When talking haemorrhage, most people think external. Our exposure to violent death in splatter flicks and video games conjures slashed throats, arterial sprays, and a creeping puddle of blood encircling victim. Fortunately for pet owners, most of the haemorrhage we see in vet practice is internal, into body cavities such as chest, abdomen and eye, around heart or brain, or under skin. This tends to sanitise the experience: less messy, and less aesthetically disturbing. Hidden from view, however, owners may be slow to realise there’s a problem and seek treatment.
Signs of haemorrhage
If you didn’t pay attention in high school biology: blood transports oxygen from lung to body tissues and without enough of it, you die. If you’re haemorrhaging sufficiently to deprive your tissues of oxygen, you’ll be light-headed, weak and your brain will be frantically telling your respiratory system to crank-up oxygen uptake. This results in a cluster of symptoms which may include: lethargy, breathlessness, panting, exercise intolerance, pale gums, abdominal enlargement, coughing, bruising, blindness, collapse, or sudden death.
If haemorrhage into bowel or bladder occurs, eventually blood finds its way to the outside world, but this doesn’t always make it recognisable to pet owners. Bloody urine can appear normal in colour. Blood in vomit may look like black specks or ground coffee. Blood in stool may be deep purple, or tarry jet-black.
Haemorrhagic disease in pets
The most frequent disorders associated with bleeding in the dog are haemangiosarcoma, rat bait poisoning, snake bite, autoimmune diseases involving platelets, and congenital haemophilia. Situations in which to be extra vigilant for these diseases and symptoms are: snake season; when using rat bait; when your dog wanders and scavenges, especially near fruit and nut orchards; and in the German Shepherd or Doberman.
Often arising in spleen or heart, the haemangiosarcoma is an aggressive cancer that has usually spread to multiple sites by the time the primary tumour is diagnosed. Vets frequently must inform owners that, although the cancerous spleen was removed at surgery, their dog may only have months to live before it returns, and at which point she may bleed to death. To the dog owner’s imagination, schooled by Friday the 13th, and Texas Chainsaw Massacre, these are often devastating words and some turn as pale as their dog. ‘Isn’t that a horrible way to die? Isn’t it better we euthanase before she suffers such a fate?’
The experience of the bleeding patient
When comforting those who have recently, or may soon lose their pet to haemorrhage, or those who get-the-guilts when using rat bait on pests, it’s often useful for vets to reflect on the human experience.
The pain we usually experience when we bleed is that of the cut, gunshot, or blow that started the flow of blood. If there’s no such trauma, and haemorrhage is spontaneous and internal, bleeding is usually painless and apart from feeling light-headed, weak, and out of breath, the patient is often unaware of what is occurring.
If sufficient blood is lost, the patient will initially faint; if more is lost they will die. There is no clutching at chest or throat, or gore of a torn carotid. Any terminal gasping is often after loss of consciousness. If haemorrhage is large, a dog’s experience would be sudden loss of consciousness, similar to that of euthanasia. If more modest, she may pass out and breathe heavily. Again, this does not reflect pain, but may demand veterinary intervention, to expedite or treat. If a dog is sleeping he may not even wake.
h
Above is a video of a German Shepherd, 2 weeks post-splenectomy. He experienced a bleed and was euthanased 2 weeks after this video was taken, one month after surgery. The time between surgery and terminal haemorrhage averages 3 months, and quality of life is usually completely normal during this period.
Once diagnosis of haemangiosarcoma has been made, some owners can only see their dog as a ticking bomb and understandably seek euthanasia. Others, however, are reassured by the knowledge their dog’s last moments are likely to be peaceful and painless. Something we all hope for. ‘Duggy’ Pettifer was such a patient who passed away, mid-stride in the yard at night, burying a bone after dinner. In such situations, death by natural causes can be seen as preferable to the stress of lethal injection at the clinic.
Tags: bleeding, canine, Doberman, euthanasia, German Shepherd, hemorrhage, platelets, quality of life, rat bait, splenectomy, vet, veterinary