Emotionally Hijacked by Cancer

One of the biggest hurdles we face at The Veterinary Cancer Center is that most people associate cancer treatment in people with cancer treatment in pets. Witnessing a friend or a family member undergoing cancer treatment; even watching an episode of House will leave even the most optimistic person with a false and preconceived notion of what to expect in regards to cancer therapy in pets.

When my own dog was diagnosed with malignant histiocytosis I was immediately emotionally hijacked by my personal experiences with how my family members handled their cancer therapies. As a co-owner of The VCC, the doctors here still needed to remind me both intellectually and emotionally of how well pets handle cancer treatment.

Since cats and dogs have a limited life span (compared to people) the primary goals is not to cure the cancer, but to significantly slow it down. This not only gives them more time, but also gives them a higher quality of life… Even during treatment!

We do this by giving lower treatment doses then they do in humans (sometimes over longer periods of time) as well as treating the symptoms prophylactically. Many pets never show symptoms of either the disease or the treatment of disease. It’s truly amazing how well most pets do!

The other fact is that many pet owners and local veterinarians might not know all the amazing and novel therapies that have become available over the last few years. With the mapping of the genome, personalized medication, Radiation Therapy using IMRT, and the latest discovery regarding junk DNA, we are on the forefront of really making a difference when it comes to not only the treatment of pets with cancer, but for us humans as well.

Most people make emotional decisions every single day; it’s part of what makes us human. But I believe that one should never base a decision on fear or a lack of understanding. Always get the facts before making decisions about your pet’s health. The truth might surprise you…

 

David Duchemin

What I would change about the Veterinary Education System

I was at a conference recently with two colleagues of mine and we started talking about veterinary education. I am not sure how the topic came up, what we all started discussing the same point almost in unison. The topic was communication and how veterinarians discuss options with pet owners.  

All three of us had graduated from different veterinary schools, gone through different internships and residencies –and yet we all agreed that veterinary students everywhere need to re-organize their communication priorities. 

What do I mean “communication priorities”—I mean medical/surgical options need to be prioritized above finances. Don’t get me wrong, finances are AN important consideration when discussing any medical therapy, but they should not be the primary one. Information about options- ALL the options available, should be THE most important consideration.  Once a veterinarian and pet owner both understand what options are available for the pet, then, and only then should finances-or whatever other constraints –time, emotional, finances, etc.--may be pertinent to that pet owner be discussed. 

By prioritizing information and options first and finances second, we can better insure that the pet will get the best care possible AND that everything will be done that the pet owner can afford. If the priorities are stay as they are, clients will continue to feel that optimal care was not recommended or given, veterinarians will feel they need to be accountants, bankers and financial managers first and medical professionals second.  

We, the veterinary profession, need to trust pet owners. Trust that they can make the best decision for their family and their pet. This requires accurate and complete information. Veterinarians need to allow the owners to hear ALL of their options and then help them make choices, rather than only communicate those options the veterinarian THINKS the owner’s can afford.  Veterinarians need to be medical professionals not financial professionals. Pet owners come to us for medical information and guidance. 

Survey after survey over the past 25 years have shown that owners would have done more for their pet if their veterinarian had recommended it. The impetus to change the way we as veterinarians communicate needs to start at the veterinary schools throughout the country, this is where we learned the current communication prioritization.  

Empowering the pet owners and informing them of all the options available—as a starting point for discussion –may not be easy, but it is the right thing to do for the pets that have been entrusted into our care.

Dr. Gerald Post

Getting to know you

 

     I thought I would use this first blog entry to introduce myself; I am Dr. Jaclyn Smith. I have been a proud member of the VCC family since July 2010, when I started a 3-year residency program in medical oncology. What’s a residency, you ask? A residency is a vigorous additional training in a specialized area of veterinary medicine. It’s typically a 3-year program, following completion of veterinary school and a 1-year internship. WOW, that’s a lot of school/training! I know! I was born and raised in Ohio, so it’s only natural that I attended The Ohio State University for undergraduate and veterinary school. GO BUCKS!! I then moved a bit further northwest, to the windy city, for my 1-year internship and following, worked my way down south for some warmer weather in Atlanta for a 1-year oncology specific internship. You see, the residency programs are highly competitive so some people choose to have an additional year of training in order to become more qualified and prepared for the rigorous residency. From there, my career took me to the east coast to join VCC.

      I grew up surrounded by animals and veterinary medicine. My dad, whom I get most of my passion from, is a veterinarian still practicing in Ohio. Having always had pets growing up, it’s only natural that I now share my home with my very own “zoo”!  My family consists of Neo, a10 year old wildly crazy, but lovable Boxer, Annabelle, a 9 year old wiggly and happy Boxer, Balboa, a 7 year old timid, but sweet Chihuahua, and Wally, the coolest 5 year old cat I know! But wait, that’s not it! I also share my home with an incredibly supportive boyfriend Stephen and my sister Erica, who is also my best friend.

                Well, that’s it for now, but more to come later!

 

Jaclyn Smith, DVM

You're a Veterinary Oncologist?!?

                         When I tell people that I am a veterinarian I am always asked what kind of animals I work with. I go on to explain that I actually only see animals with cancer, whether they are cats, dogs, ferrets or rabbits (and hopefully, one day, horses). Ninety-nine percent of the time the reply is "How sad, how can you be around such sick animals all the time?". Although there are aspects of my job that are sad there are many more aspects that are happy, exciting and emotionally touching.

                        Prior to becoming a veterinarian two of my own dogs were diagnosed with and treated for cancer. I was devastated, but I was so thankful for the help of the veterinary oncologists and technicians who were there to help me and help my dogs. That is the happy part of my job. I have the privilege of being the veterinary oncologist who is there to help people and their pets. I am able give people more time with their best friend and I can help sick animals feel better. There is nothing that makes me happier then seeing a smiling owner being pulled across the waiting room by a tail wagging dog or seeing an owner snuggling their purring cat.

                        At the Veterinary Cancer Center I also have the unique opportunity to be involved with research and clinical trials. Many of these clinical trials are looking at medications and treatments that will not only benefit our four-legged friends but may also help humans with cancer. Being on the cutting edge of cancer research for humans and animals is very exciting and rewarding!

                        Another aspect of my job that I find very rewarding and touching is being able to help someone say goodbye to their best friend. There a few things more difficult then making the decision to let your friend go. I consider it a sacred responsibility that I am trusted to help an owner say goodbye and allow that animal to transition peacefully. I am honored to be present in the last few minutes of a long relationship and hear the words of love and thanks that all owners have for their pet as they take their last breaths. Yes, it is sad but it is important and I am a better person and a better doctor because of every euthanasia that I have performed.

           

JenniferMcDaniel, DVM

The Veterinary Cancer Center

My pet has cancer…are they in pain?

As an oncologist who sees many pets with cancer this is one of the questions that I sometimes find the hardest to answer.  A few years ago I found a very small swelling under my armpit that hurt when I touched it.  My doctor told me “not to worry…if it hurts it probably isn’t cancer.”  Fortunately for me he was right, but for a lot of our pets with cancer their tumors are more advanced when we find them, so they often are painful at that point. 

How can you tell if your pet is in pain?  There are some signs you can look for.  If your pet is limping it almost always is from pain.  If your pet has a tumor that is damaging bone anywhere in the body this is painful.  If your pet is acting abnormally in any way they may have pain.  For example, if they have an oral tumor and they won’t eat this is likely due to pain.  If your pet’s tumor is red or swollen or they are licking, scratching or biting at the tumor it probably hurts.

However, it is important to remember that some pets will never show these signs, even with a painful tumor.  Not that long ago dogs and cats were wild animals and their natural instinct is to hide pain… or be eaten!   Cats may hide more or have a decreased appetite when they are in pain but most cats show no signs of pain.  Many large breed dogs such as retrievers will wag their tail and beg for food, even with a tumor that we know would be horribly painful in a person.

It is very important to try to identify whether your pet is in pain because controlling that pain will improve their quality of life and in some cases can improve their response to treatment.  The best way to get rid of pain from a tumor is to get rid of the tumor.  Surgery, radiation or chemotherapy may help achieve this, but in cases where the tumor cannot be removed or controlled, pain management is important and veterinarians are getting much better at it.  Currently there are many more choices for pain control in pets than there were in the past.  Non-steroidal anti-inflammatory drugs, pain killers like buprenorphine and gabapentin help keep animals comfortable.  Also radiation can be very effective in controlling pain for certain tumors.  In some cases acupuncture may be used.

So if your pet has cancer of any type, whether you are going through treatment or you just want to keep them comfortable, ask your veterinarian to help you determine if your pet is in pain, and discuss what you can do to make them comfortable.

John Farrelly, DVM, MS, ACVIM (Oncology), ACVR (Radiation Oncology)
The Veterinary Cancer Center

   

Cody's Legacy

For me there have always been three types of “expenses” associated with the treatment of cancer. There are the financial, time, and emotional expenses; each one of these, unfortunately having to be considered when making decisions relating to whether and how to treat a pet with cancer.

When I found out that my 12 year old Rottweiler Cody had cancer I was devastated. Tough decisions needed to be made, but being a part owner of The Veterinary Cancer Center in Norwalk, CT, these were not decisions I needed to make alone. I had a team of the best doctors, with access to the best treatment modalities and, the latest in cutting edge clinical trials.

I was able to focus my attention fully on Cody’s care and deal solely with the emotional expense and was able to do so without being weighed down by the burden of the other expenses—financial and time-- associated with her treatment.

Because of all I was able to do, Cody's outlived her prognosis by almost 9 months-- something that few dogs with her type of cancer ever do.

When Cody did finally pass in July of 2009, I set out to honor the most miraculous and marvelous dog I had ever known. In a moment of support, Dr. Post, my partner, reminded me of how lucky I had been to be in a position of being able to do everything possible to help my beloved dog and that there were many people that could not afford the expenses associated with her treatment.

It was at that moment that I knew what I wanted to do to honor Cody. Although I could not help people with all of the “expenses” associated with cancer therapy, I could help them with the financial aspect of treatment. I could do this by co-creating a foundation that would raise money to help offset the costs of treating animals with cancer.

The Riedel & Cody Fund is not just about raising money. It is about giving knowledge and hope; about giving people the tools and the place to help one another. It is a community that embodies all the values that we should emulate from our pets; one of unwavering dedication and compassion. A community that we hope will connect people in need with those with generosity of heart and of spirit.

For more information about The Riedel & Cody Fund click here.

David Duchemin
Chief Operating Officer, and Practice Co-Owner of
The Veterinary Cancer Center

Co-Founder, and Treasurer of
The Riedel & Cody Fund

 

Can my pet with cancer get his or her routine vaccinations?

Recently, I have received many questions regarding whether a pet with cancer should receive routine vaccinations. The short answer is, it depends.
 
The long answer is:
 
If a pet has a type of cancer that arises from the immune system I recommend that vaccinations be limited as stimulating the immune system MAY cause the cancer to progress or potentially come out of remission. Examples of a few common cancers that arise from the immune system include: Lymphoma, Mast cell tumors, and Plasma cell tumors. Many other types of cancer do not arise from the immune system and so there is less concern for the above.
 
Now, this in no way means that every pet with cancer should be exempt from vaccinations. Vaccinations are very important and serve to benefit your pet by protecting them from numerous infectious diseases (some of which have very serious consequences even including death, such as with the Rabies virus).
 
The best approach to determine which vaccines your pet with cancer should receive is to partner with your pet's general health care veterinarian and with us at the VCC. Instead of a blanket recommendation for every pet I emphasize the importance of looking at a pet's individual risk and benefit profile regarding each vaccination. Here is an example to help clarify: a pet that lives in an area that has a high prevalence of Lyme disease and who hunts all day in the woods would benefit from the Lyme vaccine due to that pet's personal high risk of contracting Lyme disease. In contrast, for a pet with an immune system cancer living in a geographic area that sees very little Lyme disease I would not recommend this vaccine as the risk of the vaccine would outweigh the benefit in this pet.
 
A titer can also be run on some vaccinations. A titer is a blood test that is used to determine if the immunity imparted from a particular vaccine is still high in your pet. If a titer is run and it shows that a pet still has strong immunity to a particular disease it may not be necessary to re-vaccinate for that disease. An example of a vaccine for which a titer can be performed is the distemper vaccine.
 
There are also some legal implications to consider when deciding whether to vaccinate a pet with cancer. Certain vaccines are mandated by state law for the protection of the individual pet as well as the protection of other animals and of people. The best example of this is the Rabies vaccine which is required by state law in CT. In some cases an exemption letter can be written to allow an individual pet exemption from the vaccine, however, this decision needs to be made very cautiously.
 
So unfortunately there is no short and easy answer to the question put forth above.  It is imperative that you partner with your pet’s general health care veterinarian and with us at the VCC to make the best decisions for your individual pet based on his or her risk/benefit profile.  Utilizing a team approach with input from your pet’s general health care veterinarian, your pet’s oncologist, and you (the pet’s parent) will allow for development of the optimal vaccination plan for your pet.

 

GinaOlmsted, DVM

The Veterinary Cancer Center