Cancer and Death

Dear Dr. Berg,

I am deeply worried about my dog and am hoping that you can give me some advice.  My Cocker Spaniel is 12 years old and has been diagnosed with cancer.  His neck got very swollen, so I took him to the vet.  The vet gave him anesthetic and cleaned his teeth and took a biopsy of the swelling, which he thought was a lymph node.  The test results came back and he told me that my dog had lymph node cancer, so we began treating him with shots, which were chemotherapy.

My dog ‘has taken chemotherapy treatments for about 4 months now and HE LOOKS GREAT!  Most people can’t even tell that he is sick.  His neck is back to normal size and doesn’t hurt.  The doctor has said that he really can’t tell how long my dog has to live, but he said some dogs could live for over a year.

I am very worried about the cancer, but I am mostly afraid about having to put my dog to sleep.  I just can’t bear thinking about it and wish that somehow he would just die peacefully in his sleep.  Do you have any help on making this decision when the time finally does come?  What if I can’t decide?

I am sure that you’re used to this kind of thing, but this is the first dog I’ve had with cancer.

Many thanks.

C. R., Wilmington

Dear C.R.

It is wonderful that the chemotherapy has helped your dog so much, giving you additional quality time together.  With most chemotherapy treatments that are used today, the goal of most “successful” cancer therapies is to extend the length and quality of the patient rather than totally eliminating the cancer.

There are many different combinations of drugs used in chemotherapy, and each protocol is often custom-made for the individual pet and his specific type of cancer.  Some chemotherapy treatments may be expected to extend life for, at most, a few weeks.  Lymph node cancer is more responsive to chemotherapy than most, and, in some cases, can extend a dog’s life for months or even years.  About 10 years ago, one of my patients was successfully managed with chemotherapy for almost 2 years with a very high of quality life.

Deciding whether or not it is best to consider putting a pet to sleep is one of the most difficult decisions we may make on our pet’s behalf.  When our pet is faced with a life-threatening health condition late in their life, we must consider how much such treatment is likely to help as well as what our pet’s quality of life will be like during the treatment.

If treating a serious condition in a “senior patient” is likely to help and the level of discomfort during the process is bearable, there is reason to hope and do whatever it takes to make things better.  If, on the other hand, treatment is likely to extend life a few short days or weeks and the quality of that life will be very poor, one must ask if it is truly in the best interest of the pet to extend life “no matter what”.  Sometimes, as pet owners who cherish our pets, it may be hard to be totally objective in such situations, but we must ALWAYS keep our pet’s best interests to heart.  We should keep our pets alive because it is humane and makes sense, and not because we are having trouble saying goodbye.

Most pet owners realize from the very first day they hold that cute puppy or kitten in their arms that this beautiful creature will be with us only for a few short years, but that there will be so much love packed into those years.  Overwhelmed with the joy and beauty of this precious new life in front of them, most people rarely think about when it may be time to say goodbye.  Death of an animal is just as much a part of life as is the birth of that animal, and should serve as a reminder that life on this earth is a very precious thing to be treasured.

I find it truly sad when I hear a client say to me “I’m never getting another dog, because it hurts too much when they leave”.  It is awful when we must leave those we love, and is a pain we feel for a long long time.  This deep pain tells us how very important these pets are to us and how much love and joy we feel by having them in our family.  I realize that I’m pretty biased on this subject, but, to me, this painful separation is all worth it, a million times over.  Those people in this world who have never shared their lives with a pet are missing out on one of life’s most rewarding pleasures.  My home would seem pretty drab were it not for those three happy faces staring up at me like I’m the greatest, tails madly wagging back and forth, delighted simply that I’ve come home.

My own feelings as to why pets don’t usually live as long as us is so that we can not only appreciate their years with us that much more, but also that we can enjoy sharing our lives with many different pets, all with their own unique and wonderful personalities.  Pets pack a lifetime of love in 10-15 short years, and are experts at this task.

When faced with a pet’s terminal illness, I tell pet owners to trust their own hearts during this difficult time.  There is no one in this whole wide world that knows your pet better than you.  You know when your pet is happy, when he’s mad, when he’s in trouble, and when he’s sad.  And when you pet hurts, so do you…deep down inside.

When an animal hurts, they will usually want to be by themselves more and tend to resist handling.  Movement may be painful, and their appetite will often be poor.  Most of all, when animals hurt, you can see it in their eyes and their expression.

If an animal is seriously ill, if there is hope for recovery in the future, then pain and discomfort can be managed while the healing progresses.  But when an animal has an illness that is difficult to treat and which is likely to get progressively worse and more painful for the animal, one really has to question whether prolonging of a pet’s painful life “no matter what it takes” makes sense.  Pet owner must try hard to imagine what it is like to be their pet and what they think their pet would ask them to do.

Just a few months ago, a very good client of mine lost two of her dogs within a period of about 2 years to kidney failure.  Both dogs were fairly old and had a form of kidney failure that usually gets progressively worse over days or weeks.  Dogs with weak kidneys will become lethargic, stop eating, have vomiting and diarrhea, and finally will die.  Kidney transplants are just beginning to be performed at teaching institutions, but are very very expensive and usually only performed on young animals. 

The standard treatment for kidney failure is to hospitalize the animal, insert an intravenous catheter, and then give 24-hour fluid therapy in an attempt to flush the body poisons out with and increased volume of fluid.  Sometimes it will help greatly, but with the most common form of kidney failure in older animals, the improvement may be temporary, requiring multiple hospitalizations to keep flushing the body.

When this particular client’s first dog was diagnosed with kidney failure, she hospitalized the dog, as the veterinarian had recommended, and the dog was put on intensive IV therapy.  She went to visit her dog every day, but the dog failed to improve and died late one night while the owner was sleeping at home.  The owner felt very bad that she could not be there to comfort her dog when the dog passed away.

About 3 months ago, her second older dog also was diagnosed with kidney failure.  This time, she decided to do all that she could for her dog at home.  She would take him regularly to the hospital to be given fluid therapy, but then would take him home.  She used antibiotics when needed and fed a special diet to reduce the workload on the kidneys.   Her dog became weaker as the diseased progressed, but the owner had made the decision to keep her dog at home, as long he was comfortable.  The dog’s final hours were spent on the back porch (where he loved to sit) cuddled in his mother’s arms on the rocking chair.  The owner knew in her heart that she had made the right decision, providing comfort and companionship for her dog right up until his final breath.

It may help greatly to discuss your concerns and feelings with your veterinarian or close family members.  Pet grief counselors and pet loss support groups are also available, if they would help you.  More than ever before, your dog is counting on you to do the right thing. 

The last few days of a pet’s life are a very important time.  It is only fitting that our beloved pets leave this world with dignity and the least amount of pain possible.  It is our final gift of love to our pets and we must do everything in our power to make it so.

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