Veterinary Communication with Clients: Breaking The Bad News When It Could Be Something Else—Penny Does Not Have Cancer
Is there a good way of breaking bad news to dog parents?
That is a hard one. But what if there is a lack of certainty? How would you like your veterinarian to discuss such news with you?
Penny
Recently I received a distressed email from a friend regarding her dog.
I wanted to reach out to you and tell you that my dog Penny is very sick and in the hospital. She has had bouts of colitis and lethargy. For the last few days, she’s been very lethargic and suffered from bowel trouble and fever. In addition, the hospital discovered prominent lymph nodes and some abnormal results on the ultrasound and chest x-ray.
They aspirated lymph cells, and it looked inconclusive, so sending out to a pathology lab. They think she may have lymphoma! I am a wreck. I am just asking you to please pray for her and me and my husband as we love her so dearly.
What do you answer to such a heartbreaking email? What words could possibly make things better?
Jasmine
We were on the receiving end of such a possibility twice with Jasmine. So I know exactly how it feels.
The first time, Jasmine was still relatively young, about 5-years old, when she suddenly developed a cough. She did a lot of barking that evening because neighbors had a loud party in the backyard, so initially, we figured she just irritated her throat. But it was not going away. Kennel cough didn’t seem likely, as Jasmine was not boarded or exposed to any environment crowded with dogs.
The next day, she was still coughing.
We took her to the vet that afternoon. He checked her out and discovered she had elevated temperature and enlarged lymph nodes. She was a good girl and demonstrated her cough too.
The vet turned to us and said as if it was all the same, “it’s either infection or lymphoma. We could start antibiotics and see if the problem resolves.”
Lymphoma?
Either infection or what? My heart jumped into my throat.
I didn’t know much about veterinary stuff then, but I knew what lymphoma meant… Jasmine’s best buddy died to it. Trying the antibiotics made sense, so that’s what we agreed to. But the word lymphoma lingered in the air.
Fortunately, the cough resolved very quickly with the antibiotics, and on the follow-up exam, everything looked good.
Could I have lived without the “L” word tossed around during the initial visit? I wouldn’t have spent a night tossing and turning, that’s for sure.
Complicated matters
Of course, sometimes things get more complicated.
That was certainly the case the second time we had to face the possibility of the big “C.”
After Jasmine was diagnosed with a torn cruciate ligament, hubby dropped her off at her then-new vet to get more x-rays. While she was under, the vet decided to give her a good look over. And then we received the phone call, “I was palpating her abdomen, and I felt a mass. Would you agree to take additional x-rays of the abdomen?” We, of course, agreed.
And then we got called to his office.
My knees were buckling underneath me.
The mass could be felt, but it also showed up on the x-rays. Also, both Jasmine’s spleen and liver were enlarged. So the vet recommended starting with a blood test, and if negative for cancer markers, exploratory surgery to see what it is and, if possible, get it out.
The world turned black.
Wasn’t it enough that Jasmine had a bum knee? We were trying to figure out what to do with that the whole time, and now, it might not even matter?
When we took her for a walk that afternoon, the ground was covered with fresh snow. Jasmine adores the snow, and she wanted to run around in it and dive into it … but we couldn’t let her because of her bad knee.
Last photos?
We took a camera with us to take what, potentially, could be the last happy photos …
I looked into her eyes, full of fire, and I could not accept that she might be THAT ill. It didn’t make any sense. She had so much life in her!
Fortunately, the blood test came back negative. It didn’t mean it could not be the big “C,” but it said it was not likely and that the exploratory surgery was on.
The exploratory surgery revealed that the mass was not an actual defined mass but rather a thickening of part of the stomach and small intestine. So the vet did a biopsy and sent it out to the lab.
Waiting for results
Another wait.
Eosinophilic gastroenteritis isn’t exactly good news, but it certainly was to us! The heart-wrenching week took a good couple of years of our lifespan. But Jasmine was going to be OK!
Back to Penny
I didn’t know how to respond to my friend, except for words of support, so I asked further questions instead. If it wasn’t the big “C” either time with Jasmine, maybe this isn’t?
I knew it was grasping at straws, but maybe, if we can come up with another possibility, it will make it so.
I asked about the lymph nodes and whether the spleen was also enlarged.
Yes, all the lymph nodes were involved, and the spleen was enlarged on ultrasound. However, Penny also showed positive for Lyme exposure, and she was started on doxycycline for that. They were waiting for the C6 Lyme quantitative test and the cytology results.
Meanwhile, I dug out all the info about the latest and greatest lymphoma treatments.
Lymphoma or an infection?
But perhaps it is just some systemic infection? It was a long shot given the signs, but it was not impossible.
Penny seemed to be doing a bit better on the antibiotics and was able to go home from the hospital. She was still weak and coughing badly. But she started eating.
The Lyme test came back inconclusive. The cytology report still wasn’t in.
I was turning the internet upside down, trying to find some confirmation that all this could indeed be from a systemic infection. There was some chance that it could be …
The cytology report
Finally, they got the cytology report.
It came back reactive to infection and negative for lymphoma!
It wasn’t clear what infection it was, probably tick-borne, but the important thing was that Penny was responding very fast to the doxycycline. Even the cough had somewhat improved.
Today, Penny is doing well. She is back to her full self, active, and with a good appetite.
On her last re-check at the internal medicine vet, all looked good.
Advocating for our dogs
All good decisions need to be based on good information. Being well-informed is crucial. But sometimes I wonder, how much do we REALLY need to know, particularly when it could be something else?
Sometimes I yearn for the days of blissful ignorance.
When we discussed this, my friend asked me a valid question, “Why couldn’t they have just started the antibiotics before looking for the worst-case scenario?” Wouldn’t that be the kinder and better approach?
I would have been happier if I’d never heard the “C” word and Jasmine’s name in the same sentence.
The truth is that with Penny’s presentation, the odds that those symptoms and signs could add up to lymphoma were relatively high. This would make considering that possibility the diligent and responsible thing to do. On the other hand, how mad would one be if they just started the antibiotics, the dog kept getting worse, and it turned out that precious time got wasted?
Sometimes the only choice is to consider all scenarios, no matter how painful, to cover all the bases.
A friend’s sister died just recently of advanced cancer in her lung. It started in her shoulder. She was seeing doctors with her shoulder for a long time, and nobody caught it until it got into her lung and it was too late.
What do you think?
Related articles:
Veterinary Communication: Dead Giveaway—Your Vet’s Tone of Voice and the News that Is Coming
Further reading:
When Words Fail: How to Deliver Bad News
Cancer is such a scary diagnosis – even just to consider. My Cinco (my heart kitty) passed away because of Lymphoma. I think that knowing how to handle the potential of a cancer diagnosis is more of an art than a science. My inclination is that I would rather know. That’s just me though. I guess it is hard to say until you are faced with that. When it comes to how to handle the situation with your friend, I think you did the right thing. I think I would tell my friend that we have to try and not worry until we know for sure. Easier said than done. Still, we have to deal with things that are in our locus of control.
Knowing is always better than not knowing. On the other hand, I’d prefer ruling things out first, or further testing rather than cavalierly throwing the word into the mix.
I’m glad that Penny has recovered! I feel like medical professionals are in a damned if they do and damned if they don’t situation when it comes to mentioning the Big C. I would rather they don’t mention it as a possibility when they are first trying to determine what is wrong, but I’m not sure that is good medicine. My vet usually says something like “It might be ______(not terrible), but there are other possibilities too, let’s do this (procedure/medications/wait and see) and take it from there.”
Exactly, I totally agree. Unless there is a strong suspicion, don’t just throw the word around unless there is a basis for it.
This is such a great article for pet parents being the advocate for our furry friends. You did a fabulous job despite the signs you were given. This also goes to having a great vet. Also, a line of communication with your vet. I remember once my mobile vet was on vacation and one of my horses got colic. I called the on-call vet. Her immediate assessment was “you have to put him down now!” I looked at her and said, “NO! You need to give him a shot for pain, oil him, and pull out the blockage on the back end.” She was a bit taken aback, but I think she realized she crossed the wrong person at the wrong time. She did as I instructed, which is what I’d seen my vet do many times. Within 30 minutes he was nearly back to his normal self. Of course, she didn’t apologize. Macho went on to live another 20 years. Now I have a vet that knows I need open honest communication, but prefer preventative measures to stay ahead of anything. I’m so glad you are an avid researcher. Great job! I’m sharing with my animal friends.
That happened to us with an emergency vet–they just recommended putting Jasmine down based on their MISDIAGNOSIS. We sought a second opinion at the teaching hospital. Jasmine lived five more years. We would have ended her life based or a misdiagnosis!
I am certainly glad both came through and not “C.” I am all for second opinions if one has any doubts. I was fortunate that my vet team was top notch and I did trust their findings, but they also always included me in viewing the Xrays, even specimens under the mircroscope, so I always was part of everything. My experience with my one Husky who had epilepsy was different. He could not get up suddenly, no matter how much I encouraged him. The night before he had been running after a long time rehabbing via Conservative Care Management from a partially torn CCL. (We opted for CCM to avoid his going under and possibly triggering seizures after, and his was a partial tear). When we got him over to the ER, he had spiked a high fever (107) and we were losing him. I was beside myself. The ER doc however was more interested in what was happening on the slides than in the actual patient who lay dying on the table. I insisted for a cool towel, IV and fan and was asked if I was a vet. No. But a very hands-on pet parent whose vet always educated me and shared ideals. So at 2:30 in the morning I placed a call to my vet for his opinion that I trusted, and he called the ER to TREAT my dog’s symptoms and not just let him bleed out on the table. We then transferred him to my regular vet later that morning and Gibson survived. But he did have some type of internal bleeding. It was his spleen. For a week my vet treated my boy at home with IVs and medication and got him strong enough to undergo a splenectomy surgery. However, we had the conversation before hand that if he found anything bad, let my boy pass peacefully while under. Sadly, there was an orange size tumor hiding behind the spleen and his stomach was full of cancer. Hemangiosarcoma. And we let my Gibson go. While it was one of the most heartbreaking times, and I had hoped a splenectomy would have saved him, I never suspected “C.” My boy had beat epilepsy for 7 years, came back from a bromide toxicity, healed from a torn CCL, only to be felled by the nasty Hemangiosarcoma. How I wished for a better outcome for this beautiful boy who was truly a warrior and had such a zest for life. I console myself that at least he went peacefully with my vet, than rather horrifically at the ER. So second opinions, yes.
A a second opinion can be literally life-saving. Was for our Jasmine when the ER vet would have us to put her down. Meanwhile, she lived five more years.
I’m so glad Penny and Jasmine didn’t have the big “C”. Yes! I agree. How nerve wracking and stressful. I’m all for getting a second opinion for this reason. Whenever dealing with something so potentially serious, I want double confirmation, because veterinarians are human and can be wrong. I agree with the friend though, it would be nice if vets used more careful thought and consideration when expressing their thoughts and theories to pet parents. It can make the process of “waiting for an answer” less stressful.
Jasmine’s old vet was great that way–he didn’t throw the word around lightly; he didn’t do anything lightly.
When Baby got IMHA, it took 24 hours and two vets and different tests till they found the virus as they told me it is not common, I brought her home with medications but 24 hours later she collapsed and went into a coma so I had to let her go. It killed me but as the vet explained to me it is one virus that has no cure. I am so happy Penny is ok that is such a relief.
So sorry about your baby. IMHA is even worse than most cancers.
It’s such a difficult thing to answer – that exact thing just happened with my Husky Icy. She injured her paw and we assumed it as a bee sting because she just doesn’t leave the darn honey bees alone! After 6 days with no improvement we took her to the emergency vet, the same one that treated my poor little Phoebe who did not survive her serious infection. One of the same Vets treated Icy, and she immediately wanted to do an x-ray to see if she had any broken toes & she said depending on how that went she wanted to run tests to see if there might be a cancer in her foot! My husband and I were like WHAT?!?! It took 45 minutes for the x-ray to come back and the Vet to tell us that she must have stepped on something, as she had a hole in her paw! In that instance, we wish she’d never said the C word, especially after Just going through hell losing my other dog. It was 45 minutes of pure hell and fear. She should have just done the x-ray and never mentioned cancer until she felt there was a strong chance of that. She terrified us for nothing.
They ought to be more careful with that word. That said, unfortunately, when a dog breaks a leg, one should always seek x-rays because bone cancer is, sadly, frequently the reason.