We were having this "discussion" on the day after Tasha, a beautiful, sweet Golden Retriever had been in to see me. She had some ominous swellings under her throat, in front of her shoulders, in her axilla (arm pits) and inguinal region (groin.) These are all areas you will find a dog's lymph nodes, and even though enlargement can occur because of infections, I felt this wasn't the case for Tasha. We took aspirates of those swellings, put the material on slides and submitted them to the lab for a diagnosis. Sometimes needle aspirates are non-diagnostic or only suggestive of certain conditions or diseases. This wasn't the case for Tasha-the diagnosis was definitive-she had lymphoma.
Lymphoma is a cancer of the lymphatic system, the nodes and vessels in our bodies through which foreign material or organisms get "filtered" or dealt with by the cells of the immune system. There are actually a number of different ways this can occur. Some cells produce antibodies, others phagocytose or literally "eat" the foreign material or organisms. Some "turn on" other cells, regulating their activity to help destroy those invaders.
Lymphocytes are the main cells of the lymphatic system and they act in all of those ways mentioned. The lymph vessels serve as a circulatory path for lymphocytes as well as being a collection system directing foreign substances toward the lymph nodes where the processes occur. Lymph vessels connect with the blood stream at several points allowing lymphocytes access to virtually the entire body.
Many people who "always wanted to be a veterinarian" mention their love of animals, their goodness, how wonderful it must be to work with them, etc. But most forget the very real "human factor" of veterinary medicine. Who is actually bringing that pet in to the veterinarian to begin with? Who is responsible for describing the illness or symptoms-certainly a good physical exam reveals a lot, but really knowing a pet's personality and how his or her behavior is changed is essential to coming to a complete diagnosis. And of course, who will be administering any needed medications? Loving animals isn't enough to work in the veterinary field, really in any capacity. Humans are a pretty important component.
The human-animal bond is a wonderful thing-we see examples of it every day. An older man with his cat-talking with him I found out she was actually his recently deceased wife's cat, and this kitty is his link to her. A bouncy, happy Cocker Spaniel puppy-in a household full of kids because of a daycare situation. A Border Collie who's job it is to alert her owners to oncoming seizures so she can get herself into a safe place/position. You remember Mikey and his owner-she is working very hard to afford his treatment for cancer. The list goes on and on...and on! It is awesome to see the varied ways the bond is manifested-we love humans who love animals!
So it goes that when I make a terrible diagnosis like lymphoma, it really isn't just Tasha that gets that diagnosis. It is the entire family's diagnosis. Of course they all were devestated. I found a couple of booklets that I hope will help Tasha's children in the family hear the news of her cancer and how to cope with her impending death. The books might allow them to put together mementos, photos, poems or other writings about her. I gave her adult humans information on lymphoma itself, how it could be treated, referral options to veterinary oncologists, chemotherapy, the works. The whole family will have to be involved in the decisions that will have to be made, what kind of treatments to select, how much money can they afford to spend, when is it time to say "enough" and just how will we go about saying that final goodbye? Will each person want to be with her at the end or prefer to say goodbye and remember her that way? Should we arrange a home visit for the euthanasia when the time comes, or will that leave unpleasant memories associated with the home? Everyone is different in how they feel about those things. We gave Tasha's family a brochure about "how to know when it is time"-a question everyone struggles with. This is so very hard!
I am lucky to have this blog to write about the emotions that sure do seem to be overwhelming at times. And friends and family as I mentioned who "get it." They know I'm not the kind of person who can work 9 - 5 and turn off my emotions when I step out of the hospital. I'll be thinking about, researching for, worrying about and praying for those pets and families who love them long after the designated appointment time. But I try not to dwell on my cases-I have a lot of "extra-curricular" activities, and my own critters certainly help! My entire family comes together for me-just like Tasha's will for her.
Peace,
DrReneigh
2 comments:
That is such a touching story and quite strange I might say that you were presented with almost the same case I was presented with today (albeit in a slightly different situation). I am in my third year of veterinary school and am on my first clerkship with patient/client care responsibility in the oncology service. All things being equal this was my second real case since coming to veterinary school and I don't expect to forget it. My patient was an 11 year old male golden retriever who was so friendly. His owners were very kind and so obviously cared about him in the utmost. After performing my PE and speaking with the clients I went over the case with the oncology resident. We returned to the consultation room and the resident went over the possibilities of what we thought may be going on and all of the options for proceeding given our suspected diagnosis of lymphoma. Unfortunately the clients were not able to afford much in the way of treatment and staging for the dog's disease so we elected palliative care with L-aspar, Leukeran, and prednisone. This economic crisis has hit many people in my area of the country very hard, and i could see the regret, guilt, and pain in the client's eyes when the prices for more advanced treatment for their beloved pet's condition was discussed. Certainly something I will never forget. But I also will remember how greatful the client's were to us and happy that we were able to provide them with some medications that will at least make the dog feel a little better, and that we were able to give them an answer within their means as to what was wrong with their dog. I certainly feel fortunate to be entering a profession that cares for people and their families (including the furry members), and works to be innovative in helping people help their pets even if they are not capable of affording the mercedes benz of therapy.
You're absolutely right. As a member of a multi-dog household, when one of our members leaves us, we're all affected, even the other canines. Last year we lost two of our dogs and we humans are still grieving for them. The other dogs were unusually quiet for several days, looking for their friends. They all seem to have adjusted well.
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