Listening Is the Hardest Thing, or Practical Advice in Making Difficult Treatment Decisions

In August of 2011, just after my 39th birthday, I took our dog Muddy to the oncologist. She had this weird, fast-growing tumor between her toes, and I didn’t like the looks of it one bit. My equine-veterinarian brother, Matt, had already tried to shrink it using triamcinalone (since Matt generally treats horses, he called a vet-school classmate that did a lot of oncology for a suggestion) and then later physically removed the tumor, yet it still came back. With a vengeance. At that point I knew we had moved beyond my usual familial veterinary care to the world of specialized veterinary oncology. I felt no joy, no happiness, only dread, as we crossed this barrier.

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Muddy, Ever Ready for a Biscuit

I gathered a recommendation from a friend and called the clinic for an appointment. Normally, they would not see me without my veterinarian’s recommendation, but once I gave them the “My dad is a vet and my brother is a vet, so trust me, I know cancer when I see it” spiel, they agreed that I should come in. I entered the reception area and found myself amongst magazines such as the New Yorker, Cigar Aficionado, Golf Digest, and Architectural Digest, whereas I was used to seeing ancient issues of Western Horseman and old pamphlets on calf scours or pet vaccinations. The first thought that came to mind was “I don’t think this is going to be an average vet bill.” (I do so dislike being right about certain things.) My second thought was that I wasn’t even used to the field of veterinary oncology. Dad specialized in everything, even if he had never done it before.

The veterinarian called me back to an exam room, and she and her tech examined Muddy’s tumor. She didn’t like the looks of it, especially when I showed them photos of the tumor taken a scant month earlier, and she asked to keep Muddy that afternoon to take some ultrasounds. I cried leaving Muddy, even offering to leave our other dog Reba there so that Muddy wouldn’t be as lonely or as scared, but the vet said that Muddy would have to go it alone. When I returned to pick Muddy up, I met with the veterinarian again. She told me what the ultrasound had shown and the various lymph nodes in which they found indications of cancer. Without treatment, she gave Muddy 3-6 months to live. She recommended chemotherapy, and if that did not work, then we could discuss amputation of that right hind leg.

When I went into the vet’s office, I thought that I was prepared to hear words like metastasis, amputation, or life span. I already knew this tumor was cancerous, I knew what that word often indicated in older dogs, and as I’d grown up in a veterinary clinic, I thought I should be better able to handle this news. I thought my experience should trump emotion. The hard truth, however, is that I was not. I drove home with both dogs, sobbing, and I never made it back to work that day.

Let me be clear: the veterinarian communicated clearly. She was very clear about what she had found, her diagnosis, and what she thought Muddy’s long-term prognosis would be. She was thoughtful and caring, sympathetic, and very nice. I just couldn’t hear what she was telling me. It wasn’t that I wasn’t trying to hear what she was telling me, because in fact I desperately was. I just could not remove my emotional response long enough to process the information she was trying to convey to me. I was frustrating myself as I knew what I was doing, but I couldn’t stop doing it. This went on for a couple of days, which somehow made it worse. I’m used to being a solution for communications problems, not part of the problem myself.

I did some research regarding chemotherapy for dogs with digit tumors, talked with my dad, and then my husband and I discussed what we wanted for Muddy. Ultimately, we decided that the best option for us was to put Muddy on prednisone and some benadryl to inhibit (hopefully) the tumor’s growth and metastasis and to let her eat whatever she wished. If she only had a few months to live, then who was I to say that she couldn’t have 16 biscuits and bacon for dinner. I wanted what time she had left with us to be happy, not morose because we were miserly with the diet dog food. If she was sick, then at least she should be fat and happy.

So, why am I reliving what was obviously a very painful experience? Simply put, I think there is something to be learned from it that will hopefully help others, especially when painful or awful news is involved.

  1. It’s okay to cry. When you get bad news, it’s perfectly okay to feel shell-shocked and stunned. Take a day or two to process that information, getting used to the idea that things are going to change. Very few decisions need to be made immediately, and a good, informed decision is always better than a hasty, rash decision.
  2. Once you’ve gotten to the point of breathing again, make certain you have your best understanding possible of your animal’s diagnosis and long-term options. Don’t be afraid of contacting your veterinarian again–and even again–to ask questions.
  3. Do some hard thinking. It’s likely that you’ll have more questions, so write those down.
  4. Talk to your veterinarian and anyone else that will be involved in making treatment decisions regarding your pet. Use the questions you wrote down, check them off, and make certain that you get all of your questions answered.
  5. Do some of your own research. I’ve found that if you are involved in making a decision, it is much easier to feel a part of the treatment process. (This goes for pretty much anything in life.)
  6. Sit down with relevant parties and make a treatment decision that you feel is best for your pet and your family. Remember, there is no wrong decision, just one that works the best for you.

When veterinarians deliver bad and painful news regarding an animal, they often walk a difficult line of explaining what is wrong with an animal, its prognosis, and care options, all without crushing a client’s hope. True, many veterinarians and doctors have stall-side and bedside manners that leave much to be desired, but just as many have your animal’s and your best interests at heart. They know this is not easy, and they want to help you make the best decision possible. My father has had the long-standing advice and practice of “When you stop doing something for them and are doing something to them, it’s time to let go.” I’ve found this to be an imminently practical statement, and it applies to so many things in life.

Muddy went on to live another 18 months, and I firmly believe it was because we had a free hand with the bacon. And the cheese. And the Triscuits. But mostly I believe that she knew that she was so very loved. She’s been gone five years now, but we still love both her and Reba as much now as we did back then.

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