Most pets don’t suffer side effects from chemotherapy
THE O'REILLY family trooped in to my consult room: two parents, three children and a tail-wagging, easy-going Labrador called Bob. Most pets come to the vet with one human: Bob was so important to the O'Reillys that it was always a family affair. The children ranged in age from ten to sixteen, and Bob was nine years old: he was like a brother to them.
Bob had never been seriously ill. Previous problems had been simple to solve. One time he'd suffered an upset stomach after being given the leftovers of a weekend fry up. On another occasion, he'd cut his foot when paddling in a river on a walk with the family. He'd bounced back rapidly from these minor setbacks, and so his visits to the vet had never been anything to worry about.
On this occasion, I could see that Bob was downcast. He didn't try to jump up on me as usual, and he stood quietly, rather than dashing around the consult room, sniffing every corner.
Mr O'Reilly explained the background as he lifted his dog onto the table: “I don't think there's too much wrong with Bob, but he didn't want his dinner last night, and he isn't hungry this morning either. He usually loves his food, so we thought we should bring him down to have him checked out by you. It's probably nothing, but better safe than sorry!”.
As I checked Bob over, I asked a few more questions, but there wasn't much more to say. As far as the O'Reillys were concerned, Bob just wasn't quite himself. It was nothing more serious than that.
My brief physical examination left me with a sick, hollow feeling inside. Bob had golfball sized lumps under his chin, in front of his shoulders, and at the back of his hind legs. The most likely cause was a serious type of cancer. I glanced around at the family, still smiling and laughing, enjoying their visit to the vet.. How was I supposed to break this terrible news to them about their beloved dog? This type of consultation must be one of the most difficult tasks that a vet needs to do.
I quietly finished my examination, and lifted Bob down from the table without saying a word.
“What's the story then?” Mr O'Reilly asked. “Has he managed to eat something that's disagreed with him? He sticks his nose into everything!” The children giggled in the background.
I decided to break the bad news gradually. “I'm afraid that this time Bob might have something more complicated wrong with him this time. If you leave him with me today, we'll do a few tests, and by this evening, I'll know a bit more.”
The children were excited for their pet, as if he was having some sort of adventure, and they went back out to the waiting room babbling with enthusiastic chatter. As they went, I gently held their father's elbow, and asked him to stay with me for a private chat on his own.
I then told him the full, serious story. It was very likely that Bob had a condition known as Lymphoma, a cancer of white blood cells. The bad news is that it's a serious type of cancer; the good news is that it can respond well to treatment. We'd need to wait for biopsy results to have the diagnosis confirmed, but in the meantime, he should try to gradually let his family know that this was more than a minor blip for Bob.
The children weren't there for our next consultation: it was just Mr and Mrs O'Reilly, with Bob by their side. I had the full biop- sy results, and they already knew that the cancer diagnosis had been confirmed. There was no banter in the room this time: this was a serious no-nonsense discussion.
I gave them a simple summary of Bob's prospects. Without any treatment, he would get steadily worse, and he'd probably only live for a few weeks. Mrs O'Reilly sobbed quietly as I said this, and I moved rapidly on. “The good news is that just with simple treatment using steroids, Bob would rapidly return to his normal bouncy self. The lumps would go down in size and his appetite would return”. She'd stopped crying now, and was listening carefully to me. I went on to explain that this improvement would only last a few weeks or months, and then he'd fall seriously ill again. But there was one other option: chemotherapy.
Mr O'Reilly shook his head as I said this. “We don't want to put Bob through that” he said. “We don't want him to go bald and we don't want him to stay alive if it means suffering the constant side effects of drugs”.
I explained the facts: chemotherapy, as used in pets, is not the same experience as the human equivalent. 95% of dogs have no side effects from chemotherapy, or mild ones that go away by themselves. Less than 5% of dogs have unacceptable side effects, most of which can be treated. And for lymphoma, the results can be impressive: there is a good chance (90%) of getting complete remission, which lasts a year or more in around 50% of cases. And one in four dogs is still doing well after two years.
The O'Reillys listened to me but they couldn't give me an answer. They went home to think.
What happened to Bob? Did his owners choose chemotherapy or not? I'll finish his story for you in next week's column.
Bob is facing a cancer diagnosis. Will his owners put him forward for chemotherapy? Find out next week.