Most stories about dogs with the deadly cancer hemangiosarcoma end sadly and this one does too. Just so you know. But I want to tell the story because canine hemangiosarcoma is so sneaky and can be hard to diagnose. For Summer, it all started with a backache, though it turned out not to be the main problem.
Hemangiosarcoma is a type of cancer that originates in the blood vessels and their linings. It is also called angiosarcoma and hemangioendothelioma. In dogs, visceral hemangiosarcomas are usually in the spleen, liver, or heart, and are almost always fatal. They grow fast and they bleed, episodically or explosively.
Summer had a couple of flare-ups of intervertebral disc disease in her last years. The first one was from an obvious cause: we were playing with the garden hose. She loved to jump and bite the water. She jumped one time too many and landed wrong and very soon after was experiencing back pain. I was familiar with how dogs’ posture can change with that particular problem because I had had two previous dogs with back issues and I took her straight to the vet.
Summer got a course of steroids and muscle relaxants and soon seemed as good as new. I didn’t let her jump anymore when we played with the hose and was more careful with her activities in general.
She had another bout of back pain a few months later, and this time the cause was not obvious. But I saw that posture again, took her to the vet, and again she responded well to the medication.
In June 2017, when she was 11 1/2, she had a physical with a full blood workup. Everything looked great. I was working on a blog post about how special she was, having no idea that it would become a tribute.
On July 21st, we were playing some very active training games. Too active for a senior doggie, and she slid and fell. She was in that “backache” posture again a few hours later. She was panting and in a lot of pain this time. It was after hours and I took her to the emergency vet clinic. I didn’t crate her in the car because she was so weak that I was afraid I wouldn’t be able to get her out. She threw up on the way to the vet.
Vet Visit 1: ER Vet 7/21/17
After ascertaining that she probably wouldn’t bite him, a tech carried Summer into the clinic. The ER vet was thorough. He reported to me that he tested reflexes and the back issue was affecting all four of her legs. He showed me which part of the back was likely affected. He mentioned that the nerves that came from that part of the back also went to the heart and lungs so impairment could become serious. He said we were “not nearly at that point” but he wanted me to know. I had brought the meds that my regular vet had prescribed the last time, but he said he preferred a different approach. He prescribed gabapentin and meloxicam. Summer didn’t perk right up, but over the next two days got a lot better.
I needed to accommodate her infirmity. I have 12 steps down into my back yard and we worked out a system of walking around the side of the house—day and night—to avoid the steps. She was a little too big for me to carry safely down the steps. It would have been great if she would eliminate in the front yard, but she refused to go that way. I have no idea why. That refusal was a completely new behavior for her.
The pain started to dwindle, but her behavior got a bit strange. She would avoid certain areas of the yard, peering around, seemingly afraid of part of her regular areas. She started acting a little like my dog who had dementia, standing in the bathroom, staring off into space, seemingly unable to turn around to come out.
Vet Visit 2: Our Regular Vet 8/1/2017
On August 1st, I took Summer to my regular vet. She had finished the course of the RX prescribed by the ER vet, but she was still showing pain and discomfort intermittently. She panted a lot. It may have been pain, but she was also clearly hot—I started setting up a floor fan for her and she would lie in front of it day and night.
My vet checked her out. She showed me some sluggish responses in her feet that indicated neurological problems related to disc disease. She palpated Summer’s back and identified the same area the previous vet had said was probably the location of the problem. She suggested steroids and muscle relaxants, and I was glad to switch back to that strategy. We both believed that the gabapentin was causing her strange behavior. But Summer didn’t bounce back as she had previously. I texted with the vet the next day because Summer was still very uncomfortable, and she said Summer could also have tramadol to help control the pain. I filled the prescription and ended up giving her the high end of the dosage the vet suggested.
Vet Visit 3: ER Vet 8/13/17
We were in the weaning down phase of the steroid treatment and Summer was having one pill every other day. She was still taking tramadol, and still a high dose. She had never felt great on the steroids and now she was feeling worse again. Sometimes she would just suddenly lie down in the yard while walking. We ended up at the ER vet again on a Sunday afternoon. I felt I had to try again. It was the same practice, different vet this time. They were very busy and we were there for four hours.
This vet couldn’t detect any pain in Summer’s back. She wrote down her symptoms as seizures, “risk of ” back pain, and “risk of” dementia. She was seeing the zoning out behavior that had started when Summer was on the gabapentin. I realized she could only advise on the symptoms she could identify but this was frustrating. She said we could do X-rays but she didn’t think they would show anything. Since we had already been there all that time, and it seemed to me that we were eventually going to have to do X-rays, I asked them to do a set.
The vet showed them to me. Summer’s back looked pretty good to her—no gnarly arthritis or anything obvious. She showed me a couple of places where the discs looked a bit too close together, which could indicate a problem. She didn’t notice the big round blob in Summer’s abdomen that was visible on at least two of the slides. I did, but I didn’t know what her abdomen was supposed to look like so didn’t mention it.
I asked the vet what I should do since my dog really was still in pain. She said to keep giving her the tramadol if that was helping. (I guessed it was.) She said I could talk to my regular vet about putting Summer on an NSAID, but that there was supposed to be a two-week washout period between the steroids and the NSAIDs. So I took Summer home and didn’t schedule another appointment right away. Two vets had suggested joint supplements so I bought some.
Summer got more restless at night. She started lying on her side almost all the time when she lay down, preferably next to an air vent or the fan I kept running for her. She started licking the bed covers sometimes, which I knew could be a sign of nausea.
August 20, 2017, was the last day she had a steroid pill, and the last day she ate normally. The next day she wouldn’t eat some of her usual favorite foods. I scheduled an appointment with the vet for August 25th. I was still trying to give some time for the steroids to wash out. But I felt like she was starting to fail physically.
On Thursday, August 24th, Summer was running a fever and also still not eating. I wondered suddenly about tick-borne diseases. I had already had a rough experience with one dog with that. Many of Summer’s symptoms matched. I called the vet practice to see if I could change Summer’s appointment to that day. I prepared materials for the vet: some videos I had taken of Summer practically collapsing, and the X-rays.
Vet Visit 4: Our Regular Vet
I brought my vet up to date and showed her a video, then the X-rays. She pointed to the white blob in Summer’s abdomen on the X-ray and said, “I don’t like the looks of that.” She immediately started telling me about tumors on the spleen. I was familiar with hemangiosarcoma but was stunned at this development. The owner of the veterinary practice, a board certified internal medicine specialist, was there and did an ultrasound of Summer’s abdomen.
My vet came back looking grim but said there was some hope. It did look like a hemangiosarcoma, but because it was already so very big and they didn’t see any metastases, there was a possibility it was a very rare, benign type. She said that she normally didn’t recommend surgery because with the malignant tumors the life expectancy was very short even after removal. But if it were her dog, she would get the surgery because of how the tumor looked. And get it ASAP. I looked at the image of that big blob and thought about what could happen, what would happen if this was a hemangiosarcoma.
We scheduled the surgery for the next morning. She told me to be ready for a phone call during the surgery. If the tumor was metastatic, I would need to decide whether to remove everything they could and wake Summer up again or have them euthanize her.
I thought I had gone to the vet with a dog with a bad back. And now I was facing possible euthanization in less than 24 hours. But even in my stunned state, I knew that if the tumor were metastatic, that’s what I would opt for. Summer had had a month of discomfort, the last 5 days of which had been pretty miserable for her. If I had them perform surgery on the metastatic tumor and wake her up again, she would have to recover from major surgery with no future except more tumors coming very soon. It wouldn’t be fair.
I took her home and proceeded as if these were our last hours together. Her appetite was poor, but she would eat chicken baby food and beef jerky, so I gave her tidbits through the evening. We sat on the bed together with the other dogs locked out. I wished I had spent more time with her by herself. She loved just being with me. The other dogs didn’t like her and she didn’t like them. We made those 18 hours count.
In the morning we sat on the bed just a little bit more before our dear friend came to pick us up. I gently petted her head and she would put her paw on my hand to ask for more when I stopped. I told her she would feel better by afternoon. That was the only true thing I knew to say about the future.
Leaving her at the vet’s was horrible. I had dreaded it. I could barely think about the fact that possibly her last couple of hours on earth were going to be in a cage, scared, waiting for surgery. But I had no choice. And she had been through procedures before and I had always come back for her. I hoped against hope that she wouldn’t be petrified; that it would just be another episode at the vet for her. One she would survive.
This is one of the many reasons that it’s a really good idea to condition vet visits to be a positive as possible for our dogs. And even to include procedures that “take the dog to the back” so she could get some practice with that.
A technician called at 10:45 AM to tell me they were starting the surgery. At 10:55 AM they called again. This time it was one of the veterinarians and as soon as I heard her sympathetic voice I knew the news was bad. They had found tiny cancer metastases all over Summer’s abdomen in addition to the giant tumor. And the tumor was bleeding. There had not been blood in her abdomen per the ultrasound the day before but there was no. Weeping, I told them to let her go.
In a later conversation, my vet said that the tumor had probably been bleeding episodically. That’s why she would feel really bad for a period, then recover and clearly feel better.
I’m not upset at the ER vet for not noticing the tumor. At that point, the outcome was predetermined. All that would have happened is that I would have had 10 fewer days with her. I’m sorry that for 5 of those 10 days she was feeling badly, but I’m selfishly glad we had them. From most of the stories I have read, this is actually one of the less awful hemangiosarcoma experiences. Summer was spared the acute pain and trauma of a bleed-out, and I have read stories where it took much longer to diagnose the problem. By all appearances, she was feeling quite good at the beginning of July. She had episodes of pain and discomfort through late August, but things didn’t turn really bad until four or five days before she died. Her last night was a good one and she seemed comfortable and was calm on the morning of her last day.
I do believe she had an episode of disc disease. Both vets did neurological tests and had the same diagnosis. But it’s possible that our rowdy training that day caused the tumor to bleed, rather than causing a back problem. But I don’t think so. Her abdomen was never tender and her back was. It just made things really complicated when trying to track down the serious problem.
I debated making this video, but it seemed important to document the episodic nature of her pain. That’s part of what made it difficult to diagnose.
Note about the video: while perhaps not a really smart thing to ask an 11-year-old dog to do, the jumping in and out of the bathtub training at the beginning of the movie is not how Summer hurt her back.
If your dog exhibits symptoms of apparent pain, weakness, or intermittent fatigue, see your vet. It could be so many different things, but you and your vet need to know.
- Unsung Summer (this is a tribute I wrote shortly before I knew she was sick)
- A New Resource and Our Rally Weekend
- Letting the Treat Fit the Feat: A Real World Application
- What Summer Learns an Alternative to Being the Fun Police
- Ground Scratching: Why Does My Dog Do It?
- Summer’s Turtle Diary
- What Is Summer Saying? Observing a Bark
- Miracles Can Happen: Summer’s Good Behavior Generalizes
Copyright 2017 Eileen Anderson