This past June, I saw my old friend, Zaatar, for his annual physical exam. He had a few minor issues, common in middle-aged golden retrievers. An ear infection. A tendency to pack on the pounds. But overall, he looked in good health. The “no-contact dropoff” protocols we have been using since April made it harder to chat with his owners, but over the phone they expressed concern about his panting. Now, any veterinarian practicing for more than a few years knows that flicker of dread we experience whenever a large-breed, middle-aged dog has issues such as labored respiration. Especially golden retrievers. I rolled back Zaatar’s lip and looked at the color of his gums. Nice and pink. I relaxed a bit. I auscultated his heart and lungs. Sounded fine. I relaxed a little more. I palpated his belly. Admittedly, he was rotund, so it wasn’t easy, but I didn’t detect any large abdominal masses. I relaxed even more.
Hemangiosarcoma is a highly malignant type of cancer that grows from cells lining blood vessels. It occurs most commonly in the spleen or heart of large-breed, middle-aged dogs. These tumors can rupture, causing profuse internal bleeding. Since the bleeding is inside, owners do not see visible blood. They also may quickly metastasize to lungs and/or liver. Clinical signs depend on the tumor’s location and severity of hemorrhage. Mild bleeds may just cause vague signs of weakness; major bleeds, collapse and sudden death.
When I rolled back Zaatar’s lip, I was looking for the classic paleness often seen in dogs with hemangiosarcoma. I was happy this color was so good, but pink gums don’t completely rule out the possibility of hemangiosarcoma. Why was Zaatar panting? Well, older dogs do tend to pant more. Their lungs just lose some of their oomph with age. We old docs just call it “old dog lungs” though I’m sure there is a more impressive, highly technical term I have long since forgotten. Zaatar was also … well … fat. No judgment. I’ve struggled with my weight all my life. Like Zaatar, the older and fatter I get, the harder I breathe when exercising. “I think Zaatar is just overweight and out of shape,” I told his owners. “But it wouldn’t be a bad idea to run a few tests.”
I suggested that baseline radiographs of his chest and abdomen could give us more confidence that there was no gross evidence of hemangiosarcoma. Bloodwork could check for anemia, another common sign with this kind of cancer, as well as evaluate basic organ function like liver and kidney. Finally, a thyroid panel was indicated to rule out hypothyroidism as the cause of obesity. His owners agreed to think it over.
Four months later, I saw my old friend Cinnamon, also a middle-aged golden retriever. Cinnamon had been coughing for a few days. On his first visit, I wasn’t too concerned. His color was relatively good. He didn’t have a fever, and his heart and lungs sounded fine. When I pressed gently on his windpipe, he let out a soft cough. “Probably just kennel cough,” I said. Kennel cough is a catchall phrase for a group of upper respiratory infections caused by any of a number of different organisms, and technically called “infectious tracheobronchitis.” The “kennel cough vaccine” provides moderate, though not 100 percent, protection against one type, a bacterial infection caused by bordetella. Most dogs are also vaccinated for parainfluenza (not to be confused with canine influenza), a viral disease that can cause kennel cough. There are other organisms that can also cause it, such as mycoplasma, for which there are no vaccines. We usually don’t run any fancy tests on dogs we suspect have these diseases, just treat them symptomatically, as kennel cough is generally mild and self-limiting. I sent Cinnamon home with antibiotics.
The next day Zaatar came in for the recommended tests. Chest and abdominal radiographs were normal, as were complete blood count and chemistries. We are still waiting on his thyroid panel, but I gave him a clean bill of health and prescribed weight loss and moderate regular exercise. The same recommendations my doctor gave me.
The next day Cinnamon returned. He wasn’t coughing anymore, but had suddenly developed labored breathing. Now I was worried. We took radiographs. No evidence of a tumor in his spleen, but something wasn’t right in his chest — faint, fluffy densities throughout his lungs that shouldn’t be there. The possible diagnoses included bacterial, viral, or fungal pneumonia, pulmonary edema secondary to primary heart disease, or metastatic cancer. I did not see an obvious primary tumor, like heart-base hemangiosarcomas I have seen in the past, but his heart did look a little bigger than normal. This slightly increased cardiac silhouette could mean that the heart itself was enlarged, or he could have pericardial effusion, i.e., fluid buildup in the sac around his heart. I consulted with radiologists and cardiologists online who concurred, suggesting an ultrasound of Cinnamon’s heart and lungs, and if needed, a pericardial tap to remove any fluid from around his heart,
The next morning Cinnamon’s family took him off-Island to specialists on the mainland. Pericardial effusion was confirmed, and a tap performed to relieve the pressure around his heart, but additional radiographs found that he indeed had severe, diffuse, metastatic lung cancer. When I last spoke with the specialist they had not determined whether it was hemangiosarcoma or some other cancer, but the prognosis was sadly the same. His owners said goodbye, letting him go peacefully and humanely over the rainbow bridge.
Two middle-aged golden retrievers: my old friend Zaatar, who has been panting for months but probably just needs to lose weight; my old friend Cinnamon, whose symptoms began only days before being diagnosed with terminal cancer. Why? I think of all my human friends, those who have beaten cancer, those who have succumbed, and pray for the day that scientists find the explanation and that elusive cure.