The Most Important Question in Dog Cancer Care
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
Updated: October 10th, 2018
Many dog lovers arrive at The Dog Cancer Blog looking or information. There is a problem though, and I would like to begin to spread the word about the most important question in dog cancer care.
Here it is: What type of person are you?
To many, this may sound very bizarre, so give me a moment to explain myself. In the world of dog cancer care, there are very few “right” choices. The reason for this is that most of the real cancers are not curable.
When we navigate a course in disease management that focuses on balancing life quality, life expectancy, ethics, and the ability and resources of the dog lover, we find quickly that the waters are murky indeed.
The “retrospectoscope” (a made up tool that allows one to see future events as if they had passed) would provide 20-20 vision, but in reality we have no crystal ball to see the future. There are very few ways to know if our choices are the correct ones at the time we are making them.
For example, you have a dog that is 6 months shy of her average life expectancy based on breed or body weight (this data is in the Dog Cancer Survival Guide). She is afflicted with a cancer that has a median life expectancy of 10 months with chemotherapy (say, lymphosarcoma). This dog is close to her life expectancy, and there is no guarantee she will get the 10 months.
On the other hand, maybe she is one of the incredibly rare dogs that goes into a permanent remission (cure). Chemotherapy would have been a good choice.
She could though be one of the dogs that has a horrible drug reaction. Chemotherapy would have been a bad choice. (Incidentally, a test to help predict certain chemo drug sensitivities is the MDR 1 mutation test, very easy to do for your vet.)
So it is clear that we just don’t have the needed data to always know the best course for our dog’s care. What to rely on?
In conventional cancer care thus far, treatments with longer life expectancies yield increased side effect risks. This point is perhaps overlooked many times in decisions involving dog cancer care.
Now we get to that question: What type of person are you? Defining you, your canine companion’s number one health advocate, is the most important first step in a dog cancer treatment plan.
Since there is no “right way” (and by right way I imply that your personal ethics are incorporated in the plan), we need to establish some guidelines. First, is your priority life expectancy or life quality? What is your tolerance for risk? Can you live with some of the graphic realities of your choices?
What has been the way you have lived your life in the past? This is a very useful question. The answer can be illuminating when contemplating treatment decisions with your dog.
In the Dog Cancer Survival Guide, I outline three different types of people who range from accepting of aggressive procedures with the possibility of more serious side effects, to those who prefer to avoid side effects at any cost. This latter group will, out of necessity, often be forced to accept shorter life expectancies.
Pinpointing yourself somewhere in this spectrum will provide you with valuable insights in what to do for your dog. Remember, the right choices are usually determined with the “retrospectoscope”. Use what you know now about the type of person you are.
When you are tackling a tough decision about dog cancer care, first ask yourself, “What kind of person am I?”
Best to all,
Dr D
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
I can feel your pain. It’s hard to digest, but you’ve got to let go of the guilt. The bottom line is, no matter what happened or how it did, your girl absolutely knew that you loved her, and she cherished every moment with you. Just like you did with her. It’s hard to do, but if you honor her by remembering all the years of healthy, happy life you both shared, you will be celebrating the time together, instead of raging against the small bit of time at the end.
Yes, you are damned if you do, and damned if you don’t. I allowed the vet to amputate one cat’s legs. They released her immediately, despite my protests. The suturing was poor. I wasn’t in great shape to care for her, but they said, “Oh, they do just fine on three legs and no recuperative period.” Then, one day later, the bone was exposed. Things worsened and she was put to rest, and that procedure was not done well either. When in crisis with limited options, all one can do is pray/hope for the best. The guilt doesn’t vanish, though. “Why was I so financially restricted that I couldn’t take her around to other vets?” “Why did I allow them to convince me having her leg amputated was a walk in the park.” 15 years later…
Great info, but I think something else needs to be addressed.I think for some, which may represent quite a few in numbers, the conflict may be that you may be a certain type on the retrospecto scale, meaning you would ge do not have the available financial resources, and therefore may also feel guilty, which they shouldn’t or worse get caught up in all the hope without seeing the potential trade off of impact, and especially if treatment doesn’t get the minimum results. Some don’t realize that they may even be tieing up funds that they need for their own or families healthcare, as their judgement is clouded. is it the vets or practice’s responsibility, not really. But they should be very clear that they should be prepared to part with money and not see expected results, much like don’t lend money to family, unless you are fine with never expecting to ever get it all or or any of it back, or don’t gamble with money you don’t have or can never get back. I hate to use analogies when it involves a loving pets life, but perhaps can be explained with serious emphasis to Guardians, as much as you want to, don’t want to go into debt, especially for an unguaranteed result. In fact I think they should even be told once they know that there is cancer, and even before they spend another dime on doing more tests, staging, DNA typing T or B etc, biopsies as many can’t even afford that. And they must not feel less or guilty if they can’t and look at the practical side. You may not have 6 mos to a year extra with chemo or surgery ,etc., but you may still have a month or two and we can still try to make your pet comfortable and some quality time, and there’s no guarantee anyways that your pet would make it much longer, except you would have spent or owed a lot of money. After you have time to heal you will realized you made the right choice, and their are no wrong choices as long as you care and love your pet, the outcome will be the same just perhaps sooner and it doesn’t matter to your pet, it only matters to you. You gave that pet love every day of its life and not all pets or animals are that lucky or blessed to have someone like you or your family. I just think all these new advancements are great and should be offered but it also puts many people in guilt mode or broke and can become worse off and even more real depressed beyond normal grieving because vets and articles are touting the potential positive outcomes without emphasizing reality and costs beyond many guardians reach. Comes a point where every one has a limit. And a vet does not nor can’t judge a book by its cover a person’s financial means, but should be frank and upfront about it and extend other graceful alternatives.
I too think this is an excellent blog. I believe it is a difficult decision no matter which way one decided to go. My decision has been for quality of life. My little dog has a MCT on her left hind leg and I chose not to do any medical intervention, however I determined I would give her the best quality of life I could with the time I have left with her. She has lived past her life expectancy of 13 yrs plus months. She is now 14 yrs plus 2 months and 9 months past her diagnosis of cancer. She is on no pain medication at all, she walks morning and evening and besides dragging her leg because the cancer has encapsulated the muscles around her upper joint she appears healthy. Eating can be a problem at times so we’ve used the information from DR D’s book using baby food when necessary. I use the alternative vitamins and minerals as well as herbs suggested in DR D’s book. I crush these and put them in her doggy treats I make. I use Mega Red daily. I make sure to the best of my ability she gets no preservatives in her food and I cook everything from scratch. It is more work and probably more expensive however it is the route I’ve chosen and as a result I believe my little dog has outlived what she would have without my interventions. I have been truly blessed finding this site and getting Dr D’s book. Of all the research I’ve done and I’ve done a lot, the book and information here is the best!
I had a 14 year old retriever dx with bone cancer in r front leg. Amputation and chemo was suggested. She was healthly in other ways. she was also a little overweight. We decided to manage pain and do nothing else except for the bisphosphonate tx. We did it one time and had the second scheduled. She was showing too much pain and I had her put to sleep the day afer the appt made for her next treatment. If she had been younger, I probably would have had the amputation. I know surgery could have spared her pain but possibleu opened too many doors for potnetial difficulties. Very tough decision in some ways; other ways it seemed like a no-brainer. Always second-guessing.
Had a dog have surgery to remove tumors on his chest. It spread like wildfire after surgery. I began second guessing myself about what if I had not had surgery. Damned if you do and damned if you don’t.
Excellent article. It is always such a hard decision. I think overall for me it is a quality of life. With Benji we had the surgery but the cancer would return at some time and at best within ten months. He developed other serious problems after the surgery – unrelated but requiring more intensive surgery and recovery. At this time the vet suggested it may be better for him to let him go now. Hard yes, heartbreaking yes, but I think it was the best for Benji as his quality of life would not have been what he liked