In July of last year, a young couple brought their two Greyhounds to see me at the clinic. Joel, the 11-year old dog, had begun coughing over the last few days. (Toast, Joel’s faithful companion, came along for moral support.)
The couple and I talked about how the dogs were doing, and possible causes for this mild but persistent cough. As I examined Joel, our conversation drifted to work, married life and local restaurants. The room was full of smiles and laughter. Then I put my stethoscope on Joel’s chest.
His lungs sounded terrible. I immediately feared severe lung disease.
To avoid alarming Joel’s owners, I simply said, “I don’t like the way Joel’s lungs sound. Let’s take some X-rays to make sure everything’s OK.” They agreed, and I led Joel from the room as Toast looked on warily.
When his x-rays appeared on my computer screen, my heart sank. Joel’s lungs were full of soft-tissue nodules. He had metastatic cancer.
What followed was a painful and emotional conversation that I have had far too many times. I began by displaying the x-rays so I could explain my findings to Joel’s unsuspecting owners. The first thing I said was, “I’m afraid I have some bad news to share.”
The First Question
Telling people their pets have cancer is probably the worst part of my job. Unfortunately, I have to do it with some regularity. Cancer is the most common cause of death in dogs over age two and one of the most common causes of death in cats.
Twice this week I have talked with pet owners who just learned their pets have cancer. In both cases, the first question they asked me was: “What do we do now?”
As someone who finds great comfort in having a plan, I understand this question. Often, pet owners receiving this news feel shocked, scared and powerless. They frequently believe that their only options are either to make their pet comfortable until he or she passes away or is euthanized, or to jump into expensive surgery and/or chemotherapy treatments. The idea that anyone would feel they must immediately choose between these two rigid options bothers me deeply.
Six Steps to Take Before You Make a Choice
I have talked to many veterinarians about how they approach the “What do we do now?” question. Putting their answers alongside what I’ve heard from pet owners over the years, I’ve compiled these six tips for moving forward after a pet’s cancer diagnosis.
Stop and Breathe: Unless your pet is suffering or in immediate danger, you do not need to make an instant decision about how to proceed with his care. Take some time, even if only an hour, to collect your thoughts.
Every Pet and Case Are Different: Know that there is no one “right” course of action. The best plan for you and your pet depends on the type, location and severity of the cancer, on your financial resources, and especially on your pet. Some pets handle medical treatment and frequent trips to the veterinarian very well; others do not. Some patients have additional health problems that complicate treatment. Some are advanced in age, and their limited natural life expectancy may deter pet owners from pursuing aggressive treatment. Then again, other pets of advanced age may handle treatment wonderfully. Your goal should be to find the course of action that best suits your specific situation.
Consider Staging: Often, the first step to feeling empowered to make good decisions is to get more information. This is why I recommend talking to your veterinarian about staging. Staging involves doing diagnostic tests to determine the severity of the illness and get a better idea of the expected outcome for your pet. These tests may include x-rays, blood tests, urine tests, biopsies or tissue aspirates (tissue samples collected through a needle). Even if you decide not to do all the diagnostics, doing one or two may yield enough information to help you make a more informed decision.Seek an Outside Opinion: The input of a diagnostic specialist can be valuable; it may confirm a suspected diagnosis or give insight into the type and severity of the cancer. Ask your veterinarian if conferring with a pathologist (for tissue samples) or a radiologist (for x-rays) would be beneficial.
Get Educated: Once you know what kind of cancer your pet has, I recommend reading all you can about the disease, treatment options and expected outcomes. Ask your veterinarian where you can find good information (bearing in mind that not everything you read on the Internet is trustworthy), and make a plan to talk later to ask questions.
Remember That a Talk Is Just a Talk: The last thing to do, after gathering your thoughts and getting all the information you can, is to decide how to move forward with treatment. This brings me back to that decision we discussed earlier. At this point, pet owners often feel that they have only two options: choosing palliative care (keeping their pet comfortable for as long as possible) or starting oncology treatment.
Consider All the Options
I always stress to pet owners that, at this point, treatment or no treatment is not the decision you have to make. What you do have to decide now is whether to provide palliative care, or make an appointment just to talk to the veterinary oncologist about treatment options. Too often, pet owners feel that if they go to the oncologist, they are obligated to proceed with extensive therapy that they don’t know anything about. This is definitely not the case. You can always schedule a consultation with an oncologist purely to discuss your options and to hear about their experiences and recommendations. If advanced treatment doesn’t sound right for your pet, you can still decide palliative care is the best course.
Ultimately, Joel’s owners elected to keep him comfortable, treat him at home and celebrate the time they had with him. We put Joel to sleep three weeks after he came to see me about his cough.
While Joel’s passing was very sad, we all felt we did what was best for him. Joel never suffered, and his owners knew what to expect in the progression of his disease. Together we carried out a treatment plan that was best for his specific case, and I think that’s an accomplishment that pet owners and veterinarians can both be satisfied with.
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