Posted on January 6, 2013
Not All Patients Read the Textbook
My dear friend Juli is a seasoned veterinary technician. So when her own 16-year-old Cattle Dog named Easy developed bleeding into his belly because of a cancerous growth, Juli had a clear sense about the prognosis. Surgical removal of the tumor would likely buy some good quality time, three to six months on average before the cancer recurred. Post-surgical chemotherapy might expand that time frame just a little bit.
After some serious soul searching and “conversation” with her beloved dog, Juli opted for surgery without chemotherapy. Easy experienced a smooth, uncomplicated recovery. Within just a couple of weeks of surgery he was back to his normal routine of gentle walks, relaxing with Fannie (his little sister), good food, and enjoyment of an excellent quality of life. Every few months thereafter, Juli asked me to ultrasound Easy’s abdomen in order to detect recurrence of his cancer. Over and over again we were pleasantly surprised to nothing out of the ordinary. At the very generous age of 19, Easy succumbed to issues completely unrelated to the malignancy that had been diagnosed three years prior.
How is it possible that Easy’s cancer never recurred when statistics tell us that surgery should not have been curative? The answer is simple- not every patient reads the textbook! For every possible disease, there will always be “outliers”- those patients who fare far better (or far worse) than research statistics predict. Such “surprises” are part and parcel with the treatment of disease, whether treating dogs, cats, humans, or any other species.
Is there a way to predict who these outliers will be? Don’t I wish! With such a crystal ball I could alleviate so much angst for my clients as they wrestle to make good decisions for the animals they love so dearly. For a small percentage of my clients, medical decision making is relatively easy. They may be “numbers people” who base their decision solely on statistical predictions. They deem the outlier population to be too too small to be statistically significant. And then there are those clients whose decisions are made easier because they have absolute faith that their best buddy will be that outlier. No question, but they will opt to carry on.
Most of my clients struggle a great deal when there is uncertainty about the outcome. They know the prognosis is bleak, but not hopeless. Maybe their pet will be the one who defies the odds. When counseling these clients, in addition to engaging in some serious nose-to-nose “discussion” with their four-legged family member, I recommend that they play out all options to both their best and worst possible outcomes. I advise them to then consider which option provides the outcomes that will likely provide them with the greatest long term peace of mind. Juli did exactly this with Easy. She knew that attempting surgery, no matter the outcome, would provide her with the greatest peace of mind.
No one ever said this role of medical advocate was going to be easy!
Have you been in the position of making a difficult medical decision for your pet? Have you ever cared for a patient who didn’t read the textbook?
Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook
Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.