiograph is the best way to decide which of the above Buddy has going on. ($100-$150 at JVC).


And there it is.. well, maybe not a basketball,, but it is a big round mass in Buddy's belly. 


After the radiograph was taken it was time to make some decisions. Up until now every vitally needed diagnostic has been done. You need to do these two things if this happens to your dog. I also should mention that the radiographs allowed us to assess the chest for evidence of metastasis. This piece of information is vital to the dogs prognosis moving forward. If there are mets in the chest the surgery will likely not change the prognosis or lifespan. 

The next decisions and steps are the ones filled with question, doubt, and intense scrutiny for clients.

Here's my advice on where to go from here;

1. Listen to your dog. Buddy was still rambunctious and barking at every passing dog. Buddy was still behaving like Buddy. In other words, Buddy thought he was perfectly fine. Huge prognostic indicator for a likely successful surgery. Do surgery on these dogs. Don't sit there thinking about worst case scenario. 

2. Be prepared for a financial hit. These happen to every dog that lives long enough. Every pet owner should have pet insurance for these situations, OR, a pet savings account. I recommend $1,000 for each pet. If you do not have this have a way to get access to this; a friend, a vet who trusts you, etc.

3. Start strategically planning the next few scenarios. Here is how I approach these cases with my clients; I want to get as much information as possible pre-operatively. This includes blood work ($170). I also want to do an ultrasound ($200) to "see" what the rest of the internal organs look like. If there are other lesions throughout the abdomen the prognosis is more guarded. 

4. Here's what my reality for these cases is;
I am NOT GOING TO SPEND SO MUCH OF MY CLIENTS MONEY THAT THEY CANNOT AFFORD SURGERY. I sit down with my clients and discuss what everything costs and what I want to do with the money they are spending on the information I am gathering. Nothing in the world drives me to the brink of insanity than talking to a client who has exhausted all of their resources on diagnostics and now cannot afford to treat their pet. There is no sense spending money to get a diagnosis if the treatment then becomes unattainable. I consider it unethical and reprehensible.

We suspected that Buddy's spleen was the culprit and that spleen needed to be removed ASAP! 

If you do not do surgery these dogs will very likely die of internal blood loss. 

The estimate for a splenectomy at JVC is $1000*. Buddy's parents did not have $1,000. We did what we always do in these cases. We discuss with our clients how we can get them the help their dog needs. This is the difference between JVC and too many other clinics. We will help your pet get back out the door. We have multiple options to help insure this. For Buddy's family a deposit and a payment plan through our good friends at Vet Billing Solutions were his answers. 


Buddy's spleen was the only thing you could see in his belly when we opened him up. It never ceases to amaze me how large a tumor can get and how incredibly resilient these patients are. When it comes to splenic tumors a few things are key;
  1. Get it out as soon as it is discovered. The spleen is essentially a blood sac. It loves to bleed, even when it is happy and healthy, if it has even the tiniest bit of trauma. BUT, when it is an abnormal mass of tissue it really, really, likes to bleed. A bleeding tumor, especially in the spleen, is ticking time bomb. 
  2. Get as much information as possible. radiographs, blood work (full chemistry, CBC, PT/PTT), and ultrasound are super helpful.
  3. Buddy was happy and acting oblivious to his tumor. This is the best prognostic indicator I ever hope to have.



Have an excellent surgeon and support staff. I don't say this often. In my heart I love being a small town quiet rural practice, BUT, I also have a stacked exceedingly capable veterinarians and staff. At JVC we can do almost every emergency surgery on almost everyday. When it comes to picking a vet to call your own, remember to ask about the dark days that may lie ahead. I know of many small practices that either do not, or will not, do emergency surgeries. There are too many times where the cost to go to a specialist prohibits care.* 


When I am about to do an exploratory surgery on a patient I ask my clients to be standing by a phone. Here's why;
Closing.. with a big sigh of relief!
I am never really sure what I am going to find until I look inside that patients abdomen? In some cases I have found widespread disease that was not evident in the pre-op work-up (most of the time we had to skip these due to finances), and in others the mass is not resectable (cannot be safely removed). If the patient cannot be saved by the splenectomy I want to discuss whether it is fair to wake them up?

The very dark red at the 9 to 11 o'clock position is normal spleen tissue.
Everything else is tumor.

The most common presentation of dogs in need of a splenectomy are weak, lethargic, pale, internally bleeding, and teetering on the brink of death. These cases require quick confirmation of the diagnosis and surgery.



Buddy is a 20 pound dog who had a 3.25 pound splenic mass. That's enormous on anyone's scale. Buddy did very well through surgery and woke up calmly, quietly and effortlessly.

Buddy returned the next day his normal bull headed dominant self. He also had a beautifully quiet incision.


And now a trim waistline.







Closing Notes;
  • There are some surgeons who perform routine gastropexy after splenectomy to prevent post-op GDV. It is something you should discuss with your vet pre-operatively.
  • Post-operatively these patients should be monitored very closely. Ideally, at a 24 hour facility. ECG, blood pressure, PCV/TP. Transfusions may be needed in cases where blood loss was severe.
It is my belief that any and all abdominal masses warrant an internal look before euthanizing. We are reminded daily that life is full of miracles and second chances. I know it is hard to hear, scary to admit, and expensive to treat but 50% of these pets are curable! Take a leap, look inside, and get the spleen out fast... sometimes fate will deal you a good hand and often life will remind you it is worth fighting for.


Buddy's cost of care at JVC was as follows;

Presentation;
  • Exam $50 and radiograph $100.

Surgery Day;
  • pre-op chemistry w/ CBC $50
  • injectable NSAID $20
  • injectable antibiotic $30
  • iv catheter and fluids $80
  • splenectomy $350
  • surgical supplies $75
  • anesthesia $200
  • post-op analgesia and antibiotics $40
Total cost $1050. 

Many thanks to Vet Billing Solutions for helping us provide a way to make Buddy's surgery affordable to his family.

*Estimates for this surgery at an emergency clinic can range from $1500-$3500.

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If you have a pet question, or want to share your pet knowledge, please join the free online pet information exchange network that is dedicated to helping pet parents learn about how to best care for their pets. Pawbly.com is free to use and open to anyone who loves pets.

I can also be found at the clinic, Jarrettsville Vet, in Jarrettsville Maryland. We post our prices and fees every year and we have a wonderful Facebook page. I am also on Twitter @FreePetAdvice.

6 comments:

  1. Very good post and pictures. Thank you for taking the time to write it!

    Best, Roberta in Half Moon Bay, CA

    ReplyDelete
  2. My 10-year old chocolate lab has the same prognosis. After reading your post I am convinced the right course of action is to proceed with spleen removal surgery this afternoon. Thank you for this post and information!

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  3. Stumbled on this post as we got the scary prognosis on our 9 year old black lab yesterday. When I returned from the vet thinking that it was down given the prognosis, my wife reminded me that she had had trauma a few months back and that's when it started. Give the hat fact and that she acts completely coupled with your article, I feel good about going for the surgery. Thank you for the great advice.

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  4. My golden doodle is almost 11. He was recently diagnosed with diabetes. It's been about 5 mos since his diagnosis and we are still working to get his glucose regulated. He has also started to lose his site. He recently had an ultrasound that showed an enlarged spleen. The biopsie results were questionable. Our vet recommends we have his spleen removed. Given the cost, age and current health is it wise for us to carry out the surgery? We love our dog but want to be practical about his treatment. Thank you!

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  5. I have a 11 year old golden doodle that was recently diagnosed with diabetes. It's been about 5 mos and we are still working to get his glucose levels stabilized. He is beginning to lose his sight. A recent ultrasound showed his spleen is enlarged; the biopsy was nt positive but questionable. The vet is recommending we remove his spleen. Given his current age, the cost of the surgery and his health does it make sense for us to proceed with the surgery. We love our dog but want to be sure this is the best treatment for him. Thank you

    ReplyDelete
    Replies
    1. Hello,
      I am sorry for the delay. I dont always check this daily. If you do ever need help quickly please use pawbly.com.. it is free to use and monitored by lots of pet experts.
      your question is a bit difficult to answer without knowing lots more info,, so I am going to do the best I can with some general advice.
      1. try to never use age or disease status to convince you not to do something beneficial to your pet
      2. if you are not sure your pet needs a surgery (or anything else) get a second opinion.
      3. diabetes with difficulty in regulating is often due to another concurrent problem ( i always start with checking urine) so try to not get frustrated,, but do be diligent in looking for the reason.
      i hope this helps.
      good luck!

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