WWDD? (What Would the Doctor Do?)
One of the most difficult questions I am asked by owners is, “What would you do if this were your own pet?” Though intellectually I understand why my answer would be perceived as meaningful, I find it challenging to respond. If I speak truthfully, the time it would take to answer their question would likely surpass the hour I have allotted for the appointment.
My dilemma is as follows: It's impossible to approach my own pet’s health without examining the situation through the lens of my life as a doctor, since as a doctor I am afforded insight and opportunities that are not available to the typical pet owner. I am simply unable to separate being a pet owner from being a veterinarian when it comes to decisions regarding the care of my own animals.
Despite the variety of diagnoses and prognoses I discuss, the majority of owners have the exact same concerns when considering whether to pursue treatment for their pet. Their primary concern centers on what can be done to maintain a good quality of life for their pet while not acting selfishly with regard to decisions. Their secondary concerns include the emotional, time, and financial considerations the decision would entail. I would want all of the same things for my own pets if placed in a similar situation and I know these are all surprisingly subjective scenarios.
Quality of life in veterinary oncology is a gray area. Sometimes it may appear straightforward: Pets that are no longer self-sufficient or are clearly exhibiting signs of pain have a poor quality of life.
Other examples are less clear-cut: a dog with a bladder tumor that continually strains to urinate but still can empty her bladder, or a dog with a brain tumor that has occasional but controllable, seizures. Are their lives poor and should I recommend euthanasia for those cases?
Even with the more obvious scenarios, it’s not exactly black and white upon further consideration. I have the ability to place feeding tubes in animals to bypass an unwillingness to eat, and I can prescribe strong pain medications to sedate a pet and relieve pain temporarily. In each of the above-mentioned scenarios, I struggle with what’s right and what’s wrong and what I might do if I were in those owners’ shoes.
More specifically, when it comes to decisions about pursuing chemotherapy for pets, as an oncologist I have a very different (and possibly skewed) view of what the expected side effects from a particular treatment could entail. For example, with all the different chemotherapy drugs I prescribe, I know mild side effects are seen in about 25 percent of pets, and severe side effects are seen in less than 5 percent. I recognize that what is considered in objective medical terms to be a “mild” side effect may mean something completely different when the pet is your own. No one wants to see their pet experience even a single moment of sickness, especially one secondary to a treatment they chose to administer.
I have so much firsthand experience with chemotherapy, and medical knowledge about what signs are typical and what are atypical, I know I would feel comfortable administering chemotherapy to my own pet. This is not true for the average pet owner — signs can be confusing and stressful, and not every owner is equipped with the ability to handle complications related to treatments. Were my pet to become sick from its treatment, or from the cancer, I could easily bring it with me to work and provide care, without concern for how it would impact my employment. This makes it difficult to be impartial about some of the concerns typical owners would face regarding pursuing treatment and the potential side effects.
I also (fortunately) have very limited personal experience with owning a pet with cancer. My cat was diagnosed with an aggressive form of leukemia when I was a first year vet student, and although I was far more balanced on the “pet owner” side of the bar than the clinician’s side , there weren’t really any options available for him, so my decision was ultimately not at all difficult in the end. I cannot begin to imagine the emotional rollercoaster owners face, especially while undergoing treatment.
Remissions can be temporary, complications can arise in the middle of a plan, and sometimes it just seems as though bad news follows certain pets around like a dark cloud. The emotional aspect surrounding the role a pet plays in its particular household is so unique and complex that I feel it’s virtually impossible for me to impart my own thoughts on someone else’s situation.
I think the best I can do is attempt to assure owners that the recommendations and discussions I make would not be any different if I were talking to myself versus talking to them.
My objective is to be honest regarding my opinions without feeling as though I’m trying to predict the future, and to remain open to deviations from the “ideal” plan. If I accomplish this, then I am doing my job to the best of my abilities. In other words, I need to be able to sleep at night feeling comfortable with knowing that I’m being true to my chosen career and, ultimately, to myself, regardless of whether I feel comfortable or not in my specific answer to that difficult question.
What would I do if this were my own pet?
I’ll think about it and get back to you.
Dr. Joanne Intile