Ok, I have a few pictures to show you. I will tell you this about it. The pictures are of the skin of a 4 year old Golden Retriever. He has a brain condition which required him to be put on long term phenobarbital and prednisone. The neurologic issues resolved with medication. Approximately 6 months after the medication was started, this happened:
The lesions are hard and crusted. The hair that is attached easily pulls off. There is some itching/discomfort associated with it but overall the dog is doing well - happy, eating, etc.
This WAS biopsied and so we do have a definite diagnoses.
Any thoughts or further questions?
I realize what *I* commonly see, may be "weird" or "rare" or frankly, SHOCKING, to most of you.
One of the most common things I see is dogs or cats with late stage cancer that were showing no signs until the day or two before they came into my office. Sometimes, thankfully rarely, people ignore signs like weight loss, lethargy, vomiting and inappetence and let it go for months. Though THAT does happen. It saddens me because there are times we can help those pets.
We have to remember our pets often deal with pain and disease better than we do. It's truly part of their "predator" nature to hide illness. Or else they could become "prey." It's truly amazing what processes animals are going through and yet they continue to eat and greet us as happily as ever.
But remember, we too can have things going on that no doctor in the world could see and often we have tests that are negative or normal while severe disease rages on inside.
The other day an older German Shepherd came in (7 years) for being lethargic and a distended abdomen. The owner noticed this. Now, because I know what I know and do what I do, one of the top things that came to MY mind - breed, age, signs - bleeding splenic tumor. This is very common in our GS, Goldens and Rotties as they get older. I've seen dogs come in fine and they went out for a run and collapsed because the bleed was fast. I've seen dogs I've examined and palpated come back in 3 months later with a mass that was NOT there before.
This is how cancer works - in us and them.
So this dog needed some tests to confirm this and also to see how good of a surgical candidate we were - always possible for other diseases to be going on AT the same time. Dogs, cats and people can live just fine without a spleen.
Other questions:
1. Was there any evidence of spread (namely to the chest)?
2. How anemic was this dog (do we need a blood transfusion)?
Dogs can have benign or malignant splenic tumors. The only way to know is to remove the spleen and send tissue to the pathologist. The most common cancer is hemangiosarcoma.
The dog was moderately anemic (not in need of a transfusion) and the x-ray confirmed a bleeding mass with loss of detail on the image in the area of the spleen. An ultrasound was done to check for any spread to the liver (other types of cancer would do that - mast cell, lymphoma).
We do these things to see what kind of surgical candidate the dog is AND to help the owner make the most educated decision possible. This is a serious surgery and they can die from secondary cardiac arrhythmias, blood clots, etc.
So, we take the dog to surgery and this is what we see:
What you see is a big mass on top of the spleen, a smaller one off the front edge and then hundreds of little red/brown masses all over the omentum, and I mean, ALL over. There are more than what is even in this picture.
This was not going to be visible on any other test other than..bingo: an exploratory surgery. Sometimes the best test is using your eyeballs!
There was evidence that some of these "little" spleens had started to grow and bleed out. There was NO way this was resectable. The owner was notified and chose to humanely let the dog go while she was sleeping. No other choice really. The kindest but hardest one.
We thought we could fix this one. We couldn't. We didn't know until we got in there. This is what happens sometimes.
This is another picture of the same cat's feet a month or two later. I'm not sure if you can truly appreciate how crusted and thickened the toes/feet are. This was present on all four feet. I cannot imagine this would be very comfortable for kitty. I didn't have a second picture of the face/ears but suffice it to say it was much worse and the cat was now clinically not doing well. She was losing weight and not very active. This, despite steroids.
So what is this?
Well, ONLY a biopsy of the affected tissues would tell us but the most likely two differentials, given the lack of response to typical skin medications, the severity of the disease and the progression to affect overall health are:
1. Autoimmune disease
2. Cancer (neoplasia)
We do see cancers that present ONLY as generalized skin disease. It's not as common as other types of cancers in pets. Cutaneous lymphoma is a "more common" one seen in dogs.
Also, other types of cancer can result in skin disease from the suppression of normal immune system function.
Autoimmune diseases are a group of conditions where the body attacks itself. In this case, the immune system is OVER doing it's job! These are often treated with high (or immunosuppressive) doses of steroids. This cat didn't respond AT ALL to the steroids. However, there are cases where other, more potent medications are required. These often carry with them more serious side effects, so we would never want to just give them without a confirmed diagnosis.
The owner had declined biopsy from the beginning due to cost and so we will never know. The cat was euthanized the day I took this picture due to her poor and declining quality of life. She was 5-6 years of age.
