I’ve practiced in some very rural parts of the country, meaning that my clients often had to travel long distances to get to and from the clinic (and everywhere else, for that matter). The lack of nearby veterinary care presented real challenges when it came to emergencies, but also affected decision making with regards to how to address non-emergency health crises. One such scenario immediately comes to mind.
Picture yourself as the owner of a dog that has just been diagnosed with osteosarcoma — an excruciatingly painful and deadly type of bone cancer. You’ve been told that amputating the affected limb is the only way to definitively get rid of your pet’s pain (referral for limb-sparing surgery or radiation isn’t an option), but that amputation alone usually only results in a survival time of around five months. Adding chemotherapy after surgery typically increases that survival time to seven to thirteen months, depending on the protocol, but here’s the kicker: To partake in chemotherapy, you will need to bring your dog in every two to three weeks (at least), and he absolutely hates going to the veterinarian’s office.
So you’re faced with an awful choice:
1. No surgery or chemo, knowing you’ll have to euthanize, most likely in a few weeks, when the pain overwhelms our ability to deal with it medically.
2. Amputation followed by chemo to eliminate pain and get the longest survival time possible, knowing you’ll spend a lot of that time stressing out your dog by traveling to and from the veterinary clinic and monitoring for the adverse effects of chemo.
3. Amputation alone, to get the benefit of pain relief but deciding against chemo to allow him to spend what time he has left away from doctors.
But what if there was a way to reap the benefits of chemotherapy without all the back and forth? Turns out there may be. A study published in the September 1, 2012 issue of the Journal of the American Veterinary Medical Association reported that a single subcutaneous infusion of the chemotherapy drug carboplatin given after surgery resulted in similar survival times and adverse effects when compared to traditional chemotherapy protocols for osteosarcoma that involved giving drugs intravenously multiple times over the course of several weeks.
Veterinarians inserted a sterile urinary catheter under the skin, fixed it in place, and infused diluted carboplatin using a constant rate infusion pump over three, five, or seven days. On average, the dogs in the study survived for 365 days — that’s pretty good for osteosarcoma. The researchers found no difference between the dogs that received chemotherapy over three, five, or seven days, so I can foresee another therapeutic option that goes something like this:
4. Amputation followed by three days of hospitalization, during which time a dog would recover with the benefit of the best pain relievers, receive all his chemotherapy, and be able to go home with only one recheck appointment scheduled for approximately one week later to check for adverse effects related to surgery and/or chemotherapy, and to remove skin sutures if all looked good.
I’m sure a lot of my rural clients (and the townies, too) would leap at the chance to maximize their dogs’ comfort and survival times while minimizing the number of veterinary visits involved in treating osteosarcoma.
Dr. Jennifer Coates
Image: Jumping three-legged dog at The Great GoogaMooga Festival by Timothy Krause / via Flickr