What Happened To Sophie Marie

In September 2005, Sophie Marie seemed to be slowing down a bit, but we attributed that to her age -- eleven. October 1, she went to a reunion of her rescue league, and though she was quiet, again, we put it down to her age. The following weekend, she still seemed fine, though Sunday night she ate less than usual. Monday, she enjoyed her usual daily routine: up on the bed with Mama much of the day, posing on her window box to bark at baby carriages, and rushing to the door in the evening when Daddy came home. She and her daddy went for a walk that night. She exhibited the very unusual behavior of not pulling at the leash, and was willing to cut things short. She wouldn't eat Monday night -- but she'd been eating crabapples and possibly voles in the yard for the past several weeks, plus a generous complement of daytime treats, so we weren't that concerned. And she'd put away quite a large breakfast of lasagna noodles, sauce, and kibble Monday morning.

Tuesday, she went out several times but didn't want to play. She wouldn't eat her breakfast. She felt hot. Her lips and gums seemed paler than normal, and she seemed very depressed and very tired. She did get up on the big bed to nap with Mama during the day, and she did greet Daddy by rushing to the door Tuesday night. Tuesday night, he enticed her to have fresh-cooked bacon for dinner.

Wednesday, the morning of October 12, she would not eat, and her breathing was labored. She had a previously-scheduled vet appointment for six pm, which was moved up to mid-morning. The vet immediately found a mass in her abdomen. After five hours of testing, including xrays and ultrasound, it was certain that she had a very fast-growing cancer of the spleen known as hemangiosarcoma, and that it had spread to her lungs. It was large enough (bigger than half a loaf of bread) to have spread her ribs and put pressure on her heart, lungs, liver, bladder, and other organs. It was inoperable. Aside from the lung and spleen damage, her other organs were also compromised, certainly by crowding and to some extent possibly by additional metastases.

According to the veterinarian on Wednesday afternoon, she might -- or might not -- live until Saturday, and her death would be a very painful one via internal bleeding. She might also have non-fatal, but still painful, episodes of internal bleeding before the final one. The vet could not even guarantee that Sophie would live through Wednesday night.

We stayed with her through all the tests, and brought in her own bed for her to rest on between procedures. At the end, the bed was put in one of the carpeted private offices, and Dr. Wilson and her tech did what they had to do while we stayed on the floor with her.

Her blood samples may become part of a DNA study of this disease.

DR. WILSON'S INFORMATION

Sophie's condition was hemangiosarcoma, which has two forms. Cutaneous HSA is in the skin, and generally has a good prognosis. Visceral HSA is in the organs, usually the spleen, and is rapidly fatal.

In the reference manual in Wilson's office, the incidence was noted as .03 -- 2% of all dogs, and 7% among all dogs with malignancies. The vet said she thought these figures were low, based on her experience. 50% of dogs with this have splenetic tumors, 5% some other I forget, and they didn't spec a location for the remaining 45%. They are fast and fatal, and metastasize readily. Surgery gives the dog only about twelve weeks, with some of those few weeks taken up by recovery at first, and decline at the end. Dr. Wilson had a dog of her own with this, and referred to "torturing" him with chemo, which she said she would never do again. Sophie was not eligible for chemo or surgery regardless.

What follows are two sections, one which gives general info, and one which is more technical.

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GENERAL INFORMATION
http://www.vetinfo.com/dhemangio.html#Hemangiosarcoma
Hemangiosarcoma

Hemangiosarcomas are a form of cancer which originates in the endothelium, which is the lining of blood vessels and spleen. As might be expected of a tumor arising in the blood system they are highly malignant and can be found almost anywhere in the body since blood vessels are necessary in almost all body tissues. There is a strong predilection for the spleen, pericardium and heart. These tumors are most common in middle aged or older dogs which are medium sized or larger but can occur in any breed. German shepherds are reported to be more susceptible to this tumor than most dog breeds. In our practice golden retrievers also seem to have a higher than normal incidence. [breeds noted in vet's reference manual included Great Danes and "pointers," generally understood as a reference to what used to be called English Pointers. -- LS]

Because these tumors arise in internal organs there is often little warning that they are present prior to time they cause severe clinical signs of disease. A common estimate of the average time from discovery of the tumor until death occurs in affected dogs is six to eight weeks but death occurs more rapidly than this in a number of cases.

Visible bleeding, usually in the form of nosebleeds, and signs associated with blood loss, such as tiring easily, episodes of unexplained weakness, pale color to the mucous membranes of the mouth and eyes, increased respiratory rates, abdominal swelling and depression are the most common presenting signs for patients with hemangiosarcoma. A few dogs just suddenly die with no clinical signs having been noted by their families prior to death. Bleeding disorders associated with hemangiosarcoma are sometimes confused with immune mediated hemolytic anemia (IMHA) because the type of anemia caused by the two conditions is very similar and early clinical signs are often very similar, as well. Hemangiosarcomas can cause very large tumors, sometimes as large as ten or more pounds, when they affect the spleen.

In most instances tumors of this size in this location are found on physical exam. In other cases the tumor affects the heart and is hard to find on a physical exam and even easy to miss or X-rays. Sometimes there are hundreds of small tumors spread throughout the body and surgical exploration or an autopsy are the only ways to identify the problem.

The blood disorder that most commonly accompanies the presence of hemangiosarcoma tumors is disseminated intravascular coagulation (DIC). This is blood clotting that is occurring inappropriately inside the blood vessels. It uses up all of the blood clotting elements rapidly and dogs with this condition usually have platelet deficiencies, increased blood clotting times, decrease in fibrin content in the blood and an increase in fibrin degradation products (FDPs). This is probably the cause of death in most dogs affected with hemangiosarcoma.

Diagnosis of hemangiosarcoma can be accomplished in a number of ways. Identification of a tumor in the spleen or heart raises a high degree of suspicion for this tumor. Abdominal swelling is also highly suggestive in an older large breed dog. If fluid is aspirated from the abdomen and it looks like blood it is even more suggestive of hemangiosarcoma. If blood is drawn and will not clot when left in the syringe it is another sign that a dog may have this tumor. In some cases careful evaluation of the type of bleeding disorder present is necessary to raise the suspicion of hemangiosarcoma.

If a tumor is identified when it is small it may be possible to remove the spleen if the tumor is there or even to remove tumors found near the heart and prolong the pet's life. Most of the time this will not make much difference, though. These are highly malignant tumors and most have spread by the time they can be identified. To the best of my knowledge there is not a very successful hemotherapeutic or radiation protocol for this cancer at this time but dogs treated with chemotherapeutic agents do live a little longer than dogs that do not receive this treatment.

Treatment for the bleeding disorders and aggressive supportive care also prolong the life of patients with hemangiosarcoma. If treatment for IMHA or immune mediated thrombocytopenia (ITP) are instituted due to confusion over the underlying cause of clinical signs early in the diagnostic process there is not likely to be any harm to the dog.

Due to the tendency to look for an inciting agent in IMHA and ITP it is a good idea to consider an autopsy exam if a dog dies before a definite diagnosis of any of these conditions can be made. Finding hemangiosarcoma saves a lot of agonizing over possible causes of the death of a friend. There are no known predisposing factors other than size and breed that I am aware of for hemangiosarcoma.

Mike Richards, DVM
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MORE-TECHNICAL INFORMATION
http://www.vet.uga.edu/vpp/clerk/frankhauser/
revolting photos; do not visit site.


HSA occurs most frequently in older dogs with a mean age between 8 and 13 years. It occurs most commonly in large breed dogs. German Shepherd Dogs are the most commonly affected breed, followed by Golden Retrievers and Labrador Retrievers. Other commonly affected breeds of dogs include Pointers, Boxers, English Setters, Great Danes, Poodles and Siberian Huskies. There is no clear sex predilection [though the veterinarian's reference manual suggests there may be a slight predisposition in males -- LS]. Cutaneous [versus internal, or visceral] hemangiosarcomas are more common in poorly pigmented breeds and dogs with light hair, including Beagles, Bloodhounds, white English Bulldogs, English Pointers, Salukis, Dalmatians, and Whippets.
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Noncutaneous HSAs are aggressively metastatic, with greater than 80% of cases having metastasis at the time of clinical diagnosis. HSA tends to metastasize through hematogenous or transabdominal implantation and the most frequent metastatic sites are the liver, omentum, mesentery and lungs. Splenic HSAs metastasize to omentum, mesentery, and other abdominal organs, whereas right atrial HSA is more likely to metastasize to the lungs. Other reported sites of metastasis include kidney, muscle, peritoneum, lymph nodes, bone, adrenal glands, eye, prostate, brain and diaphragm.
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Clinical signs will vary depending on the location of the primary tumor and can range from sudden death to very vague symptoms. Sudden death via hemorrhage can occur from rupture of a cardiac or visceral neoplasm or from acute blood loss into a body cavity. More subtle clinical signs associated with visceral masses may include weakness, abdominal distention, tachycardia, tachypnea, mucous membrane pallor and weight loss. Often there will be a history of episodic weakness or acute collapse followed by gradual recovery. These clinical signs are associated with episodic acute hemorrhage from a visceral mass followed by clinical recovery as the blood is reabsorbed from the body cavity.
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Surgical intervention traditionally has been the treatment of choice for dogs with HSA. Surgical removal of a bleeding mass provides relief from clinical signs for a period of time, although it does little to improve overall survival time. Unfortunately, many cases of HSA already have metastasized by the time they are clinically evident.
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The prognosis for patients with splenic HSA is poor despite aggressive surgical, drug, or radiation therapy. Median survival times for splenic HSA treated with surgery alone range from 19 days to 3 months; a one-year post-treatment survival rate for dogs is less than 10%.