The hard choice is not a bad decision

Published 5:44 am Saturday, October 1, 2022

I think it started with a young Boxer.
His owners had been told that he was neutered, but he was a cryptorchid, meaning neither of his testicles descended from the abdomen at birth.
Because the testicles were kept warmer than they should have been, the left one became cancerous. Although it was benign, it secreted lots of female hormones that essentially killed his bone marrow.
Although he had five blood transfusions, his bone marrow never did start producing red blood cells after the tumorous testicle was removed.
We all cried the day his young owners brought him in to put to sleep. Not one of us was happy with this outcome.
We just put Brownie to sleep Thursday.
His owners had gone out of town for diagnosis of his splenic tumor. I don’t know if they were given options or not.
There are good options.
Josie, a large happy poodle, had her splenic tumor removed in Jan or Feb and was euthanized in the fall.
Buster, a medium sized fluffy black and white dog, is happy at home and doing well after his surgery.
Little Boo’s tumor was found later and the owners opted not to do surgery on their beloved dachshund. A few weeks later, we were tearfully putting her to sleep.
None of these owners made bad decisions.
The decision to treat or not to treat, to do surgery or not to do surgery and to do chemotherapy or not to do it is very complex. It includes the family, the finances, the age and health of the pet and ability of the family to get the treatments done.
Many times, cancer treatment starts with surgery.
Some tumors we know we do not cure with surgery. We often amputate legs for osteosarcoma in dogs, not because we cure the dogs, but because we relieve the pain.
After the pain is gone, they can live the rest of their shortened life with their family.
Other tumors can be completely removed before they spread and the animal (or human) go on to live a normal life.
Isaac had a mast cell tumor when he was nine months old. Two surgeries were required to get good margins and he had an unusual scar, but he died years later from something unrelated. It is not just skin cancers that get surgery. Maggie had a major abdominal surgery that took almost two hours of precise surgery for her large tumor that was formally her kidney. After the surgery, chemotherapy is often the option.
That has traditionally meant a specialist. A board-certified oncologist is going to be the most up to date on treatments and options.
For example, Buster is a PSTD service dog with a Grade 2 mast cell tumor. His treatment will probably include radiation therapy at the specialist.
Everyone cringes when discussing chemotherapy. They envision being sick and bald. Perhaps that is why two clients have told me that they have cancer weeks or months before they have told their family.
Chemotherapy is not what it used to be.
The goal for pets is different than humans. Animals are not sick for weeks or months at a time.
Lenore is a cat that was on oral chemotherapy.
Other than her time for diagnostics at the specialist, she was not hospitalized at all.
Maggie is a great dog and a true fighter through her 2.5 pound Renal papillary tubular adenocarcinoma surgery.
If she goes through chemotherapy, she could come in the morning, have blood work and an IV, her meds and be home for supper. She may have minimal side effects for a day or two and be back to normal until her next treatment in three weeks.
Instead of the $2-3 thousand dollars for treatments, it may be a tenth of that cost.
IV chemotherapy is not to be taken lightly. These drugs are carcinogens and often teratogens (they cause birth defects). A safety hood is for human protection. A chemo hood should be a class 2 b cabinet and should be a closed system for drug transfer.
If this doesn’t mean anything to you, you are not alone.
Suffice it to say, I am glad we have a large building with plenty of space and a client has been doing some fund raising.
I am often asked if “we aren’t just buying the pet time?”
There are many types of cancers. Not all are created equal, just like in people.
Some cancers can be cured. Some cannot.
Sometimes we can cure them in cats, but not dogs. Others may do better in dogs. Some cancers such as leukemia or lymphoma, the goal of therapy is remission.
In people, that could be five years. In pets, we try for a year.
But, yes, we are buying them time.
It is all how you look at things.
That glass IS half full, by the way.
Of course, the goal of surgery and treatment may not to be cure, but to increase the quality or quality and quantity of life.
However, some cancers may have a possibility of a complete cure.
From my oncology continuing education last month, some statistics:
An estimated 50 percent of all dogs over the age of 10 will get cancer. 50 percent of those can be cured with surgery or radiation.
The other half is in two categories: malignant cancers without effective treatment. We will only manage the pain and symptoms for a short period of time.
And the other half that are responsive to chemotherapy. Ones that chemotherapy does significantly extend their survival time.
Unfortunately, there is another statistic.
Many of my clients are unwilling and/or unable to drive hours with their pet to the specialist for treatment. They stop the whole process because of the distance, time off work and expense. I have always resisted offering chemotherapy, but I am beginning to rethink that decision.

MJ Wixsom, DVM MS is a best-selling Amazon author who practices at Guardian Animal Medical Center in Flatwoods, Ky. 606-928-6566

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