2001-Fri Apr 28 12:16:01 EDT 2017
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My dear friend Juli is a seasoned veterinary technician. So when her 16-year-old Australian Cattle Dog named Easy developed bleeding into his belly because of a cancerous growth, Juli had a clear sense of what the likely prognosis would be. Surgical removal of the tumor would probably buy some good quality time—three to six months on average before the cancer recurred. Post-surgical chemotherapy might expand that time frame just a little bit.
After some serious soul searching and “conversation” with her beloved dog, Juli opted for surgery without chemotherapy. Easy experienced a smooth, uncomplicated recovery. Within just a couple of weeks of surgery, he was back to his normal routine of gentle walks, relaxing with Fannie (his little sister, who is also an Australian Cattle Dog), good food and enjoyment of an excellent quality of life. Every few months thereafter, Juli would ask me to ultrasound Easy’s abdomen to see if his cancer had recurred. Over and over again through the years, we were pleasantly surprised to find nothing out of the ordinary was wrong with Easy.
Finally, at the very ripe old age of 19, Easy succumbed to health issues that were completely unrelated to the cancer I had diagnosed three years prior.
Hmm… How is it possible that Easy’s cancer never recurred when statistics tell us that surgery shouldn't have been curative? The answer is simple—not every patient reads the textbook! For every possible disease, there will always be “outliers”—those patients who fare far better (or far worse) than research statistics predict. Such “surprises” are part and parcel with the treatment of disease, whether treating dogs, cats, humans or any other species.
Is there a way to predict who these outliers will be? Don’t I wish! If I had that kind of crystal ball, I could alleviate so much angst for clients who wrestle to make good decisions for the animals they love. I have to say, for a small percentage of my clients, decision-making in the face of a sobering diagnosis is relatively easy. These clients areoften“numbers people” who base their decisions solely on statistical predictions and who decide the outlier population is just too small to be significant. On the other hand, I have clients who have absolute faith that their best buddy will be that miraculous outlier case and, without question, they opt to carry on with treatment.
I think the greatest struggle for my clients is when the outcome is uncertain—bleak, but not hopeless. Despite the grim outlook, they may wonder if their pet could be “the one” who defies the odds. For these clients, I tell them to engage in some serious nose-to-nose discussion time with their four-legged family member. Then, I suggest that they play out all the options, envisioning both the best and worst possible outcomes. Finally, I advise them to think about which option for their pet would give them the greatest long-term peace of mind.
Juli did exactly this with Easy. She knew that attempting surgery, no matter the outcome, would provide her with the greatest peace of mind. And thankfully, amazingly, it also worked out to be the right answer for him.
No one ever said this role of medical advocate for your pet was going to be easy, but at least you can take steps to make sure you know you’ve made the best decision possible!
Have you been in the position of making a difficult medical decision for your pet? Have you ever cared for an animal who didn’t read the textbook?
Dr. Nancy Kay graduated from Cornell College of Veterinary Medicine and is the author of Your Dog's Best Health: A Dozen Reasonable Things to Expect From Your Veterinarian and Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life. Dr. Kay is a specialist in small-animal internal medicine at Upstate Veterinary Specialists, with offices in Asheville, N.C., and Greenville, S.C.
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