Ethical Issue: Cancer Treatment Decisions

[woward]

I'm facing the difficult decision of making treatment choices for my Rottie recently diagnosed with lymphoma. He's a gorgeous two year old who we love dearly. I’m trying to decide what level of treatment to commit to knowing that lymphoma is not curable but that with certain treatments we might buy some extra time for him, albeit at some cost to his quality of life.

As background, I faced a similar situation earlier this year when my 9 year old female Rottie had lymphoma. In her case we spent several thousand $ on diagnostics, surgery and other treatments before we realized what we were getting into because her situation started as an emergency case at a major vet school hospital. In my girl’s case we elected a moderate chemo regimen which she did not tolerate so had to stop after a few weeks and another $1,500. We stopped all treatment after that. After about 6 weeks (we think when the poisons cleared out of her system) she returned to her old self and now appears to be a happy, playful, high-energy Rottie again. We concluded that she did NOT maintain her normal quality of life while being treated, although being a stoic Rottie bitch she never complained about a thing. She has since turned 10 and shows no signs of recurrence although we know it is just a matter of time. In her case, we have concluded that she is living a better life untreated. We are willing to lose her sooner if she has a higher quality life while she lives.

My dilemma is partly caused by the current state of veterinary medicine. There are many chemotherapy options that have reasonable history of extending a dog’s life for some period of time. With lymphoma, vets tell us that the median survival time is 11-12 months during which time the dog undergoes about 6 months of intense treatment. Where we live the estimated cost of such treatment (for a Rottie size dog) is $9-15 thousand when all the cost are added up (veterinarian, drugs, lab work, etc.). Vets claim that “dogs tolerate chemo very well” but our experience earlier this year is that our dog’s quality of life was materially compromised while undergoing chemo.

Like doctors, veterinarians are trained to treat their patients in virtually all circumstances. It is what they do and I understand that. When we discuss this issue with our vets (we are talking to both our local vet and the vets at the vet school) there is an automatic presumption that we will elect to treat the dog with little consideration of cost or other impacts on the dog or the owner. This attitude puts intense pressure on us as owners who question the propriety of taking extreme measures to buy a small amount of time for a terminally ill dog. I’m normally a pretty tough, decisive guy, but am feeling more anxiety over these decisions than I ever would have predicted.

And, it’s not just about what to do for my puppy. There seems to me to be an ethical dilemma regarding how appropriate it is to spend a large sum of money to possibly buy a little extra time for a terminally ill dog. Given all the other needs of our society should we consider using those resources somewhere else? Sending a child to college, helping with Katrina aid, etc. It is not my intent to be critical of anyone who decides to spend whatever they choose for medical care for their pets. I am simply wrestling with how appropriate it is in my case and am curious if others have considered this issue.

Any thoughts?

[Miabella]

As someone going through a similar dilemma with my own bitch who has Lymphoma, I totally sympathize. I think this is a very individual decision, there is no overall right answer, just the right answer for your circumstances. I don't know if that helps.

Just one thought. It's unusual for a 2 year old dog to have Lymphoma, and the fact that your other dog was also diagnosed with Lymphoma in the past year makes it more suspicious. Could there possibly be a link, i.e. some carcinogen around your property, lawn chemicals used by a neighbor, etc.? Just something to think about, not only for the dogs, but also for your family's health.

[2rotties2luv]

In the space of 2 years, I've had two rotties diagnosed with terminal hemangiosarcoma. In both cases, I was offered surgery and chemotherapy to 'buy them some quality time". In both cases I chose to euthanize them shortly after diagnosis, as their illness had come on suddenly and they were in discomfort.

If there were any chance of a cure, I would have reconsidered further treatment. However, I believe that treating terminal cancer with chemo and/or surgery buys time for the owner, not the dog. Dogs live in the here and now, and a few more months of life is meaningless to them especially if it involves more pain and discomfort.

My dogs have given me loyalty and companionship. In return for this I allowed them to die with dignity, with a minimum of pain and discomfort. I believe this was the greatest gift I could give them.

I realize that not everyone agrees with this point of view. I know all too well that putting down a beloved pet is probably the most difficult responsibility of pet ownership. And yes, I do believe that if one has thousands of dollars to spare, it is much better spent being donated to rescue, animal shelters, hurricane relief, or cancer research than to use it to prolong the life of a terminally ill pet. Just my opinion.

[moondog]

I can't say how one's money should or should not be spent. What I can say, however, is that when my dog was diagnosed with a terminal cancer, I could have requested and would have received treatment to prolong her life even though her cancer had already metastasized to her lungs. After seeing her xrays with my own eyes, I knew there was only one option for my girl.

After seeing those xrays, I called and made an appointment with her regular vet to euthanize her even before the specialist called to discuss treatment options. When he called, before he could say a word, I just asked him to listen. I told him that Luna had always been such a good dog, that it was very clear to me this was not something she could survive, that she had been through enough, and that I could not see any reason to subject her to treatments she had no way of understanding just so she could suffer and die anyway. I don't know what else I said, but when I finished he very quietly said to me, "If I had disagreed with anything you have just said to me, I would tell you so". That was the extent of our discussion over treatment options. I know they would have been offered had I not spoken up, because that's what a vet's obligation is - to treat the sick - and I needed to be Luna's advocate the best way I knew how. The best way I knew how was to make darn sure she did not have to bear any more pain from a disease that was ravaging her body and not something she could survive.

Not all cancers are alike. Some are survivable, others develop slowly so there is a good chance with proper treatment for a long stretch of good quality of life, and then there are the ones that ravage the body unmercifully. In order to determine the right thing to do for our dogs there are many things to take into consideration, and the only pat answer is to remember that our dogs cannot speak for themselves and we must do the best we can for them, because they are the ones that quite literally bear the consequences of our decisions.

It was not a financial decision for me, and the ethics involved had not to do with money, or lack thereof, but with what I owed in integrity to this dog I loved so dearly.

[lblax]

if i were to get a definate diagnosis that one of my dogs had cancer i would not treat them i personally wouldnt kill there body with chemo to bring them back from deaths door only to watch them die all over again in a few months remember when we do this we are not doing it for the dog as they have no concept of time or plans for the future they live in the here and now

[KRISSIE]

I know exactly what you are going through....everything you said hits very close to home. MY Brenda was diagnosed with Lymphoma , not a day has gone by since I received the news that I have not cried my eyes out . I also was not sure what road to take regarding her treatment . Chemo was also recommended by my Vet. Brenda is 7 and I am not sure if this is the right treatment for her and like you have said , the cost is in the thousands . If I was to decide to do treatments, I would have to take out a personal loan just for the Chemo treatment. If there was a chance that it would cure her, I would do the treatment no matter what the cost but the sad truth is , there is no cure, it can only put her into remission and buy her more time.
I feel the decision to do treatments is a very personal decision and one that should be considered on a case by case basis. I don't think their is a right or wrong answer . When dealing with Cancer we try t be optimistic and of course it is natural for us to want to save the ones we love so dearly.
I wish I had the power to take away Brenda's Cancer , there is nothing I would not do for my girl but in my case I have decided not to do Chemo bc I Don't want to just put her into remission, I want to take her Cancer Away completely and this just doesn't seem possible . I understand all to well the unfairness of this and I am angry and sad more then words can express , but I know others who are going through can understand. I want Brenda to have a great quality of life, that is to me the most important thing . I want to remember her as she is now , not ill . I will love my girl and make her as comfortable as possible and when the time comes that I must say Goodbye to my baby, I will walk her down that last mile , hold her in my arms and let her go knowing that the greatest act of friendship I can give to her is to let her go with dignity . She has given me love , loyalty and friendship and in return I will give her peace. .....
I don't know If I have been able to help answer your question but I do hope you know that you are not alone and no matter what choice you make , you will make it based on love . I know you will make the right choice for your baby whether it be to treat or not treat with Chemo, this is something only you can decide , dig deep into your heart , you will find your answer there. ....

[woward]

I appreciate all of your thoughtful responses to my dilemma. You guys put into words what I was trying to articulate. Thanks for the support.

My guy got a "magic bullet", one-time chemo treatment yesterday in an attempt to reduce/eliminate a tumor in his skull that was causing his eye to bulge. We told the vet that we would not make him live with such a condition. To our surprise and delight, his eye appears nearly normal this morning and he had a good appetite. However, he is not his usual playful self (he is still just a big puppy at two years) but does not seem to be in pain, just lethargic. It is too strong a reminder of what we saw a few short months ago with his sister who also lost her fire while receiving treatments. We are now convinced more than ever that buying the dog more time, but at serious loss of quality of life, is not a good trade-off. We plan to take the same course we did with our older girl and take him off the meds and let nature take its course. In her case, she's enjoying an amazing revival and is back to being an active, playful girl. We know her days are numbered, but the days she's getting are good ones. Maybe he can get some of the same. It's hard knowing we face a terminal decision every day about each of them. However, I wish someone could do the same for me if I'm ever in their situation...

[woward]

Miabella:

We did consider the odds of two dogs in the same household, genetically unrelated and 8 years apart in age, both getting lymphoma in a short period of time. We discussed it with vets from both vet schools. While they agree it is suspicious they claim that after extensive research they can find no solid evidence of environmental causes for such conditions. That being said, our local vet says there are studies proving a link between ingestion of the chemicals in Roundup herbicide and the incidence of lymphoma in humans and animals. We don't use Roundup so if our dogs got into the stuff it had to be in open-space areas where we frequently hike. It would be hard to verify and difficult to prove any connection. It is scary since our primary local source of water also comes from that same open-space. We're concerned for any future pups we get but don't really feel there is much we can do. We've lived in the same area for over 30 years, had many dogs, and this is the first occurence of this issue. It's probably just bad luck and chance.

[Mochasmom]

During Fritz's chiro treatment yesterday his new vet and I discussed the occurances of cancers in Rotties, Berners, Mastiffs and GR's. She plans on studying and researching these instances more in depth when she retires to see if she can't find a correlation to environment and/or genetics.

I agree that treatments for this disease are to buy you more time with the dog. We did not opt to treat Mocha's lymphoma other than managing her with prednisone. Although her time was short between the dx and us having to put her down this time was mainly for us to be able to say goodbye. But we did this with her interests at heart too...we did not let her lose her dignity.

It is an emotional decision that has to be made with the individual dog's quality of life and dignity as the sole interest.

I am so sorry you are having to go through this. You are in my thoughts.

[MontanaRott]

It is indeed a very personal and individual decision. Our Frenchie was diagnosed with Lymphoma this summer, because of his age, and prior history of health issues, plus how advanced the disease was, we elected not to treat him with chemo. He took a course of antibiotics and prednisone and that was it. He was happy and himself for a bit, and we watched him, and listened to him very carefully. When he no longer did the things he loved, we let him go.
I think one really should take prior history, age and general health of the dog in question into consideration when making the decision. Not to mention one's financial situation. As much as we love our dogs, we cannot afford to drive ourselves bankrupt to save them, just do what we can afford to do, within reason, and don't drive ourselves nuts with the what if's.
I am sorry you are going through this, it is never easy.

[poohbearsmom]

Wow. This in an excellent topic, albeit a topic brought on by an extemely distressing situation. It is a topic, however, that all pet owners should really put thought into before they are faced with the difficult, and emotional decisions they are faced with more often than they should be.

Speaking personally, I take into consideration the dignity that my dog was born with, and I go from there. I take into consideration a very good point that Larry brought up - our dogs live in the here and now... and to take this thought a step further, I believe that when my animal companion is involved, every consideration needs to made in regards to his/her ability to endure not only the physical repercussions of treatment, but the mental stresses as well. It's so heartbreaking sometimes that these wonderful beasties we share our lives with have no mental capacity to understand the pain and recouperation necessary to withstand some of the medical therapies available today. This, to me, is one of the biggest considerations of all. These are my feelings on the subject, and mine alone... My dog and his/her dignity comes first, no matter how much it may hurt me and my longing to cling to this being that I love so much.

I often think that animals have more fundamental rights than we, as humans do.... more often than not, they have the ability to leave this physical world with the dignity in which they enter it - when they have a selfless guardian.

[StephanieandToby]

I believe if a dog has a terminal illness, it should be PTS before it loses it's dignity. We owe the dog that much for being such a loving companion.As Larry stated, dogs live in the "here and now"...they don't mope about death,or worry about their future...after the diagnosis, we keep them alive for OUR sake...

[damp]

Originally Posted by lblax

if i were to get a definate diagnosis that one of my dogs had cancer i would not treat them i personally wouldnt kill there body with chemo to bring them back from deaths door only to watch them die all over again in a few months remember when we do this we are not doing it for the dog as they have no concept of time or plans for the future they live in the here and now

If my dog is diagnosed with a deathly illness, he will be put to sleep the day I get the diagnose and I will say Good Bye My Friend, and I will not prolong his life with just one day!

As Larry said, a week, 3 months etc. doesn’t make sense to a dog, and you just fool your self if you think you do your dog a favor to prolong a "death sentence"

You will miss and cry, no matter if you make the decision the day when the dog can still walk into the vet with a wagging tail or you wait a few months to carry a dog in pain to get the reliving syringe.

[emillinium]

"If my dog is diagnosed with a deathly illness, he will be put to sleep the day I get the diagnose and I will say Good Bye My Friend, and I will not prolong his life with just one day!"

thats alittle harsh and un nessarry if your dog is not feeling the disease yet?

[LynnS]

Hi Woward

I am so glad you found this amazing group. Reading your post, and knowing you in "real life" I understand what a difficult and heartbreaking situation you are facing. I think you are asking yourself (and soliciting others opinions on) all the right questions. I learned the hard way with my last dog, that (as moondog so eloquently said) I need to be my dogs advocate when it comes to medical treatment, instead of blindly following a Vet's advice.

Many of the members on this board have faced this type of decision (or some variation of it) before and can validate your thoughts as well as empathize with what you are feeling....

My heart aches for you and your wife...

Lynn