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.
Mary Anne Kochut
November 17, 2020
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VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email email@example.com.