Second Opinions Canine Cancer

SHOULD YOU GET A SECOND OPINION?

What to do when a pet is ill... it's a no-brainer! Still, every caretaker has experienced that moment of indecision and self doubt, when it's unclear exactly how serious the problem is or exactly how ill a pet is feeling. Sometimes, deciding when to make the call or whether or not to visit the emergency clinic involves a great deal of deliberation and anxiety. We don't want to act too soon and earn the reputation of an alarmist (Maybe it’s nothing or it will pass by morning). On the other hand, there may be danger in putting that visit off (Maybe this is serious and I’ll do my pet harm if I wait until tomorrow).

Err on the side of caution! At worst, you’ll be called an alarmist; at best, you’ll save your pet’s life. If you're unsure, call ahead and describe to your vet or to an emergency clinic vet the clinical signs (symptoms) that you see. Ask them to help you decide whether or not your pet should be examined on an emergency basis and if not, find out what steps you might take to resolve the problem at home.

When a pet’s survival is in the balance and something must be done immediately, we obviously cannot take the time to get a second opinion. But when cancer is suspected, there is generally time to get a second opinion and to explore options. Diagnostic tests…Will they be traumatic for my pet? Does the test require anesthesia? Will it be expensive? If the tests show that my pet does have cancer, then what? This last one is the toughest question and there is rarely only one correct answer. Take a few days (not weeks!) to consult specialists, research the disease and make a decision.

When a diagnosis of cancer is given, your vet may make a recommendation of euthanasia at the time of diagnosis, or deliver a very poor prognosis. Choosing euthanasia or not to treat cancer are both choices with far reaching consequences. A second opinion would be invaluable before making such irrevokable decisions. Euthanasia is a difficult and unnecessary choice to make when a pet is still having good quality of life. Dr. Alice Villalobos of Hermosa Beach CA has developed a progressive program for "Pawspice" as an alternative to early euthanasia, allowing pets the opportunity to pass peacefully at home while ensuring their comfort and freedom from pain.

Because oncology is a very new field within veterinary medicine, there are still many vets who are not believers. Some haven't seen first hand the successes that are possible and others are not believers simply because of their own personal philosophies about cancer treatment for dogs.

Seek a second opinion at any point when the best next step is unclear or when the execution of that next step may have long term effects. Treatment recommendations may be based on the type of equipment that a veterinarian has access to or is most experienced in using. Seek a second opinion to either confirm the first one or to discover a better option. There is often more than one logical course of action and another vet may have a different evaluation of the situation, a different diagnosis, a different prognosis and/or a different treatment plan.

Specialists have more experience and more training in the tests and treatments within their specialty than do general practice veterinarians. In the cancer field, this includes board certified surgeons, oncologists and oncology radiologists. On the other hand, because there are only 160 veterinary oncologists in the U.S. and millions of dogs and cats with cancer, many generally practice veterinarians have become experienced and competent in providing cancer treatment.

Lumps should generally be diagnosed, via fine needle aspiration (FNA) if possible. The "Let's wait and see" approach is a gamble. At the diagnostic stage for a tumor, when FNA was inconclusive and surgical biopsy is the next step, you or your veterinarian may want to consult an oncologist for guidance before proceeding. When a tumor is removed, the amount of surrounding tissue that is removed with the tumor and the achievement of "clean margins" determine whether or not the cancer will recur. Oncologists and surgeons are generally better equipped for and more experienced in tumor excision. If a specialist is not going to perform surgery on a tumor, the veterinarian should consult an oncologist about exactly how much tissue should be removed and about the follow-up treatment plan. Cryotherapy is sometimes an option. Keep in mind that when an unbiopsied tumor is removed via cryotherapy, information is not attained for diagnosis or prognosis and clean margins are not attained. Cancer cells may remain in the surrounding tissue, ready to grow and multiply.

Some types of cancer are treated with chemotherapy. The current "best" chemotherapy protocol for a particular type of cancer is easily ascertained by any vet and treatment may be given by any vet with experience. When side effects occur and are not quickly resolved, however, consult an oncologist - unmanaged side effects can be terminal or can end treatment altogether.

Radiation therapy is generally given by specialists in veterinary radiation oncology. The equipment needed is simply too costly for most non-specialists to purchase. Here again, side effects can be devastating if not managed properly by a vet experienced in this type of cancer treatment.

Never be embarrassed or shy about asking for a second opinion! Don't worry that your vet will take this as a personal insult. Often there are differences of opinion in what the best treatment plan will be. When you have discovered the various options, you will be better able to decide what's best for you and your pet.