Dear Dr. John,

I recently made the difficult choice to put my Wheaten Terrier to sleep. She was 11. Recently she had lost four pounds and her spine seemed more prominent. Her appetite was a bit off. I had her looked at with findings of a normal physical examination, bloodwork results and a negative fecal exam. Then it was suggested that she have an abdominal ultrasound and the results were highly suggestive of cancer.

How does this happen so quickly? The report noted some mottling and nodules in the liver and a spleen with one hypoechoic mass and multiple similar nodules suggestive of hemangiosarcoma. How is it that the mass was not felt on physical examination? I was told that surgery to look further was an option but that the odds were against her, so I chose to watch her at home. Despite an appetite stimulant, she declined in a matter of days. Was I premature to let her go? Your thoughts would be appreciated! L.D.

Dear L.D.,

I am so sorry for your loss. Sadly, some forms of cancer are more aggressive than others and can come on very quickly. Splenic hemangiosarcoma is one of those. The term hypoechoic suggests a dark lesion seen on ultrasound when the tissue or organ being looked at should be lighter in appearance. While not conclusive, it can be suggestive of cancer but only a biopsy can be definitive.

Splenic masses or other abdominal masses can be palpated when they are large enough, but location and size may prevent a veterinarian from being able to feel them on an examination. It seems as if the work that was done for your dog was thorough and the ultrasound was looking for a needle in the haystack since all other parameters seemed within normal limits. Unfortunately, a working diagnosis suggestive of a more serious issue was found.

My thoughts for you and anyone who must make a similar difficult choice is never to second guess yourself after the fact. I always tell my clients that they will know when it is time to let a pet go. Letting her die with dignity was a true act of kindness and love.

Dr. John de Jong is President of the World Veterinary Association. He owns and operates the Boston Mobile Veterinary Clinic and can be reached at 781-899-9994.