*sigh* Hemagiosarcoma

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Emily
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*sigh* Hemagiosarcoma

Postby Emily » Mon Aug 10, 2015 12:39 pm

So, for those who don't know from facebook, Willy had surgery last week to remove some ulcerated tumors. He had some removed and biopsied 2-3 years ago that came back as hemangiomas. What couldn't be removed was treated with a high dose of prednisone, and it seemed to knock it out.

Over the last few months, they began to return, and over the last few weeks, they began growing very rapidly. I had him checked at my vet on a Saturday, we tried the same treatment, but by Wednesday, the largest one started bleeding, by Friday, the skin around it began to thicken which led my vet to offer a referral. Our appointment was scheduled for Wednesday (8/5). Tuesday night before that, it ruptured, and was pretty necrotic.

The vet did an in-house needle biopsy, removed them that day and was hopeful, although not completely convinced it was benign. She sent of for histopath, and we got the results today. Not good. It came back as hemangiosarcoma. We've got an appointment next week with the veterinary oncologist for some options, but from what little bit of research I've done so far, it doesn't look like there's a whole lot of hope regarding lifespan longevity with this one. I know every case is different, but does anyone have any information regarding a treatment (chemo, etc) success rate? He has not yet had ultrasound or radiographs to determine if it has spread or not. His blood work and overall condition is the picture of health.

I am stuck on the financial side of this. I know I can go as far as I want to regarding treatment costs, etc...but he is a 13 year old dog. Not super old, but most likely on the down swing of life (especially now). I can't go into financial oblivion treating him to buy him 3-6 months. I don't want to put a price on my dog's life, but I do have to look at this realistically. His surgery last week alone was nearly $1000.

My main goal for him is comfort and quality of life rather than quantity. Will I be a horrible pet parent if I opt to not treat him (chemo, etc...). If I opt for no chemo, how far should I go diagnostically? If I know it is in his spleen/lungs/etc, what will it change other than the fact I would have to consider euthanasia sooner. I know we've lost a few ODO dogs to this, so I would greatly appreciate your input. Uggh!!! They shouldn't be allowed to get sick!

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Re: *sigh* Hemagiosarcoma

Postby SherriA » Mon Aug 10, 2015 3:03 pm

I don't know anything about hemangiosarcoma so I'm no help there but I'm so sorry to read this. I hope you have some good options to maintain a good quality of life for sweet Willy.
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Re: *sigh* Hemagiosarcoma

Postby LisaT_II » Mon Aug 10, 2015 4:01 pm

I'm so very sorry :(

I don't know much about the skin form of the disease. I do know that the circumstances under which I would do chemo is very narrow, and the type of chemo might be more non-standard, and this is not a situation where I would do chemo. I think there is a lot of pressure to do chemo, because vets, etc, want to feel like they are doing something.

Here are is some info I've collected, I suspected it's mostly internal stuff - there is a yahoo group.
http://germanshepherdhome.net/forum/ubb ... #Post33013

I will say that I firmly believe that the aggressive dose of doxycycline that I had Max on either slowed or stopped the progression of his hemagio (internal). He was on it for years for other issues. He last about 2 months once I stopped it, before he rapidly declined. I would put any hemangio dog on doxy, and also turkey tail mushrooms (if tolerated), along other things helpful for cancer, and then go for quality over quantity, particularly with hemangio.

Again, I'm so sorry.
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LisaT_II
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Re: *sigh* Hemagiosarcoma

Postby LisaT_II » Mon Aug 10, 2015 4:06 pm

Btw, doxy is considered part of some chemo protocols. I have wondered if something like tumeric/cumadin might be substituted for some of the other drugs in the protocol. This is a circumstance where you might also consult with the person connie uses - I forgot his name...

http://www.vmcli.com/veterinary-article ... erapy.html
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Re: *sigh* Hemagiosarcoma

Postby LisaT_II » Mon Aug 10, 2015 4:16 pm

Oh, as for the diagnostics, I would only do something that would affect treatment, or give you info that helps you emotionally. That is, sometimes not knowing is very stressful, and you might want to know. If anything, I would probably want an ultrasound, just so I know where things are right now - if it's isolated to the skin, tbat might affect what protocol I put together with supplements, etc. Hemangio is so awful - max had a clear ultrasound one summer, and by February, it was everywhere. It's fast - so maybe the u/s doesn't give you a good sense of timing. I just have it in the back of my mind that the skin version was slower growing, but that could be very wrong.

ETA: Is Willy a pittie? Not sure if I read your profile right. The only other dog I knew with skin hemangio was a pittie :(
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Emily
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Re: *sigh* Hemagiosarcoma

Postby Emily » Mon Aug 10, 2015 6:10 pm

Thanks for the input! I checked out some of the links, and it seems like a lot of useful information. My computer is being stupid, though and not wanting to cooperate totally...

I'm still really torn on how far to go with diagnostics financially. I believe Molly's ultrasounds were around $600 when I had them done a few years ago. I feel like I am putting a price on his life, and I feel so badly about it, but I do have financial limits. I am planning on talking with the oncologist still, but I don't want to waste her time if I decide to not go further with treatment.

It does sound like the skin hemangio is a bit better than those first discovered internally, but none of it is good news. Lisa, yes, he is a pittie (mix).

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Re: *sigh* Hemagiosarcoma

Postby connie » Mon Aug 10, 2015 6:13 pm

I would never call you a horrible pet owner if you opt for palliative care only. I am doing just that with the two senior Sheltie that I adopted from the NY rescue this summer. Posey, 12, has dental disease and mammary tumors. She is not a candidate for surgery.

Good luck. I'm sorry you're facing this.

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Re: *sigh* Hemagiosarcoma

Postby Calypso » Mon Aug 10, 2015 8:58 pm

It's such a hard decision. How does Willy handle the vet visits and work ups and such? If he hates them, then I'd say palliative care is the way to go. If the oncologist can give you a feeling that some kind of treatment will give you a year or more, then it might be worth it. But in and out of the vet for weeks or months for only a few more months of life may not be worth it, IMO.

And you're not a terrible person for considering finances. It sucks, but it's a fact of life.

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Re: *sigh* Hemagiosarcoma

Postby JudyL » Mon Aug 10, 2015 9:44 pm

I'm sorry about the diagnosis, Emily. I don't have any firsthand experience with this type of cancer or using chemotherapy in dogs.

I do have a book about cancer in dogs written by Damien Dressler that I got when Dixie had her anal sac surgery. It is very informative, and he devotes and entire chapter on this type of cancer, by stage and by type, and discusses the treatment protocols for each of those. I did read the chapter, and I found an interesting section about "metronomic chemotherapy" that isn't a cure but is meant to slow down the spread, extend life expectancy, and is given orally at home with much less side effects. He does also make a brief mention that similar results have been achieved with "certain botanicals" that he doesn't elaborate on. I don't know that I'd buy it again, but maybe you could see if your library has it. Here's an internet page about the metronomic chemo by him that I found: http://www.dogcancerblog.com/blog/low-d ... iosarcoma/

A couple of things struck me while reading the chapter where he said that most dogs with this type of aggressive cancer are not diagnosed until they are in distress with symptoms such as lethargy, GI troubles, etc, so the fact that Willy feels good and isn't showing these signs, and the fact that his labs are excellent, gives hope that you caught this in its early stages and that you might have a real possibility of slowing its spread or have more time with Willy than statistics show. I surely hope that is the case.

You are correct about the price range for the ultrasound. I was spending about $500-600 each time Dixie had hers of her heart. If it will bring you peace of mind, benefit you knowing that cancer has or has not spread and affect your decisions regarding a treatment plan, then you might consider having it done. If it won't bring peace of mind or won't change your plan of treatment, then probably not. In the last weeks of Dixie's life, the cardiologist tried to refer me to their internal medicine specialist for an u/s and other expensive tests, but based on her labs and discussions with him and my regular vet, having those done wouldn't really have changed or added anything I wasn't already doing for her, so I chose to not spend the money or put her through any of the additional tests.

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Emily
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Re: *sigh* Hemagiosarcoma

Postby Emily » Wed Aug 12, 2015 12:56 pm

Thanks for the input, everyone! I am going to keep the appointment, and just see what the oncologist says. If I go with further diagnostics, I am considering having x-rays done at my clinic and just bringing them with me for the oncologist to see. It would be much cheaper than having x-rays there. I am still torn on doing an ultrasound...on one hand, it would be nice to know if his spleen, etc is compromised, but on the other hand, I don't see going through with a spleenectomy.

He doesn't mind the trips to the vet - he isn't a nervous dog at all. He enjoys they attention he gets there. I guess I'll have a better understanding next Friday when we have his appointment on treatment options/diagnostics/costs/etc...

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Re: *sigh* Hemagiosarcoma

Postby Jen » Wed Aug 12, 2015 12:59 pm

I'm sorry about the diagnosis. No one sane and compassionate could ever say you were a bad owner for prioritizing comfort over treatment and for taking your own finances into consideration.

Our vet recommended applying the "Will an answer change my treatment path?" when deciding on what diagnostics to pay for.

I also would want to know how miserable the treatment would be. Like Jill said, for some dogs, back and forth to the vet would be stressful enough.Even for Roscoe, the most laid back dog on the planet, going to the vet got to be a drag for him and we didn't even go all that often compared to if we had pursued a more aggressive plan.

And even if the vet said that would give you another year or two, you'd have to ask yourself how likely would it give you another year or two? If it's - for example - a 50-50 chance, would you hate it if he spent his last several weeks miserable and ended up in the 50% it didn't work for or would you hate it if you hadn't done everything in your power to try? Or would you rather go for a less aggressive treatment that is focuses on symptoms only and cross your fingers that gives you some more good time?

Only you can answer that for yourself since everyone is different. But it sucks that you're having to answer that. I'm sorry. :(

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Re: *sigh* Hemagiosarcoma

Postby Jen » Wed Aug 12, 2015 1:00 pm

You respond while I was typing, but I posted anyway. :) Good luck with getting answers.

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Re: *sigh* Hemagiosarcoma

Postby MaisyPancakes » Thu Aug 13, 2015 6:21 am

I'm sorry to hear this, Emily. I hope the appointment goes well! Glad to hear that Willy likes vet visits—that makes a big difference. :)

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Re: *sigh* Hemagiosarcoma

Postby PofiMia » Thu Aug 13, 2015 6:47 pm

Emily, our lab mix, Jesse, was 15.5 when she was diagnosed with hemangiosarcoma. She suddenly had collapsed with a sort of seizure and could not stand on her back legs. Gums were white. She was in cardiovascular shock and we nearly lost her. Xrays showed masses near the liver and spleen. I knew we would not put her through surgery and as it seemed those organs either were or might soon be compromised, we did not really consider chemo. Our vet was of the opinion the internal hemangio tumors were not really painful for a dog - just potentially deadly when they rupture, but that that even that was not really painful. Jesse lived another 2.5 years. She had much less severe bouts with internal tumor ruptures that somehow clotted over or were minor enough to not impact her - she would bounce right back. Her case was not typical, of course. She defied all expectations. And when we had the last episode, there was too much indignity for her and her eyes asked me for help and I knew the only means left to help. My point is, her quality of life for nearly all of that span was good - possibly exceptional for a large dog of that age.

We have no regrets about our course of action and choice not to treat. A younger dog would possibly have made for a different decision. My friends have an English Setter who had a compromised spleen with hemangiosarcoma quite young. They did the splenectomy and chemo and 8 years later, they have just had his parathyroid removed as he has a new cancer, but he is doing great and the hemangiosarcoma never returned.

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Re: *sigh* Hemagiosarcoma

Postby Emily » Tue Aug 25, 2015 9:51 am

So, Willy had his consult this past Friday and his stitches and staples removed from his surgery site. The vet pretty much said what I already knew (re: how aggressive this cancer can be, etc) The options she gave us was pretty much what I expected also.

1) Do nothing other than the surgery he's already had. It could stay cutaneous, and if it does, we can remove it as it pops up until we can't anymore. 2) Ultrasound and radiographs to determine if and how badly is has spread, then start chemo. 3) Same as 2, but add an additional chemo drug and treat very aggressively.

She said that *if* it has spread internally, based on statistics, to do nothing else, would give him about 6 months to live. If we did a chemo regimen, it would give him about a year to live (or he could be totally cured - although that is very unlikely). If it hasn't spread, he's likely to live quite a while, and die of something not even related to this cancer.

We have decided to not pursue further diagnostics because we wouldn't put him through the chemo anyway. It is not without its own risks and possible complications. He is happy and otherwise healthy right now, so we're going to keep him that way until we can't.

I am going to look more into the links Lisa shared regarding diet, etc.

Thanks, everyone, so much for your input and advice, I will definitely keep ya'll updated.

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Re: *sigh* Hemagiosarcoma

Postby SherriA » Tue Aug 25, 2015 10:05 am

Sounds like a well thought out plan (and the same path I'd take). I hope it hasn't spread and Willy has plenty more time.
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Re: *sigh* Hemagiosarcoma

Postby emmas_mom » Tue Aug 25, 2015 12:42 pm

I hope Willy has lots more time with you. Your choice is the same one I'd make, for the same reasons.
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Re: *sigh* Hemagiosarcoma

Postby Sabine » Tue Aug 25, 2015 1:17 pm

I'm so sorry, Emily. :( This is what Quigley died of.

Hopefully you will still have lots of quality time left.
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Re: *sigh* Hemagiosarcoma

Postby Jen » Thu Aug 27, 2015 3:28 pm

I hope Willy shows you what he's made of and outlasts all the predictions. :(

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Re: *sigh* Hemagiosarcoma

Postby Calypso » Thu Aug 27, 2015 9:28 pm

I think your plan is a sensible one. I'm just sorry you have to make it.

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Re: *sigh* Hemagiosarcoma

Postby JudyL » Thu Aug 27, 2015 9:56 pm

That is the choice I would make too, Emily. I'm still optimistic that you'll have more time with Willy than the averages show since you said he otherwise feels and acts fine.

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Re: *sigh* Hemagiosarcoma

Postby Amanda » Fri Aug 28, 2015 1:25 pm

I agree with you and everyone. I hope he has lots of quality time left.

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Re: *sigh* Hemagiosarcoma

Postby MaisyPancakes » Fri Aug 28, 2015 3:58 pm

It sounds like a good plan! Rooting for you guys!


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