Join us as we ask a veterinary oncologist (a.k.a. pet cancer specialist): "What would you do if your dog had cancer?" "What are your most inspiring pet oncology cases?" "How is cancer treatment for humans different from cancer treatment for pets?" and "Best advice for someone whose pet was recently diagnosed with cancer." We talk about chemotherapy, radiation therapy, surgery for cancer, as well as osteosarcoma, mast cell tumours (MCT), lymphoma and more!
On today's episode we are joined by Dr. Jim Perry to discuss the field of veterinary oncology and answer common questions about cancer treatment for pets. Dr. Perry's qualifications are extraordinary; he is double-board certified in veterinary oncology, veterinary surgery, and he also has a PhD. in Immunology. Dr. Perry practices at Veterinary Referral Center of Central Oregon (in Bend, Oregon).
We hope you enjoy this episode! Please leave your questions and comments below!
FULL BLOG POST: https://twintreesvet.com/blogs/vet-talk/what-to-do-if-your-dog-has-cancer-oncologist-answers-twin-trees-vet-talk-free-vet-advice-podcast
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WELCOME TO TWIN TREES VET TALK! An informal chat with Dr. Lopez (Emergency Veterinarian) and friends to share our perspective on pet predicaments, being a veterinarian, our shared love for animals and more! Have a quick question? Want to run something by us? Or just need our two cents? This is your chance! Each week we select a handful of questions to answer.
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00:58 Intro: Dr. Jim Perry, DVM, PhD, DAVIM (Oncology), DAVS
01:10 What would do if your dog had cancer?
04:36 Most inspiring cases?
06:42 Human vs. pet cancer treatment
08:53 Best advice for someone whose pet has cancer
14:24 Take-home points
When you say cancer there's a huge spectrum of diseases with different behaviors. Surgery is a big deal. You have a chance to make them better, but you also have a chance to make them worse. My goal as an oncologist is to try to do things as much as we can where the treatment's not going to be worse than the disease. We just adopted a two-year-old dog with osteosarcoma- I can show you she's sitting here- at the time of diagnosis she was just not getting up because she hurt so much. And then the day after the leg was off she was trying to play fetch. And that dog is happy loving life. So just like to see the spirit of, you know, taking away some pain or disease that is making them feel crappy. Immediately, they don't think about what they just went through treatment-wise, they just know that they feel better
[Dr. Lopez]: Today we have a very special guest, Dr. Jim Perry. He is actually double board-certified in two specialties: Veterinary Oncology and Veterinary Surgery.
So everyone always wants to ask someone that they trust: "If your dog were diagnosed with cancer what would you do?" Like would you go through chemotherapy? Would you go through radiation? Would you go through surgery on your own dog? And I was like a big wimp with my own dog. Like I couldn't even give her vaccines- somebody else had to do it and I had to be out of the room. You know? I could do all this other gnarly stuff on other people's dogs, but like my own dog, I just couldn't do it. But we never really went down the cancer path-she never got it. So I never had to make those decisions. But you do this like on the day to day, and you see the side effects, the outcomes, the rough recoveries, the cures. What would you do if it were your dog in those shoes?
[Dr. Perry]: It's hard, people ask that all the time. I think the most important thing is looking at the patient and the owner as a whole. there's a fair bit of estimating, you know, what the expectations are going to be. And complications can happen, so even if you think this is a great idea, it doesn't always end that way. But bottom line it really depends on what stage of life the dog is in, and then also what the cancer and outcome is going to be. But most the time I say if it's something I'm recommending or even discussing, I wouldn't discuss it if it wasn't something I wouldn't do. I display my bias I think a lot of times, so if I don't feel comfortable doing it on my dog, I'll you know often give as an option, but I'll quickly say, "Hey this is a big you know, a high risk low yield, or sometimes high risk high-yield thing." But I definitely am very honest. I let the owners know what I would do almost before they ask me when I'm discussing what the treatment options are. But to specifically answer your question- absolutely. I think the majority of cancers we see, I think I would treat my dog for. You know, put them through surgery if that's going to benefit them, and even chemo. Right now we just adopted a two-year-old dog with osteosarcoma. It was a case that came to the clinic, and it wasn't the best for the owners to go through all the treatments. And so I was like, well young dog, happy. It's easy enough for me to deal with it. And she has two chemos, already done the amp, and dog is like happy loving life. So that I have no problem, you know. It's a good example of- yeah I would do it. And now I actually did do it.
[Dr. Lopez]: Yeah I think it's like such a common theme, like everybody ends up with dogs that come through their department that the owners are like- nope this is the end.... and you just see that spark of life. You're like- is it the end?
[Dr. Perry ]: Yeah, it's not the wrong decision. But it's just, you know, hey this is not right for them, but is it is it right for the dog? Is it worth trying? So it depends on the dog. And very much, if you can avoid a big surgery to give dogs quality of life via another means of treatment- absolutely. Like if surgery is going to buy them 12 months but some non-surgical approach is going to buy them 10. Surgery's not always the answer.
[Dr. Lopez]: For sure. Yeah totally. It depends on the type of cancer, the expected outcome, and then also a lot of patient and owner factors as well.
[Dr. Perry]: Yeah and I think too, so the nice thing about surgery sometimes is-you get it off, you move on. Whereas other modalities, you're on treatment till the end. So like a bone tumor is a good example. You just want to do surgery, take off the bone tumor, the dog's not in pain and you move on. Whereas other times if you decide not to do surgery, the dog is going to be on pain meds until the end. So it's kind of a balance of you know, hat you want the middle road. the interim, to look.
[Dr. Lopez]: Okay well that's very helpful. What are your most inspiring cases?
[Dr. Perry]: My satisfaction, I think owner satisfaction too, is just seeing how well dogs in general go through and deal with treatment. So it's not one particular case, but I think the big ones are like lymphoma, which is really common too. And dogs come in, they're often sick, their lymph nodes are huge. And even with the first treatment, they are like back to normal two days later. Those are probably the most inspiring. And even the dog that I adopted- I can even show you came to show you, she's sitting right here.
[Dr. Lopez]: Awww. Oh my God, she was only two?
[Dr. Perry]: I know, but it's like, seeing her... so she could at the time of diagnosis she could barely like she was just not getting up because she hurt so much.
[Dr. Lopez]: So much pain.
[Dr. Perry]: And then the day after the leg was off she was trying to play fetch. And it's just like, seeing the spirit of you know, taking away some pain or you know disease that make them feel crappy. Immediately they just, they don't think about what they just went through treatment-wise, they just know that they feel better.
[Dr. Lopez]: Yeah it's crazy to think that an amputation is less painful than what she was dealing with 24 hours a day with her leg.
[Dr. Perry]: Yeah and no question. Like repeatable. We see that all the time.
[Dr. Lopez]: Yeah. Like feel better now that that leg is gone. That pain is gone.
[Dr. Perry]: Yeah but I think that's a big key point in thinking about the process. It's like: is the disease worse than the treatment? And I think that on the human side a lot of times that's not the perspective sometimes. And sometimes it's not avoidable. Like radiation a lot of times, I see, yeah there's going to be a period that's worse than the disease as they heal. But my goal as an oncologist is to try to do things as much as we can that the treatment not going to be worse than the disease. And most times you can achieve that, I think. Surgery is a big deal, and you have a chance to make them better but you also have a chance to over treat and make them worse, or go through a lot of recovery. So I really enjoy the kind of the perioperative discussions and management on top of the surgery itself too. And we have such good pain management now and local anesthetics and things go a long way. And even drugs to help nausea and all that for any kind of part of the treatment process we can palliate the treatment effects.
[Dr. Lopez]: Yeah. That's really helpful. I think a lot of people are kind of distrustful of chemotherapy, radiation, surgery for cancer just because they might have had family members who went through that kind of thing. I recently heard a friend say, "I don't ever want to be a science experiment." You know, and so I think that that's a sentiment that a lot of people have about watching a family member go through cancer treatment. In the end they had a bad outcome but they had to go through a lot of suffering and side effects and procedures lots of hospital time. And people don't want that for their pet. How would you say that oncology is different in pets from how it is in people?
[Dr. Perry]: Yeah right off the bat I almost always say that especially chemotherapy is very different. It's different both in the way pets handle the chemotherapy, but also different in our overall goals. Obviously our goal is always to cure, but we always have in mind that we don't want to kill the patient with the treatment. So in general less aggressive from a chemo standpoint side. Part of it comes from we don't have as many options to rescue dogs and cats from really high doses of chemo, so we don't have reliable, financially accessible oftentimes, bone marrow transplants if we wipe out their bone marrow. So our aggressiveness with chemo is less and in turn dogs tend to tolerate it well. So I start everything off with, you know, you hear "chemotherapy" it's immediate: "I don't want to do it because I've seen what it does to people." But in dogs, most dogs just cruise through it, and most protocols that we use in dogs are set up to kind of keep them happy throughout the treatment. So reiterate the goal is to buy them time, not necessarily cure them, but we will hopefully keep them feeling good throughout the process. So that's the chemo side. And then the other thing is just, you know, right at the outset it's a little bit of a change of subject, but just asking the owners goals. And having an owner ask their clinician to say okay what if I don't do XYZ treatment? I always try to have a discussion back and forth, okay if we do this this is the expected outcome, if we don't these are the other options. And this is the expected outcome. I think really from a pet parent's side is to say: "okay what if I do A, what if I do B, what if I don't?" And just kind of be comfortable with the outcomes that way.
[Dr. Lopez]: Yeah that's good to know all of your options. With dogs the emphasis is always on buying more time, but with more quality of life. So like a little bit less heavy-handed. So a pet owner asks: "My dog was just diagnosed with cancer. What should I do?" What would be your best advice?
[Dr. Perry]: Well number one, it's nice to have the internet as your first resource. but I would say a lot of cancers that we deal with in dogs there can be a spectrum of disease severity. So jumping on sometimes when you go online, you see the reports of the worst case scenario oftentimes. A good example is mast cell tumors. So mast cell tumors are the most common skin tumor we see in dogs. And what's posted typically is the bad experiences, just like any other Yelp review. You don't hear the: "yeah there was a small mass, we took it off, and the dog was cured." You get the: "Oh we took it off and it spread everywhere, and it was a miserable existence after." So I think the key is to really find the information from your vet. And learning to ask basic questions: "If I were to look this up online, what are the specifics of this that I should search for?" (and not get down a wormhole of... this might be a really aggressive tumor). And I see more and more that once we get a diagnosis from their general practitioner, oftentimes it says we're going to refer you to a specialist because they can handle it better. But the hard part is oftentimes getting into a specialist can take weeks or even months. So I think really knowing the type of tumor and what they're up against is helpful. both for relieving the pet parent's stress but also to really let the receptionist know at the specialty clinic how urgent it is. Because that's another thing I see oftentimes, you know, if the wait is two months for a certain appointment, certain cancers that's the time that your dog has if you don't treat it. So knowing how aggressively you need to find an appointment. and should you travel to a place you can get in sooner? Knowing that info is helpful.
[Dr. Lopez]: Yeah I think that's really good advice. One thing that you brought up- mast cell tumors. So sometimes those are diagnosed in the emergency room. Like a dog will have a lump for a really long time and people will think, "oh it's no big deal" and then it's not until it becomes something quite horrible that they'll come in to get it diagnosed. By the time it's gotten really massive, and it's bleeding. And then occasionally I'll just find a little tiny mast cell tumor that is incidental on a dog that comes in with like a broken arm or something like that. And just because I know how urgent this can be, like I'll just go ahead and FNA it right there, just to be sure. And that's not something I like to do, because it's not really my territory. But there was one year where it was like, I think, there was a whole handful of mast cell tumors that got diagnosed in the ER, and at the three-month point, only a third of those animals were still alive because so many of the ones getting diagnosed in the ER are really late stage. And the ones that were alive were the ones that were kind of just like small and incidental, and the owners were really swift about getting them removed with good margins. And I was thinking also about all the emails I get from people you know subject line: MY DOG HAS CANCER!!! You know, and then it's like, " They said he needs surgery tomorrow; he's 14. I'm not sure what to do..." I'm like, "Okay. Woah. Put the brakes on. That's the C word. Like how was that diagnosed? What steps were performed? Did they take any samples? Did they do any FNAs?" And sometimes they will have had an ultrasound with their vet and it wasn't performed by a radiologist. Vet told them dog has cancer everywhere. And I'm like. "let's go get all of that confirmed with a radiologist." Radiologist does the ultrasound.... no cancer. You know what I'm saying? Getting an accurate diagnosis by undergoing the necessary steps, and understanding that different types of tumors have different urgencies. And if it is something that needs intervention, making sure that you follow a swift path that's appropriate for that tumor type.
[Dr. Perry]: So yeah it goes back to just knowing that and when you say cancer, there's a huge spectrum of diseases with different behaviors. So I think reiterating to people, I mean, number one: my rule of thumb is if it's that emergent to me, the only urgent cancer to get off [surgically] is something that's causing either pain or bleeding. If it's a skin tumor that's just big, it's not an emergency and oftentimes we can do things to try to shrink it or decrease inflammation around it, that sort of thing. But to me if it's an emergency where somebody's saying: "if you don't get this off tomorrow they're gonna, you know, die" ... oftentimes that's a bad sign that, you know, even if you do an aggressive surgery, it probably not going to have a really you know fruitful outcome. So fortunately in oncology. there's very few emergencies unless it's like a bleeding spleen, or you know something where it's more of a critical thing, or you know the other example is like that painful osteosarcoma that's fractured, that would be more or less an emergency. But oftentimes you can manage pain while you're making the decisions. And then you emphasize the importance of, you know, if it is a tumor that is a high risk of spread, knowing the behavior of that is super important to do the proper test before jumping to surgery, because the last thing you want to do is to do a big local surgery only to find out that it has spread to the lungs or or other areas in the body that's not amenable to surgery. So taking a step back is super important. And I think the most important thing is getting into a vet, either a specialist or general practitioner that's interested in following through the course of the disease. So you definitely don't need a specialist for the majority of cancer treatment in dogs, it's just you know having a veterinarian that knows the general behavior of the cancer and is willing to treat it and see it through the treatment. So I think that's one thing I've learned. I mean, General Practitioners are amazing at doing a ton of things, and some of them are really good at cancer care. So you don't necessarily need a specialist, just finding somebody that's willing to take you through the journey though is important.
[Dr. Lopez]: Is there anything that we missed? Like take-home points?
[Dr. Perry]: I think you really have to be your pet's advocate through it. And if you're wanting to treat your dog or cat, finding out from your vet kind of what the expectations would be. And then if you do want to seek specialty care, not only you necessarily call the specialist, but have your regular vet be an advocate, they call the specialist too, to say hey this pet needs to be seen. Or at least have a discussion [with the specialist] to say: "okay how much of a rush?" In my experience, especially with post-COVID, is we get booked out three months in advance with anybody who calls, but there is a very clear *more urgent cases* out there. So having that advocacy for something that might be an emergency to get them in sooner. Because last thing you want to see is a pet that comes in is too late to treat when it was something treatable before it got to that point. Really being persistent on that side and getting help from your regular vet to get in is beneficial. If they can travel that can be very helpful.
[Dr. Lopez]: Yeah to go to a nearby specialist. Well that was very helpful. I feel like we learned a lot!
3 BEST PIECES OF ADVICE FROM THE EMERGENCY VET THAT COULD SAVE YOUR PET'S LIFE
1) DON'T WAIT TOO LONG TO GET HELP! If you wait too long, it could be too late. This is especially true for concerns such as laboured breathing, pale gums and weakness. You know your pet best, so if you are worried or concerned, "when in doubt, check it out!"
2) PREVENT THE PREVENTABLE. Learn as much as possible about dangers that face your pet, such as household poisons, seemingly harmless objects (like toys, clothing, garbage and rocks), other animals, and vehicles. Pets are like toddlers and they need a responsible adult/babysitter to protect them from danger. Puppies and kittens need to start their vaccines at ~8 WEEKS (and they need boosters too!) to protect them from deadly diseases.
3) BE PREPARED FOR THE WORST CASE SCENARIO. Have a plan in place, know your nearest emergency clinic, have the ASPCA phone number on speed dial. Know basic first aid training and CPR. But MOST IMPORTANTLY, BE FINANCIALLY PREPARED. The cost of medical treatment in an emergency, and the owners' ability to pay for it, is probably the most important factor that determines whether a pet will receive the medical care it needs. The best way to protect yourself is to have good medical insurance for your pet. Do your research.
**REMEMBER**: WE ARE ALL ON THE SAME TEAM, with the best interest of the patient as everyone's first priority. Let your vet do what he/she does best, and don't try to grab the steering wheel and obstruct your vet from doing his/her job. We are all in the same car, we are all headed to the same place, but only one of us has the driver's license (meaning, only the vet has the medical training and background to "drive the car").
The medical information on this site is provided as an educational resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any veterinarian-client-patient relationship, and should not be used as a substitute for professional diagnosis and treatment.
Please consult your pet's health care provider before making any health care decisions or for guidance about a specific medical condition. Twin Trees Vet expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.
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