I have a close friend that has a dog with a bad diagnosis. The closer the patient and/or the client is to me, the more I see I have trouble with objectivity. This manifests in two ways.
Number one, I have a tendency to think in my mind that the problem is less likely to be a bad thing than it is.
Number two, I have trouble presenting the information regarding choices of therapy without putting in my own opinions.
I know this about myself, and alot of my clients and patients feel close to me. I get to know each person and their pet, and over the lifetime of the pet, I get very attached.
So, to get around this, I go back to my training and look immediately for a definitive diagnosis. That means what it sounds like….proof of what the problem is.
Then when sketching out the options, I review the literature and don’t just say what I would do. The other problem is that the closer a client is to me, the more they are likely to trust my opinion.
…and that is a bit of a problem when the outcome is hard to predict.
I want to introduce you to Sullivan. Sullivan is a 10 1/2 year old Golden and he is a sweet one.
Sullivan came to me limping a few weeks ago and I radiographed (xrayed) his leg. There was a lesion in the bone and I wasn’t sure what it was. So I sent the radiographs to a radiologist. She wasn’t sure what it was either, but recommended biopsy.
Last week we did a biopsy and it came back osteosarcoma. Osteosarcoma is a bone cancer.
A bad bone cancer.
I took radiographs of his chest and there is no evidence of cancer there. We know that 10% of dogs with bone cancer have metastasis to the chest at the time of diagnosis. Many more have microscopic metastasis at the time of diagnosis, but there is no way to tell.
With no treatment, the survival time is about 3 months. New medications allow pretty good pain relief during that time, but eventually the pain gets too bad, the tumor spreads or the bone fractures.
Amputation alone allows for a little longer 3-6 months survival, with 10% still alive at 1 year.
Amputation and chemotherapy is the best outcome , with 50% of dogs alive at 1 year and 10%-20%at two years.
The chemotherapy protocol requires regular injections and testing of blood to check for low white blood cell counts. Most dogs do ok with chemo as far as side effects, but it is a big commitment.
For the sake of this vote, assume you can afford the amputation and chemo. Factor in chemo every 3 weeks for 4 months. Also, on off weeks Sullivan will need bloodwork to determine if he is tolerating the chemo. Also assume his hair won’t fall out (lots of people ask that).
I will hold on my opinion, although I will share it when the results are in.
I know this seems like a harsh situation, but it is real. The exercise of putting yourself in Sullivan’s mom’s position may help you in the future with your pet….plus many people wonder what other people do in difficult situations.
So here goes…
Almost 500 people completed the survey on Sullivan, and before I give you the final results, I want to let you know that I got an enormous amount of emails with an explanation of why you answered as you did. I also got a lot of emails and Facebook posts in support of Sullivan’s mom regardless of the outcome. At the end of the day, I think the love that you all sent is the most important thing.
We can’t always control the outcome, but we can control the way we support the people who make the decisions. As a community, your support meant a lot to Sullivan’s mom (Valerie).
So, the day after the emails started coming in, Valerie decided to give him his comfortable time and with that mindfulness went to visit her granddaughter with Sullivan in the car.
Sullivan had a ball. He is totally comfortable for now with the medication and is able to play.
79% of you that completed the survey said to give him his comfortable time.
16% would have done chemo and amputation.
5% would have just done amputation.
I really appreciated (as did Sullivan’s mom) the explanations and thought that many of you put into this. Let me say once again that there was no right answer here. What is right is right for you and your pet.
I had several people write me who had made that decision before and in one case one of our Kindred Spirits who moved away to Florida had to make this decision with two of her greyhounds. The cancer was the same. She chose chemo and amputation in both cases. The first dog lived 1 1/2 years. The second dog lived 3 1/2 years. She had no regrets and would choose the same if faced with the opportunity. We had dinner with my sister and brother in law last night. Their dog had lymphosarcoma 3 years ago and passed away after trying chemotherapy. He would never make that choice again.
Making the decision is difficult no matter what. Considering your pet’s personality, statistics, opinions of others, and most importantly listening to your heart is the best you can do.
But in the process, know that there are a lot of people who know how significant this decision can be.
I told you that I would share my two cents on this one after the results were in. Valerie asked me what I would do and at first I answered I would give him his comfortable time. When I reviewed the literature, I found the chemo protocol that allowed for 50% survival at one year with amputation and began to think that I would have cut his time left by deciding that. The closest dog I have in age and temperament to Sullivan is Gizmo. But Gizmo is 14 years old. I don’t think I would do it with him. But if I did, I think he would do pretty well.
Many people asked how dogs do with amputation and chemo. The answer to both is surprisingly well. Since dogs have 4 legs, loss of one is not as bad as it is for humans. They also don’t have the self image issues we do.
Check out the discussion on our Facebook. Sullivan’s mom outed herself during the discussion to thank everyone for their input and love.
The power of this exercise got me thinking about something we could develop as a practice. Over the past year, the increasing sickness of Polly was difficult for Mary, the family, everyone. One of the things that was a gift during that process was the support of Hospice. I think it would be great to have a Kindred Spirits Hospice. The idea is simple…make those with a limited time left comfortable and out of the hospital. Veterinary patients lack the support staff that human patients have. When we get older, we have nursing homes, assisted living, home based nursing care, rehab facilities, palliative care. It takes a village…and having recently gone through end of life care, I can say that it really does take a village.
For those who choose to take care of their pets to the end, there typically is no support. I think we might be able to change that. I could have one of the team do hospice, but I think that we could also do the same thing better for no charge if we have a group of volunteers. I wonder if any of you would be interested….
In my head it would go like this….
We have a crew of volunteers that do hospice. There would have to be at least 20 or so of you so that no one got burned out or overworked. Its going to be emotional but gratifying.
We would have monthly meetings to learn about the grieving process, medical support for geriatric patients, brainstorming sessions.
Those who sought out hospice could have in house help for taking care of their pet. Perhaps that is letting a pet outside that is stuck inside all day because of their owner’s work schedule. Perhaps its weekend care so that the owners can get away. Perhaps its just having a witness for a difficult time.
Those who volunteered with hospice would have several people sharing a client. They would have access to me or a tech at all times. The primary care would be given by the hospice volunteers. They would use their experience, or what they learned from our sessions, or medical training they have had to help.
As with everything, I throw this out to you all to see if there is enough interest to move forward. Email me if you are interested and if there are more than 20 we’ll move forward.
If any of you have special training (grief counseling, nursing care, history of a pet with a long or challenging decline) let me know and we’ll include that in the training of the group.
If there is a big goose egg in the inbox tomorrow, I’ll consider moving this forward with our professional staff.
Either way, I think its a good idea and would be helpful to those who are losing a pet.
I’m so grateful for you all no matter what. In a day where sometimes it feels like the world is going in the wrong direction, it turns out that people that come together for a common cause can still make a hell of a difference.