Palliative Treatments: Is it Ethical to Treat if there is no Cure in Sight?

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Palliative treatments are those treatments that are aimed at not curing the disease, but increasing the patient’s comfort. It is an area of some controversy, as some people don’t believe it is right to put an animal through procedures–be they surgery, chemotherapy, radiation therapy, the list goes on–if there is no way the animal will be cured of the disease in the end.

Whether the reasons be financial, ethical, compassion, or personal, many people feel passionately about their stance. People say that veterinary medicine is rapidly evolving, and that the “younger generation vets” are more pro-treatment and active to find a diagnosis; I would have to agree, and say that I typically fall into that stereotype. I for the most part believe this is a positive step for veterinary medicine. Mostly.

Even how you & your vet reach a diagnosis should customized.  We went against the text-book medicine route, as we felt it was pointless, and would only cause her pain.

It was a personal experience, the loss of our first pet as adults, that truly opened my eyes and made me realize it truly is a personal decision, one that must be customized by every pet owner, pet, and vet. I wish Dr. Jed and I had not gone through the story that follows in a multi-part post, but am grateful for the lessons it taught us.

It was the evening of October 27, 2008. Dr. Jed and I were newlyweds, and he was back in school full-time studying for his MBA and working as a business consultant, while part-time still “vetting;” I had taken over the hospital. He had just returned home from night school when Madison, our beloved Great Pyr limped. Just a little bit, but with two vets as parents watching over our four-legged children like hawks, not much gets past us medically.

We immediately did a lameness exam on the kitchen floor, and Dr. Jed found a slight swelling towards the end of her radius, one of the bones in her front leg.

Our guts dropped, as we immediately knew what this tiny bump was: osteosarcoma, one of the most deadly & painful cancers a dog can get.

Of course, we couldn’t confirm the diagnosis without tests, but given her age, breed, the mass’s location, and the way the mass felt, that was virtually no chance the mass was anything else.

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The tumor is the black irregular area inside the bone *Not Madi's films*

We stayed up all night researching the latest journal articles, scouring for a bit of hope that progress had been made in the treatment and prognosis of osteosarcoma since we graduated vet school, but the time the morning sun came around, our initial wide-eyed devastation was confirmed.

X-rays that morning showed the typical osteosarcoma pattern. With the dreaded diagnosis confirmed, we began our quest to develop a treatment plan appropriate for Madison. The options? Even how to reach a 100% diagnosis was customized. It is largely recommended to biopsy the tumor to get an exact diagnosis, as that is what it takes to observe the tumor on a cellular level. It is true. A visual diagnosis is not reliable.

But with all things considered (age, breed, location, visual appearance on x-rays) there was about a 1 in a 10,000,000 chance that it was not osteosarcoma.

To biopsy the tumor was quite invasive. It required a bone biopsy, sedation, severe pain afterwords–bone pain can be controlled less well than soft tissue pain–and, the worst part, we would be taking out a piece of her already weakened bone.

how to tell if my dog is sick, is my dog sick, ask a vet, my dog has a mass, is it a tumor

Osteosarcoma under the microscope

The bone was being destroyed by the tumor, and was already at risk for fracture, so the last thing in the world I wanted was to weaken the bone and increase her chance of breaking her leg. So we decided to take the route against the text-book recommendations.

Now the treatment options: Amputating the limb, chemotherapy, radiation therapy, oral steroids and pain meds, nothing. Being avid animal lovers, you can clearly see the last two were automatically out. Any combination of these was an option as well, but the bottom line was…

this cancer would kill her, & there was no chance of a cure.

All treatments would be palliative.  Two vets’ worst nightmare realized overnight.

Read Part 2.

Have you had a pet with cancer? Where you overwhelmed by the options? I’d love to read your stories.

Dr. Laci

SIGNATURE DVM

Dr. Laci Nash Schaible, DVM, online vet



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20 Comments

December 1, 2010 at 04:04
 

I pray to God that cancer is one thing we won’t ever have to face! My heart goes out to anybody who does. Jasmine’s best friend died to cancer as well.

Overwhelmed by the treatment options? Sadly I have to say I’m rather underwhelmed than overwhelmed.

Breaks my heart that as smart as we humans feel that is the best we can do. Why is it that we have way more treatments than actual cures?

Doesn’t the body have the tools needed to fight cancer? I believe it does. When for some reason these tools fail, can’t we find a way to put them back to work?

While on one hand I’m avoiding thinking about cancer, on the other hand I am on a lookout for some new good ideas. I find immune modification a promising direction. I also notice some research using viral treatments. (kind of wild but interesting in theory)

I am surely hoping that soon enough we’ll be able to do better!

December 1, 2010 at 17:09
 

Jana, yes the treatment options, quite frankly, suck. In Madi’s case–surgery, chemo, radiation, all these three main treatment options have really negative side effects. Surgery less so, but wasn’t even an option for us. And of course, you can’t explain to a pet that they are going to feel some pain now, but it will improve with time.

I often feel we went too far, and I would do it differently next time, but my best friend’s dog (also a vet) was diagnosed with a very aggressive cancer yesterday–sorry I have been a bit absent this week, this is why–and she lost her last dog about a year ago without doing a whole lot in the way of palliative treatments, and now she feels guilt over that and is going to the end of the world with treatments with this pet. Long story, wonderful owner, I can’t do it justice in this reply.

It is sad indeed that we haven’t come further in the fight against cancer for both people and animals. Thanks for your ideas–stimulating as always.

December 1, 2010 at 18:11
 

So sorry to hear about your best friend’s dogs. Guilt is the worst thing that can happen to a person. But maybe doing nothing was the best option in that case. I feel that things happen for a reason.

My dad died after he got food poisoning. With the blood thinners and meds he was on he literally bled out internally. Sounds so pointless. But who know what future suffering this had save him.

I think the cancer treatments presently available are much like many other treatments we have; superficial solutions really. There are some interesting ideas in The Nature of Animal Healing by Dr. Martin Goldstein.

I know an owner who when their dog got diagnosed with cancer threw every holistic and alternative idea into a pot. The cancer went into complete remission.

The Healing Art of Pet Parenthood is also interesting (though I didn’t manage to finish the whole book yet.)

The paradox I find in the present treatments is that at the time the body and immune system need all the help they can get to deal with the disease they end up in a crossfire instead. Intuitively that feels counter-productive to me.

December 2, 2010 at 13:01
 

I am so sorry to hear that you lost your father, especially in those horrible circumstances Jana. How devastating.

Yes, chemo and radiation are quite mind boggling–the body is ill, so attack it and make it more sick?

Both Dr. Jed and I have been reading up on holistic or natural remedies, not specifically for cancer, but for all sorts of things written by a holistic veterinarian. I do find it fascinating, and so many of things are already incorporated into mainstream western medicine. It’s just been adopted so long ago we don’t think of it as “holistic.”

December 1, 2010 at 17:30
 

Mom lost 2 cats to cancer. By the time she knew they were sick there was nothing to do for them. They were also pretty old kitties, so she just had them put to sleep on the spot. She still cries when she thinks about it and misses them terribly.

December 2, 2010 at 13:05
 

I am sorry to hear that your mom lost her cats to cancer. Yes, it is true, sometimes seeking treatment is an option, but sometimes if the pet is already old and ill, treatment is really selfish. It is never easy to decide what to do, and it seems that guilty almost always accompanies our decisions. Thanks for reading!

January 27, 2011 at 10:24
 

There are options between aggressive treatment and euthanasia. We will all die and our companion animals will all die. What we can do for them is the same as what we can do for any human member of our family – give them love, support and comfort in the time they have left. Just because that time is limited does not mean it is not worthwhile. Use this time to connect with your animal, to think about what it has meant to be together, and to bring what joy you can into the time they have left. Hospice care can control their pain and discomfort in many cases so they can live out their time in peace. This can be a loving, tender time for you both. Caring for an animal at the end of life can be a deeply moving experience that teaches us much about life, love, dying and grief. It is your animal’s final gift to you – accept it with an open heart.

- Heather
Founder and Team Leader
New England Pet Hospice

December 2, 2010 at 10:03
 

Great post, thank you.

This question as to options we have with our dog friends really need us, must be a personal decision. I’ve had 2 dogs with cancer, one with Cushing’s and the most recent with lymphoma. We opted to do our best, but after chemo pain meds. etc. they were PTS.

Did we do the right thing, that is always in the back of my head. I think the hardest part for most may be Chemo seems to be working, then after all the treatments, the cancer returns with a vengeance, and that information needs to be voiced at the time of decision making.

I will be again faced with the same decision in the no so distant future, my dog friend has an arthritic spine and can’t take NSAIDs.

So the search goes on to find the right answer to the question, when is it time, I really hate playing God.

George

January 20, 2011 at 17:37
 

Georger, there are a lot of options for arthritis other than NSAIDs. Laser therapy, acupuncture, stem cell therapy …

January 22, 2011 at 10:32
 

Thank Jana, I know there are, I’ve done all but the stem cell thing

January 22, 2011 at 14:07
 

Check it out, it’s great stuff

December 2, 2010 at 13:15
 

George, I completely agree that it’s a very personal decision. I think guilt and did we do the right thing will always haunt us, regardless of what treatment options are taken. Like you said, in the end, the pet owner must play God.

As for the arthritic spine, there are other drug categories that might help alleviate pain. I don’t know your friend’s dog situation, but the options are endless, and affordable–always a plus!

Thanks for reading.

December 3, 2010 at 11:31
 

Sorry, it’s my dog pal, she’s on Gabapetin 100mg daily and it is working great for now, along with Glucosamine, chondroitin with MSM. We did acupuncture which had no effect.

I would like to suggest, when the time comes, find a veterinarian who will come to your home, don’t put any more stress on your pet then possible. By doing so, some of the guilt one has may be lessened.

Thanks for the reply.
George

December 3, 2010 at 16:18
 

George,

That is definitely one of the benefits of being a household with two –we were able to treat right here in our house. It really does ease the stress on the pet!

January 20, 2011 at 16:51
 

Dr. Laci,
The time has come to memorialize my pal, Sadie. Here’s my poor effort to do so. Please delete if you wish,
http://honeysjourney.wordpress.com/in-memory-of-sadie/

January 20, 2011 at 17:11
 

I wouldn’t dare delete! I did read and comment–such a moving story! Now you’ve got me in tears and I’ve got a lot of work left!

January 20, 2011 at 17:24
 

Sorry about the tears, or maybe all the work you have before you can turn the “open” sign around.

January 20, 2011 at 17:28
 

Oh, well we never turn the open sign around. 24/7 but it is nice to help pet owners in need when they can’t reach their vets.

Sometime in 2011, we vow to take a vacation and have someone else run the biz!

January 20, 2011 at 17:38
 

Dear George. Ok, this story put ME out of commission! (((hugs)))

January 21, 2011 at 08:52
 

Thanks Jana, Sorry.