Zoe

If you share your home and heart with a dog sooner or later you will be called upon to step up to the plate and make tough medical decisions on his behalf (the odds of avoiding this are right up there with winning the lottery). In exchange for all that tail wagging and unconditional love, you’ll need to sort through unfamiliar medical terminology, risks and benefits, cost analysis, your value system and beliefs, along with your dog’s opinions and character to come up with choices that will serve his best interest as well as your own peace of mind. This can be a daunting task, especially if you have no medical training.

I’ve decided to use this blog format to provide you with some decision-making guidance- periodically I will include stories about my real-life patients (dogs) and clients (the humans at the other end of the leash). Only the names will be changed to protect the innocent! These vignettes will supplement the chapters in Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life that are devoted to teaching people how to make tough medical choices for their four-legged best friends.

Decision-Making Vignette
Patient: Zoe, a nine-year-old female Doberman Pinscher- an incredibly sweet girl with a successful career in agility competition. She’d become reluctant to complete the agility course, she had diarrhea, and her food intake had diminished. When I entered the exam room, Zoe was reluctant to get up, her breathing was somewhat labored, and she did a good deal of deep moaning and groaning. She was thin with pale gums and atrophy of her musculature. I performed chest X-rays and ultrasound of her abdominal and chest cavities. Unfortunately, my workup discovered a huge mass within her chest cavity that was displacing her heart from its normal location. Additionally, multiple tumors were found throughout her liver- a clear indicator of malignancy and metastasis (spread of the cancer). Ultrasound also documented the presence of blood in both the chest and abdominal cavities- evidence that the tumors were bleeding.

Client: John, an intelligent and highly concerned middle-aged gentleman. He and his wife share their lives with a handful of Doberman’s. He loves Zoe deeply and is proud of her accomplishments in the world of canine agility. John expressed that he would gladly do anything and everything to help Zoe- cost was not a factor.

The Decision: Although John’s initial response included some shock and denial, he came around to the reality of the situation- Zoe was terribly sick and uncomfortable, and the prognosis (predicted outcome) was terrible. The ultrasound appearance of Zoe’s tumors combined with the fact that they were bleeding internally suggested that her disease was very likely hemangiosarcoma, a cancer made up of cells that normally line blood vessels. Unfortunately, Zoe’s cancer was too widespread to be treated with surgery or radiation, and chemotherapy is of minimal if any benefit with hemangiosarcoma. John and I discussed every single option I could think of:

  • Take Zoe home for purposes of carving out some “closure time” during which time she could be treated with medication to control pain and a Chinese herb to help slow internal bleeding.
  • Perform a biopsy of the mass in the hopes of being 100 percent (rather than 95 percent) about the type of cancer. This procedure would have the potential of creating risk and discomfort for Zoe.
  • Treatment with chemotherapy without knowing with certainty the type of cancer. This could cause adverse side effects, and in Zoe’s case would unlikely provide significant benefit.
  • Hospice care- making Zoe as comfortable as possible at home (even to the point of induced coma) until she died naturally.
  • Euthanasia

John’s initial reaction was to proceed with the biopsy. When he voiced this decision, I gently suggested that I agreed- I thought it would make sense to proceed with the biopsy as long as John could answer “yes” to at least one of the following questions:

  • Would the biopsy results change what we would do for Zoe- would John want to try chemotherapy even if it was highly unlikely to be of benefit?
  • Would the results provide John and his wife with some necessary peace of mind?

For John, the answer to both questions was, “no.” Given this response, he was hard pressed to come up with a good reason for subjecting Zoe to the biopsy procedure. He opted to take Zoe home for purposes of some closure time prior to euthanasia.

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