Chemo can give a dog and owner more time
Toby was a 3 1/2-year-old English cocker spaniel who got a buzz cut every spring. ''He had a lot of hair," says his owner, Pat Lash, a marketing manager from Arlington. ''We would let it go wild in the winter, then shave it off."
Two years ago, a freshly shaved Toby was sitting on the lap of Lash's husband, Paul Ferrari, when he noticed a lump not much bigger than a grape under the dog's elbow. ''We wouldn't have found it if he hadn't been shaved," notes Lash. She was concerned, because although she knew that fatty tumors are common in dogs, and are normally harmless, those tend to be soft and this lump was rock-hard. Still, she wasn't terribly alarmed: ''I figured, dogs have tumors, and he's only 4."
Lash became more worried when her veterinarian wanted to see Toby right away. Things only got worse as she learned that Toby had malignant histiocytosis, a form of cancer so aggressive that survival rates are described in terms of days, weeks, or months at most. Between the time of that first call to her veterinarian and the start of treatment (less than a week), the lump had grown to the size of a walnut and Toby had become listless and weak. ''I thought, 'Oh my God, how could this happen so fast?' " she says.
Malignant histiocytosis is not common, and usually strikes older dogs. Because Toby was so young, says Lash, ''everyone was shocked." She and her husband quickly opted for the treatment recommended by doctors at New England Veterinary Oncology Group (NEVOG) in Waltham: surgery to remove the lump and chemotherapy to follow up.
The chemo, which Toby received every other week, consisted of pills that Lash or her husband gave him at home (wearing gloves so the chemicals would not touch their skin). Before each round, they took Toby to the veterinarian for blood tests to make sure his white cell count was high enough to receive the drugs.
Altogether, the treatments cost $5,000 to $6,000 (''We have never totaled it up because we don't want to know," says Lash). But even though Toby's doctor never spoke in terms of a cure, but rather of prolonging the dog's life for a few months, Lash says she never considered not proceeding with treatments. Not even when relatives told her, ''Let him go, it's just his time." Toby was her dog before she got married. He was there at the couple's outdoor wedding, where he created a stir by consuming a lamb shank too quickly, then throwing it up. He was part of the family.
Lash and Ferrari's decision to buy a few more months of life for Toby may strike some people as above and beyond the call of duty for a pet, but their choice is not as unusual as it might have been several years ago. While there are no statistics for the number of dogs and cats receiving chemotherapy or radiation treatments in the United States, the number of veterinary oncologists certified by the American College of Veterinary Internal Medicine (www.acvim.org) has more than doubled in 10 years, from 74 in 1995 to 151 in 2004.
At Animal Care Clinic, a general veterinary practice in rural Peterborough, N.H., there's been a steady increase in owners seeking cancer treatments for their pets, according to veterinarian Charles De Vinne. He estimates that 10 years ago in his practice, about 75 percent of owners whose dogs or cats were diagnosed with cancer would seek treatment of some kind -- surgery, radiation, chemotherapy, or alternative medicine -- rather than letting the disease run its course. Nowadays, he says, ''the percentage is closer to 90."
Veterinarians believe that increased awareness and a sea change in attitude are causing more owners to seek aggressive and expensive treatments for their pets with cancer. ''In general, over the last 10 to 15 years, people have begun to consider pets more of the family than they used to," says Susan Cotter, a veterinarian at Tufts University School of Veterinary Medicine, one the three main oncology specialty centers in Greater Boston; NEVOG and Angell Memorial Animal Hospital are the other two. Some individual practices also offer chemotherapy and other forms of treatment.
Two aspects of pet chemotherapy that most people aren't aware of is that dogs and cats suffer less from side effects such as hair loss, nausea, and diarrhea than do humans, and that its purpose is usually not to save life but to prolong it, while also making the animal more comfortable. ''There are certainly some cures out there, but we're talking the minority," says Cotter.
Both the lack of side effects and the palliative, rather than cure-all, view of chemotherapy can be attributed to the relatively small doses of cancer-fighting drugs that pets receive. ''With a person," says veterinarian Kim Cronin of NEVOG, ''you're looking to cure them at all costs." With a dog or cat, which presumably would suffer the side effects without a human's concurrent knowledge of the big-picture necessity, the philosophy is to balance extending a pet's life and keeping it comfortable. If the treatments do make an animal sicker, notes Cronin, ''we make adjustments." Quality of life is key.
To many pets and their owners, that quality means a lot. Chemotherapy gives an owner time to come to terms with a pet's illness, and gives the pet time to enjoy special attention during the last months of its life. Dogs and cats on chemotherapy tend to eat very well: salmon, shrimp, homemade meatloaf, prime rib, and other delicacies often find their way into the food bowl.
A year or even a few months is a lot of time in dog or cat years, especially when the pet is already older than most.
One old-timer with a new lease on life is Kathlene McGrail's 12-year-old golden retriever, Camden, who was diagnosed with lymphoma last summer but rebounded after receiving chemotherapy. ''He did really well," says McGrail. ''He was bounding around." McGrail, who works part-time in real estate and also restores old homes, is a Lexington mother of two, ages 5 and 2. ''They're crazy about the dog too," she says. Camden's chemo treatments are so low-key, she notes, that the kids often accompany him while he gets his injections, which he handles with aplomb.
For pet owners who decide not to pursue aggressive measures like chemotherapy, whether for financial or other reasons, quality of life can still be a primary concern. With the right program -- painkillers and the like --the quality of life for a dying animal can ''skyrocket," says De Vinne.
Some people reject chemotherapy but continue to fight the cancer using other means. Roo Grubis is a dog trainer who lived in Boston when her Belgian sheepdog Vilkas was diagnosed twice with cancer. About six years ago, Vilkas received surgery and radiation therapy for hemangiopericytoma. Three years later, he had surgery (a splenectomy) for hemangiosarcoma and was expected to live only a couple of months, although chemotherapy was offered as an option to extend that time by perhaps a few weeks or months. Grubis decided not to go through with the chemotherapy. Instead she researched alternative treatments consisting of supplements and a special diet -- she now buys salmon and other delicacies for Vilkas. ''We took the money we would have spent on chemo and bought a Weber grill," says Grubis. The 12-year-old Belgian sheepdog is doing well and living in Guilford, Vt., where Grubis recently relocated.
For every pet like Vilkas that seems to beat the predicament, however, there are many more whose reprieves are all too short. After some initial chemo, Lash's Toby was back to his lively self. ''You'd look at him and you'd have no idea he was sick," says Lash. After five or six months, though, the tumors began to reappear. ''We tried some new protocols, but at about eight months, the doctor said we'd sort of run through the things we could do," says Lash.
On the Sunday after his owners received this news, Toby began to fail. ''His lower eyelids stopped retracting," says Lash, ''and we had to carry him upstairs and outside." It was time to let go. So his owners brought him to an emergency facility that was open on weekends and stayed with him while he was euthanized.
The experience, says Lash, was difficult, but she doesn't regret having treated Toby with chemotherapy, despite the expense, time, and trouble. ''I didn't feel like I could have done anything else. In the end, I think we were just thrilled to have had eight months of happy dog."
