“I’m sorry, but your dog has lymphoma. We need to talk treatment options.”
It’s the news no pet owner wants to hear. Your heart suddenly drops, and you experience a flashback to all the memories you’ve accumulated with your pup over the years. You can’t believe those memories might be coming to a close. I know the feeling – I’ve been there twice.
According to The National Canine Cancer Foundation, canine lymphomas are one of the most common malignancies diagnosed in dogs, and there is no cure. And while treatment options are available, including chemotherapy, even the longest estimated lifespan post-diagnosis is only about two years. If you choose not to treat the cancer with an expensive and potent drug therapy, you’re looking at an average lifespan of just four to eight weeks.
Making the Right Decision
There’s really no perfect, best, or “right” solution for pet owners. The decision to treat or not to treat is highly individualized, and is best made based on factors such as pet age, pet health, family budget, and long-term quality of life for everyone involved. While it’s important to discuss options with your vet, you shouldn’t feel pressured into making one decision or another.
Our family’s most recent battle with canine lymphoma came to a close when we made the heart-wrenching decision to put one of our dogs down. It came just seven weeks after his diagnosis, and just 10 days after starting him on the cancer-masking steroid drug, prednisone. In the words of my vet when we brought him in to put him down, “He’s only been on prednisone 10 days? I’m so glad you didn’t try chemo. His poor reception of prednisone indicates that chemo wouldn’t have worked and we would be in the same position we are now, but you would’ve spent a lot more money.”
Her words were helpful. Scooby was almost 11 when he was diagnosed. He was happy and healthy, but no longer a young dog. The thought of putting him through weekly chemo treatments that could impact his quality of life didn’t make sense to us, and yet, there was lingering guilt over not trying to do more. Hearing confirmation that our decision was correct helped ease the hurt of saying goodbye.
But how can you possibly know what the “right” decision is without having a crystal ball to see the future? The short answer is, you can’t – but having been through the pain of canine lymphoma twice, I can tell you the second time was easier. We made better decisions because we swore we wouldn’t make the same mistakes the second time through. We were able to separate our pain from our dog’s pain, and walk as gracefully as possible through his last lingering weeks, giving him what he needed, rather than what we wanted. My goal is to help you do the same.
Know What You’re Dealing With
Both of our dogs who died of lymphoma were diagnosed with the most common type: multicentric lymphoma, or lymphoma that starts in the lymph nodes, then spreads to lymph tissue throughout the body, eventually resulting in organ failure, usually of the kidneys and liver.
Other forms of lymphoma include:
- Mediastinal: Lymphoma that develops in the lymph tissue of the chest and can restrict lung function
- Gastrointestinal: Lymphoma that affects the gastrointestinal tract and, depending on location of the tumor, can restrict the passage of bowel movements, resulting in health hazards
- Cutaneous: Cutaneous lymphoma affects the lymph tissue of the skin and can appear in the form of reddened, sometimes uncomfortable lumps on the skin
- Extranodal: The rarest form of lymphoma, extranodal lymphoma can affect practically any lymph tissue – liver, skin, breast, eye, bone, or even the mouth
If you suspect lymphoma, either before taking your dog to the vet or while waiting for biopsy results, it’s a good idea to spend some time researching the disease. While I wouldn’t spend hours pouring over canine cancer forums or websites (I’ve been there – it’s depressing), it’s important to fully grasp the effects of the disease, understand what you’re up against, and start assessing the cost of treatment.
What to Ask Your Vet
Based on your research, compile a list of questions for your vet. If you receive a diagnosis, it’s important to know the following:
- What type and stage of cancer your pet has
- What the different treatment options are
- What the prognosis for each option is
- What the costs of each treatment are
- How your vet thinks your pet might respond to treatment
- What side effects each treatment might have
- How to weigh the costs and benefits of treatment vs. a treatment’s real or potential side effects
By doing a little research in advance, you’ll be better prepared to ask the right questions and face the tough decisions with the right knowledge.
Maintaining Communication With Your Vet
Years ago, after our first dog was diagnosed with lymphoma, I pretty much cut off contact with our vet. This was stupid, and I’m not even sure why I did it. I was devastated, and I knew we couldn’t afford the cost of chemo. And after doing some research, I didn’t think we wanted to use prednisone either. But instead of leaning on my vet, asking questions, and using his knowledge to help guide our decisions post-diagnosis, I simply took my dog home and did whatever I knew how to do on my own.
She lived nine weeks post-diagnosis, and the vast majority of those weeks were “good” weeks. But having been through it a second time, and knowing how bad the disease gets in the end, I wish I’d kept the lines of communication with my vet open so that I could have asked more questions as the end approached. There are definitely things I would have done differently.
Talking to your vet is hard. It’s emotional. Depending on your feelings toward your pets (mine are like kids), you might want to cry, and it may be uncomfortable to talk about. Do it anyway.
Asking the Uncomfortable Questions
With our second dog, I asked questions – lots of questions. Since we’d lived through the experience once, my husband and I told our vet from the get-go that we were open to prednisone, but didn’t want to pursue chemo. Our vet told us she didn’t pursue chemo with her dog, either – that alone was helpful to hear.
She also explained how prednisone was an option, but it was best to wait to start treatment because it inevitably stops working, and when it does, the cancer comes back faster and harder than ever. She explained how her own dog was prednisone-intolerant, becoming completely incontinent after a single pill, to warn us of the possibility.
During our first visit, I also asked about the clinic’s policy on bringing dogs in to be put down – did we need to set an appointment? Could we be with him when he passed? What should we do if the time to say goodbye happens on a weekend? I hated thinking about his death, but it was important to know the answers.
After the first visit, I kept in regular touch with my vet by phone. As the time to start prednisone approached, I called to request the prescription and to ask for confirmation of the signs and symptoms I was seeing to make sure it was a good time to start. And when it became clear that Scooby’s last day had arrived, I knew the clinic’s policy, and was able to call and notify them that we were on our way in.
A good vet will respect your decisions regarding the treatment you choose, and will help you take well-informed steps throughout the process. Vets treat dogs with cancer all the time – they see the good, the bad, and the ugly, so keeping them in the loop can do wonders for your own peace of mind.
In summary, you should be prepared to ask the following questions:
- If I choose not to elect chemotherapy for my dog, should I use prednisone? If so, when should I start using it? What are the symptoms I should look for to start administering the steroid?
- How do I know if my dog is prednisone-intolerant? What should I do if I find out he or she is?
- Are their other pain medications or drugs I can keep on hand to administer as needed?
- What’s your policy on putting down pets – do I have to make an appointment, or can I just come in?
- Do you allow pet owners to be with their pets when they’re euthanized? How do I know if that’s the right choice for me?
- What should I do if my pet gets very sick at night or on the weekend and needs to be put down?
- I have other pets in the home – is there anything I can do to help them understand the illness and death of their “sibling”?
- How can I make this time as pleasant for my pet as possible? (For instance, my vet suggested undertaking “cheeseburger chemo” – taking both my dogs through the drive-thru once per week to enjoy a cheeseburger. They loved it.)
Treatment protocols vary based on the type and stage of cancer your dog is diagnosed with.
Generally speaking, the most effective treatment for canine lymphoma is chemotherapy, which involves the application of a combination of drugs given to dogs over several weeks or months. For instance, at Purdue’s College of Veterinary Medicine, a 25-week treatment of a drug protocol called UW-25 is considered to be the “gold standard” for multicentric lymphoma. The full six-month treatment – which includes weekly chemotherapy sessions for two months, followed by sessions every other week for the final four months – costs between $5,000 and $7,000, depending on the size of the dog. And while 80% to 90% of dogs go into temporary remission following treatment, the median lifespan of these dogs is still only 9 to 13 months post-diagnosis.
But some dogs do, in fact, live mostly happy, healthy lives post-chemo for several years. It’s hard to predict which dogs will experience the benefit of such an extended lifespan, but a veterinary oncologist should be able to help you gauge how your dog will respond to treatment based on age, other health problems, and the type and stage of cancer.
2. Surgery and Radiation
In some cases – particularly for cutaneous lymphoma where tumors appear on the skin, or early-stage, focal gastrointestinal lymphoma that hasn’t spread to surrounding tissue – surgery or radiation may be an appropriate option. As with all surgeries, costs vary significantly depending on the type of surgery necessary, but you can expect to spend several hundred to several thousand dollars.
3. No Treatment, or Prednisone-Only Treatment
Finally, if you choose not to pursue treatment, costs are minimal, but so are life expectancies. Regardless of the type of lymphoma your dog has, a typical lifespan is only four to eight weeks. While there are exceptions to the rule, they’re few and far between.
You may have the option to treat symptoms as they arise, and to temporarily mask symptoms with the use of prednisone. A month’s supply of prednisone cost us less than $30, and with our first dog, we used prescribed pain medication to help ease symptoms. Again, the cost was less than $50.
Prioritizing Your Dog’s Needs
I can’t emphasize enough that there is no right or wrong treatment, although there may be right or wrong reasons to pursue a particular treatment. For instance, if your dog is already in his or her twilight years, with multiple physical ailments, an intense fear of the vet’s office, and a late stage cancer with a poor prognosis, what sense would it make to put your pet through weekly chemo treatments at the vet’s office in the hopes that you’ll get a few more months with him or her? Of course you love and will desperately miss your dog when death comes – but if you make a treatment decision solely for your own emotional benefit, and don’t consider the affect the treatment has on your pet’s quality of life, then you’re making it for the wrong reasons.
It’s not always easy to prioritize your dog’s needs, but it’s crucial to always ask these questions:
- What’s my dog’s quality of life today?
- Is my dog happy and able to enjoy the things he or she has always loved?
- Am I forcing my dog to undergo something unpleasant that detrimentally affects his or her quality of life so I won’t have to face this loss?
- Is there a good chance today’s “bad moments” will pass and tomorrow will be a better day, or is it just going to get worse from here? (Remember: Your pet is sick, and it’s normal to have a bad day followed by a better day – but you don’t want your pet to suffer through days of pain with no chance of improvement.)
Deciding When to Say Goodbye
This is the absolute hardest decision to make – when, or whether, to put your dog down. And I have to admit, we got it wrong the first time.
When our first dog was diagnosed, we wanted her to be able to die at home so that our other dogs might be able to better understand her death. Growing up, I’d had several dogs die at home, and it was a relatively peaceful affair. I thought we could do the same thing with Billie.
I couldn’t have been more wrong. Multicentric lymphoma leads to organ failure, which leads to a long, slow, and painful death. The last week of Billie’s life we knew she was dying – she knew she was dying – and we assumed it would happen quickly.
But every day she continued to live in ever-increasing discomfort and pain. She wasn’t moving much, wasn’t eating or drinking, and wasn’t going to the bathroom. Our desire for her to die at home with our other dogs prevented us from seeing that our decision was wrong for her. We did finally clue in and take her in to be put down, but we waited far too long, allowing her to suffer for days, rather than allowing her to die in relative peace. Our choice regarding her death is one of the only things in my life that I absolutely regret.
Signs Your Dog Is Suffering:
- He or she no longer eats or drinks
- His or her breathing is labored – he or she is panting constantly
- He or she becomes incontinent, or stops going to the bathroom altogether
- He or she no longer wants to move around or interact
- He or she is having trouble resting or relaxing
- His or her eyes appear glassy or pained
With Scooby, we swore we wouldn’t make the same mistake. We decided early on that we would watch closely and let him “tell us” when he was ready. He lived for seven weeks post-diagnosis, and every single day, save for the day we took him to the vet’s to be put down, was a “good day” (in cancer terms, at least). He kept eating, drinking, walking, and breathing in relative peace. He slowed down significantly, and he started experiencing some trouble breathing, but he was happy – you could see it in his eyes.
The day before we put him down, he actually snuck away from our house and chased a herd of deer through our neighbor’s property. Then later that night, he wanted to go on a walk with our other dog. We took him. He had a good last day.
But that night, when we arrived home from the walk, he stopped drinking, and stopped wanting to move around. For the first time, I had to carry him downstairs to go to the bathroom, then carry him back upstairs to go to bed (he was a 70-pound dog – this was no small task).
I slept on the floor next to his blanket that night because I knew he couldn’t relax. At some point I woke up and felt his lymph nodes, and I realized they had quadrupled in size in a matter of hours – they were ringing his neck, affecting his breathing, and preventing him from sleeping. I looked in his eyes and knew he was hurting. It was time.
At four in the morning I emailed the vet’s office to notify them we’d be bringing him in as soon as they opened. The next morning I carried him downstairs, then let him lie in the grass outside the house just to enjoy the sunshine. Then we took him in. I’m incredibly sad I didn’t get more time with my dog, but I will never regret making the choice to put him down when we did. He didn’t have to suffer.
As with treatment, making the decision to put your dog down is highly personal, and you may not always get it exactly right. But I would caution you this: Try to make the decision based on your dog’s needs, rather than your own.
We are now the owners of one dog – a small pack compared to our once-boisterous pack of three. We will adopt another dog someday – perhaps someday soon – but I’d be lying if I said I wasn’t fearful that we could face lymphoma again. It’s a terrible disease that affects far too many pets.
What I have learned through the process, is that death, while always heart-wrenching, can be entered into gracefully. This is true of humans and animals, but it takes a willingness to ask questions, face reality head-on, and make selfless decisions to do it well.
Have you lost a pet to lymphoma? Do you have any additional tips to deal with it and the decisions that must be made?