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

April 2, 2007 — This week's DaDane is a continuation of an educational article contributed by Zeli Schulte. She is discussing the tragic loss of two of her Danes, Circe and Grendel, to hemangiosarcoma. Click here if you missed last week's installment, which ended with the following scene:

"...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."

And now, the next chapter in Grendel's fight for life:

Second Guessing
That night, after returning home, I asked myself if we had made the right decision to put Grendel through the surgery. After almost three days, she was still not standing or eating. Did I sentence her to a long and painful death among strangers? In my desire to save Grendel, had I instead created a creature of pain and suffering who in no way resembled the girl I once knew? Was it better to die suddenly, as Circe had, rather than to go through the misery Grendel was experiencing now? Bret believed that over time, Grendel would improve and reach the point where she could finally come home. Oh, how I hoped he was right!

That weekend, and over the Christmas holidays, we commuted to A&M daily. We would visit with Grendel twice a day, breaking for lunch and bringing back some tasty goody from a nearby restaurant, hoping she would eat it. On one occasion she did eat for us, but otherwise she continued to refuse food. The vets suspected that the various medications they were giving Grendel (all necessary) might be making her nauseous. They were also concerned because she was still unable to stand. However, we did get some good news. Grendel's blood tests indicated general improvement, plus she was producing urine. After her massive blood loss during surgery, there was a real possibility that Grendel's kidneys would fail. Luckily, the flow of urine, coupled with the data from her blood work, demonstated that her kidneys were functioning.

Grendel's Homecoming
Postoperatively, Grendel remained in the ICU for six days. During that time, she was receiving daily blood transfusions and being fed through a tube. On the fifth day, she was finally able to stand with assistance. The very next day, she was beginning to walk. The A&M vets were still quite concerned that Grendel would not eat on her own. Nonetheless, they decided to release her into our care. They felt that they had done everything that they could for her. Hopefully Grendel's appetite would improve once she was home.

That first night home was very challenging — for all of us. Grendel finally ate something, but shortly thereafter she vomited and then refused food altogether. (She even turned down cooked beef and liver!) Despite her nausea, Grendel was incredibly thirsty. She would drink large amounts of water at every opportunity. Per the vet's instructions, we encouraged this as best we could. Grendel's increased thirst was attributed to severe anemia from decreased liver function (as a result of the surgical resection) or else to possible kidney damage from her massive blood loss during surgery. Perhaps her insatiable thirst was due to a combination of both; the vets weren't sure. Whatever the cause, it was something we all had to cope with.

Our new routine involved getting Grendel up every 45 minutes, both day and night, to urinate and drink. Her abdominal muscles were still very sore after the surgery, so it was difficult getting her settled back down afterwards. The entire process from start to finish usually took around twenty minutes. Throughout that first week, I would set the alarm and get up at least 9 times each night with her. During the day, Bret and I would take shifts. our biggest problem continued to be Grendel's refusal to eat. This was even more serious at home where there was no feeding tube. Grendel was taking anti-nausea medication prescribed by the A&M vets, along with Pepcid A/C to decrease her stomach acid. Nothing seemed to work. I knew that if we could not get Grendel to eat in another 2-3 days, we would have to return to A&M to determine if her internal organs were failing. If they were, we'd be faced with another very tough decision.

Carafate Works a Miracle
I was desperate so I called our treating vet for her input. She suggested putting Grendel on Carafate, an ulcer drug that forms a protective coating over the esophagus and stomach. With A&M's approval, we gave Grendel her first dose. The improvement was almost immediate. Within an hour Grendel started to relax - for the first time in 2 days. Then she ate some Canine ID, which unfortunately she later vomited. However, after that, Grendel's appetite came back and she finally started eating. She was given Carafate three times a day. It had to be taken about 2-3 hours before any other meds and food. The time-frame was particularly important because Carafate can block absorption of other medicines and food

After the Carafate was introduced to her daily regimen, Grendel got much better. She was eating with gusto and it looked like she was gaining back some of the weight she had lost in the ICU. (We later learned she had lost around 15 pounds). The incredible swelling in her limbs was finally going down. She had more energy, so we had to carefully monitor any activity to make sure she was not overexerting herself. Meanwhile, we continued to watch Grendel's abdominal incision for signs of infection. The incision itself was still seeping small amounts of reddish fluid. Whenever Grendel stood or walked, it was like a dripping faucet, but thankfully there were no signs of infection. Our days and nights still required those exhausting hourly water/potty breaks, but after two weeks Grendel was drinking less so we were able to drop back to every 2 hours.

As Grendel's thirst diminished, it became increasingly difficult to administer the not-so-tasty liquid Carafate. We did our best. Two weeks after the surgery, we took Grendel to A&M to have her stitches removed. I requested new blood work. It revealed that Grendel was still very anemic. Our treating vet recommended Lixotinic, a supplement that provides nutrients essential for the production of hemoglobin in red blood cells, including iron, copper and B-vitamins. It would help Grendel get over the anemia and recover her strength.

On-going Nursing Care
During her initial recovery, Grendel required around-the-clock nursing care. Bret and I were lucky in that we are self-employed and live just five minutes from work. At one point during that first week she was home, we had to leave Grendel unattended for half an hour. Bret came home to find that she had chewed off one of her toenails!

By the time Grendel had recovered to the point where we could take her for short walks, we were finally able to leave her unsupervised for an hour or so, with no problem. We still had to get up with her several times a night, though, so she could drink and urinate. All in all, I'd say Grendel really did quite well at home. She was showing improvement every day. We knew the old Grendel was finally back when we noticed that she was flirting and stealing bones from Grimm.