Don’t Forget Your Dog at the Veterinarian
Updated: October 4th, 2018
When booking a new consultation with me, pet Guardians often ask if it is necessary to bring their dog to the appointment. From their point of view, they are often concerned about the stress of the visit on their pet, or maybe the travel itself.
But from my point of view, a consultation without the pet is like a visit to the pediatrician without your toddler. So, yes, you should bring your dog!
In some ways I am happy that someone wants to meet me and listen to the overview of their pet’s cancer and ask questions. Educating yourself about your pet’s cancer is important. But the visit is so much more than hearing about an overview of the how the cancer presents, behaves, treatment options, and prognosis. I also review your pet’s medical record; including previous history, previous tests and the cancer cytology or biopsy report.
But a critical part of the consult is my personal evaluation of your dog.
For example, if a mast cell tumor has already been removed, but the surgical margins are narrow or incomplete, I can only discover if a second surgery is possible with a physical exam. I need to see the previous scar on your dog. I may lift the scar, and see if we can remove more tissue. I may even show the dog to our surgeon so see what she thinks and decide if surgery is even an option. If she says no, I just saved you the time and cost of a consult with the boarded surgeon.
Or, I may feel a small mass already coming back at a scar. If the tumor is back, it changes the recommendations. I only can determine that if I examine and feel the dog in person.
Measuring Is Key
I’ve also had cases where the biopsy report lists a soft tissue sarcoma (STS) as completely removed, but the vet notes the mass was 2 cm and the scar is 3 cm. Well, we need 2 to 3 centimeter margins AROUND the tumor … so a 2 cm STS should have an 8 cm scar. I will literally measure scars to make sure that they are actually as complete as reported on lab reports. If not, it’s unlikely the margins are clean and recurrence may be likely. And if that’s true, we need to know, so we can make the best plan.
I may also need follow up tests, like an ultrasound to monitor progression of an abdominal mass or to get a baseline.
Finding Other Tumors
Just last week, I saw a dog with a mass in the bladder, most likely a tumor called transitional cell carcinoma (TCC), based on the ultrasound at the primary vet. Penelope had the classic signs of TCC – straining to urinate and blood in the urine. The vet said the mass was not in the trigone area, which is great, because then we could remove the tumor with surgery before starting chemo. (Many tumors are in the trigone where all the nerves and the urinary tubes that connect from the kidneys and out the urethra. This area is usually inoperable.)
From the ultrasound at the primary vet, it looked like Penelope was a surgery candidate.
To be safe, I recommended a repeat ultrasound. This time the boarded internist not only saw the mass in the non-trigone area but also a larger mass in the urethra, the tube through which urine flows from the bladder to the outside.
Unfortunately, that discovery meant surgery was definitely not an option. With this new info, I changed my recommendations and we discussed medical management like NSAIDs, chemotherapy, and even a stent to keep her peeing if she gets blocked.
So Penelope’s prognosis and treatment options all changed based on the exam and tests. If she hadn’t been physically present, we might have gone ahead with a surgery that would be unnecessary and not even treat the larger mass.
I may also discover something new on the exam, like an enlarged lymph node. If we aspirate that lymph node and find the cancer has metastasized (spread), it may change the prognosis and recommended diagnostics and treatments. If a cancer has spread to the lymph node, we may need to have it removed, radiated, or it may be the reason we add chemo.
Finding Other Problems
Without the patient, we could also miss other problems, like a fever, an infection, a heart murmur, or a lameness so severe that it changes recommendations.
Just yesterday, I had an appointment with Lady, a 11-year-old Russian Blue Terrier. She came to discuss CyberKnife radiation for her recently discovered aggressive bone lesion in her humerus (shoulder), consistent with osteosarcoma.
CyberKnife is an alternative to amputation, and we typically start with a CT scan of the leg to make sure the bone is structurally strong enough to be a good candidate for it. If the tumor has already destroyed too much bone, it puts the dog at increased risk for fracture even if we kill the tumor cells with high doses of radiation.
But looking at Lady (not her X-rays), I saw that she could barely get up and walk. The family was lifting the 100 lb dog to get up and go outside to relieve herself.
I was worried that her limping and disability wasn’t just because of tumor pain. It could also be neuromuscular disease, orthopedic issues, or worse, bone metastasis. I wasn’t going to do a CT scan (very expensive) and recommend CyberKnife radiation if there was some other major underlying medical issue that prevented her from walking. We had to figure this out, first.
So, during that appointment, I consulted with my surgeon, who looked at Lady and isolated the severe pain to her knees and hips, not just the shoulder with the tumor. X-rays confirmed severe degenerative joint disease and arthritis. Unless that can be helped, removing the tumor with radiation would not help her to walk. Even amputation was out, because a dog with this severe pain wouldn’t be able to recover easily.
This information was really helpful, because now we knew a few things:
- We can add pain meds, specifically non-steroidal anti-inflammatory drugs (NSAIDs) to her treatment to help bring her some relief.
- Her underlying arthritis is too severe for an amputation.
- By treating her arthritis we can improve her comfort and mobility.
Once she is feeling better, THEN we can do a CT scan to see if she is a CyberKnife candidate. She may still be!
Bottom Line: Bring Your Dog
So … will I occasionally do a consult without the dog? Yes I do make exceptions, but it really limits what I can do for the pet and the family if the pet is not there to be evaluated.
Live longer, live well,
Sue Ettinger, DVM. Dip. ACVIM (Oncology). Dr. Sue is a boarded veterinary medical cancer specialist. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), she is one of approximately 400 board-certified veterinary specialists in medical oncology in North America. She is a book author, radio co-host, and an advocate of early cancer detection and raising cancer awareness. Along with Dr. Demian Dressler, Dr. Sue is the co-author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity.
Oh Shelia, this is one of the easiest replies I get to write today. Nutrition is so, so important in the cancer fight. Important all the time of course, but when we have a cancer diagnosis for our dog, changing nutrition to real food is not only one of the best things we can do to help them stay strong, just you wait until her world lights up with the information you’re going to get.
The Dog Cancer Diet was designed by Dr Dressler to provide not only the foods that help our dogs’ immune systems thrive, but also to avoid foods which can actually ‘feed’ the cancer. The bulk of the DC Diet is available as a free download at the top right of this blog page, or through http://www.dogcancerdiet.com. The full diet is spelled out in the book The Dog Cancer Survival Guide. I used the diet for both my dogs who were diagnosed, but over and above it, the nutritional information changed the lives of all my dogs and all those to come. At first it might seem daunting, but please trust me, making the change will be one of the best things you will ever do, and you will absolutely love giving your dog foods that she begs for. Regarding Apocaps, they are not a complete food, they are a nutraceutical to help your dog fight, and they should not be given with food if possible. This is simply because they could be less effective when mixed in the gut with a meal. A small snack is OK, but otherwise please give them separately. I almost want to ask you to write back when you get into the diet. You don’t have to, I just know the journey you are about to go on and how happy you will be. When your girl thrives on the food, go back to the vet college and educate them with her example. Only vets who choose to specialize in nutrition in their career really get into it. 🙂 Good luck to you both.
I have an 8 year old Westie who has TCC. She has had 2 sessions of Chemo and recently had laser ablation for the cancer. It has not spread to any other part of her body. I am confused as to what diet now to put her on. I do not have an Ocologist where I live but do have a Vet College who have recommended Hills H/D. She really does’t like this food so I am thinking I would make her food and add the supplements but don’t know where to start. Are your Apocaps and complete nutrition to add to her food?
My thoughts are with you, as my second cancer case in our home was spelnic hemangiosarcoma. I can tell you tough, that against the odds my boy beat it and lived over 4 years post-op, passing at the age of 16. So, keep going!
As to your questions, wherever possible do not use any chemical treatments for fleas, ticks, worms etc. HOWEVER, you must weigh the risks of your dog becoming ill from these pests against the risks of the chemicals causing harm. So basically, work with your vet. If flea infestation is a real threat to health, then by all means find the kindest, most natural treatment available, same for others. Heart worm is serious, and if it is prevalent in your area, then the threat of heart worm is not worth the gamble. You can search for natural, non-chemical dog treatments for fleas and ticks and even general worms (some people like to use garlic regularly in small quantities, etc.) so please research that for your own situation. Bottom line, keep your dog as chemical free as possible but weigh the overall risks. Regarding the hemangiosarcoma, has your vet considered metronomic chemotherapy? It is relatively new and hemangiosarcoma is one of the cancers that seems to respond very well to it. It is also very easy to give, at home. Dr. Dressler writes about it in the Dog Cancer Survival Guide. My own dog didn’t bat an eyelash during his treatment. Good luck, and take care of yourself while you’re helping your pup!
I have started the Whole Spectrum program for my dog who hs had a speenectomy for hemogiosarcoma. Should he continue to take Trifexis for ticks, fleas, heart worm, all other worms.Also should he continue to take Apoquel and allergy shots for allergies.