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On the evening of February 8th, Tucker began exhibiting ambiguous signs that he was not feeling well. These signs consisted of general apathy and lethargy, not overly alarming signs. Tucker's vitals were normal (see "Know your dog's normal" below), and he was eating and defecating normally. Even so, we began watching him more closely. We began monitoring his temperature and other vitals - I am sure he got tired of us knocking on his sides - trying to discern whether it sounded like a hollow drum (a sign the stomach was filled with gas).
By February 10th at dinnertime, Tucker continued to act "in the dumps," still a vague symptom. The turning point was when he refused the first meal of his life (Tucker is now 6 3/4 years old). When talking about a dog who had a an illness so severe (probably a virus) that he had projectile diarrhea and yet still had a healthy appetite (What?? Broth again!? I want food!), this said something was seriously wrong and demanded attention. I may have gone on "wait and see" if that was the only unusual thing he did, but soon after that he drank a large quantity of water and vomited it all within 20 minutes. He was also reluctant to move of his own accord and had to be leashed to be taken outside. Once there, he merely stood in place, looking very sad and clearly distressed. He was also panting somewhat (though not excessively), drooling, and his stomach area now felt enlarged. His temperature was within normal limits, despite the vomiting he was still well hydrated, and his capillary refill rate (press the gums and check color) was normal.
I knew of a brand new emergency facility that had just opened five blocks away from our house, but I didn't know the name of it. As it was after hours (about 6:30PM at this point), I could not call my own vet for advice. We made the decision to just put Tucker in the car and get him down there. We couldn't call ahead because we didn't know the name, and in retrospect, it was probably better we couldn't. It was difficult to get Tucker to the car. He walked halfway down the driveway and just stopped. My husband had to carry him the rest of the way and place him in the car - again, quite abnormal behavior.
When we arrived, the triage personnel basically treated me as an hysteric. His temperature was within normal limits, he was still ambulatory, hydrated, and his capillary refill was still good. My belief is that she wanted to send us home on a "wait and see," but I was firm and insistent that we be seen. We were left in the waiting room for a good 20 minutes before we saw a vet.
We were finally taken back to see the vet on duty. Although he, too, seemed dubious, he sent Tucker back for an x-ray. When the x-rays came back, little doubt remained: his spleen was so huge that it filled both sides of his body cavity. Surgery was clearly mandatory at this point. "Radiographic conclusions: Severely enlarged, abnormally positioned spleen."*
Since Tucker's vitals were all good, and the x-ray did not yet indicate a torsion, he was admitted. The ultrasound expert, as well as the staff surgeons, were due in early the next morning. Tucker was placed in ICU overnight with an IV. "Recommendations: Abdominal ultrasound with splenic Doppler is indicated. However, if not available, splenectomy is strongly advised."
The next morning, Tucker had an ultrasound and the clinic phoned me with the results. They did not differ from the x-ray findings - severe splenomegaly. Also, although not known at that point in time, it was discovered during surgery that his spleen had rotated a full 360 degrees (a finding the clinic never reported to me, either, I only just discovered it from my own vet's report a few days ago). Regardless, it was clear that a splenectomy was in order - the spleen was forcing the intestines into a corner and also impinging on the stomach - it was that large.
We then drove down to meet and consult with the veterinary surgeon on duty. I was a little shocked when I met her because she looked no older than twelve! This didn't give me a lot of confidence. My only request was that no ACE (Acepromazine, a tranquilizer) be used during surgery, as our breed has a history of reactions to it. She was adamant that ACE be used and felt it would aid the healing process. In the end, though she told me she didn't use it, the full report indicates that she did - thank goodness without ill-effect. If it hadn't been an emergency, I would have gone elsewhere.
I also requested a prophylactic gastropexy at that time, which was performed. If there had been complications during surgery, this procedure would have been scrubbed. "Procedure: Splenectomy and prophylactic gastropexy. Position: Dorsal recumbancy. Description: ...the spleen was diffusely enlarged and difficult to exteriorize due to its size and 360 degree torsion at the hilus of the spleen. The spleen was extremely friable...minimal hemorrhage was noted from the spleen."*
After the surgery, Tucker was about twelve pounds lighter. This probably very nearly corresponds to the weight of his grossly enlarged spleen. Also, after surgery, his platelet count was very low. He was given a blood transfusion and was not allowed to come home until it reached an acceptable level. A day and a half or so later, his platelet count was high enough for him to come home. His recovery was otherwise uncomplicated. He was sent home with a fentanyl patch on his shoulder (for pain) and was very groggy. I set up two crates for him, one in the living room, and one in the back room to sleep in. My new puppy was overjoyed to have his daddy back home, but just couldn't understand why he couldn't play!
At my own vet's suggestion, I immediately began giving Tucker the homeopathic remedy Arnica Montana 30c. I gave him 4-5 pellets, crushed and placed inside the lip between the lip and the gum (outside of meals), 4-5 times a day. He continued to be quite lethargic for the 48 hours his fentanyl patch remained on. However, as soon as the patch was removed, he was very nearly his old self again! I strongly recommend Arnica for any situation where trauma or bruising is involved.
To make a long story short, we followed up at my vet's office - Dr. Obando on Mercer Island - about a week later. She recommended I supplement Tucker with fresh liver every day to compensate for the loss of the spleen (see above re: anemia). I did this as suggested. On the next visit, two weeks later, his platelet count was exceptionally good. I discontinued the liver at that time. Tucker recuperated marvelously, and three months later he was marching proudly in the Maifest parade, no worse for wear, and not even sporting a scar (the emergency clinic used dissolving sutures)!
It is apparently quite rare in most breeds to see an "uninvolved" spleen issue (according to emergency clinic vets and Dr. Obando). Most vets, when confronted with splenomegaly/splenic torsion will immediately suspect hemangiosarcoma (a form of cancer which originates in the endothelium, which is the lining of blood vessels and spleen4) or other underlying disease cause. However, in our breed, "uninvolved" spleen problems seem to be more the norm - at least as I've learned from my own discussions with others having experienced spleen problems. If you find yourself in the unfortunate position of having a dog with splenomegaly/splenic torsion, please do not panic until the test results are in (but do have the tests done!). My own dog's biopsy was negative for hemagiosarcoma and no other underlying cause was ever detected.
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Breed Introduction
All of us with Swissies were likely told by our breeders and others that bloat and GDV (Gastric Dilatation/Volvulus2) incidence is a risk in our breed, as it is in most large, deep-chested breeds. I imagine we all have tried to educate ourselves about the warning signs and symptoms of bloat (the reference chart in the last Summit being one good resource), some of us have taken pet first aid classes, and others have even armed themselves with "bloat kits."