The Most Important Question in Dog Cancer - Dog Cancer Blog

Featuring Demian Dressler, DVM and Susan Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide.

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The Most Important Question in Dog Cancer

Many dog lovers arrive on this site (desperately) looking for information. You probably have sixteen million questions running through your mind. But the most important question in dog cancer is one you probably haven’t asked (yet).

Here it is:

What type of person am I?

I know this might sound like a bizarre question to ask first. So give me a moment to explain myself.

First, in the world of dog cancer care, there are very few “right” choices.

The reason for this is simple: most cancers are not ultimately curable.

I know that is a hard sentence to read, so let me quickly say this: diabetes and heart disease are also not “curable.” But they are manageable, and so is dog cancer. There are lots of things you can do right now to help your dog fight cancer, live a much higher quality of life, and possibly even extend his or her life compared to the prognosis you heard from your veterinarian.

But even so, when your dog has cancer, you want it to be completely, 100% GONE. You want cancer OUT. You want it CURED.

So, you’re looking for treatments that WORK — and by WORK, most people mean CURE cancer.

But since there is no silver or magic bullet, we’re looking at managing a disease with a focus on balancing life quality against life expectancy. There are also lots of ethical decisions to make, and resources like money, time, and even emotional equilibrium have to be taken into account.

These waters are murky. There are lots of factors to consider. And that’s why the most important question to ask yourself and answer for yourself is this:

What type of person am I?

More on how to answer that in a minute, but first, let me remind you of another fact.

Second fact: there is no such thing as a crystal ball we can consult to see the future. I wish I could build a “retrospectoscope” that would allow me to project 10-20 years into the future and look back with 20/20 vision. It would be great to be able to punch some numbers into a computer program and get the “outcome” for each decision I make.

In short, there are very few ways to know for certain that our choices are the correct ones while we are actually making them.

We can’t know for certain that about our health, and we can’t know for certain about our dog’s health. And we certainly can’t, in any case, ever, know for certain that we are making the “right” choice when it comes to how we treat our dog’s cancer.

Here’s a story to illustrate what I mean.

Let’s say that we have a dog named Daisy who is just six months shy of her average life expectancy based on her breed or her weight. (You can find these tables of life expectancy in the Making Confident Decisions section of The Dog Cancer Survival Guide.)

So, let’s say she’s 9 and a half, and we could reasonably expect her to live to age 10 based on her breed or weight.

Now, let’s say that Daisy is diagnosed with cancer, let’s say lymphosarcoma, and the median life expectancy for her diagnosis is 10 months with chemotherapy treatment.

The median life expectancy number is important. It tells us how long HALF of the dogs live with this type of cancer at this stage and receive chemo. Half the dogs with Daisy’s diagnosis who get chemo live to ten months or longer, and half die sooner than ten months. This number doesn’t predict which dogs get to live ten months or longer, and which ones don’t.

So, we have no way of knowing whether Daisy herself will be in the group that dies before the ten-month mark or those who live past it.

Maybe Daisy is one of the incredibly rare dogs who will go into a permanent remission — maybe she’ll get the chemo treatment and her body will respond so well that cancer never returns. This is rare, but it does happen.

If she’s that dog, then in hindsight chemo would have absolutely been the “right” choice. Right?

But she might be one of the dogs who have a horrible drug reaction to a chemo agent, and it has to stop or be reduced for her to tolerate it (making it less effective).

If that turns out to be the case, then in hindsight chemotherapy would have absolutely been the “wrong” choice. Right?

(Note: there is a test called the MDR 1 mutation test that can screen Daisy for certain chemo drug sensitivities so you have an idea ahead of time if she will tolerate therapy. This is easy for your vet to do.)

There is no way to know ahead of time which choice is right.

There just isn’t. We cannot retrospectoscope ahead in time, look back, and see that Daisy sailed through chemo and lived another year, beating her average life expectancy by six months … or that she couldn’t tolerate chemo or was in the 50% of dogs who don’t make it to ten months.

So — do you see why it’s impossible to “know” what the right treatment is ahead of time? To “know” if something will work, or not? It’s just not possible.

Just like any other health situation, there are no absolutes.

For a more common example, many millions of people get the flu each year, and the majority feel sick a week or so and then recover fully. But tens of thousands actually die from the flu every year! How many in any given year? We don’t actually know. Not even the Centers for Disease Control can accurately tell how many adults die in the U.S. from flu in any given year. They have to use estimates. In 2016, an estimated 12,000 to 56,000 people died from the flu. That’s a lot of people, and a lot of families left bereft. From the flu.

If we can’t accurately tell how many people died from the flu in any given year, how on earth could we predict whether any given treatment will “work” in a complex, sneaky, devastating, often-aggressive disease like cancer?

We can’t. We don’t have the data.

And that’s why I ask you — I beg you — to focus on something other than “what will work.”

What to rely on?

Now we get to that question:

What type of person am I?

Defining YOU, your dog’s number one health advocate, is the most important first step in creating your dog’s cancer treatment plan.

Here are some questions to ask yourself — and answer — in order to get your head on straight BEFORE you evaluate any conventional, alternative, holistic, or any other kind of treatments:

  • Is your priority life expectancy or life quality?
  • What is your tolerance for risk? Do you need a guarantee before you do something, or are you able to “try something” without losing too much sleep?
  • How have you made other important decisions? Have you jumped in feet first, or taken a more methodical approach? Did you run a credit check on your spouse before proposing, or forget to ask them if they had any debt?

In The Dog Cancer Survival Guide, I outline three different types of people. See which one resonates with you:

  • Type A folks tend to value longevity more than life quality. They want life quality, of course, but they feel side effects will be OK as long as the outcome is more time with their dog.
  • Type B people tend to balance life quality with longevity. They definitely want their dog to live as long as possible, but they are much more likely to stop treatments if side effects get too graphic or difficult for their dogs.
  • Type C dog lovers tend to value life quality over longevity. They focus on comfort and life quality and usually opt for less treatment, rather than more.

Figuring out roughly which Type you are can really provide you with valuable insights in what to do for your dog.

The reason I call my book a Survival Guide is just this: it helps YOU to survive, just like a survival guide helps you in the wilderness. There is a literal map on how to navigate all the tough choices you have to make. The book covers all the gullies and ravines and mountaintops, and shows you the paths to take (from conventional treatments to nutraceuticals to supplements to diet to mind-body strategies, what I call brain chemistry modifications).

And knowing which Type you are — A, B, or C — will definitely help you to make more confident choices and choose your personal path through the wilderness.

Remember, the only way to know whether something is the “right” choice is to make it, live with it, and look back with hindsight. In a couple of years, you’ll know more about whether the choices you are making now are “right.”

That’s why for now, when you struggle with a choice, remember to take a breath or two and ask yourself this first, critical question:

“What kind of person am I?”

Then, turn your attention back to your decision and see how it fits with you, your dog, and your currently life situation.

In the end, this is the ONLY way to truly make a “right” decision.

Best to all,

Dr D

Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.

  • Nancy Walker April 17, 2018, 8:54 am

    Dr. D your book, your staff and your guidance have all been a Godsend to us. We are continuing to fight the good fight as long as Calie is willing and has quality of life. We couldn’t have done this, and certainly not nearly as well, without the tremendous guidance, information and support from all of you. You, Molly, Amber and your crew will always remain in our hearts. Thank you so very much for all that you do in your work. All the best to you and yours.

  • Amber Drake April 17, 2018, 11:30 am

    Excellent article!

  • BlueMule55 May 6, 2018, 9:39 am

    Dr. D , sir, if you happen to monitor this channel I could sure appreciate some assistance

    12:38P.M. PST 5/6/2018

    • DogCancerBlog May 7, 2018, 10:53 am

      Hello, Dr. D may or may not ever see this. If you have a question, please send it to cs@dogcancervet.com and if it warrants a private consult, we can tell you how to get in touch with him. Thanks!

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