1.   TREATING   LYMPHOMA

 

When Pet families come in for a consultation with me after receiving a cancer diagnosis, they often ask “Doc, what would you do if this was your dog?”

I usually refuse to answer the question (with one important exception, which I will get to in a moment).

There are too many personal factors that go into the decision of what to do. In addition to the overall prognosis for that particular cancer, there could be other pre-existing conditions. It can become very complicated, and so much just depends upon the person who is asking.

Some Guardians want to be aggressive and take the treatment approach associated with longer survival times, even if it costs more, requires more visits to the oncologist, and has more side effects. Others don’t. For example, when I tell some Guardians the median survival time for their dog’s cancer is 18 months with treatment, they don’t feel that is long enough … while others will tell me that getting an extra three months is more than they hoped for.

What I would do for my dog likely not what you would do for your dog. I used to say I would have given Paige, my Labrador, a kidney if she needed it and it was medically an option. (She is no longer with me, but she did not need my kidney. And no, you cannot transplant your human kidney to your dog.)

I am pretty aggressive with medical options for my own pets. I am not afraid of some side effects from diagnostics and treatment when the “side effect” of not treating is worse (in my opinion). I am more likely to go for surgery, radiation, and/or chemotherapy for my dog than choose a palliative approach such as pain management only. But that is a pretty generalized statement. And again, my choice may not be the choice of the Guardian sitting across from me in the exam room with their dog by their side. So, in order to keep from projecting my personal feelings onto Guardians, I usually just refuse to answer that question.

Except when it comes to lymphoma. When it comes to lymphoma, I will share what I would do. For me, this is an easy choice: I would treat my dog with a CHOP multi-agent protocol.

This protocol is a cyclic protocol usually lasting 5 to 6 months. In each cycle, the protocol includes vincristine, cyclophosphamide, and Adriamycin (doxorubicin). In the 1st cycle (usually the 1st treatment), the dog may receive Elspar. Prednisone, a steroid, is also given orally daily for the 1st 4 weeks during the 1st 4 week cycle.

Why is it so easy for me to answer this question about treating canine lymphoma? For dogs with lymphoma, chemotherapy has such a significant and positive effect on not only how long a dog lives but how well they live. Typically, a dog lives only 1 month without treatment, and the median survival time with a multi-agent chemotherapy protocol is 13 to 14 months. And dogs tolerate treatment so well that their life is considered good to great by most Guardians in my practice during the protocol and after the protocol when they are in remission. Dogs with lymphoma treated with chemotherapy live longer and live well. So, yes I would treat my own dog for lymphoma with chemotherapy. No question for me.

Dr. Susan Ettinger, DVM,Dip. ACVIM

 

2. The Biggest Mistake Pet Owners Make-End of Life

 

 

If I had a big huge red pen and could permanently strike five words from the Standard Veterinary Dialogue, it would be this:

"You'll know when it's time."

 

Waiting for The Look

Wouldn't that be great, if pets had a little button that popped up like a Butterball turkey when they were ready to be euthanized? It would eliminate a lot of agonizing on the part of loving pet owners who are struggling with one of the most significant decisions they will have to make in a pet's life. But that's rarely how it actually works.

Perhaps you've heard people talk about "The Look," the appearance a pet has when he or she is ready to depart this Earth. "You'll know it when you see it," they say, and they are right. It's hard to describe, that sort of intuitive emotional bond that develops between owner and pet when they are signaling that they are done. I've seen it and I agree, it's hard to miss. It provides a great deal of reassurance to pet owners to know that their pet seems in agreement that it's time for the next adventure.

The only problem is, this doesn't always happen

Pets have other ways of communicating with us beside a meaningful gaze that speaks to our soul; namely, their behavior. Veterinarians experienced in end-of-life care work with very specific quality of life assessments that can give more subjective endpoints than simply "a look," which can be key when an owner is waiting for a sign that may not come and ignoring all the other cues that a pet is communicating.

The Quality of Life Assessment

Appetite, mobility, hydration, pain, interest in their surroundings, and hygiene are all very specific categories we can assess to determine a pet's quality of life. Think of it less as a "yes/no" switch that gets flipped and more like a spectrum as a pet approaches death. There's a large grey zone towards the end where owners could make a good argument for or against it being "time", and that is the agony and the burden we face as pet owners.

I like the QUALITY OF LIFE assessment that uses multiple variables to assess a pet's condition because all too often, people focus on one specific thing. "Radar hasn't gotten up for a week," an owner will say. "He cries all night, soils himself, and pants constantly, but he ate a piece of hot dog yesterday and wagged his tail once, so I don't think it's time yet." In these cases, I counsel owners that we don't need to wait until every moment of a pet's waking hours are miserable before making the decision to euthanize.

It's ok to go out on a bit of a high note. It is one of the blessings of euthanasia, that we can say goodbye in a controlled, peaceful environment and eliminate the pain and stress of a crisis moment at the end.

Death used to be as mysterious for me as it is for most people, but after years working with pets Death and I have become, if not friends, at least very collegial. With that under my belt, the only thing I can tell you with certainty is this: The only way you'll know that it's time, truly and without doubt, is when the pet actually stops breathing. Everything else is open to interpretation.

Rarely do people tell me after the fact that they let a pet go too soon. If anything, most feel they waited too long. We have a saying in our field that I repeat on a daily basis to my clients: "It's better to be a week too early than a minute too late."