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

April 9, 2007 — This week's DaDane concludes Zeli Schulte's educational, and often emotional, article about her experiences with canine hemangiosarcoma. For most of us this hasn't been an "easy read." Today's installment — Zeli's final installment — will surely be the hardest yet. But Zeli offers a great deal of insight and some very valuable advice, so please stay with us:

Considering Chemotherapy
The vets at Texas A&M told us that Grendel might live as long as 2 or 3 months, or as short as 10 days, before the cancer reappeared. They pointed out that although chemotherapy might prolong Grendel's life, hemangiosarcoma is generally unresponsive to chemotherapy. Only 30% of those affected might derive some benefit from chemo; the rest will not. Our treating vet offered even lower numbers.

The discouraging statistics, coupled with the potential stress of the actual treatment itself, put us off. We decided to forgo chemo. Instead, we hoped that Grendel would be one of the lucky ones to beat the odds and become a long-term survivor. Her luck had held while she was bleeding out on the operating table, so we remained optimistic.

Still, the vets reminded us that it was not a question of if Grendel's cancer would come back, but when. Hemangiosarcoma is highly metastic and it was probably already present in Grendel's other organs. We were told that as the cancer progressed, at some point there would be another rupture accompanied by uncontrolled internal bleeding. Grendel would go into shock, and then lose consciousness. Thankfully, it would be a quick and relatively painless death.

We discussed options with our treating vet regarding what to do when the time came. We hoped a mobile vet would be available to come to the house to put Grendel down. We also discussed drugs that might be utilized to ease Grendel's anxiety, especially if no mobile vet was readily available.

Life Goes On — Or does It?
Meanwhile, with Grendel doing so well five weeks out, I lapsed into a false sense of security. I began to believe she was bullet-proof and that she might exceed our most optimistic expectations. Her incision had healed. She was no longer on pain meds or antibiotics. She was stronger. We were able to take longer walks. I was getting up with her less often during the night. I started making plans to take Grendel swimming at the Lakes as soon as spring came.

Then, on January 26, 2007, Grendel woke me up six times during the night. She just could not get comfortable. I gave her some Tramadol to help her settle down. The following morning, to keep her comfortable, we continued with the Tramadol. The fact that Grendel was still eating reassured me, but the following night she refused her dog food. She did, however, eat some steak and grilled liver. I thought she was simply being finicky and I relished the opportunity to spoil her. We figured that as long as Grendel was enjoying her walks and continuing to eat, this was just a bump in the road.

Once again, I had dismissed the warning signs.

Two nights later when I got Grendel up to take her outside before going to bed, she had a very difficult time getting to her feet and walking outside. Once she was back inside it took her a long time to get comfortable, despite a recent dose of Tramadol. I gave her some more Tramadol so that she could sleep comfortably and waited for what the morning would bring.

Time to Say Goodbye
When morning came, Grendel seemed relaxed on her bed as she awoke. She stretched and licked my face when I petted her, but as soon as she tried to stand up, she was in a lot of pain. She was stiff, panted heavily, and stumbled as she walked outside. She had a particularly hard time getting into position to urinate. We immediately realized that we had a very short time to make a decision before she would need to relieve herself again. Given the amount of pain Grendel was experiencing, I could not ask her to get up any more. We had fought the good fight. I knew we had done everything that we could for Grendel, and that her last days had been filled with good times and the certain knowledge, daily expressed, that she was loved.

Our only surprise was Grendel's obvious pain. We had been told that her death would be painless, that Grendel would simply lose consciousness. This was clearly not the case. The cancer would not loosen its grip on Grendel so easily.

Fortunately, we had the Tramadol and Valium that our treating vet had prescribed as a last resort. It was time to use it. Within a half an hour we noticed that Grendel was relaxing, and licking her paw like she usually did. She kissed my face when I kneeled down to pet her. As I lay on the couch next to her bed, Grendel eased herself onto her side and went to sleep. She remained asleep when the vet came to administer the sedative and lethal injection.

Final Thoughts
After all we went through, would I ever do this again? Would I recommend this surgery to anybody? Decisions following diagnosis of hemangiosarcoma are far from easy — and they are very personal. In my case, the decision to proceed with surgery came down to three factors:

The Cost — would we be able to handle the cost of surgery & post-surgical treatment?

The Dog — would Grendel's age and any health issues make surgery unfeasible?

The Owner — would I be able to meet the many commitments required to care for a terminally ill dog? Moreover, would I have the emotional resilience to continue or discontinue treatment, and then to ultimately make the decision to put Grendel down if the surgery or post-surgical recovery did not go well?

Grendel's surgery was over $4,800; her daily blood transfusions were $1,500 per day. Fortunately, she was in good shape at 9.5 years so that she was able to survive surgery and post-surgery. (By contrast, our other Dane, Grimm, would never be a good candidate for this type of surgery given his Wobblers, cardiac and kidney problems.) Because we are self-employed, Bret and I had the ability to adjust our work schedules to Grendel's needs. In that regard, we were extremely fortunately. Still, it wasn't very easy to go to work after getting up with Grendel 2-9 times each night. Beyond that, you have to be able to "be there" emotionally for your dog. No matter how dark things looked in the ICU, we always made an effort to be upbeat when visiting Grendel as well as upbeat in our interactions with the vets, so they would not give up on her.

And then there's one final consideration: Surgery for hemangiosarcoma, in contrast to other cancers, will prolong your dog's life for only a short time. If surgery does not improve your dog's life, will simply prolonging your dog's life for a few months, or even for a matter of days, be enough for you? More importantly, would it be in your dog's best interest? At what point might treatment cause more trauma than relief?

You have to constantly reassess your motives and ask yourself if you are doing right by your dog or just holding on because you can't bear to say goodbye. I strongly believe that Grendel — regardless of her surgical complications — had a very good last month with us. Even in her last hours, I was contemplating another surgery even though, realistically, I knew that could never be an option. I somehow thought I could keep Grendel alive because I wouldn't accept the possibility that she was going to die.

Finally, and perhaps most importantly, you must have the emotional resilience to be able to face facts, change gears and ultimately let go.

— ENDNOTES — Do you recall the A&M vet student who cried as she watched us with Grendel during that first visit together in the ICU? Later, after learning of Grendel’s passing, she shared the following with me: Although the time I spent with Grendel was very little, I could certainly see that she was a fighter and a very special dog. Her love for her family was incredibly evident. She would always brighten up so much when you came to see her, and it seems to me that much of her will to fight must have come from how much she was loved. I think Grendel fought so hard because she wanted to stay with us — her family — as long as she could. A few days after Grendel passed, Bret revealed to me something that happened while Grendel was in surgery. He had received a call from the surgical assistant informing him that the surgeons were unable to stop the bleeding. They wanted permission to put Grendel down while she was still under anesthesia. After the call, assuming Grendel was gone, Bret got into the car and began the sad drive to Texas A&M to collect her remains. Ten minutes into the trip he received another call from A&M. They were letting him know that the bleeding had suddenly stopped and the surgeons were proceeding with the operation. When Bret told me that, I realized once again how truly lucky we were. Even in our misfortune, we were fortunate that Grendel — at her age and given the surgical complications — was able to survive the surgery and battle her way through post-surgery recovery like she did. Grendel's fight for life and her struggle to return home to us will always be an inspiration.