Even when you first bring your new puppy or kitten home (the blonde baby in the photo above is Hannah when she was a puppy) and their bright little face is making you melt, you know intuitively that this relationship will be shorter than you might like. It’s not fun to think about, but it’s a part of pet ownership that is difficult to ignore. Perhaps as a veterinarian I'm more aware of this than most, but as I work with my clients and help advise them through every stage of their pet’s life, I am always mindful of just how short and special our time with our animals can be. A very important part of my job is being able to guide my clients and their pets through the final stages of a pet’s life. In this case, though, the client is my wife and I.
Just before the Thanksgiving holiday, I discovered a new health problem with my own dog, Hannah, that is likely to put an end to our time with her sometime in the next 6-12 months. At the time, she was experiencing periodic vomiting and lethargy outside of the range of what I would call normal for her. Her blood chemistries, complete blood count, and pancreatitis tests were all normal, so we decided to take xrays to see if we could determine the cause of her vomiting. This was when I discovered a new mass in her lungs. The mass had nothing to do with her vomiting and gastroenteritis, but it was a very sad development as we fit this new finding into the bigger picture of her medical history.
From a young age, Hannah has not been a stranger to health related problems. From bad knees to allergies and more, she's had quite the life. Until recently though, her medical issues were always the type that could be managed with medical treatment. From knee surgery and pain management medication to daily allergy medication, we managed each medical issue as it came up. About two years ago, though, I surgically removed her right anal gland and it was found to have a cancer called anal gland adenocarcinoma. This is a very aggressive cancer that can easily migrate to other organ systems. It can also be locally aggressive in the site where it was removed, meaning that there was a risk that the mass I removed could easily return. At that point in this cancer's progression, average survival time with chemo was likely to be about two years. In my experience though, anal gland carcinomas did not have a very good track record with or without chemo. Because of this, and because there was a strong chance that undergoing chemotherapy could damage her quality of life in whatever time she had left with us, we opted not to proceed with chemo in Hannah's case. My wife and I both accepted our decision not to intervene and life went on. Hannah’s quality of life has been excellent over the last two years since her mass removal, so we had all but forgotten all about the anal gland carcinoma diagnosis until this Thanksgiving, when chest xrays showed the new golf ball sized lesion in her lung.
Because this lesion did not appear on the xrays that we took five months ago to evaluate the progression of the osteoarthritis in Hannah's spine and hips, we know that this mass is especially bad news. With the speed of the development of this cancerous lesion, I know that we are likely inside a 6-12 month survival time window for Hannah. When I came home and told my wife Patti the news, she was equally devastated, as Hannah has been one of the best dogs imaginable. She is sweet, gentle and has the most charming facial and ear expressions that let you know exactly how she is feeling at all times. Greeting clients with an ever-whirling tail wag has been her specialty at Commonwealth Veterinary Hospital for the past 11.5 years. After talking through everything, my wife and I were settled in our decisions from 2 years ago and had no regrets at all about our choice not to do chemo for her. We are also comfortable in our decision moving forward to make Hannah's life as pain free and enjoyable as possible.
This is not to say that any of this is easy, though. We both have had to find a way forward in not being sad every time we look at her, but instead enjoying every minute we have left with her. That was admittedly hard to do for the first few days after discovering her new metastatic lung tumor, but as time passes, we are finding ways to be more normal again. Hannah also has a degenerative spinal condition, severe osteoarthritis in her hips and spine, and partial laryngeal paralysis related to the degenerative spinal condition. I tell everyone this because making decisions for our older pets is often complicated. They rarely have just one problem. I have known for some time that either one of these problems, with or without her new lung tumor, could shorten Hannah’s life expectancy.
Dealing with this process, both emotionally and rationally, will be the groundwork for this ongoing blog series. I share these moments with all of you in the hopes that Hannah’s story will help some of you as your own pets begin to age, gracefully or not. I call this Hannah’s Hospice because of our decision to not to proceed with treatment for this aggressive cancer, but instead to do everything possible to keep Hannah comfortable, with an eye always on her quality of life.
Talk to everyone again real soon.
Dr. Hawk