When you think about internal bleeding, most people picture scenes from the TV show ER where someone might have been hit by a car or fallen from a height and is bleeding internally. Trauma is definitely a common cause of internal bleeding in dogs, and actually a common type of rat bait can cause internal bleeding in dogs as well, but unfortunately these are not the most common reason we see internal bleeding in dogs. In fact, the most often cause of internal bleeding in dogs, especially in those with no history of being hit by a car or eating rat bait, is cancer.
Common signs of internal bleeding include weakness, trouble breathing, pale gums, a distended abdomen, and collapse. Less common signs are vomiting, not eating, and general malaise. And on one cold January night that is how Rice, a 12 year old terrier mix, was acting, alerting his owners that something was wrong. He was lethargic, had vomited, and became very weak. He was taken in to TPHCS and he and his family met with Dr. Brent Megarry.
His initial exam showed he was in shock, and an ultrasound and x-rays revealed that he was bleeding internally. Further ultrasound assessment also showed masses (tumors) on the spleen and liver.
As stated earlier, the most common cause of internal bleeding in older dogs in general is cancer. And the most common cancer that causes this is hemangiosarcoma. Hemangiosarcoma is a tumor made up of blood vessel cells. It most commonly causes tumors to form on the spleen, liver, and heart, but less commonly can cause tumors on any organ, or even the skin or inside of the body wall. Studies have shown that when a dog presents with internal bleeding in the abdomen, there is an 85% chance that this is because of cancer. The tumors can grow quite large in some cases, but they often don’t cause an issue until they bleed. Once they rupture and bleed, the patient becomes anemic and starts showing signs of weakness, collapse, or trouble breathing.
Sadly, this was the case with Rice as well. In many cases there are a couple options. The most aggressive is to take the animal to surgery to try to remove the bleeding tumor, especially if ultrasound only saw one tumor that could be easily removed. Another option is to try palliative care, meaning start medications that might slow bleeding and spend some time with your pet knowing that they will likely have to consider the third option in the very near future: euthanasia. For those that have surgery and do well, the average survival is 2-3 months before the cancer comes back in a way that we can’t surgically remove it. For those that choose palliative care we can sometimes get patients a couple days, maybe up to a couple weeks of survival after diagnosis.
Unfortunately for Rice, he had tumors in multiple spots and so surgery was not a reasonable option for him. We started treating him in the hospital with IV fluids and medications to try to slow bleeding, but his bleeding would not stop. The following morning Rice was worse than when he had come in and our treatments were not working, so Rice’s family made the very reasonable decision to have him euthanized.
Despite the sad ending, I share Rice’s story for several reasons. The first is internal bleeding from cancer in older dogs is not uncommon, and signs develop very suddenly, and so I think it’s something the public should know about. I am hoping people that read this article have a little more knowledge on what signs should prompt them to bring in their pet for evaluation, even if in the middle of the night. Another reason I want to bring up this story is to bring up euthanasia. It is a terribly sad and hard part of the job that most veterinarians deal with on a daily basis, but I truly feel like in cases like Rice’s where he would have suffered if he was left to die naturally, that euthanasia is a gift that can help animals die with dignity. The last reason I wanted to write this story was Rice.
Most of us in the veterinary field hear hundreds of heart-warming stories, or sad stories, or family stories, every year. And stories like Rice’s touch your heart in so many ways you just want to share them. The interesting thing about Rice is that his life with his family started out in fame. Rice was featured on the news when he arrived from Thailand to meet his new family.
Rice was one of those dogs that you will never forget. He loved every person he ever met, and most animals, unless you were a small varmint, in which case he was the “Terrible Terminator Terrorist Terrier”. He lived life to the fullest, and even got to spend some summers in Maine at the lake.
His family will miss him, and all those who met him were glad they had. We at TPHCS were glad we were there to help him and his family in that difficult time, though were saddened, as with all patients we lose, with his loss.