One of the hardest parts of being a veterinarian is when we diagnose a beloved family pet with a serious illness. Many pet owners will, at some point in their lives, have to cope with a diagnosis of cancer in their beloved furry family member. It's a painful process wrought with difficult decisions and high emotions.
Sadly, I am going through this process with my beloved girl Nala right now. I have decided that I want to share this raw experience to help others understand that they are not alone. Even a veterinarian has moments where decisions seem impossibly difficult. I have had to lean on my friends and family and colleagues for guidance.
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Many of you will recognize Nala. I have used her in several social media posts. I may be biased, but I consider her to be a perfect patient; She will let me do just about anything to her! She is a perfect dog as far as I am concerned! She is calm and sweet and gentle. She has been with me for 11 years, through the birth of my two children and a move across the country.
A few months ago we noticed that she was starting to hold up her back leg when standing at her food bowl. I investigated her leg and immediately had a deep feeling of dread when I noticed a swelling of her bone. Being a veterinarian, I already knew what the diagnosis was before I even loaded her into my car to bring her to work. I knew from the RVT's faces when they opened the door to the X-ray room after taking her radiographs that my suspicions had been true. My sweet girl had bone cancer.
We can not get a definitive diagnosis of bone cancer without a biopsy, but the radiograph, in combination with her age and breed, was extremely suggestive of a bone cancer called osteosarcoma. My family and I were devastated. We had some very difficult decisions to make in the days ahead. Osteosarcoma is an aggressive form of cancer and so we had to act fairly quickly.
Now, the sequence of events that led to my final decisions will not be the same for every pet with this condition. There are a multitude of factors that play into this decision tree. It is so very important to have friends, family and medical professionals to guide you through this process.
Nala's pain was increasing by the day. I knew that palliating her pain was going to be difficult and short-lived but might buy her some time. I was likely looking at a month or less with her. Alternatively, I could consider amputation of the affected leg. However, with osteosarcoma a high percentage of dogs will already have spread of the cancer throughout the body by the time the tumor is diagnosed. So, we must consider amputation as palliation and pain relief, with the expectation that the cancer will return, likely within 3-4 months. For best results, amputation should be paired with chemotherapy, in which case she may be with us for 1 year or more.
My biggest fear with amputation was whether her quality of life would be good after surgery. She is a strong dog and has no underlying health conditions. She has minimal mobility problems with minimal arthritis on X-ray of her joints. However, losing a leg is a major adjustment for a 100lb, 11 year old dog. I also worried about how my children would cope with her recovery, especially if she didn't do well. I have a very close friend who went through this with her Rottweiler recently, and her experience was not great, her girl did not do very well. We had many heart-to-heart talks.
However, in reality most dogs do very well with hind limb amputations. And unlike humans, most dogs do very well with the protocols that we use for their chemotherapy. I also have a good friend who is a veterinary surgeon and she offered me much guidance.
In the end, we decided to amputate Nalas right hind leg. Dr. Swayne drove in late on a Sunday night and performed the surgery for Nala, doing an incredible job as she always does. Recovery was difficult, for the first week in particular. Many times, I questioned my decision. However, in the days to follow Nala started to return to her normal self. We used a harness on her front end and her hind end to help her walk. Every day she was able to walk a little further. I remember the day that she went over to her toy bin and started flipping her dog toys up in the air. It brought tears to my eyes.
Her chemotherapy has gone very well. I drive her into the Animal Cancer Center at the University of Guelph once every 4 weeks for an IV infusion that takes about 1 hour. To date, she has never shown any signs of nausea or discomfort after her chemotherapy. We have struggled with low white blood cell counts and anemia, but some dosage adjustments from the amazing staff at the Cancer Center has corrected that. Last Friday she had her final chemo appointment!
It has been 3 months since her surgery and Nala is now basically back to her old self. She is not as mobile as before, but she can still go for short walks and it doesn't seem to stop her from chasing the cat around the house! What is most important is that she has a good quality of life right now. I know that the cancer will likely return, but having these extra months with her has already been worth it. We will continue to love her every day and cherish the time we have with her.
Dealing with a terminal illness in a beloved pet is one of the hardest things that we do in life. Major surgery and chemotherapy are certainly not in the cards for many, if not most, situations. However, our job as veterinarians is to present you with all the options, and their risks and benefits, and help you work through that decision tree however it works best for you and your family. We are here to help support you through these difficult decisions, and most importantly to ensure that whatever your decision is, your pet does not suffer. We are not here to judge, or make those decisions for you.
There will likely be a time when euthanasia enters our conversation. I know that the time will come for Nala's journey to come to an end. Your veterinary team will be there for you then too. We will help your pet cross the rainbow bridge with dignity and love, and prevent him or her from suffering. People often say to me that euthanasia must be the hardest part of my job. Of course, it is incredibly sad, but I always answer that it is not. Seeing a pet pass over the rainbow bridge peacefully and with dignity, surrounded by loved ones, who are selflessly letting their beloved pet go to prevent further suffering, is actually one of the most rewarding things that I do.
Dr. Stephanie