Lost my boy suddenly to hemangiosarcoma
We lost my dog, Buddy, two weeks ago. He was 13 years old and 110 pounds of sweetness and love. One day he was playing with his friends and then the next day he was gone. Tuesday night he seemed lethargic, but we thought it was from being at his daycare all day with all of his girlfriends. He didn't seem to want to eat his dinner but reluctantly came when I told him to eat. In the morning, my husband tried to give him his thyroid pill, but he refused to take it, which was unusual. He still seemed lethargic. He ate his breakfast but seemed very uncomfortable afterwards – he’d try to lay his head down but would lift it quickly up. I told my husband that Buddy was acting weird, so my husband said to watch him and call if he got worse. He left for work, and then 15 minutes later Buddy lifted his head up from the floor and started breathing strangely, in large puffs, then very rapidly. He got up and came over to me, but just stood there like a statue staring at the wall. Then his hips started to lean to the side. I ran over to him and held him up, but he was swaying back and forth as if he would fall over. He seemed to get steady enough to go outside. He went to the bathroom then came back in and as he walked into the house his hips started falling again and he lost the use of his back legs. They were crossed and his whole body was weaving back and forth. I managed to get his leash on and we walked the very long stretch down to the car with me trying to hold up his hips as he dragged his back legs behind him. Somehow I lifted him up into the van.
We got to the ER and they gave him fluids and performed a chest X-ray. They told us he was in shock and had lots of fluid in the pericardial sac around his heart and in his lungs. They told us they had to remove the fluid from around his heart as it was collapsing under the pressure and he looked very anemic. They performed a pericardiocentesis (tap) to remove 250 ml of fluid from around his heart. During the procedure, he developed an irregular heartbeat, which resolved when the procedure was complete. They gave him fluids. The vet told us he may have a tumor that ruptured and that he was in very bad condition and might not make it to the next vet so to prepare ourselves for that.
We safely transferred him to the next clinic and they took him into the back room. We waited for an hour and then were taken into a waiting room. Soon thereafter the vet came in and told us that our dog probably had a tumor that was bleeding out into the pericardial sac. She said he had muffled heart sounds and some fluid surrounding the lungs. His mucous membranes were pale, he had “mild pulsus paradoxus,” but he was alert. She said to find out more about what was going on, they would have to do an echocardiogram under sedation. She said the tumor could be idiopathic, or unfortunately could be hemangiosarcoma, a malignant cancer. She showed us the estimate for the procedures, and we said clearly that we would spare no expense to make our baby better. The vet seemed happy about that. She said they would sedate him for the echocardiogram. She left and we waited for maybe another hour, thinking that perhaps it was nothing more than a fatty tumor or an infection.
When she came back in her face said it all. She said that our Buddy had hemangiosarcoma – a large malignant tumor in the right side of his heart. The fluid that had been removed at the first vet had filled all the way back up by the time they gave him the echocardiogram and was compressing his heart again creating a tamponade (which she explained was the heart collapsing on itself). He was in tamponade at the first vet and then again at this vet. She said he was in very critical condition.
We stared at each other in disbelief. Our dog had been playing the day before and had no known issues besides arthritis and hypothyroidism. We had never heard of this cancer. We asked her what the treatment was for this cancer, and she said that unfortunately there was nothing they could do. There was no treatment. My husband said, “So, you're saying there is no treatment for this?” And she reiterated, “No, there is no treatment.” She said he most likely wouldn't make it through the day because he wasn't stabilizing, and that the best thing to do was to euthanize him – it was the most humane thing we could do. We asked her what she would do if this were her dog, and she said she would let him go.
We asked for some time alone. We sat crying for a long time and then began searching for information about this type of cancer on our cell phones. We saw the prognosis for this type of cancer and that the expectancy was just a matter of hours, days, or weeks. At best it could be months. The vet told us his condition was critical. We thought about our dog – how he only ever wanted to be with us, the panicked look he’d get when we would leave him at home (which rarely happened), how he would come to me like a baby when he didn't feel well, looking confused, wanting me to fix it. The two vets had told us that he probably wouldn't make it through the day. He could pass away any minute. We felt like we had to make a quick decision. At any moment he could have heart failure. Everything had happened so fast. We were terrified he’d suffer, be in pain, or be alone when he died. So we made the decision to let him go in the room with us so we could be together.
They brought him in the room with us and we spent time talking to him and loving him. He was still very sedated but took a deep, relaxed breath – the type he usually took when he knew he was with his pack and could finally relax. Then the vet came in and gave him the injection.
We left in shock. He was just with us, and then he was gone. We took him to the first vet at 9:30 and he passed at 3:30. We had less than an hour to decide after his final diagnosis.
The days afterwards were ****. I was wracked with guilt, second guessing everything. What happened? Did we do the right thing? What had other people done with their dogs? We searched the Internet for two days and saw that many people had been able to extend their dog’s life several months after diagnosis. We saw that there were options. We were told that there were no options. We cried a lot and lost a lot of sleep. This is the worst thing that has ever happened to us. Our entire lives centered around our boy. We did everything we possibly could to give him the best life, and then it felt like we took it away in an hour. Why didn't we demand to talk to the cardiologist directly? Why didn't we give him another fluid tap?
I made an appointment to see the consulting cardiologist who had been at the vet that day so that I could find out more about what had happened. The appointment was shocking. We asked the cardiologist why our dog’s condition was so critical, and he didn't have an answer. He said he wasn't sure. We told him that the vet had told us that there were no treatment options. He looked confused. He told us yes, there were treatment options. We looked at him, stunned. He got very quiet and told us to read the report and recommendations he had given to our vet, and then he left the room. The report said that our dog had a 4 x 3 cm “large cystic and cavitated mass” arising from and moving within the wall of the “right auricle proximal to the right auricular tip and extending into the pericardial sac,” and that all signs were consistent with a hemangiosarcoma. The assessment was “cardiac hemangiosarcoma causing pericardial effusion with echocardiographic and clinical tamponade.”
The next page described treatment options based on a study from the University of Minnesota Veterinary Medical Center. They were pericardiocentesis (with the risk of another tamponade within a few days), pericardial window, subtotal pericardectomy, and chemotherapy.
The cardiologist came back in and took us back to see the echocardiogram, and it clearly showed the tumor and the tamponade (you could see the heart chamber collapsing). He said it would have been a bit more challenging of a surgery because the tumor was attached to the heart wall and was not an appendage, which is easier to clamp off. He didn't seem to want to give us any opinions at all. He said it was a terrible cancer and that he was sorry for our loss. I pushed to get more information out of him but he was holding back. He then asked us to return to the treatment room and he closed the door behind us. He said that we need to tell the medical director of the clinic that we were not given any of the treatment options, and to tell her that we were made to feel rushed.
We left the cardiologist’s feeling pure rage and grief – we felt like we were being told we basically killed our dog. I immediately called the vet who didn't give us the treatment options and she seemed very flustered. I asked her why she thought our dog was critical and she said because he had an irregular heartbeat even when she brought him in to see us and because his fluid had filled up again so quickly. Her argument didnt feel good enough to me at the time.
So, I talked to the medical director twice afterwards, and complained that we hadn't been given the treatment options the cardiologist had given to the vet. She talked to both doctors and called me back the next day. She said that she is sorry we weren't given all of the treatment options and assured us that she would make sure all patients would receive a written copy of their treatment options from here on out. She said the vet remembers telling us that she could perform a fluid tap, but warned us that he could die during it and that we told her we didn't want to risk him dying without us. My husband and I remember not being given any options. I asked the director why Buddy was so critical and she said that by the time of the echocardiogram his heart had filled up with fluid again, he had An irregular heartbeat and he was having trouble walking. She said if a dog gets a tap and stabilizes, they have a better prognosis and chance at treatment. The dog has to be stable before you can consider any treatment. Our dog hadn't stabilized after the tap, and she rarely saw dogs make it 48 hrs later who were tapped a second time. Our dog had technically been tapped twice because they drew out so much fluid, so it would've been a third tap, I believe.
I understand what she’s saying. However, I’m very upset that we weren’t given the full treatment options, that we didn't insist on talking directly with the cardiologist ourselves, and that we didn't give our dog a chance to fight. He was a strong boy and deserved everything we could possibly give him. I ask myself if we should've given him a tap at the last vet. Why didn't I ask for all of his vitals? Why didn't I insist on going in the back to see for myself the irregular heartbeat and weakness? Why didn't I ask to see his echocardiogram? I suppose we were in shock and that I had seen how bad he was that morning?
My husband is at peace with our decision because he knew our dog only ever wanted to be with us, his pack, and that we would never forgive ourselves if he died alone at the vet, or during surgery, or alone at anytime. He read about the prognosis and watched his own father die slowly of cancer. I'm wracked with guilt, though, because I always research and double, triple, quadruple check everything and somehow, it didn't happen at the most critical time of my life. Perhaps at the time it felt right to let him go with the information we were given (that he could die at any minute and that this is a terminal cancer), but now that I've been reading about how some people have been able to keep their dog alive for months, I feel like I failed my dog. I didn't give him a chance to leave like the warrior he was. He died peacefully and with us, but I feel like it was unnatural and I don't know if he was ready to leave. What if we had tapped more fluid and stabilized him? What if we could've given him chemo? Could he have had more days? Could he have died on his own terms?
But, a large part of me knows this: If we had tapped him a second/third time, he could've died in the back without us with him. If he had made it through the tap, he would've had to have been hospitalized and could've passed in the night without us there. If he made it through to the morning, we would have taken him home and he could've died alone in the night or during the day, possibly from suffocation. If he had made it to the surgeon, he would've had to have open heart surgery and could've died on the table. Most pills made him sick (he had chronic GI sensitivities) so chemo might've made him miserable for the days, weeks, or months he might have been able to make it. But it seems as if he wasn't going to make it for even that last day. Considering all of this, I usually feel like we made the right decision, but I have many many days where I question it and feel haunted by it. It happened too fast. I wish we’d taken a breath – called our regular vet, talked to the cardiologist, talked to someone else, gone in the back and seen all of the data. I wish I had asked for an autopsy. I wish I could've looked into his eyes when he was himself, one more time. I feel like he was here and then just disappeared. I don't know what he wanted. I feel like he had no say. He was sedated and then passed away. But it was peaceful, and he had no pain.
I think that this is a horrible, evil cancer. All cancer is evil, but this one is horrific. I'm hoping we did the right thing. I’m hoping that our dog forgives us. I'm hoping that other people in this situation or in any critical emergency are given all of the available treatment options and the time to think them through enough to make the decision that's right for them. I'm hoping that other people will have the strength of mind to take the time to make sure they have all of the information that they need and want to feel at peace with such an impossible decision. I guess we never know how we'll react until it happens to us. And maybe we do know what to do at the critical time.