Bone Cancer and Bone Heads
Irma is a lively senior Golden Retriever patient of mine, suffering from bone cancer on her left upper arm. She lived a healthy life before this, so I only got to meet her after this calamity called osteosarcoma was diagnosed in October 2014.
Irma’s one of those dogs who’s friendly to anyone she meets, who knows no strangers. Her face turned white when she was only four years old, and now there’s a whole lot of white hairs mingled into her coat at age 12.
Luckily for Irma, she didn’t experience too much conventional medicine, though she did have some vaccinations up until age eight. More telling, when I asked Mike about the possibility of any injury earlier in life was this:
“When she was a young pup, she fearlessly leapt off an 8 foot ledge, surprising the friend who took her for a walk. She limped for a bit after that, and that limp reminded me of this limp she shows now.”
Interesting. Research shows that a high percentage of cancer cases had an earlier history of traumatic injury, 50% or more according to one of my teachers.
Rx: Death, Based on Radiograph. Patient Ignored.
Irma went in to get radiographed last week to see how her bone cancer looked. It’d been there in her left arm for a few months by now, and while she limped, she was every bit the engaged, happy, hungry and even playful dog she had been for years. Her pain was being managed with a couple of well known pain meds.
The radiographs showed the cancer had advanced. That’s not uncommon in osteosarcoma. Here’s what that looked like to the x-rays that were beamed through her arm to visualize the brute:
See where the borderline of Irma’s humerus gets fuzzy up near the top? That’s the cancer, and the bone’s abnormal growth in this disease.
In discussing her findings, the conventional vet suggested the limb could fracture and euthanasia should be considered in the next couple of days. Mike and Shelley, hearing this, were taken aback.
I was called to weigh in on this idea, as was a Canadian vet Irma saw briefly when she was there for a spell.
We both agreed: unless Irma is clearly giving up or in intractable pain, it’s premature to get her scheduled for euthanasia. She was nowhere close!
[Now, even 10 days later, as I’m writing this, Mike stopped in to pick up some Irma supplements and reiterated how glad they were in not heeding this advice. “She’s still happy to be alive!”]
Irma is still wagging for each meal, cleaning up her raw food like there was no tomorrow, and very involved with her owners and their kids. Earlier, Mike sent me a video he’d taken on that scary day. There’s Irma, lying on her back in the living room, happily wriggling and even reaching playfully for her tail.
Put her to death? That’s a very final decision. There may come a time for it, but we’ll all know when that time comes.
What’s Wrong with This Picture?
There are some surprising attitudes on Dr. WhiteCoat’s part that drive euthanasia decisions. They unfailingly catch me off guard and often make me furious. There’s no returning from that decision once it’s made. While I see its place in the grand scheme of things, it needs to be the final card played. If it’s played at all.
The recommendations that most rub me wrong are the ones based on the disease instead of the patient. The gross incongruence in these situations is jarring. I’ve had cat patients whose owners were told, “She’s positive for feline leukemia. We should euthanize her.” After homeopathic treatment, these guys inevitably have thrived, often for years. Same with FiV, feline AIDS.
Irma’s cancer is a another example. Those radiographs show her pathology clearly, and make it look like recovery is unlikely. I’d agree, and we went into her homeopathic treatment knowing those odds.
The best we seem to be able to achieve with homeopathy is curing about 10% of our patients who are living with a malignancy. The other 90% live a better quality of life than what conventional medicine offers, especially chemotherapy. And, when it’s time to die, the homeopathically treated ones can often die peacefully at home on their own. That stands in stark contrast to those who’ve undergone chemo, radiation, or surgery, who often need euthanasia in the end to relieve a very difficult state.
Dogs with this very disease have largely done well after amputation, as well.
So, I wonder if Dr. WhiteCoat’s thinking becomes,
- We’re going to lose her anyway, so let’s wrap this up.
- This is impossible to cure but I need to do something.
- I’m a doctor. I can control even death with my medicines!
But what about that happy dog who’s walking around your exam room, getting pets from anyone who offers them, and still has a happy attitude and an eager appetite? Can you really, in your heart of hearts, think it’s time to put this animal to death?
When It’s Clearly Euthanasia Time
It’s not always easy to call it, but there are some infallible markers in my experience that say, “It’s time.” I’m talking about end stage disease in the following examples, where the owners and the doctors know that recovery is impossible, short of a miracle.
- 1. It’s impossible to rest or sleep uninterruptedly.
These animals are continually shifting position. It just seems the pain of their condition is inescapable. If they can’t nap or sleep for hours, life is hell and it’s time to help them transition with euthanasia.
- 2. Vocalization.
The level of pain and discomfort is at the point where moaning or barking or whining is now a regular part of every day, multiple times a day. When they are calling out like this, it is clear: it’s time to offer the gift that euthanasia is.
Less Clear, But No Shame
There are also times when I’ve offered euthanasia as an option when the following line up:
- The disease is clearly not going to be cured, even with the best homeopathy has to offer.
- The animal’s quality of life has really deteriorated:
- Incontinence is the norm, not the rare exception. Every elimination is unpredictable and lands where ever the animal is at the moment.
- Paralysis makes the simplest act, like standing to eliminate, impossible. I see this in the German Shepherds and others who have spinal disease: normal from the waist up, but completely paralyzed in their lower half. They are often the victims of scalding from dribbling urine and/or stool.
- Multiple senses have failed, so the poor beast no longer sees nor hears her world. Touch startles her.
That’s not to say these animals must be euthanized. There are owners who would do what ever it takes in terms of supporting these creatures and don’t mind cleaning up after them on a regular basis. I’m only suggesting that I will never object to euthanasia if the owner sees it as an option in advanced terminal conditions like these.
It’s exhausting, caring for an animal in this stage, and I think euthanasia is a very acceptable decision at this point. That’s especially true in animals you’ve known to be extremely clean in habit, or who would never, ever, even with a bursting bladder, eliminate in the house. How must they feel now? We can only guess, but there could well be an emotional price exacted daily when they are no longer in control.
How about you? Tell us in the comments how you’ve dealt with this often difficult time at the end of life . And tell us if you’ve had to ignore a recommendation for euthanasia that was clearly premature.