The Dog Cancer Survival Guide (37 page)

Before then, there will likely be some at-home care you can administer. How much depends, of course, upon your dog’s overall state of health and how invasive or complicated the surgery. You may have to change the bandage and clean the wound. Your dog may need an Elizabethan collar to keep her from licking the incision. Your dog may be incontinent for a while, which might mean you have to clean up after her. You might have to construct a convalescence area, where your dog can rest and not move around much while she heals. You may need to help or even carry your dog over to her food and water, or outside, when necessary. You may have to administer pain or other medications. Some dogs, particularly elderly dogs, can get depressed after surgery, so you may have to provide extra encouragement and affection.

Make sure you ask your vet to describe, in as much detail as possible, what kind of nursing responsibilities the surgery will require, once you leave the hospital. Surgery costs money, but it also costs time, both in and out of the hospital.

The tissues removed from any cancer surgery will be submitted for a biopsy and a comprehensive margin evaluation. If there are cancer cells along the margins, the margins are called “dirty” or “incomplete” and your vet may recommend another surgery, radiation or chemotherapy to clean them up.

Vets and oncologists have to walk a fine line when it comes to discussing side effects with guardians.

On the one hand, there
are
risks for every drug, surgery and radiation treatment (and many “natural” treatments as well). You, as the guardian, should be made aware of those risks, so you can make an informed decision.

On the other hand, side effects can sound so scary that they trigger fear-based thinking in guardians. Many vets are afraid that if we tell the whole story, guardians will get so scared that they’ll refuse any treatment whatsoever. Immediately after vet school, I had an experience that perfectly illustrates this dilemma.

I was a brand-new vet, trying very hard to adjust quickly to my new role and responsibilities. I was working with a very nervous guardian, who felt frightened about every possible side effect for the medication I recommended.

As she asked about each side effect, I felt more and more tense. She just didn’t seem to understand that I had prescribed the antibiotic because I thought its
benefits
for her dog far
outweighed
any
potential
(and
unlikely
) risk of side effects.

Finally, I couldn’t take it anymore. I looked her right in the eye and said “Listen! One of the side effects is
an allergic reaction!
It’s
possible
that your dog could have an allergic reaction so
bad
to this
antibiotic
that your dog could
die
!”

As you can imagine, the conversation ended rather abruptly, as did the relationship. She turned pale, called her dog, and hurried out of the office, never to return. I might as well have said to her what some parents say before spanking their children: “You want to cry about something? Cry about this!”

Losing a client, because I could not effectively communicate both the risks and benefits of a treatment (and because I was so insensitive), was a life lesson for me. It certainly inspired me to become a more supportive clinician.

I still wonder if her dog ever took an antibiotic for his infection – or did my revealing the extremely remote possibility of death, turn her away from antibiotic use forever?

The take home message is this: very few treatments are 100% safe ... but there are also risks to not treating. As a vet, it is my responsibility to advocate for the health of your dog. If I think a treatment is worth the possible side effects, I will make that clear. A risk of
possible
side effects isn’t the same as
probable
side effects.

Your own emotional management skills will be important as you read through this and the next few chapters, and particularly as you consult with your vet or oncologist. If you get overwhelmed, take a break and do an exercise from
Chapter 2
, to help you calm down and focus. Your dog will thank you for it (and so will your veterinary health professional).

Whether surgery removes a pea-sized lump or one the size of a grapefruit, it carries some risks and complications, which have to be proactively managed. In addition to the prolonged recovery times and intensive home care already discussed, be aware of the following risks:

• Untreated Pain:
  Most humans feel some level of pain after surgery, and it is safe to assume most dogs do, too. Often, guardians don’t realize their dogs are in pain because it can be hard to pick up on canine pain signals. Your vet will probably prescribe pain medications for the days following surgery, and I recommend using them, as directed, to be on the safe side. Unmanaged pain is a stressful and horrible experience, and reducing your dog’s pain is an important part of Full Spectrum cancer care (see
  page 229
  for more details). In the unusual event that your vet doesn’t bring up post-surgery pain management, make sure that you do.
  
• Anesthetic Issues:
  Every time we use anesthesia, there is a risk. Mild problems include stiffness from staying in one position during a surgery, throat irritation or coughing from the tube used to deliver the gas, razor burns where the shaver nicked the skin at the catheter sites, being smelly from urine that pooled underneath the body during surgery, and slightly lowered body temperatures from anesthesia. Much more serious problems include: brain damage, kidney failure, stroke, extreme hypotension (low blood pressure) during surgery, allergic reactions to medications or anesthetics, severe heart rate and rhythm problems, and death.
  
• Bleeding Problems:
  If your dog’s blood does not clot well on its own, he is at increased risk for excess bleeding on the table (hemorrhaging) or bleeding later, after the surgery is over. Ask your vet if he runs coagulation panels or does a bleeding test before he begins the actual surgery, in addition to the standard CBC.
  
• Infections:
  Both friendly and unfriendly bacteria can be found on the skin, and if unfriendly bacteria get into the surgical site, they can cause painful and dangerous infections. Since your dog’s immune system is likely already suppressed, due to the cancer, preventing infections is particularly important. With the rise in drug-resistant bacteria, this problem is only growing. Impeccable sterile techniques are very important. Interestingly, however, the two things that most affect whether an infection occurs – especially a MRSA infection – are the length of time spent in the hospital and whether the surgical team wears masks. Humans carry germs with them all the time, and MRSA and other equally dangerous germs tend to lurk in our sinus cavities. They can be there whether we feel sick or not – and when we breathe out, they can leave our bodies and infect others. Wearing a mask, which filters the vet’s breath and traps germs, is the best way to minimize surgery-related infections in your dog. If an
  infection does develop, a culture can be taken to find the right antibiotic to kill it. As the ten days necessary to do this can be a very long time for a dog with cancer – here in Hawaii, where MRSA is epidemic, I often give a double-dose of Clavamox immediately, when I suspect the culture will come back positive. That particular antibiotic is often effective with MRSA bacterial infections; other possibilities your vet may consider are doxycycline and clindamycin.
  

These risks are serious, and you want to be aware of them – but do not take my warnings as evidence to avoid surgery. Just because these side effects are possible, does not mean that they are probable. After all, cancer is serious, too. Use this information to have an open, informed dialogue with your vet or oncologist, so you can make the best decision for your dog and her particular cancer diagnosis.

It’s a fact that anesthesia carries risks, including serious ones like kidney damage, brain damage, and death. Even mild affects, such as stiffness, nicks, and getting cold, make it unattractive. On an instinctive level, it can just seem wrong to let someone put your dog “to sleep.” No wonder so many guardians are afraid of anesthesia.

To put these risks in perspective, I invite you to compare anesthesia to driving a car. If you get into a car with a very bad driver, you are more likely to experience “driving side effects” than you would be with an excellent driver. Side effects could include mild ones like an accelerated heart beat from driving too fast and a headache from loud music, and serious ones, such as broken bones, glass embedded in the skin, or even death.

There are a few studies that look at the risk of anesthesia-induced death. In one, of the 6,026 dogs who went to a specialty center (which means they were sick enough to need specialist care) over a three-year period, 20 died because of anesthesia-related accidents – or 0.33%. In another, the risk of death was less than 1% or one in 173 dogs.