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
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:
STORY: The Fight for Life
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!
go to the local ER
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.
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.
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.
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
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.
|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.
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.
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.
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
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.
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