Sorry, no woo for you today. Or: Cancer isn’t just for humans

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Today is Friday, which has normally meant for the last two years that it’s the time every week when I poke fun at some particularly outrageous woo. Indeed. I even had a great idea for a 4th of July-themed post today that (I hope) would have been hilarious. I had even started to write a bit of it a couple of nights ago.

Then real life intervened, and I didn’t feel the least bit like humor last night. I still don’t feel capable of humor this morning, either. Those of you who don’t have pets may want just to skip the rest of this; you may not understand why I’m feeling so down and may view this post as nothing more than self-indulgent whiny twaddle. But what is the purpose of a blog if not to be an outlet for self-indulgent twaddle from time to time? Of course, those of you who do understand (which, I hope, is the vast majority) won’t view it that way.

Yesterday afternoon, eight years to the day after the day we first picked her up from the shelter, my wife and I learned that our dog Echo, the sweetest, most even-tempered dog in the world (unless you’re a bunny), has terminal cancer. There will be no more bunny carnage in our yard.

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It all began last weekend, when we noticed that Echo was favoring her left hind leg. At the time, I also noticed an asymmetry in her hips, with a bulge on the left side. I palpated the area and found what I thought to be a soft tissue mass. A large soft tissue mass. Remember, I’m a surgical oncologist; I’ve palpated many, many soft tissue masses in humans, and this one felt ominous. It was hard, fleshy, and big. I suspected sarcoma right away, as it felt a lot like many sarcomas I had felt in human patients.

Still, I’m not a veterinarian, and I wasn’t entirely sure. In retrospect, I’m sure it was denial, but by the time I took her to the vet for the first time on Tuesday I had convinced myself that it was an orthopedic problem, not a soft tissue mass at all. It just goes to show that denial isn’t just for patients; doctors can fall prey to it as well. In any case, I had taken her for a walk on Sunday and noted her favoring the leg, but otherwise she seemed more or less normal, although my wife and I had also commented at times recently that she seemed to become easily winded compared to her old self. However, we had just attributed this to her getting older and the fact that we had been remiss in getting her enough exercise lately; so our initial thoughts were that we needed to take her out on walks every day and try to get her (and us) into better shape.

The visit to the vet on Tuesday confirmed that it was definitely a mass, and I got that ominous sinking feeling when the vet was kind of vague about what he thought the problem was. It’s not just people doctors who do that. Still, I remained optimistic. We just so happen to be lucky enough to live a mere two or three miles from one of the best veterinary oncology hospitals in the region, and I made an appointment for yesterday afternoon. Showing the power of denial again, by yesterday morning I had convinced myself that this mass would be resectable and that at the worst it would require an amputation of that limb. I was even joking that I guess I wouldn’t be buying that new car that I was contemplating buying if I ended up spending $10,000 or $20,000 on surgery and radiation for the dog. (Many of you who love your dog or cat as much as I love mine know you’d spend that much and more too, assuming you have the money, if there was a decent chance it would save her life.) Heck, I even managed to hold out hope that it was an inflammatory or infectious mass rather than a tumor, given that the fine needle aspiration (FNA) of the mass showed nothing more than blood and white blood cells.

A fantasy, I now know, but a useful one.

Yesterday afternoon, I blew off work early and accompanied my wife to the veterinary surgical oncologist. Yes, there is such a specialty. Just as I’m a surgical oncologist for humans, this surgeon was a surgical oncologist for animals. Better yet, this surgeon had been in practice for some 25 years and is well-respected nationally. He treated Echo with the utmost care as he did some X-rays, an ultrasound, and another fine needle aspiration of the mass. (In retrospect, maybe I shouldn’t have allowed the general vet to do the FNA; as is the case with humans, surgeons tend to be much better at doing them. But I wanted an answer, and I didn’t want to wait a couple of days for it. I ended up waiting anyway.)

The news was, as I said, not good.

The primary mass looked classically like a hemangiosarcoma with bleeding into the center of the tumor, which is probably the reason for its rapid transition from not noticeable to a large mass. There were multiple masses in her liver, and her spleen was enormous, chock full of hemangiosarcoma. She even had some enlargement of the right atrium of her heart, suggestive that tumor was there, too, as is common for this cancer. There was the explanation for her increasing shortness of breath. There was nothing that could be done. Game over.

Hemangiosarcoma is an incredibly nasty and insidious tumor in dogs. Indeed, one of the more common ways that it makes itself known is when a dog just drops dead for no apparent reason, and an autopsy shows the cause of death to be massive bleeding from one of these tumors. Usually, by the time the tumor becomes apparent clinically, it’s far advanced, and this was the case with our poor Echo. Upon the diagnosis, my wife and I both felt tremendous guilt that we hadn’t noticed this before. Indeed, now that I know her diagnosis I look at her and I can see the bulge in her abdomen from her enlarged spleen. Why hadn’t I noticed that before? What kind of surgeon am I? However, after reading just how nasty this tumor is in dogs and how it’s rarely noticed until very late, we feel less so. Sadly, Echo is a classic case, a dog between the ages of 8 and 10, whose tumor didn’t cause signs and symptoms until it was far too late to do anything about it.

There’s also a horrible irony here that is eating at me. It’s more than just my profession as a cancer surgeon. After all, cancer is a common disease and common cause of death in both humans and animals. Few people make it through life untouched by its deadly hand, either in family members or personally–or even in pets. Rather, it’s the kind of tumor. Hemangiosarcomas arise from vascular endothelial cells, the cells that line the inside of blood vessels and capillaries. What’s one of my areas of research interest? Tumor angiogenesis. What cell is critical to tumor angiogenesis? Vascular endothelial cells. I study vascular endothelial cells as one of my two primary areas of research interest. Lovely.

What’s hardest to deal with now is how normal Echo behaves at the moment. True, last night, in the shock of the diagnosis, my wife and I thought she looked so very, very ill given that she was sleeping a lot and seemed to be breathing heavily, but this morning she seemed back to normal, even spunky. We’d never know there was anything wrong with her were it not for the small shaved spot on her hindquarter where the FNA had been done and the bulge lying right underneath it. She did her usual morning routine of planting herself near the front door and waiting for people to walk by with their dogs, at which point she’d start barking. She loves protecting the house this way and driving away interlopers. Normally, this behavior drives me absolutely loony, but this morning I treasured it, because I know it won’t last very long. Soon, something bad will happen. Either the tumor on her spleen will bleed and she’ll collapse into unconsciousness (in which case she will probably die quickly), the tumor in her heart or anemia will make her increasingly short of breath, or she’ll stop eating and drinking. When one of those things happens, my wife and I will know it’s time to act expeditiously to end her suffering. In the meantime, we’ll give her lots of love, lots of treats, and, while she can still physically handle them, lots of walks. Eight years, it’s too short. We had hoped Echo would live at least another few years, or even a couple more.

I hate cancer more than ever right now.

To complete my self-indulgence, here are some pictures.

Here she is just this morning:

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Here she was in her youth, charging through snow banks (she’s very difficult to photograph, especially in the snow, because she’s so black):

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And, best of all, just chillin’ a few years ago:

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