A common anxiety among most owners of pets with cancer is a fear of not knowing when their pet is in pain or is suffering as a result of their disease, and the ensuing concern about keeping their pet alive for their own benefit.
Veterinarians use objective parameters for determining if an animal is painful, such as looking for an increased heart rate and/or respiratory rate, noting vocalizations or the presence of dilated pupils, etc. However, these are relatively “obvious” signs even non-medically trained individuals would likely be able to recognize.
What about more subtle signs of pain? How can we tell if a pet is nauseous? Can we detect achiness or fatigue? How do we know when these signs impact a pet’s life so greatly, the solution to end the suffering is the fairest option?
You may be surprised to learn I often have no black and white answer to those important questions. I see how this frustrates owners, especially when one of their main goals in talking with me is to find out the statistics of what their pet’s expected survival time would be with or without treatment or how will they know when it’s time?
It’s nearly impossible for me to predict how long a pet will live based on tumor type. I can usually describe what the end stages of disease may look like, but it’s impossible for me to know when those will be so impacting to an owner that they would decide to humanely euthanize their pet. I can only tell them things to look for that will potentially affect quality of life, I can’t make the decision for them.
A few examples may be the best way to clarify my point.
Dogs and cats with tumors of their urinary bladder and/or urethra will often show signs of straining to urinate, passing only small amounts of urine, and increased frequency of urination. They may even show signs of incontinence as the pressure in the bladder builds up against the obstruction of the tumor.
Typically the pets are completely normal in every other way: they eat, drink, play, sleep, and cuddle just as they always did, but there are clear signs of discomfort observed when they try and eliminate. When I see dogs and cats show such signs, I do not hesitate to tell owners I feel their pets are in pain. Even so, I’ve seen pets with such tumors live more than six months with their signs. Is that fair for that pet? Would it be better to euthanize them before these signs show up or is that equally unfair because they seem so happy at all other times?
Pets with lymphoma, a common cancer of a white blood cell called a lymphocyte, will often show signs of lethargy, nausea, vomiting and diarrhea, and weight loss as their disease worsens. Signs are progressive and may persist for weeks or more before an animal might pass away naturally, but is this fair for an animal to endure? Do I believe these animals are painful?
Basing my information on what we know about humans with lymphoma, the discomfort associated with the disease is not acute and sharp, as would be expected from a wound or a fracture. But does this mean it’s acceptable to watch pets not feel well before making the decision to end their lives? What, if any, degree of nausea, lethargy, or weight loss is acceptable?
The most difficult cases to manage are pets with tumors within a bone or multiple bones. Pets will show outward signs of pain by limping or not bearing any weight on the affected limb, but often still appear happy, active, and well.
Logically, we know such pets are painful. If they weren’t, they would be using the limb normally. Despite having several options for treating bone pain, I don’t believe we really do an adequate job of keeping the pet comfortable and I do discuss euthanasia as an option for pets at the time of diagnosis. Since many of these animals aren’t typically showing other outward signs of sickness, owners can have a hard time rationalizing this.
I always say, “What one owner will tolerate, another will not,” and there is no way I can predict how long any of those pets with the aforementioned tumor types will survive because it ultimately will be the owner’s decision as to how long they will be able to live with their pet showing clinical signs.
A major part of my job is to be the strongest advocate for my patient and to let owners know when I think we are out of options and when their pet is suffering from their disease. It’s not a particularly enjoyable part of my job, but it’s a responsibility I’ve taken on. Likewise, owners also have a huge responsibility for making sure their pets are well taken care of, and also to know how to relieve suffering when it’s “time.”
How would you know when enough is enough? In my experience, those who fear answering this question are the most prepared because they are so cognizant of their pet’s needs and well-being.
They often simply tell me they “just knew it was time.”
Dr. Joanne Intile