When it Comes to Pets, Life and Death Decisions Are Never Easy
To describe animals as essential family members is somewhat of an understatement. Most of the pets I see are considered “children” to their pet parents, or “siblings” to their human counterparts. The unconditional love we receive from our pets is something nearly unexplainable to those without animal companions. This bond is the essential force that sustains my ability to practice the craft I’ve devoted myself towards.
Yet this same strong bond can create exceptional struggles and create many challenges when it comes to issues related to the healthcare of pets. Specifically, people tend to project what they understand about their own medical issues and care onto their pets, sometimes to the detriment of the care for their beloved companions.
After seeing thousands of appointments over the years, I am certain that everyone’s goal (whether owner, veterinarian, or otherwise) for patients with cancer is exactly the same: to maintain a good quality of life without causing harm, pain, or suffering, and with the greatest potential for longevity as possible.
In exceptionally rare instances, an owner will tell me they would be okay if their pet experienced undue side effects or discomfort from treatment if that would mean they would live longer than if they did not.
It’s difficult to guide owners through such decisions without feeling as though I’m being too pushy or forceful. It’s equally difficult to not feel as though I’m acquiescing to their concerns too quickly. I’m there to listen and to offer advice and recommendations, but I simply cannot remove the personal feelings from the equation.
As an example, for the vast majority of dogs with appendicular osteosarcoma, the primary recommendation will be amputation of the affected limb. This is the single most effective way to remove the source of pain for those dogs, and there are surprisingly few contraindications to this procedure and few pets that are considered poor candidates for the surgery. Even for large breed dogs or those who are overweight, old, or arthritic, I will still generally recommend amputation for the pet because my primary concern is to relieve their pain.
Many times owners will struggle with this decision, with the focus of their uncertainty stemming from concern their pet would not "do well" without their limb. They are concerned because the animal is too old or already has trouble walking, or that it would not be able to do the things it enjoys doing, such as swimming or fetching.
Despite attempts to reassure them and to focus on the need for immediate relief of discomfort, I’m continually surprised at the number of people who simply will not consider this option for their pets. There are plenty of times I simply cannot convey that their pet is crippled with pain at that time or that they would likely never fetch or swim again with a leg riddled with a tumor.
I received a phone call earlier last week from an owner updating me on her dog, who was previously diagnosed with osteosarcoma. Initially the dog’s family was certain they would not amputate his limb because he was a 14-year-old large breed dog. Their first appointment was with our radiation oncologist to discuss a palliative course of radiation therapy, designed to provide temporary pain relief but spare their dog’s limb.
After meeting with the doctor and listening to his take on this disease, they ultimately changed their minds completely and decided to amputate their pet’s limb and follow this with a course of chemotherapy with our service. Their dog sailed through surgery and treatment with only very minor issues, truly never missing a step over his protocol. Though we recommend routine follow up with our service, his owner worked at a veterinary hospital closer to her home, so all of those exams were done locally.
Nearly eight months after finishing treatment and almost one year since surgery, the news at this time wasn’t good. It sounded as though the dog developed spread of the cancer to a bone within the spinal canal and was showing signs of difficulty walking. However, the main point of the owner's call was to let me know how grateful they were towards me and the radiation oncologist for providing them with accurate information and statistics about their dog’s chances with surgery and treatment.
They were able to do their nearly impossible task and set aside many of their own pre-conceived feelings and emotions and listen to the suggestions we made, which were truly offered up in their pets best interests.
Often, the ability for owners to care so deeply for their pets is both a blessing and a curse for veterinarians. On the best of days it means people are able to listen and be open minded as to our suggestions, recommendations, and opinions in much the same way they might entrust their health with their own physicians. On the worst of days their attachment can preclude their ability to understand our concerns and suggestions, closing them off to opportunities for healing out of fear or anxiety.
Veterinary medicine is unique in this capacity. Our patients cannot speak their opinions or their concerns, so we rely on their caretakers to provide a voice and make decisions. It’s nearly an impossible task to perform, so I would urge you all to greatly consider the experience and wisdom of your veterinarian. And if you are not happy with the things you hear, please seek a second opinion. It’s the least you can do for the silent but unconditionally loving member of your family.
Dr. Joanne Intile