Barely a month ago new clients asked me to not only guide them thru their dog’s treatment, but to treat Chandler like he was my own dog.
That is a hard thing to do because what I may choose for my pet may not be right for someone else. I said in our book, The Dog Cancer Survival Guide that I would have given Paige, my Labrador, my kidney if she needed it and it was medically an option to donate your kidney to your dog. I was pretty attached to Paige, to say the least. (She died 6 years ago, and she never needed my kidney, but I would have if I could have.)
But Chandler’s parents looked me right in the eye, and I knew we were on the same page (no pun intended), and I promised.
Chandler was referred to me for CyberKnife radiation of a tumor called transitional cell carcinoma (TCC) in the prostate and urethra – the tube that connects urine from the bladder to the outside world.
In order to be a candidate for CyberKnife these prostate tumors cannot extend in to bladder, because hollow organs like the bladder can rupture after radiation treatments, as the invasive tumor is killed.
At the original appointment, I determined the cancer had spread to the local lymph nodes under the lumbar spine, but not beyond. Ideally we would radiate the lymph nodes, in addition to the tumor itself, which added a significant cost to the already expensive CyberKnife protocol.
“Would you do it, Dr. Sue?”
Honestly I would, I replied, but I asked them to make sure that was the right choice – or at least the best choice for them and for Chandler.
But before we started the CyberKnife protocol, the radiation oncologist determined the tumor was also invading the colon … making the risks to the patient outweigh the benefits. So, we recommended against CyberKnife for Chandler.
Since the cancer was more advanced than we originally thought, I changed treatment recommendations and we went to plan B. That’s what I would do for Matilda (my current dog), I told Chandler’s Guardians. We started chemotherapy and pain medications, including an NSAID (non-steroidal anti-inflammatory drug) which can also have anti-cancer properties for TCC.
Chandler was scheduled for his 2nd chemo treatment when the family was out of the country, so they had friends bring him in for treatment. They reported to me that Chandler had been vomiting. It couldn’t be the first chemotherapy appointment that was causing it, I knew, because it had been a long enough time between appointments. Some cancers can cause vomiting, but TCC isn’t typically one of them. It had to be something else.
I ran blood work and determined Chandler was in severe kidney failure. That definitely causes nausea and vomiting.
On the ultrasound, I could see the tumor was even more advanced. Now the urine flow into the kidneys through the tubes called the ureters was being blocked by the tumor.
We admitted Chandler for aggressive fluid therapy and scheduled a surgery to stent the ureters – both of them – for the next day. Stenting is a sort of propping-open procedure used to open up arteries, or in this case, ureters, that have a blockage. It’s a surgical procedure that only some boarded surgeons do. Luckily my surgeon does the procedure, and has done many. The plan was to restart chemo treatments after Chandler recovered from the surgery.
The next day Chandler went to surgery to relieve the obstruction, which would improve urine flow and help with the kidney failure.
But, disappointingly, at surgery the surgeon saw that the cancer had spread all over his abdomen. It was much more advanced than we could tell on ultrasound.
Stents were not going to help Chandler.
At this point, even our plan C treatments for TCC was not a fair option for Chandler.
So, I told the family we should euthanize while the dog was still under anesthesia.
Remember, the family is still out of the country at this point. They couldn’t get home for days.
But yes, I told them, this is what I would do for my own dog.
So they consented, far away and unable to say their goodbyes.
And I hung up the phone and cried like it was my own dog. I literally sobbed. As promised, I went into the OR and kissed Chandler goodbye, like he was my own.
I work with the best internist, surgeon, nurses, and support staff. We have advanced treatment options like CyberKnife and ureteral stents.
All the money, the best health care, and it still didn’t matter.
It still shocks me – I cannot get over how aggressive and quickly cancer progresses.
I could not help this dog. It’s defeating, humbling, depressing. I mourn for the family and thank them for the trust. I am sorry we could not do more. All I could do was end his suffering.
I am always hesitant when someone asks me to treat their dog like it’s mine, because I would go pretty far for mine, perhaps farther than most people would. It’s hard to know when the time is right to stop treating.
I was trained to fix pets with cancer, but sometimes we need to let go. And when it’s time to do that, we need support to help us know it’s the right time.
I know we made the right decision for Chandler, and I vow to do the same for all my patients and their families.
But it is not easy.
In memory of this special dog,
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.