Figuring out what is ailing your dog is sometimes only the first step.
Often the optimal treatment is straightforward. But there are times when figuring out what is best for your dog is far from easy.
This story is an excerpt from Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life by Dr. Nancy Kay. I chose this story because it particularly touched me—it is quite similar to a situation we’ve been through with Jasmine.
When nobody knows what is best for your dog
Shortly after her thirteenth birthday, we noticed our Lily girl [a Golden Retriever] slowing down in the food department. If you are familiar with this breed, you know that this is a serious symptom. In fact, most Goldens would quit breathing before they’d stop eating!
An abdominal ultrasound showed that Lily had a large mass within her liver. We obtained a biopsy using a nonsurgical ultrasound-guided technique. However, the pathologist couldn’t be certain whether the mass was benign or malignant. Thus, my family and I were faced with a monumentally difficult decision.
Making the decision
Dare we ask our beloved 13-year-old to endure major surgery in the hopes that the mass was benign and could be successfully removed? Or, should we provide her with supportive care, keeping her as comfortable as possible for as long as possible?
Surgical removal of a liver lobe is no walk in the park for any dog, even one much younger than Lily. What if her life ended as a result of surgical complications? How would we feel if the mass turned out to be cancerous and couldn’t be removed? How would we live with ourselves knowing that we’d subjected our dear dog to such an invasive procedure during the last few weeks or months of her life?
We thrashed around with our decision for days, looking at it from many different angles and discussing all the pros and cons. Time, lots, and lots of time were invested, observing and “talking with” Lily. We studied her demeanor and expression—especially what her eyes were telling us. Did we sense that she was ready to “throw in the towel,” or was the game to take that giant step into the surgery suite?
No one could predict whether surgery would do her more harm than good. When such uncertainty exists, I encourage you to work through what I refer to as a “peace of mind exercise.” My husband and I used this exercise to make our decision for Lily.
Working it out
Here’s how it worked in our case: we were considering two options.
The first was surgery in the hopes of successfully removing her liver tumor. The second was to forego surgery and use supportive measures (special diet, antinausea, and pain medication) to keep Lily as comfortable as possible for as long as possible.
Although we felt, based on her overall health, Lily was a reasonable surgical candidate. Unfortunately, we had no way of knowing which of these two options was truly in her best interest.
Playing out the options
The first step in the “peace of mind exercise” is to play every option out to its negative and positive conclusions. In other words, decide what the best possible outcome and the worst possible outcome are for each. When my husband and I did this, we came up with the following:
- If we opted for surgery, the best case would be that her disease would be cured and her normal good quality of life restored. However, in the worst case, the surgeon would be unable to remove the tumor, and additionally, there would be significant surgical complications, perhaps resulting in death.
- If we went with the supportive-care option, the best scenario—even if the mass was benign—would be that Lily’s symptoms would progress slowly. She would have another few months of reasonably good quality time. The worst outcome imaginable would be a rapid progression of her symptoms resulting in the need to consider euthanasia within a few weeks.
Step two of this exercise is to determine which set of outcomes would best serve your peace of mind. With Lily, our goal wasn’t to find an option we “liked.” That was impossible under the circumstances. Rather, we tried to determine which we could most readily live with. This was the key to making our choice about how to proceed.
My husband and I were fortunate that we found ourselves on the same page. That is not always the case when more than one decision-maker is involved. The process certainly wasn’t an easy one. It took a great deal of thought, investigation, introspection, and yes, it required “discussions” with our deal old dog. When we made our choice, did we know with certainty that it was correct? Absolutely not! We did know it was well-informed with nothing but the best of intentions for our sweet girl. No matter how things turned out, we doubted we would have regret, sadness, and disappointment perhaps, but no regret.
What happened to Lily?
So, whatever happened to Lily? We decided to take the more aggressive approach. We asked a board-certified surgeon to attempt to remove her liver mass.
The surgery lasted almost four hours, and thank goodness, the mass was removed in its entirety. And, it turned out to be benign rather than cancerous—the icing on the cake! Lily took a considerable amount of time to recover completely. However, we had our Lily girl back within a few weeks. She spent her next three years in Golden Retriever bliss (good food, good company, and the opportunity to swim regularly).
Lily lived to the ripe old age of 16! We felt extremely fortunate with the outcome of our decision but knew in our hearts things could have gone wrong. However, we would have had peace of mind knowing that we’d done our very best. We stayed true to our good intentions throughout the decision-making process.
DR. NANCY KAY wanted to become a veterinarian for just about as long as she can remember. She has a veterinary degree from Cornell College of Veterinary Medicine, and she completed her residency training in small animal internal medicine at the University of California—Davis Veterinary School.
Dr. Kay is a board-certified specialist in the American College of Veterinary Internal Medicine. She published in several professional journals and textbooks. She lectures professionally to regional and national audiences. One of her favorite lecture topics is communication between veterinarians and their clients. Since the release of her book, Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, Dr. Kay has lectured extensively and written numerous magazine articles on the topic of medical advocacy. She was a featured guest on the popular National Public Radio show Fresh Air with Terry Gross.
Dr. Kay is a staff internist at VCA Animal Care Center, a 24-hour emergency/specialty care center in Rohnert Park, California. As a way of providing emotional support for people with sick four-legged family members, Dr. Kay founded and helps facilitate the VCA Animal Care Center Client Support Group. She also facilitates client communication rounds for VCA Animal Care Center employees.
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