Decision Time

After a weekend of soul searching (and a lot of crying in the shower) we came back Monday and had the opportunity to talk to all of “the teams”. It takes a village to keep an old Great Dane going and we are lucky enough to have a teaching hospital close by that we also use as our “regular” veterinarian.

I think that this is a great time to pause and talk a little about the term “teaching hospital.” Many times this brings up the wrong impression — that this is a hospital where people experiment or let unqualified people practice on your pet. It’s really not true and just the opposite. You have a team of people on each service (usually a board certified senior clinician, a resident and a 4th year veterinary student) that works with your pet. The resident has already graduated veterinary school and undergone at least one year of VERY intense specialty training and was now selected to pursue an additional 3 years of specialty training. No on experiments on your animal — however, if you are lucky you may have the OPTION to enroll your pet in ground breaking clinical trial research but it is YOUR option and you are ALWAYS fully informed and ALWAYS have the option to say no. And really, no one (student or resident) is allowed to do anything that they are not fully prepared to do and without intense supervision. The AMAZING side of teaching hospitals is that while the senior clinician may have many patients, and the resident has less but still many patients the students usually just have a few … this means that your pet gets so much extra attention.

The other benefit of a teaching hospital is that you get many specialists under one roof. So, Monday we met with the team. We met with oncology, soft tissue surgery, rehab, neurology, anesthesia, cardiology and orthopedics. Everyone got a chance to evaluate Grover, express any concerns that they had about going forward with an amputation. No one felt that he should NOT have an amputation, but everyone had concerns that there was a possibility it could go poorly based on his pre-existing issues.

Our amazing oncologist sat down with us and presented our options and spent so much time answering our 1 million questions while we continued to process the news.

(1) we could do nothing and stop. euthanasia is never a “wrong” answer and always an option to end pain and suffering.

(2) we could try palliative radiation. It could provide him with better pain control and on average gives animals 3-6 months. With this we wouldn’t have to worry about him not managing on 3 legs.

(3) we could amputate and go for chemo. Together, on average, this gives dogs 9-12 months. However, first the oncologist recommended a CT to take a closer look for thoracic metastases of the cancer. In a large dog like Grover, radiographs can be harder to interpret and she suggested that if the CT showed mets we may not have enough time left to make recovering from surgery worth it for him (given that we are expecting a harder and more challenging recovery).

To make things harder, I had to leave in just a couple days to go out of town for work. It couldn’t be re-scheduled … should we try to fit surgery in before the trip knowing I couldn’t be there right after surgery? Should we make him wait?

At the end of the day his CT still didn’t show any mets and we decided to do (2) doses of palliative radiation 12 hours apart to see if it made him more comfortable so that I could come back for his surgery. The great news … within 12 hours of the last dose of radiation Grover was back to being grover! He was off opioid pain medication, playing and comfortable on his leg!

A video of Grover back to playing with his favorite lamb chop (ok, lamb chop the 12th) IMG_0407

Author: jkopper

The lucky owner of Grover, a Great Dane, living with osteosarcoma. View all posts by jkopper