It was the day after Christmas, which is how these things always seem to go. I looked at the x-ray on the monitor and smushed my lips together at what I saw. “That looks terrible,” I say to my friend Kristen, also a veterinarian. She nods glumly. A lytic, destructive bone lesion. Pretty cut and dried for cancer.
Survival statistics for cancer depend on a lot of things, but one of the main prognostic indicators is type of cancer. Bone cancers are notoriously nasty and challenging to treat. Typically, one would deal with a lesion like this- sitting right on the ankle bone- by amputation, a treatment that removes discomfort on the part of the pet but doesn’t increase survival time. So, it’s a palliative treatment. There aren’t a whole lot of options.
Kristen scratched the patient behind the ears. “I’m sorry, old girl,” she said.
And Koa licked her hand, like she always does.
So yes, that’s been our holiday, which is fast turning into my least favorite time of year. As you all know, Koa has been at my mother-in-law’s for a period of time, during which she has done very well. But it also means I didn’t see her ankle joint starting to swell. I noticed it right after she came home on Christmas, as she was walking in the backyard.
There are a lot of different reasons I assumed it was what it turned out to be, that “clinical intuition” in actuality a combination of physical exam, statistics, and experience. Sometimes things surprise you, but usually they don’t. The radiograph the next day confirmed it. Koa has a cancer lesion on her ankle, and it sucks.
With the exception of Taffy, my childhood Lhasa who expired of heart disease, all my dogs have died of cancer. Hemangiosarcoma, melanoma, lymphoma, and now what is most likely a synovial cell sarcoma. I’ve spent more time than I care to talk about at the local specialty hospital and I’ve done some pretty aggressive treatments, both radiation and chemotherapy. And this is what I’ve learned:
- It’s OK to be angry, even if you kind of knew it was coming.
- It never gets easier, no matter how many times you’ve gone through it.
- You know your pet has a finite lifespan, but there is something about getting the diagnosis of a terminal condition that is just so final. The sense of dread when the stopwatch starts ticking is always there.
- It’s OK to not do the most aggressive thing.
Suffice it to say, there are a lot of factors that go into deciding on an appropriate course of treatment for your pet. Their state of health, economics, effect on outcome, quality of life- all of that matters. And it’s your veterinarian’s job to help you make the best decision for yourself and your pet. That is what I want to stress to everyone, because I know so many of you have agonized over the same questions- you don’t have to do everything if it’s not the right thing for your family.
For a variety of reasons I spent a good deal of time thinking about, I have decided not to do a limb amputation on Kekoa. I’ll be as aggressive as I can with pain management and keep her quality of life good for a long as it makes sense. To be honest, were it not for the swelling I probably wouldn’t have noticed anything amiss- she’s as happy and active and prone to stealing rolls as always, and the only difference now is that I don’t get mad when she does it.
Today, she sneaked into the garage through a door normally just cracked open for Apollo.
This was an unopened can of cat food. How she managed that, I’ll never know.
Then to top it off, she had cat litter for dessert.
Cancer. Cancer sucks.