First on a happy note, Look who returned this week for their puppy vaccination.
Cujo. Can you tell he's growing from the photo? The first photo is from 4 weeks ago. The second one is from last Monday.
Now, here's my question. Last week I had to euthanize a 9 1/2 year old German Shepherd patient with bone cancer in her forelimb. She weighed over 100 lbs. 10 years old for a dog that big is about the human equivalent of 78 years old. Just for reference.
She was lame last December. We put her on arhritis medications for a few days-weeks, but that didn't seem to give her much relief. So we shot a radiograph (an x-ray). You could see areas of bone missing, which puts bone cancer on top of the list of possibilities. There was a little swelling around her joint but not terribly noticeable.
So, I sent her and rads to an orthopedic surgeon, since they deal with these cases more than I do . She needed a bone biopsy to confirm the lesion as osteosarcoma, but since the prognosis wasn't very good, her owners decided to try and make her comfortable for as long as possible.
This were their options for patients with osteosarcoma-
Amputation alone has a median survival time of 3-4 months.
Amputation and cisplatin (chemo) have a median survival time of 260 to 400 days. The 1 year survival range is 38% to 62%.
For a human, that doesn't sound like very long. For a large dog, a year is relatively longer in time reference.
J had been on narcotic pain meds but last week they noticed she seemed more uncomfortable and having way more diffuculty getting around.
I will say this though- I initially wasn't sure how well a 110lb. dog would be able to get around with missing a front leg. The orthopedic surgeon said that they do well since they are already accustomed to walking on 3 legs by avoiding weight bearing on the affected limb.
Here are photos I took of her leg last week. I had not seen J in several months and was expecting the tumor to be larger. There probably was also some metastasis to her lungs, which were still clear on radiographs back in January.
So my question is this. What would you have done? Knowing now that she made it almost a year, without surgery and without chemo, would you have done things differently?
Some owners might not be able to afford surgery, hospitalization, labwork and chemotherapy.
Chemo costs more in big dogs, than little dogs, as the drugs are dosed by weight.
In J's case, I think it was a little of it all- the poor prognosis, the expense, and not wanting to put her through all that.
Years ago, I had another German Shepherd who had lymphosarcoma. She did go through Chemotherapy over 12-15 weeks, and did quite well. She stayed in remission for about a year, and then when the cancer returned her owners opted to euthanize her too. But that is about the extent of practical experience I've had with chemotherapy.
Have any of you had a pet go through Chemotherapy? How did it go? Would you do it again, in hindsight?
3 comments:
Dear Doc,
After experiencing my late husband's 13 months of surgery, chemo and radiotherapy for stage 4 lung cancer, I would never put my pet through it if it was metastacized already, especially if to the lungs. I'm not even sure I would put myself through it. The only advantage for a human is that it buys time to put one's affairs in order. Cancer is a beast, at best. It's a case of the treatment being as bad as the disease. I could not prolong agony for my pet.
I am an animal lover who has had to make the life and ending life decision many times as family pet dogs have grown older and ill. I do not believe in putting them through any unnecessary pain and suffering. A friend of mine sent her beloved golden retriever in for chemo when he was diagnosed with cancer. But he suffered terribly from the chemo and still had to be euthanized. Our pets cannot make those decisions and we are responsible for making good kind decisions for them. A beloved pet deserves a good ending to its life. They give us loyalty, unconditional love, and joy. We owe them our deepest devotion and care.
I received several comments off the blog, as well as these you see, and most people had the same conclusion.
That they would prefer to not put their pet through chemo.
Many were fine with diagnostic tests necessary to make sure cancer was present, but at that point, the treatment would turn to making them comfortable.
Not that I personally would fault anyone for choosing the chemo route. It really depends on the type of cancer I think. Dogs do seem to tolerate chemo better than people, or they are so much better at hiding their discomfort.
Years ago, ABC's 20/20 did a feature on advancements in veterinary medicine- dialysis for pets, chemo, and robotic surgical units.
They were discussing an ethical question if such procedures should be made available to pets, when some people were denied or didn't have access to such treatment. People overwhelming felt that such treatments were fine. Dialysis of a pet, didn't necessarily prevent someone from getting dialysys. It's people discretionary income and they can spend how they choose.
At the very end, they interviewed the family with a Golden Retriever. She only had 2 legs. On the same side. The first one was injured by trauma, I think. And the second with bone cancer.
They struggled with their decision to amputate the second leg.
The dog appeared to be happy, and they used a sling, to aid her getting around.
Then over time, the dog learned to walk on 2 legs. It was really amazing and inspiring to see her enjoying a day at the beach with her family.
I saved that clip on video tape for years. I am not sure if I still have it.
Thanks to everyone who took the time to write or comment.
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