Severe blood loss causes a dog's gums to become white.
There are all sorts of pluses and minuses to the world of veterinary medicine when compared to human medicine, but in one area veterinarians come up clear winners: In all but the most vanishingly rare situations, dogs don’t get heart attacks.
Dogs almost never develop the same sort of hardening of the arteries, known as atherosclerosis, that makes middle-aged men and women clutch their chests, drop the 3-wood and shuffle off this mortal coil. Human medicine has all the shiny toys, insurance money and human-life-is-so-important stuff going for it that it makes veterinarians green with envy, but I thank my lucky stars every day that I don’t have to deal with heart attacks.
The canine equivalent, at least in my opinion, is probably a phenomenon known as ‘spontaneous hemoabdomen' even though it is not related to coronary artery disease. Your average veterinary ER probably sees two or three of these types of cases a week, and as the pet population ages they are bound to become even more common.
The thing about hemoabdomen cases that makes them so frightening for pet owners is that they seem to come out of nowhere, and they hit like a random, unforeseen lightning strike on an otherwise sunny day - like a human heart attack. One moment their dog may be happily cavorting in the yard, and the next they’re lying on a gurney in a veterinary ER fighting for their lives.
In most cases, a tumor on the spleen, which may have been growing for weeks in the abdomen without being detected, ruptures and starts to hemorrhage internally. This condition is called hemangiosarcoma. Dogs can bleed to death within a few hours if the bleeding continues unchecked. They can be quite literally felled in their tracks.
The bleeding is internal, and there is no evidence of bleeding that can be seen externally by the pet owner. All they know is that their dog was fine one minute, then collapsed and couldn’t get up the next. No blood in the stool, none in the urine, none anywhere; just a big pool of blood building up inside the abdominal cavity. Blood that should be circulating and bringing oxygen to tissues is suddenly settling in the abdomen. Shock and low blood pressure set in almost immediately.
The signs are typically a sudden onset of weakness and inability to get up. These can happen in any breed of dog, but the majority are in dogs that share a genome with German Shepherds. Golden Retrievers, sadly, probably take the number two spot. Any dog over eight years old that’s related to a German shepherd or Golden is potentially at risk for a spontaneous hemoabdomen, and this disease should be considered in any dog of this type who has a sudden episode of unexplained weakness. Check their gums, as they are often as white as a sheet during this event.
In about three quarters of the cases, the ruptured mass on the spleen is due to an aggressive malignancy called a hemangiosarcoma, a really nasty cancer that grows out of blood-forming organs (the spleen is a tongue-shaped, flat organ that sits on the left side of the abdomen, all snuggled up to the kidneys and other giblets). Hemangiosarcomas love to grow rapidly, spread to other parts of the body and, worse, they usually eat powerful chemotherapeutic drugs for lunch. It is just a miserable type of cancer to have, and most patients with them are not around for long, even with a full-court press of medical intervention. I hate diagnosing hemangiosarcoma because it usually means I have just pronounced a death sentence for a patient.
For that lucky one out of four that doesn’t have a hemangiosarcoma, they likely have a benign and slow-growing tumor called a hemangioma that just decided to break open and start bleeding (we keep the names similar to confuse the tourists). These, fortunately, can be completely cured through surgery. You still have to deal with all that life-threatening hemorrhage and accompanying scariness, but at least you get good news when the biopsy comes back.
The survival rate for dogs with hemangiosarcoma after emergency surgery to stop the bleeding is, on average, about three months. That time span can be doubled with the help of powerful chemotherapy, which is an option that all owners should be offered. We tend to not be as aggressive with chemo for our pets as they are with people, so that can mean fewer side effects. For some folks, six months of good quality life is a blessing, while for many that is nowhere near enough to justify the medical high-wire act that must happen to even hope for a little survival. The word ‘cure’ is almost never uttered in the same sentence as the word ‘hemangiosarcoma.’
Many owners decide to not pursue surgery when we make the diagnosis of hemoabdomen, and I can’t blame them. They are usually looking at a 75% chance that their dog has a disease that will very likely kill them inside of 90 days. The alternative is a fast and painless euthanasia, or, in some special cases, a death at home. Despite all the drama of this disease, it is usually totally painless and I will honor requests to take pets home to die if the owners are educated about what may happen. For those that elect to pursue treatment (I would say about one-third to one-half of owners opt to treat), the goal is to take them to surgery as soon as they are stabilized. This means blood transfusions and other methods to try and make them the best anesthesia candidate we can, quickly.
All of this comes at owners with dizzying speed. I am often in the unenviable position of trying to get them to make a timely decision on a very expensive, delicate matter with little information and no guarantees. Unfortunately, lengthy Q&A sessions in the middle of this type of crisis only makes the prognosis grow more dim for the patient as their lifeblood seeps into their abdominal cavity. I have had patients go from the front door to the surgery suite in under an hour, and sometimes with only the briefest of introductions of myself to the pet owner.
However, I recognize the need for people to feel that they have made the best and most informed decision that they can in this scenario. I try to answer as many questions as time permits for the patient, and steer them to make a decision if we start covering the same ground repeatedly. I want to note one important point right here. This is an excruciatingly difficult point in the lives of pet owners, and it becomes a critical juncture for me to talk to the owners, hear their concerns, and help them make the best decision we all can, given the imperfect information we have on hand. Unfortunately, in this case the patients simply don’t have time for anything but a rapid decision.
The cost for surgery and ICU aftercare can easily run into the thousands (many will hit the $5,000 mark before discharge), and many will have post-op complications that can escalate that amount.
I had one case several years back where post-op complications kept the dog in the hospital for a week, at a cost of over $10,000. The biopsy came back shortly after discharge and was what we all feared worst: hemangiosarcoma. The dog, owned by a very nice and caring physician, lived for another month before the cancer grew back and caused more bleeding. For most of us, $10,000 for another month of life would never fit the budget (or, for some people, their concept of what is right), but for this man, he assured me it was the best month he ever had with his dog. They hiked, they fished, they lounged on the couch eating Doritos and drinking Yoo-Hoo. They did everything but go 2.7 seconds on a bull named Fu Manchu. They lived like the dog was dying, and got everything out of it they could. He was happy with his initial decision and told me, as I put his dog to sleep, that he would have made it again.
For a bad outcome, that’s a pretty good way to look at it.
96 Comments
Anna X.
March 14, 2024
My beloved Youpi 13 years old was diagnosed with lymphoma in May 2023, completed chemotherapy in September and until March 2024 was in complete remission happy and healthy. All of a sudden one day she vomited once and two hours later started breathing heavily. We rushed to the clinic where she suffered two cardiac arrests they rescucitated her and she was diagnosed with hemangiosarcoma of the heart (very aggressive and asymptomatic cancer). The mass ruptured and caused cardiac tamponade. But she suffered serious neurological symptoms from the arrests.. she could not see, she didnt recognise us, could not move. We decided euthanasia.. I believe we could not have done anything more.. She will always be our fur baby, always in our hearts.
Sheryl Lowe
September 7, 23023
Wow, so many heart wrenching stories and I'm so sorry for all that has gone through this. It may be comforting to know all of your stories have helped others, including me.
Our 11 year old Lab retriever was diagnosed with this (probable) about 12 days ago. Although the emergency vet recommended immediate euthanasia we decided to take him home for at least one day to say our goodbyes and bring him back to put him down the next day. Once we got him home that also changed again, he has been acting himself basically since we brought him home, running around, eating, begging for food, scratches, fetch and cuddles. Once I started researching I realized there was no treatment in his future, as short as it may be, but we are taking it one day at a time and he may pass any time or we may have to take him back if he is suffering but we are enjoying every minute of the past 12 days. I'm literally by his side all day and only leave to do necessary shopping for his foods and vitamins. If we hadn't seen the xray we wouldn't even believe he was sick, he's acting so normally. In hindsight some things I thought was just a little quirky were probably early signs but we hadn't ever heard of this "common" cancer in dogs. Looking back, there were tiny things that I now question if I had ever been told of this predisposition in Retrievers I would have picked up on the tiny clues. About 2 months ago he had started being a little vocal during his sleep, nothing that sounded like pain or distress at all, we've had many dogs that "talked" constantly but Shad had always been so quiet. I thought it was kind of cute, something silly he just started doing (like all silly dogs), if only after paying thousands of dollars in vaccinations and tests for lyme, rabies, distemper, etc,etc, why didn't they ever mention cancer.. once he reached at least 10 I'll never understand why they didn't even ask us if we wanted testing for that.. and give us the option of paying extra for more frequent checkups or tests? We would have gladly paid for a blood panel,xray,etc. Our pets are our babies and just like humans get preventive tests, why can't animals? I get preventive tests all year long in order to catch something early before it's fatal. I know it's too late for my Shad boy but I wish it would still change, our dogs deserve the best we can give and we just aren't given those options. My Shad is still with us and I truly adore the vets and vet hospitals for everything they do, I just feel so cheated because I wasn't aware. My dogs from now on will be seen every 6 months and have xrays or blood tests specifically for cancer. It seems so surreal to look at and play with Shad and know that he doesn't realize it might be his last day, his last fetch and he won't be in our lives anymore, and that will all happen within days or weeks. The vet already had a catheter in his leg to euthanize him within an hour and I told them they all had to wait until I got there so I could say goodbye, it was the longest 20 minutes of my life. Once I saw him he was so happy to see me and he was so lively I just couldn't let them kill a completely happy dog. The vet didn't tell us any other information that we might need for home care and we had to ask for something for pain, he was upset with us for taking him home and kept pushing for euthanasia immediately. Unfortunately my husband doesn't like conflict and just agreed to it without asking any questions or asking me. They almost took away this long and loving goodbye, something that has made a huge difference in how I'm processing it all. This page has helped me tremendously in being comfortable with our decision to bring him home that day. My prayers for all of you before and after me. I've had many dogs and each one feels like the most special one, but this time.. Shad boy is the most special of all my special babies. Ask questions, follow your heart, and cherish them all.
Linda Sanders
August 25, 2023
My dog just had to be put down because of a mass that ruptured. my question is we have his brother as well, can he get the same thing being they are brothers.
Carole
February 24, 2023
That is the most comprehensive explanation of what’s just happened to my precious dog. We chose to put her to sleep when we were told her abdomen was full of blood, and have been racked with pain and guilt. What a blessing to read this breezy, plain English account of what happened to her, after all the conversations with our emergency vet that left us bereft and bewildered. What a brilliant attitude and an absolute blessing .
Debbie
January 16, 2023
We lost our 4 year old Dachshund on 1/7/2023. He was an extremely playful and healthy dog. Very sweet and active. On Saturday, he seemed fine. Fed him at 4. Took him out around 6. He did his business but when he came in he didn't want his treat. Which was odd. I noticed his chest was heaving up and down very quickly. He was not panting. After about 30 minutes, I decided to take him to the emergency animal hospital. I was about to pick him up and leave and he got up, walked around the kitchen then collapsed in his bed. He lifted he head and took a big gasp and died. There was a pink colored mucus coming out of his mouth which I know to be internal bleeding of some kind. It all took place in less than 45 minutes. He was not in any pain. During the entire ordeal, he kept wagging his tail and laying next to me. Miss him very much. Leaves you feeling very helpless.
Jackson's Dad
December 24, 2022
Jackson is 14 yr old German Shepherd mix. He was diagnosed with a tumor on his spleen. It bled some the other day which when we found out during vet visit. He’s been home, taking Yunnan Baiyao So far he’s been eating, going for walks, tail wagging and lots of snuggling. I’m struggling with understanding if it ruptures, will it be painful for him. Do I let it happen or schedule the vet? I feel like I’m robbing him of time if he’s feeling fine but I also don’t want the end to be painful for him
Gail
December 23, 2023
Our Lab, Rebel, was perfect on 12/20/22 and the next morning, could hardly walk. We thought he got a hold of a bag of beef jerky because we found a wrapper. We thought his tummy was just hurting because he had thrown up. We watched him until the afternoon, and when his breathing was not right, and gums pale/white, we rushed him into our vet who assumed it was a speenic rupture. We wanted to find a surgeon to remove it and called for 2 hours to finally find someone who would do it late on the 21st but by the time we drove the 1.5 hours, he was in bad shape. The vet made us feel it was dire and the outcome was bleak and that the exploratory surgery would run $9K - $11K and may have a bad outcome. His HR was 220 and systolic was 70. He was clearly dying on the table. We surrounded him with the entire family. As soon as he was wheeled into the room we were going to let him finally be at peace, he raised his head and shoulders up and look at us all. It was like he was finally at ease because we were all with him. He laid back down, eyes rolled back, heart racing and we loved on him and let him know it was ok, he can relax, we are there. Then he let him go. Reading the end of your information about the Vet who chose to do the surgery makes me second guess our decision. I miss him so much. I wish we would have had that week to love on him, let him east steak and chicken and butter, (for some reason he loved the smell of butter) and made sure he knew he was the best thing ever. I hate the second guessing.
Thank you for this article. I woke up angry this morning and between tears and anger, I started researching to find answers. This article helped. But there will always be that small question in the back of my head.... did we do the right thing.
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