Caring for a Three Legged Dog or Cat
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So, in playing the "keep DH happy" and "stick to our resolution/plan of treatment" games, I got to wondering about mets and when/if they show up and how people know--obviously, for those of you doing chemo and stuff, you have regular bloodwork and other testing to see the "state of the state". So you're already looking, and you'll know when they pop up.
But for those of us NOT doing chemo, how do we know? How do we know that the extra panting is a side effect of steroids or heat or whatever, and not a sign of mets (or that it IS)? And, really, if the quality of life is still good...does it matter? When DO you go in to get things checked out? Where do you draw the line?
Do I go in to find out if the pain in his back/hips is no longer b/c of arthritis and trigger points, or b/c of spinal mets? Do I do that full set of films to see "what's lurking"? Even if the answer regardless is to continue palliative care?
I suppose this is really all rhetorical--I don't think there is any one right answer. I'm just thinking out loud...and probably looking for a kindred spirit who has gone through the thought process. It gets down to that tricky question about the slippery slope of "when do you say when when there is always more you COULD do"...
"Let us think the unthinkable, let us do the undoable, let us prepare to grapple with the ineffable itself, and see if we may not eff it after all."
-Douglas Adams, Dirk Gently's Holistic Detective Agency
"May I recommend serenity to you? A life that is burdened with expectations is a heavy life. Its fruit is sorrow and disappointment. Learn to be one with the joy of the moment."
-Douglas Adams, The Long Dark Tea-Time of the Soul
I don't know if this will be helpful or not as we did do chemo. Our oncologist said to look for the following as a sign of "change": lethargy, difficulty breathing, refusing to eat, vomiting and diarrhea. Personally, if it were lung mets, breathing would be labored. If it were anywhere else in the abdomen, I'm thinking stomach issues would point in that direction. Of course a blood test or xray would help rule such things out, but I don't know where I'd draw the line. Well, maybe I do. I see no problem with the xray, but if anyone were to suggest a CT or MRI, I would draw the line on that only because of the issue of sedation.
Sassy was doing chemo. We were scheduled to do our last chemo and have chest x-rays. She coughed once. I freaked out as that is a "sign". bawled my head off. Took 1/2 day off of work and took her in early 4 days for her chest x-rays. And she had lung mets. I notices she had gotten a little more tired but We are still going strong.
She is doing metronomic therapy. We started that March 8th. She was diagnosed March 1. Starting our 4th round of Metronomics. Many more to go hopefully. She is doing great
I have done more lung xrays up until this last Time on the 8th of June. I decided I wasn't going to do anymore. We know everything is status quo until she shows more symptoms. Which she hasn't coughed anymore other than the 1 time in March.
Sassy is a proud member of the Winter Warriors. Live long, & strong Winter Warriors.
sassysugarbear.tripawds.com
07/26/2006 - Sassy earned her wings 08/20/2013
05/04/2006 - Bosch, Sassy's pal, earned his wings 03/29/19 fought cancer for 4 months.
"You aren't doing it TO her, you are doing it FOR her. Give her a chance at life."
It's been a wild ride the last year - and now that we are getting to the pointy end of things I'm contemplating this stuff more and more ... so you are not alone!
Again - chemo dog here. So Peda had regular vet checkups etc, but we finished chemo etc and had clean bill of health in Dec 2012.
Decided that (for my own sanity), she would have 3 monthly checkup visits which was basically a good look over and blood test, with x-ray if any concerns.
At March 2013, one lung met found. We've not had any further testing at all.
We did the chest x-ray because about a week before her scheduled 3 month checkup she was out of sorts, flat and lethargic. Nothing to really hang your hat on. She had a bit of a cough (argh!) ... but it was the same 'hack' cough she has had on and off for years! So while i was freaked it was 'that cough', i tried really hard to think it was just a cough.
I've battled back and forth for months whether to have ongoing checking (since the lung met) ... 'is she a bit worse today .... has it spread ... is it the cancer ... is it arthritis etc ... is it that her mum overfed her yummy food and she stacked on 2kg! that is making her slow and wobbly' ...
I decided to basically keep a close eye on how she seems in herself .. is she bright and happy, or uncomfortable. Is she coughing or showing respiratory distress? Is she showing pain?
My understanding is that a 'cough' is not a good predicator of lung mets ... though there is 'that cough'! I would advocate being in tune with your dog and just take your lead from them as much as you can - if they are flat / lethargic (for no reason), off food etc, you may want a quick visit (if that goes on for 24 hours or so). I've also discovered that listening to chest sounds is not predicative of a good clean chest! X-rays are only good for beasties over 5mm (or so) ... so a 'clean x-ray' may not actually be such.
So I think a useful perspective for me has been to work out what I will do if ....x, y, z happens?? Do my actions change depending on what is found? It's helped to calm my stress levels a little ... in as much as 'does it matter what the xrays show'? While she is still bright and happy and active, I'm taking my lead from her. (I also have a fear I will let her go too long - but her vets keep reassuring me that they don't think I will let that happen ... that I'm pretty switched in to where she is at and how she is doing). I decided that putting her through lots of testing wasn't useful at this stage - but i think that depends on the symptoms and what is going on.
Kirsty and Peda
Hey Megan,
As you may know, I didn't do chemo.
When it comes to mets, I don't believe that how they present themselves really has anything to do with chemo treatments or without. There is a general presentation that happens, but sometimes things are completely different, depending on the dog.
When I was diagnosed with mets at 17 months out, my people took an x-ray. They needed to know what was going on. They saw the size of the mets, got me on metronomics and they went back in a month or two to see how the chemo was affecting the tumors. The tumors stabilized and we went on with life.
About six months later, I was growing more tired, and my people thought they heard "the cough." So we went for an x-ray, and saw the mets had grown, and one was interfering with my lung passages. With that information, they were able to make a decision to either continue treatment or not. So they threw out the drugs and we lived life by the seat of our pants. No more x-rays. Since we knew sort of what to expect, (coughing, slowing down, panting), they figured we would go with the flow and take each day as it came. And that's just what we did.
Yes, the steroids had side effects like panting, excessive thirst, and my quality of life was suffering. So we stopped that, and again, went day by day. The progression of my mets was textbook, and typically that's how it goes for a lot of dogs. Unfortunately, there is no crystal ball that says "this will happen like this and that will happen like that." If you decide on no more x-rays, that's when you go with your gut instinct. After 13 years together, I know yours will serve you well with Samdog.
Hope this helps.
{{{hugs}}}}
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Thanks jerry/rene 
The only reason I break it into chemo people/non chemo people is b/c since the chemo folks are already having regular checkups to look for things like that, they're...already having checkups to look for things like that. Whereas, those of us treating palliatively, sort of have to decide at what point do we go in for tests, and are those tests warranted, when it may or may not change the outcome.
And really, I'm not concerned right now with Sam...well, I AM, but not any more or less so than usual. Just in general, the whole idea of when to do and what to do and how to do everything, and the wondering about the increasing numbers of treatment options (and the sophistication/lengths of treatments) and how that has affected people's ideas of "what the norm is" in treatment, etc. has been on my mind lately (more than normal :p).
My sister-in-law and her husband just put their 1 year old lab down b/c of a liver shunt, and leading up to that moment (and following it) there were a number of discussions about what's too much or not enough, and when to go on diagnostic fishing expeditions, and what things are "worth", etc. It has become a sort of thinking exercise, I guess.
For me, it is hard, b/c I have this need to KNOW--even when knowing The Answers tells us nothing. I have to restrain myself, sometimes, because I WILL go on fishing expeditions b/c having some definitive answer somehow makes me feel better. I am an inveterate collector of knowledge, of all stripes...no data is wasted data.
So even if the endpoint is the same, regardless of the cause, I feel like I need that information. DH, OTOH, feels that the endpoint is the endpoint, and if that information in the middle doesn't change things...it's not worth the price of acquisition.
Huh. I am all about the rambling here. Please excuse it! I'm finding it very difficult to be articulate today...especially b/c I think I've got like three different ideas going on, and even though they are related, they aren't the same. :p
For one: I am interested in how the general public's opinion of "what is normal" or "what is acceptable" or "when enough is enough" is changing in response to the changes in the vet med and holistic vet med industry.
For two: I am struggling with my need for answers to questions that may or may not even need asking...and trying to make sure in my quest for balance, I DO ask the questions that DO need asking/answers.
For three: Commiseration. 
It all comes down to that :p Every so often, you just need to ramble on in front of people who have all had that need themselves to ramble on, and then let them say "Yup. totally been there." 
"Let us think the unthinkable, let us do the undoable, let us prepare to grapple with the ineffable itself, and see if we may not eff it after all."
-Douglas Adams, Dirk Gently's Holistic Detective Agency
"May I recommend serenity to you? A life that is burdened with expectations is a heavy life. Its fruit is sorrow and disappointment. Learn to be one with the joy of the moment."
-Douglas Adams, The Long Dark Tea-Time of the Soul
This was a really timely post for me. We are two weeks post-amp and have been stuck with two different pathologists reading Dotty's tumour differently. One pathologist says fibroblastic osteosarcoma (boo!) and the other says fibrosarcoma (yay!). Tissue staining is still being done and we are still in limbo as to what treatment, if any, we need to consider. We are not sure whether we are ok with chemo, but if she DOES have osteo I'm tempted to try it and see if she handles it and take it from there.
So we live with the possibility that Dot has osteosarcoma and we also are looking at each other everytime she makes a noise in her sleep or whistles a bit when she's breathing, all things she used to do from time to time but which now have a sinister meaning. She had lung xrays before we did the amp surgery and her chest is clear to listen to...but it doesn't mean there aren't mets on the go in there.
Thanks for articulating all the philosophical questions about treatment of companion pets, when is it "too much"? Am I not doing "enough"? I find myself vacillating wildly when I'm talking to people about it, I must seem very woolly.
Hopefully, some definition on the diagnosis front will emerge and I can revisit all these ideas with a clear course of action.
In the meantime, thanks for thinking out loud, it echoes what I've been trying to avoid thinking about, but really needed to!
Best of luck with your pup, paws crossed!
Victoria and Dotty
Here is the way I have been looking at these decisions- will the test results lead you to change what you are doing? I'm not sure if this is the right way to do it, but it has worked for me. But what I do first is decide what I am willing to do test wise or surgery wise, invasive or non-invasive. Now I'm having a bit of trouble articulating... I've been in a mind numbing, all day class at work 
.
So lets try examples. This is one where I did a test I regretted doing. When Maggie turned 10, having survived way longer than predicted, I decided that there would be no more invasive tests or surgeries or for her. She was having some other health issues, and she was not a good patient AT ALL! Besides, I almost lost her twice when she did not come out of anesthetic as expected. Her check up routine for mast cell cancer had included ultra sound of the abdomen as that cancer tends to met to liver an spleen. So although I wasn't going to do anything invasive I went ahead and did an US. Wouldn't you know it, after 3 years of testing this one came back with suspicious lesions on her liver! The vet suggested a biopsy as the next thing, and to get a better idea of what it was. I stuck with my decision not to do invasive stuff, so all the US gave me was a reason to worry.
When oral melanoma was suspected I allowed a biopsy that confirmed because if it was some other type of mass I MIGHT have had it removed. But once melanoma was confirmed I declined all further tests. The vet suggest a CT scan (I think that was it)- but the only real benefit was to see how far the tumor had infiltrated and get a better prognosis. By now there was kidney failure and the suspicious liver US, and I knew there was nothing more I could do. I didn't want a prognosis. I knew how thing would end, but I didn't want the added burden of a ticking clock.
I hope some of that makes sense- I have used this with my quad pug Tani as well. She is almost 13 and has lots of health issues. So we are treating non-invasively what we can and not worrying about the rest. As long as she is happy, engaged, eating and sleeping through the night then I am happy not knowing all the gory details.
Karen
Thought provoking question!
I think you need to go with your gut.... the level of testing etc that feels right for you.
I always wanted to know everything. I was talked out of getting xrays of Magnum's leg/hip by the oncologist when she began having problems just before the mets in the lungs were found. I was told it wouldn't change the treatment protocol. So I didn't. But I wish I had done it. Then I would have known for sure and while that may not have mattered as much to some people it mattered to me. We didn't get xrays until her last day in the vain hope that her symptoms might be due to something other than the cancer. They weren't.
So, if ever there was a next time (God I hope not) I would still want to know everything because that's what I need. it gives me a sense of control. Knowledge is power and all that stuff.
Even if the news is bad I am more able to "live in the moment" knowing what is going on than if I didn't know. Otherwise I'd constantly be going "what if..." But for others, they may find it easier to live in the moment without all those tests clouding everything. At the end of the day "living in the moment" and giving our dogs quality life is what counts.
Karen
Magnum: 30th May 2002 to 5th May 2012. Lost her back left leg to osteosarcoma on 5th Sep 2011. Lung mets found on 20th Mar 2012 but it was bone mets in the hip that ended her brave battle. Magnum's motto - "Dream as if you'll live for ever, live as if you'll die today" (James Dean). Loyal, loving, courageous and spirited to the end. My beloved heart dog, see her memoirs from Rainbow Bridge ...... http://princess.....pawds.com/
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