What happens if we don't give our dog chemo?

August 6, 2009 9:11 AM

My dog has just been diagnosed with lymphoma. For various reasons, my husband and I are probably not going to do the chemo and radiation treatments outlined by the oncologist. If you have made a similar choice with your pet, can you tell me what happened?

Our dog is the sweetest, most wonderful 10.5 year old greyhound. The form of lymphoma she has (T-cell) is more aggressive and resistant to chemo than the more common form of lymphoma. Given her age (although before this she's never acted or felt like a senior dog), the cost, the potential for it to not work at all, the emotional trauma for us and the physical trauma for her, and everything else, we are probably not going to try the chemo and radiation treatments. We have heard that prednisone can keep the swelling down and her appetite up for a little while, so we may try that. The one really swollen lymph node was already removed a couple weeks ago when we and the vets thought it was just a stubborn infection. (The first biopsy only showed an infection.) That's when they found a mass on her tongue and the subsequent biopsies revealed the cancer.

She has been somewhat lethargic for a while now, and we have to encourage her to eat. It seems like she will eventually eat a regular amount of food, but does it in several small meals rather than wolfing it all down at once. Unfortunately, with the antibiotics and surgery and everything else (she had a hard time eating dry food prior to the surgery, so we had to try soaking, pureeing into a gruel with a blender, etc.), she has lost a few pounds and as a greyhound, she doesn't carry much extra weight. She still seems happy and loves being with us and cuddling. She doesn't play as much on her own, but still gets excited to see her doggy and human friends.

Basically, we want to know what to expect in terms of her health - Will she have a long, slow decline or feel mostly ok before things go downhill quickly? What signs should we look for that she's unhappy or in pain? What kind of treatments, medicine, foods, etc. are available/should we be prepared for in terms of pallative care? We know that the timeline without treatment is short, but we just want to be prepared. If you have had the misfortune of a lymphoma diagnosis in your pet, and chose not to do chemo, would you mind sharing your experience?

By the way, we do have a call in to the oncologist to ask these questions as well - hopefully we can get some answers without having to pay for another consultation, but we will pay if needed. We know that chemo in dogs doesn't have as bad side effects as in people because it is administered at lower doses, but we think (hope) we are making the right decision here.

posted by misskaz to pets & animals (17 comments total)

Yeah, had this - with an otherwise completely healthy dobie at 13 years. The vet can help you a lot with this once you tell them you've decided not to go with the chemo. Its a pretty common decision, our vet was kindly honest with us that the chemo was at best a 33% chance of working and would probably only buy a year or two at most before it was needed again, plus all the additional meds and whatnot. There are not easy answers here.

Will she have a long, slow decline or feel mostly ok before things go downhill quickly?

Downhill quickly - our vet told us to be prepared to bring her back sooner rather than later for kindness' sake. Ours didn't have it on the tongue, so there weren't as many issues with eating - I suppose yours will in some sense give you quicker signs via her resistance to feeding. You may try buying the wet canned food for a while to make things easier on her. Eggs can also be an easy food to slurp. This may sound dumb but I've always felt like my dogs' eyes have been the best place to gauge how they are feeling. I'm sure you'll be keeping close enough of a watch on her to know when the pain is outweighing the desire to live.

What signs should we look for that she's unhappy or in pain?

In our case it was a resistance to movement - once she didn't want to be up and walking around anymore because it was too painful. Not even wanting to get up to go do her business outside - needing coaxing and even carrying. This of course didn't last long - maybe only a day or so before we had to finally take her in, but she got pretty lethargic and made a significant turn from her normal active self.

What kind of treatments, medicine, foods, etc. are available/should we be prepared for in terms of pallative care?

Our doc gave us some kind of medium-strength (from my limited POV) pain-killer but was clear that once we were done with it we would need to bring her in. I suspect he did it to give us some kind of forced time-horizon if you will. It was probably about 2 weeks worth - might be worth asking your vet. Wet, smooth foods are probably best. My opinion was to give her all the treats you normally never would have - we were cutting strips of raw steak for her and whatnot. Perhaps a little foretaste of dog heaven.

I think you are making the right decision. Many times that isn't at all easy. Good on you. Hold her when they put her down, and consider a new pup (or maybe a rescue dog?).

I am sorry for your loss.
posted by allkindsoftime at 9:32 AM on August 6 [7 favorites has favorites]

There comes a point at which, for a pet, you have to say that enough is enough. It seems as though there are almost as many medical interventions for dogs and cats as there are for humans.

Several times, we have made decisions to either allow a pet to die, or to have a pet put down, due to excessive suffering, even though, in both cases, we could have prolonged a pet's life (through regular dialysis and other means).

Am I a bad pet owner? Heavens, no. You just have to make a "quality of life" v "quantity of life" decision, and it sounds as though you have made it. Finances have been part of this for me, as I am sure it is for you. I have spent a lot of money on pets (i. e. both ACL's on my dog operated on) but that money has bought years and years of quality of life. In this case, that does not seem to be so.

I hope that you are at peace with this. It's fucking hard.
posted by Danf at 9:32 AM on August 6

Oh, I am so, so very sorry to hear about your dog -- she's beautiful, though. I just lost my 4.5 year old German Shepherd to lymphoma at the end of May -- she was diagnosed in April of 2008 -- and it's one of the worst feelings in the world.

Because of my dog's young age and the fact that she really wasn't exhibiting any symptoms other than her grossly swollen lymph nodes, we did make the decision to try chemotherapy, but I hope you'll allow me to share my experience anyway.

The lymphoma was highly aggressive [and also initially diagnosed as an infection] and when her time came, it was quick. Her last checkup was on a Thursday and the vet noted that the latest chemo drugs were not working though she wasn't exhibiting much in the way of other symptoms, and a treatment appointment was set up for the following Tuesday. Thursday night she had a seizure lasting only a few seconds, then another of the same duration several hours later. The increased throughout the night and by Friday morning, the seizures were minutes long and occurring half an hour apart. The lymphoma had spread to her brain, and there was nothing more to be done. We had her put down Friday before noon.

Throughout everything, though, regardless of when she was on or off chemo, she didn't ever seem to be in any pain. She was quiet, but did still light up when she saw her family. We soaked her dry kibble in warm water for half an hour to forty-five minutes before we would feed her, making it more soup-like -- much like your dog, it was easier for her to eat. Her appetite was rather healthy, but one of the side effects of the prednisone is, as you noted, increased hunger, as well as thirst, and she was on pred fairly steadily throughout.

As allkindsoftime noted, the eyes have it. That last night before we lost her, once the seizures started, the light went out of my girl's eyes and I knew we had done everything we could, that it was the end.

Stay strong.
posted by alynnk at 9:44 AM on August 6 [2 favorites has favorites]

I am currently facing this same situation with my lab/husky mix, Charlie.

He has lymphoma in his mouth, which currently is a large lump sticking out from his gumline at the front lower left canine tooth. He also has a lump on his neck. Right now he still gobbles up food like he's starving and acts perky enough. I suspect this will change soon, based on the size of the lumps, but when it's time, we will let him go without prolonging his pain.

He's been a good friend and I owe him that.
posted by Fleebnork at 10:05 AM on August 6 [1 favorite has favorites]

You want a high-protein/VERY low-carb diet (Innova EVO is about the highest protein/lowest carb diet you can get). You should supplement with DHA/EPA like 3VHP capsules. Definitely at least use the pred, this can also help with appetite. These things can slow the progression in some dogs.

I'm sorry you're going through this. I suggest you make a list of your dog's 10 favourite things in the world (running in the yard, chasing a ball, sleeping on the couch, playing tug, eating hamburgers, whatever), and when your dog no longer wants to or cannot do them, it's time to make your decision.
posted by biscotti at 10:06 AM on August 6 [2 favorites has favorites]

When this happened to my dog of 15 years I cried. A lot. She had a very fast moving cancer and kidney failure. She couldn't get up without a lot of pain. I slept on the kitchen floor next to her the night before I had to take her in.

Love them, but don't let them suffer.
posted by Hugh2d2 at 10:32 AM on August 6

Oh, misskaz, I'm so sorry to hear about Alina!

We lost one of the dogs (a Lab mix) I grew up with to bone cancer when she was 8. At first we just thought she had a bumpy head. She grew more lethargic, never had any seizures or anything like that, but slowly it became clear that she was miserable.

We all admitted in the end that we waited too long. Looking back at pictures is painful, because the bumps on her skull were more obvious. My mom took her alone to the vet and a woman asked her, "Oh what an interesting looking dog, what kind is it?"

I didn't know whether to laugh or cry when my mom told me about this. Just writing this is hard. Being responsible for your pet includes knowing when to let them go.

Like everyone else has said, when she loses interest in her favorite things, it's time.

I'm so, so sorry.
posted by canine epigram at 10:36 AM on August 6

Not a dog but we have just gotten a tentative lymphoma diagnosis with our ferret, Qanuk, who happens to be my profile pic. Hard decisions, but if confirmed we will opt for SubQ chemo + pred. The SubQ chemo is not as aggressive as an i.v. and seems to have minimal side effects with the potential to maintain quality of life for another year or so. From our point of view, the little guy deserves this as long as there is little disruption of quality of life.

Every animal I have had, because ferrets often get some odd -omas, has been on pred. Long term pred use causes muscle wasting and odd fat build ups. It can be difficult to watch. I imagine there is little difference between the various carnivores.

One of the biggest issues for us is the amount and nature of side effects. Animals can not rationalize their suffering... "I am suffering chemo side effects for the sake of an extended life". So from our point of view, as long as quality of life is maintained with minimal suffering treatment is worthwhile. An aggressive chemo treatment (for a ferret that would be i.v.), from our point of view, is out of the question for our animals as it yields more side effects, more discomfort and in the near term lowers quality of life without being a cure.

These decisions always suck. While not dog related, I hope some of our thoughts on this whole process can be helpful. I wish you the best.
posted by sundri at 11:23 AM on August 6

We lost both of our 9.5-year old English bulldogs to cancer this summer. One was diagnosed rather tentatively with pancreatic cancer, and the other had bone cancer, mostly in her jaw. We didn't request chemotherapy or have surgery performed to remove the tumor in either case.

With Millie, the one with bone cancer, my parents were making her chicken and rice, and noodles and things that were soft and easy for her to eat. It was plainly obvious to me that she was in a great deal of pain, as she was having difficulty sleeping, and a dog who was previously always happy had lost all of her sparkle. My parents held onto her pretty tightly, though, and probably took a little too long to make the decision to put her out of her pain.

The best advice I can give to you is not to wait too long to make that decision. You'll know when the time is right. In the meantime, ask the vet to give you some painkillers for her. Make her soft food to eat - either wet food, or make up something. In Millie's case, our vet told us to let her eat whatever we could get her to eat (and since we knew she wouldn't be around all that much longer, that ended up being White Castles and Jimmie Dean sausage patties).

As for the consult, your vet should be able to answer all of these questions without need for further consultations. I think that you are making the right decision. Cancer treatments are hard on human bodies, and we can understand why we're putting our bodies through it. Dogs can't. It's a hard decision, but it's the one that takes quality of life into account. I'm really sorry you're going through this - enjoy the time you have left with her!
posted by honeybee413 at 1:17 PM on August 6 [1 favorite has favorites]

I'm sure you are making the right decision for your sweet girl. I'm so sorry for the loss you are already no doubt grieving. It's hard to lose a dog and hard to make the decisions about their life and death, even when you believe you are making the best decision.

I just want to say for others reading that chemo for canines is not necessarily a burden to them physically, as it is for people. Our English bulldog had chemo after surgery for a mast cell tumour in her leg. She had no ill effects that we could see from the chemo at all. Her appetite (hearty) and activity level (calm with bouts of insane playfulness) remained exactly the same. She didn't lose fur. It's been almost 2 yrs since she finished the chemo, then with no relapse or recurrence. We feel very lucky.

I agree with those who've said that the dog's eyes will tell you. A previous bulldog we had, near the end of her 14-year life, got a look in her face sort of like she had a bad headache when she wasn't feeling well.

I wish you and Alina the best as you support her during this stage of her life.
posted by mmw at 4:44 PM on August 6

I'm so sorry to hear about your doggy. While not cancer, my first Frenchie had a progressive very degenerative bone disorder that really caught up with him the last few months of his life. I took him to a few different specialists and they really couldn't provide me a straight answer, short of saying that any surgery held a likely chance of rendering him completely paralysed, and potentially unable to breathe.

So, we held on, trying all different kinds of pain killers and different supplements. I asked my vet, who had become a friend, when I would know it was time. She told me to pick three of Willy's three favourite things in life. When he no longer responded to them, or they no longer made him happy, it was time.

He was in pain, and he couldn't walk by himself anymore. He would get stuck in a room, and would try and bark for somebody to get him. He completely lost function of his entire back half. He no longer picked his head up, or was happy when you rubbed his 'bib'. And he no longer perked his ears when you asked him if he wanted cookies. I knew it was time when it was the cookies. But mostly, yes, it was the sadness and pain in his eyes. And in retrospect, we waited too long. Mostly due to our own selfishness of not wanting him to leave.

So, I wish you the best with your girl. Take care of her. But most of all, find it in your heart to know when it's time to let her go. It's the best way to show her you love her.

Hugs to you and your family.
posted by dancinglamb at 6:23 PM on August 6

Do yourself a favor - make all the plans now for what you will do when the time comes. Get that done, get it out of the way, have a plan, and then never ever have to think about any of that so you are free to spend the time you have with your dog.

Your vet can probably tell you what the options are - sounds like the vet is a good one - and you should deal with all that now, while you're in a relatively sane state of mind.

Your vet may also be able to give you some recipies for home-cooked foods that will be easy for her to eat and digest. You might also ask how much water she should have per day - if she's having trouble drinking and is dehydrated, she'll be uncomfortable. (This can happen well before they're really in crisis.)

She's a beautiful animal and I'm sure you'll be able to do what's best for her.
posted by Lesser Shrew at 6:45 PM on August 6

My gf's dog was diagnosed with lymphoma in the spring of last year. My gf is very smart and she decided like you to give palliative care and not put him through chemo. We started him out with prednisone and tapered the dose.

He did not have identifiable masses, but his spleen was enlarged and the tubulations (sorry, I don't know the right medical term) in his lungs were thickened. He had a persistent cough that was just awful to hear. The prednisone eliminated that.

Today - a year and three months on - he is still taking prednisone. His appetite is much better than it ever had been before, and he is now treat-motivated whereas he had to be encouraged to eat for maybe four years before the cough started.

I hope you are as lucky as we were.
posted by jet_silver at 8:13 PM on August 6

Our dog was diagnosed with lymphoma in September. He died in mid-March. How I miss that dog ... I'd had him six years and I still believe he was more human than dog. He had T-cell lymphoma that was in either stage 2 or stage 3 when he was diagnosed. He hadn't been eating for about two weeks and had started to develop golf-ball sized lumps on his neck.

We made the tough choice to do chemotherapy. My parents and many of our friends completely disagreed ... they were worried about the excess cost and health risks to my wife (she was pregnant at the time.) We spent probably $4,100 from initial diagnosis cost to cremation when it was all over. I do not regret a penny of the money we spent on that dog. Those six months were wonderful. He had maybe 2 bad days in that entire period (plus nervousness every time he went to the vet for treatment, which was sometimes once a week and sometimes only once a month.) But he acted like his normal self until the last 36 hours, when his breathing became labored. He died en route to the vet's office for his euthanasia appointment.

Our vet told us that chemo for dogs with aggressive lymphoma gives them about a year, on average, to live. Perhaps since our dog died at the six month mark, your dog is destined to live a year and a half if you try it, I don't know. Not doing chemotherapy is completely understandable if you can't afford it. We went into debt for it, and I don't regret it, but not everyone can (or should) do that. I was really, really hoping for that 5 percent chance that he would go into complete remission, but it didn't happen.

I'm pretty sure if we'd done prednisone alone he wouldn't have lasted more than 5 weeks. Once the vet had been through 3 chemo protocols, we went back to prednisone. He died a week later.

If I were you, I'd do chemotherapy. It doesn't seem overly hard on the dog, and the quality of life is so close to optimum that you forget the dog is even doing treatment. It IS a bit rough on the human owners ... seeing your dog get pumped full of drugs, and the look the dog gives you when drop him off at the vet's office for 2 hours ... man, it's tough. But everyone at the vet loved Jack and were very, very kind to him. And after a week or two of chemo, it became a natural thing to give him the drugs, give him the steroids, etc. You just sort of fit it into your routine, like daily vitamins or milk with cereal.

Feel free to memail me if you'd like to talk about this more. I spent days and days sobbing when I first got his diagnosis, and then another day in tears when he finally died.
posted by Happydaz at 1:09 AM on August 7

You are doing the right thing. We had to put our 11 year old mini schnauzer to sleep earlier this year after not pursuing treatment for her liver cancer. We waited way too long, and it was heartbreaking to see her so frail and weak (we only waited that long because the vet assured as she wasn't in pain, and she hadn't lost the "light" in her eyes yet). I wish we had done it sooner, when she was still able to run around the yard to play fetch - albeit weakly, but still.

My advice to you? Make her as comfortable as possible. Let her sleep on the bed. Give her whatever kinds of treats she will eat. Most importantly spend time with her. Things will most likely go downhill very quickly, and at that point you will never be able to play your favorite game with her/run around the block/go for a walk with her again. Have a "heart to heart" with her before things get too bad. I had an hour long crying/hugging/explaining/apologizing session with my pup before things got bad, and it is one of my favorite memories of us together.

Bottom line? Take LOTS of pictures and spend time doing the things that you love to do together. When she is no longer able to do those things, it is time. In a terminal illness there is only one outcome, so why let them suffer in those last painful weeks? My only regret is that I didn't take very many pictures of her in her last 2 years of life.

Hug her often. Hold on to her tight, but know when it's time to let go.
posted by Gonestarfishing at 6:30 AM on August 7

Thank you for your thoughtful answers. Sorry for marking so many as best answer, but almost all provided me with some form of information or comfort that I found helpful. I feel very shmoopy, to steal from recent MetaTalk threads, about Metafilter right now. I am sure we are making the right decision, it's just helpful to be prepared for what's ahead.
posted by misskaz at 6:39 AM on August 7

I thought I should update with the sad news - we had our sweet pup put down this weekend. The pred helped a lot for a long time, but eventually the lumps in her neck came back and got really big. She had lost her enthusiasm for things and just seemed uncomfortable most of the time. I'm sure she could have held on for a few more weeks, but we wanted to avoid the possibility that the uncomfortableness would turn into pain. This way we could plan ahead with our amazing vet and make sure it was calm and peaceful. It's the hardest thing I ever had to do. Our hearts are broken.

Thank you all for your advice and kind words. It helped so much. She was a special girl.
posted by misskaz at 7:49 AM on September 29