— THE TWO FACES OF HEMANGIOSARCOMA —
As Experienced by Zeli and Bret Schulte
Introduction | Part 1 | Part 2 | Part 3 | Conclusion

March 26, 2007 — This week's DaDane is a continuation of an informative article contributed by Zeli Schulte. She is telling us about the painful and unexpected loss of two of her Great Danes, Circe and Grendel, to hemangiosarcoma. Zeli and her husband, Bret, live in Houston, Texas, with their remaining Great Dane, Grimm. They, along with Grimm, are mourning the loss of their beloved, long-time companions. Adjusting to life without them hasn't been easy, but they are workign on it.

Click here if you missed last week's installment, which ended with the following statement, "I vowed that Circe would not die in vain and that the next time we would be more aggressive with regard to diagnosis and treatment." Zeli's story continues:

GRENDEL'S STORY: The Fight for Life

On December 20, 2006, we were finally put to the test. I noticed that our 9.5 year old bitch, Grendel, seemed a little uncomfortable that day. I assumed it was because we had run out of the Deramaxx she was taking for arthritis. That evening Grendel refused to eat her dinner. This was very unusual because she was normally such a chow hound. I offered her some steak from my plate. She ate it, but afterwards she seemed nauseated. About an hour later she vomited but after that she seemed to relax. Her belly was not distended or rigid and she appeared to be resting comfortably. I wasn't particularly worried until my husband, Bret, noticed Grendel's head and limbs felt unusually cold to the touch. Something was wrong!

We couldn't go to the local ER
We didn't know what to do. I refused to take Grendel to our local ER after our past experience there with Circe, so I called Texas A&M University's vet hospital in College Station and described Grendel's symptoms. The vet student who answered the phone seemed to think I might be overreacting, telling me if there was a problem I should take Grendel to the local ER. She strongly discouraged us from driving up to A&M because our local ER was closer. However, she told me that as long as Grendel was not running a fever she should be okay. Unconvinced, I decided to pull an all night vigil with Grendel.

You would think that alarm bells would be going off by now, but they weren't. Grendel didn't look sick, just mildly uncomfortable. At 1am I woke her to see if she was any better. As soon as she walked outside for her potty break Grendel lay down in the grass with her head hanging down. Now the alarm in my head went off — this was exactly how Circe had behaved. I immediately woke Bret. Meanwhile, Grendel was going into shock. I felt that taking her to our local ER vet would be a death sentence, particularly after experiencing another near fatal misdiagnosis at that same ER less than six months after Circe died. So we made the decision to drive Grendel to Texas A&M — 2.5 hours away — where we felt she had the best chance. I just hoped she was stable enough for the long trip. Bret carried her to the car, being very careful to keep pressure off her abdomen by supporting her under her breastbone and her hip.

Texas A&M swings into action

What is Hemangiosarcoma? Hemangiosarcoma is deadly form of cancer that most commonly affects large dogs, including the Great Dane. It is a rapidly growing, rapidly metastasizing cancer that originates in blood vessels. These cancerous growths are usually found in a victim's spleen or heart, often with involvement of the liver, lungs or brain. Blood vessels feed into tumor site(s), which become engorged with blood. The tumors eventually rupture, causing the victim to bleed to death, often with very little warning.

After a white-knuckled drive, we made it to A&M. The doctors determined that Grendel was extremely anemic. They suspected her anemia was caused by internal bleeding so they performed an exploratory laparotomy. They were looking for splenic hemangiosarcoma. Unfortunately their suspicions were confirmed. They found hematomas on Grendel's spleen, plus a large mass in the middle lobe of her liver. They also found evidence of a rupture. When the surgeon informed us of the findings, he warned us that the prognosis for Grendel was not good. Hemangiosarcoma is terminal, and aggressively so. He pointed out that surgery to remove hemangiosarcoma tumors is very risky, and even with a successful surgery, some patients don't survive more than 10 days. He explained that surgical removal of the tumor does little to improve overall survival time because, in most cases, hemangiosarcoma has already metastasized before becoming clinically evident. Typically, microscopic portions of the tumor break off and spread through the blood stream to other internal organs. Hoping that Grendel would be one of the lucky ones who would survive long after the surgery, we decided to go for it. I felt that in spite of her age, Grendel would bounce back from surgery. She had already survived (thanks to A&M) a life-threatening bout with aspiration pneumonia two years earlier, and more recently she had sailed through another surgery at A&M. To my mind, if any dog could survive this crisis, Grendel could.

Emergency Surgery
At our request, the surgeon performed a splenectomy and a resection of the left middle lobe of Grendel's liver. Unfortunately there were serious complications during the surgery — severe blood loss, cardiac arrhythmias and hypotension. As often occurs in cases of hemangiosarcoma, dogs develop a blood clotting disorder. This is because blood clotting is occurring inappropriately inside the blood vessels that are created to support the hemangiosarcoma tumor. In effect, the tumor uses up all of the available blood clotting elements. This is what happened to Grendel during her liver resection. Her blood loss during surgery was so massive that it was beyond anything the surgical team had ever experienced. A second trauma team was called in to assist. Grendel was given two blood transfusions and eventually the two surgical teams together were able to control her bleeding, but not before they called to tell us they expected to lose her on the table.

Grendel miraculously survived the surgery, but she was not yet out of the woods. The surgeons informed us that the next six to eight hours would be critical. Due to her severe blood loss, she was facing cardiac arrhythmias and possible kidney failure. She was hooked up to a heart monitor and given oxygen. She had a urinary catheter inserted. She also continued to receive blood transfusions after surgery. Twenty four hours after surgery, Grendel's condition remained critical.

Two Days Later
Grendel was not standing after surgery and she was refusing to eat. This greatly concerned the surgeons. I was very surprised when the the vet student in charge recommended that we visit Grendel at the ICU to give her some moral support. (We have had a total of 7 surgeries at A&M University vet hospital over the course of three years, and we were never allowed to visit our dogs during their recovery!) We jumped at the opportunity. Unfortunately I had to stay in Houston to run our business and care for our 7.5-year-old Dane, Grimm, who suffers from Wobblers, but Bret was able to go.

Visiting Grendel at A&M
Bret did not tell me too much about his initial visit except that Grendel was very happy to see him. Little had changed regarding her condition. She refused to eat anything offered by Bret and/or the A&M staff. She was so weak that she couldn't summon the strength to stand, despite encouragement from Bret and physical assistance from the staff. Concerned that Grendel had not eaten for a couple of days, Bret requested the insertion of a feeding tube. He also asked the ICU staff to cover Grendel with a blanket because she was shivering so much. (The shivering might have been a side effect of the heart medication to counteract the cardiac arrhythmias or it could have been the result of post operative pain.)

The following day, when I was able to see Grendel for myself, I was shocked by her condition. Grendel was lying on a mattress on the floor of the ICU. Her eyes were closed and her head was hanging. Her four paws were severely swollen with edemas. Her abdomen was swollen and seeping a reddish fluid. She was hooked up to two monitors and there were several tubes coming out of her. She also had a staple through her nose for oxygen. When we called her name, Grendel opened her eyes and started howling hoarsely. To me, that howl was one-part greeting and two-parts anguish. She was longing for home. It was as if Grendel was finally able to express the anxiety she had bottled up during her painful ordeal in this strange place. The relief in her weary eyes at seeing us was clearly evident. During our entire visit Grendel would not take her eyes off of us, even though at times she had to struggle to keep them open. We both lay down on the floor next to her. At one point, when I looked up, I could see tears running down the face of the vet student who had accompanied us into the ICU.