The Big Casino

With apologies to my grandmother and other more sensitive readers, the working title while I was writing this post was “f@#king cancer.” I’m not sure why I felt the need to tell you that except that it illustrates how I feel on the subject. I would open my “drafts” file every few days and see this post and start writing, scrap it and start over. This post really only applies to terminal cancers. There are a few cancers that can be cured with aggressive and sometimes even modest surgical or medical approaches.

The big casino, the “C” word. The big C. It’s one of those things that comes out as a heavy weight attached to even heavier weights. Words like surgery – not so bad – often followed by horrible words like chemotherapy, radiation or metastasis. Chemo, the other C word. When I bring up the word chemotherapy in an exam room, I know the face I’m going to see. I wish I could put myself in people’s shoes and see what they were picturing when I say the dreaded chemo-word. But I can’t forget the things I know and I can’t erase my experiences. To me chemotherapy is time, it’s a chance to set the clock back a little bit. We can take a pet who is really sick and help them get back some of that quality of life they’ve lost. For some time. It’s a chance for people to come to terms with the fact they won’t get to see their pet grow old or that their older pet is dying.

People generally have someone in their circle of loved ones who has gone through the nightmare of chemotherapy. I think they picture that experience when making the decision and to me that’s a mistake. I would never knowingly suggest putting a pet through something as horrible as what some human cancer patients endure. In our world however, we aren’t going for maximizing the total number of days nor are we hoping to strike on the cure. Our aim is to work with you to find a way to maximize the total number of tail wags (dogs) or head butts (cats) we can experience before we have to make a tough decision.

Chemotherapy is typically a series of visits, monitoring and then administration of drugs that are designed to target rapidly dividing cells, turn off the pathways that these cells use for growth and sometimes they even prepare the body to do battle with the cancer by ramping up antibody production.

Sometimes this will followed by or in rare cases replaced by radiation oncology. Radiation can also be used to control symptoms in patients who have tumors that can not be operated on or in cancers that can not be cured. It involves “firing” ionized radiation in specially shaped beams that maximize the dose of radiation at the site of the tumor while sparing the healthy tissue as much as possible. For us here in Rutland, Vermont, the closest facilities that offer this service are in Boston and Montreal.

Chemotherapy and radiation oncology sometimes follow surgery, sometimes there is no surgery and sometimes they are used to shrink a tumor enough to allow surgery. It depends. No matter what course of action is taken our goal is always to maximize the number of tail wags or head butts you and your pet share.

That doesn’t mean there won’t be bad days. There will be nausea. There will be diarrhea. There might be vomiting. There will be blood. Draws, that should have said blood draws. Holy monitoring there will be a lot of blood draws. But we can manage all of these things. And if we know they are coming we can manage them effectively before they happen. An ounce of prevention and all that.

No one wants to tell you your dog has cancer and no one wants to explain options and decisions while your head is reeling from the initial blow. I can still remember one client stopping me mid-sentence and asking me in a very concerned and serious tone, “Dogs can get cancer?” She had no idea. And why should she? She had never experienced it nor had anyone she knew. But she had a mother who went through cancer and it was terrible. She was in no shape to discuss cancer in her dog. She just found out at the same time that not only could dogs get cancer but her dog actually had cancer. So we rescheduled the conversation for a few days later and boy did she come in with some internet articles for us to peruse. I am always slightly tempted to remind people that I also have internet access, at work and at home. But she informed herself and we made some decisions for her dog and he went on to do well for an acceptable period of time.

The one take away I want you to get from this or to pass on to a friend who is going through a tough time. Please, if you can, please at least sit down with an oncologist. If you’ve gotten far enough to diagnose the cancer into a specific kind, it should be compulsory to have a conversation with an oncologist. This is not because they great sales people and will talk you into maximizing your dog’s quality of life thus justifying my means with an end. No, all of the oncologists I know are way softer and sweeter than this hard boiled, fast talking, quick blogging country vet. I want you to sit down with an oncologist because they can give you all of your options and allow you to make an informed decision. I promise they won’t push or force the issue. But it will always be worth your time to find out what can be done.

So yes, cancer is terrible. Yes it is always bad news but it is a situation where getting all of your options explained by experts is always going to be worth your time.

Thanks for reading.

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