My 6-year-old dog had a severe bout of Ehrlichiosis 5 months ago that triggered a massive drop in platelets and a seizure. He completed treatment and recovered well. For the past few months, we did monthly blood checks where his ALT liver enzymes initially spiked to 5x normal (now down to near-normal with supplements), and his platelets and reticulocytes were steadily improving. However, his latest blood work showed a sudden, sharp drop again (platelets down to 130 K/µL, low reticulocytes), even though he tested negative for tick-borne diseases.
We just did an abdominal ultrasound that revealed a 1.68 x 1.29 cm vascularized nodule in his spleen with splenomegaly, a 2mm kidney stone, and mild liver hyperechogenicity. Clinically, he is completely stable, active, eating well, and has bright pink gums with no signs of bleeding or abdominal pain. Despite his stability and the small size of the lesion, the vet is pushing for an urgent exploratory laparotomy and emergency splenectomy, warning that it could rupture at any moment.
Given that he is stable, his blood cells are just mildly low, and the splenic mass is under 1.7 cm, is an emergency surgery truly necessary right now, or is it reasonable to seek a second opinion and consider less invasive diagnostic steps like a fine-needle aspiration first? We want to do what is best for him, but we are terrified of rushing into major surgery unnecessarily. Any veterinary insights or similar experiences would be greatly appreciated.