What does Obama have to do with Euthanasia?

Your travels through social media may have brought you to a photojournalistic webpage of a dog named Duke’s final day of life (see: http://www.robynarouty.com/i-died-today/) If you not seen it before, I’ll issue a fair warning to be sure you have a handful of tissues nearby before opening the link. The images and words are guaranteed to cause the most stoic of souls to tear up, if even just a little.

I don’t remember how or when I first came across the story, but as I stared at the photographs and read and re-read the words on the site, I found myself thinking, “Even though I do not know this dog, I know this story.”

In my mind, Duke was previously diagnosed with a terminal cancer and his owner had recently made the most difficult of choices that it was time to end his pain. The pictures clearly illustrate though Duke’s disease was advanced enough to affect certain portions of his life, he still was able to face death with dignity and peace, enjoying his favorite things and people during his last day on Earth.

A factor particularly significant to me was Duke’s euthanasia was performed not within the sterile and clinical confines of a veterinary hospital, but rather was done outdoors, in a tranquil and comfortable setting. Duke spent his final hours doing what he enjoyed most, surrounded by the people who cared for him the greatest, in a completely natural setting. The images tell us he passed serenely and calmly, outdoors, on a beautiful summer day.

On a related note, you may have heard some of the buzz surrounding the “Veterinary Mobility Act.” This piece of legislation makes it legal for veterinarians to transport and use controlled substances beyond their primary places of registration and across state lines to treat patients. Much to the relief of veterinary professionals who have lobbied for this legislation since 2009, President Obama very recently signed the act into law.

Controlled substances include pain medications, anesthetics, and drugs used for euthanasia. For veterinarians who provide house call services, travel to farms or backyard barns, or work with wildlife and in the field of research, these are indispensible treatment options. Prior to the passing of this law, it would be illegal for those doctors to carry and use medications necessary for even the most rudimentary of treatments.

The American Veterinary Medical Association’s (www.avma.org) press release regarding the law states: “By passing and signing this legislation, the president and our legislators recognize the critical role veterinarians play in treating sick animals and relieving their pain and suffering. The health and welfare of our nation’s wildlife, food animals, and even our companion animals depend on veterinarians being allowed to do their jobs wherever the need arises.”

The importance of Veterinary Mobility Act is obvious when we consider veterinarians practicing in rural areas, or for those who run mobile or ambulatory services. These doctors need to be able to transport and administer controlled substances in order to perform their jobs. They also need to be able to do so without fear of breaking a law or losing their license.

What may not be obvious is why a veterinary oncologist would care about whether or not it would be legal to transport pain medication or euthanasia solution from their base hospital to another location or state?

I’ve written before about the “specifics” of the euthanasia process (http://www.petmd.com/blogs/thedailyvet/drjintile/2014/july/heartbreak-losing-pet-can-be-cushioned-planning-31864), with the details centering on the actual event occurring within the veterinary hospital.

Though we make every effort to ensure pets are comfortable during this time, for some animals the simple act of traveling to the vet can be so stressful and anxiety provoking. For many owners, there can be a “trickle-down” effect of increased strain and worry.

Some pets with end-stage cancer can be painful or so debilitated from their disease that they are unable or unwilling to walk out of their homes. Some owners may not be able to carry their pets or lift them into their cars. I’ve even had some owners tell me their pets bit them out of fear or pain during attempts to transport them. Therefore, in certain cases, it truly is in the pet’s best interests to not spend their last moments in a veterinary hospital.

Owners have asked me if I could perform an at-home euthanasia and I know I’ve disappointed them with my answer. I’ve had to tell them that legally, I cannot do it. It’s typically a somewhat awkward conversation, where I think both the owner and myself feel unsatisfied.

This isn’t to say I possess a strong desire to euthanize pets at home and certainly it would not be practical to make such practice a routine part of my daily schedule. I’ll leave that up to those veterinarians who make this part of their professional services. But being able to provide this option for owners in particular cases would be invaluable.

Many pets with cancer will die from their disease. Veterinary oncologists are integral to the successful treatment of such cases. We are able to afford animals with longer and happier lives and manage their diagnosis as a chronic disease. Unfortunately, cures are uncommon and in most cases owners must consider euthanasia at some point. It is a part of our job and a part of our responsibility to always put our patients needs first.

Duke’s story is just one of many – but I think it brilliantly outlines why the Veterinary Mobility Act is so important and provides owners and pets with additional options not previously established.

It’s wonderful to know the President, an obvious animal lover, feels the same way.

What Makes A Veterinary Specialist So Special?

Becoming a veterinary specialist is difficult. I don’t say this looking for sympathy, as I am well aware I chose this career, and the stresses I’ve sustained thus far are primarily of my own doing. But there are times when I do question my path. Not because I’m thinking about pursuing a completely different profession, but more because of the frustration of feeling undervalued and underappreciated when I consider the work I’ve accomplished to bring me to this point. There are days where it seems no matter how late I stay to make phone calls, or how many times I am willing to discuss the same recommendations with an owner, or how many times I try and battle the misconceptions surrounding cancer care for animals, I feel my efforts are not valued and I’m left feeling a bit purposeless.

I knew from a very early age I wanted to be a veterinarian when I “grew up”. As a child, my aspirations were to heal sick animals, relieve suffering, and discover new treatments for previously incurable diseases. With the optimism and creativity only afforded to the very young, my career goals were lofty and impractical, lacking the specificity and applicability that comes with age. I remember being told, “how hard it was” to become a veterinarian, and though family, teachers, and friends supported my decision, I still can hear the concern in their voices centered around the “what if it doesn’t happen” option.

It’s not as though they didn’t know what they were talking about and I experienced firsthand exactly how tedious the process of gaining admission to veterinary school could be. Some people are fortunate to be admitted after only 2 years of undergraduate work. I needed a Bachelors degree, a Masters degree, and a few years of a PhD before becoming the “ideal” candidate to start applying.

Once graduated from veterinary school, after passing a national board exam, new veterinarians are considered capable enough to finally begin “practicing”. Individuals who begin working immediately after graduation are typically referred to as general practitioners. They are skilled in the diagnosis, treatment, and management of all aspects of veterinary medicine, and often their skill set encompasses multiple species as well as disciplines. General practitioners need to maintain licensure within the state in which they practice, and depending on particular state requirements, they may need to pass one or more state mandated exams and likely maintain a certain amount of continuing education credits on an annual basis.

I had no personal concept of what specialty medicine entailed until I started veterinary school, and it was always my intention to become a general practitioner. Once I began learning what veterinary internists, cardiologists, radiologists, surgeons, neurologists, dermatologists, behaviorists, nutritionists and yes, oncologists did, on a daily basis, I began rethinking my future. Specialization appealed to my academically driven personality; always wanting to achieve and attain the “above and beyond”, but more so specialization meant the opportunity to favor depth over breadth and really understand one particular aspect of veterinary medicine to an “expert” degree.

For veterinarians, it is optional to pursue an internship after graduation. Most internship programs are about one year in length, and for those treating primarily small animals such as dogs and cats, internships typically consist of rotations though a variety of subspecialties of veterinary medicine. Some veterinarians will decide on an internship as a means to expand their practical knowledge and gain more experience before heading out into the “real world”. Internships are also required before pursuing most residencies, so for some it’s a means to an end. Internships vary in difficulty and stress level; the rigors are designed to strengthen skills and it’s often stated the internship year is equivalent to 5 years of work in general practice. My internship year helped solidify my choice to specialize, as well as to help me decide upon oncology as my chosen field.

Most residency programs are a minimum of three years duration. Individuals apply to programs through a “matching” system, where ultimately the decision of where you will wind up training is not really your own. During a residency, veterinarians spend the majority of their time training in their field of expertise, with some time allotted for rotations in other specialties. Most programs require veterinarians to participate in the teaching of underclass veterinary students as well as “house officers”, which is the term used to describe interns and residents in other training programs. Veterinary residents are usually also required to complete at least one original research study before obtaining board certification. There are also many on-call hours, required attendance and presentations at national conferences, and a less than minimum wage salary to consider.

The typical “end all be all” of veterinary specialization is the board exam, which ultimately decides whether a resident is successful in obtaining board certification (or not). Although there are so many other hurdles we go through during the process, board exams loom as the main obstacle in attaining the almighty diplomate status. It doesn’t matter you’ve completed veterinary school, passed a national exam, endured the rigors and emotional tolls of an internship, persevered through a residency program, published at least one research paper, spent countless hours studying and on call, and managed hundreds of cases related to your area of expertise. What stands between you and your ultimate goal of specialization, is yet another test.

It seems trivial adults who have proven their academic talent for a minimum of 12 years of post-secondary training, performed hundreds of procedures, and spent thousands of hours focusing on one particular area of interest would have their future depend on correctly answering a few dozen questions. Fortunately for most of us, it works out in our favor and the exams are passed and board certification is achieved. It’s a rigorous road, leading to a relatively undervalued lifestyle, yet we pursue it voluntarily and without regret. We’ve worked harder than you probably could imagine getting to this point – so maybe tread a little lighter when making statements about us being in it for the money, or that we “torture” animals, or how we’re not “real” doctors.

We’re as real as it gets, and we wouldn’t want it any other way.

The dreaded diagnosis of a feline mammary tumor…

Mammary cancer is a particularly frightening diagnosis for cat owners. Over 90% of feline mammary tumors are malignant, meaning they grow in an invasive fashion and spread to distant sites in the body. This is in contrast to dogs, where only about 50% of mammary tumors are malignant. Tumors tend to affect older, unspayed female cats, but all cats, including males, are at risk.

The age at which a female cat is neutered plays a role in protecting against tumor development, with the greatest benefit seen for kittens spayed before 6 months of age, who have a 91% reduction in risk compared to non-spayed cats. Spaying between 6 months and one-year results in an 86% reduction in risk. Spaying between 1-2 years leads to an 11% reduction in risk, and spaying after age 2 does not reduce the risk of mammary cancer development at all.

Sometimes owners will detect a mammary mass incidentally while petting their cat. Other times the cat will draw attention to a tumor by showing signs of increased licking or chewing at the affected area. Masses can also be discovered “accidentally” on routine physical exams.
The size of the tumor at the time of diagnosis makes a difference in patient outcome:
Cats with tumors less than 2cm in diameter at the time of removal have a median survival time of 4.5 years.
Cats with tumors greater than 3cm in diameter at the time of removal have a median survival time of 6 months.

Because tumors can go undetected for a long time and the size of the tumor is prognostic, routine physical exams are of absolutely necessity for pets (see http://www.petmd.com/blogs/thedailyvet/drjintile/2014/july/regular-exams-can-save-more-your-pets-life-31887) This is especially true for cats known to be neutered later in life, or for those cats adopted as adults with an unknown medical history.

Surgery is the mainstay of treatment for cats with mammary tumors. The current recommended “surgical dose” for cats with no evidence of spread of disease is a procedure called a staged, bilateral radical mastectomy. This entails surgical removal of all of the mammary tissue on one side of the body, followed by removal of the tissue along the opposing side following about a 2-week healing period.

Many owners are anxious when they hear the details of this type of surgery. Though it is an aggressive procedure, what I try and remind them is the surgery is less invasive than one that opens up a body cavity and we are very pro-active about our pain management measures.

It’s always difficult to make this type of a decision for our companions; one where we know we are making a choice because that has the best chance for prolonging their life but also knowing there will be an impact, albeit temporary, on their quality of life.

A few important considerations for submitting feline mammary tumors for biopsy:

It is essential that all of the removed tissue be submitted for histopathology. Most feline mammary tumors are carcinomas or adenocarcinomas, but other histological subtypes do occur.

Submitting all of the tissue also allows us to know if there were additional tumors located in other mammary glands. Often I see a report indicating pre-cancerous tissue was removed in glands adjacent to the one with the tumor.

The biopsy report will also let us know if there are adequate surgical margins on the tissue, or if the chance of regrowth is more significant because cancerous tissue was left behind.

The biopsy should also provide information as to the grade of the tumor. The pathologist should examine specific histological features under the microscope to assign a grade to the tumor (grade 1, 2, or 3)

Each of these factors listed above help veterinary oncologists decide on risk assessment for need for further therapy beyond surgery.

Based on the information above, I often discuss using chemotherapy after surgery to treat what is known as “microscopic residual disease”. These are tumor cells that may have spread to distant sites in the body prior to removal. The most commonly prescribed chemotherapeutics for feline mammary tumors are doxorubicin, carboplatin, and cyclophosphamide, though many other options exist.

We lack studies that adequately “prove” treating with chemotherapy after surgery is truly beneficial for cats with mammary tumors. Although one study showed survival in cats receiving chemotherapy after surgery was not improved when compared to cats undergoing surgery alone, the disease-free interval was increased, meaning the patients receiving chemotherapy felt well for a longer time period.

Chemotherapy can also be used to treat cats with tumors that cannot be removed surgically, or for cats with spread of disease. Roughly half of those cats would show some form of response to treatment, and about 1 in 5 will achieve a remission (i.e. a period of time where no tumor would be detectable). Cats that showed a response to therapy have median survival times of about 6 months compared to < 3 months if they do not respond to treatment.

Owners of cats with mammary tumors often ask me what will happen “in the end”. In my experience, there are usually one of two outcomes: 1) cats develop large, non-resectable tumors that grow rapidly and become ulcerated and infected and ultimately make them feel sick and have a poor quality of life or 2) cats develop spread of the tumor to their lungs, and show signs of difficulty breathing due to the physical presence of the tumors or due to fluid building up around the lungs secondary to the tumors.

A diagnosis of mammary cancer can be a scary and overwhelming, however it’s important to arm yourself with all of the facts. Often, the best way to do this is to seek consultation with a veterinary oncologist or a veterinary surgeon prior to any major treatment decisions. The information you gain will be well worth the price of the referral, and could just mean the difference between life and death for your cat.

What in the world is my vet talking about???

Medical jargon can be confusing and I know I easily fall into the trap of using terms whose definition may not be intuitive to a non-medically trained person.

Here are some basic definitions of the more common oncology terms as a resource for owners who may be puzzled by the words we use on a daily basis.

Cytology

Typically we obtain cytology samples when we perform what are known as fine needle aspirates. Fine needle aspirates are when we introduce a small needle (generally the same size as used to administer a vaccine or draw a blood sample) into a tumor and then try and extract cells. The material is usually dispersed on to a slide, and generally always submitted for analysis by a clinical pathologist. Fine needle aspirates are quick, relatively non-invasive tests we do routinely as a means to obtain rapid results as to the cause of a tumor or to investigate whether an organ or structure is showing evidence of tumor spread. The major con to cytology is the samples obtained are usually small, and may not represent the entire tumor, so it’s possible to have a non-diagnostic sample, or even completely miss a diagnosis of cancer.

Biopsy

Biopsy samples are obtained in two main ways: incisional biopsy or excisional biopsy. Incisional biopsies are when small pieces of tissue are removed from a larger tumor, with the intent to try and characterize the mass prior to more definitive treatment. Excisional biopsies involve the removal of the entire tumor, or affected organ or structure. It is often it is more valuable to take an incisional biopsy first, even if this means two separate anesthesia or sedation procedures, and slightly increased cost. This is because a great deal of information can be obtained from an incisional biopsy that is used to plan the more definitive surgery. Several studies have proven performing a pre-treatment incisional biopsy is beneficial for outcome for pets. Biopsies, therefore, are considered the “gold standard” diagnostic tool for most cancers.

Stage

Stage refers to where in the body to we find evidence of cancer. Most human tumor types have specific staging schemes, and we have applied these same outlines to our veterinary patients. In order to assign a particular stage to a tumor, the pet would have to undergo all of the required staging tests. For examples, dogs with lymphoma can be assigned to one of five possible stages, but only if all the required tests are performed, including labwork, imaging tests of the chest and abdomen, bone marrow sampling, and lymph node biopsy with immunophenotyping. The stage of cancer is important because it can dictate treatment options, prognosis, and also allows owners and veterinarians to literally know everything about the pets from nose to tail.

Grade

Grade is a specific term used to describe biopsy features related to a tumor. Grade can only be determined when a biopsy has been performed on a tumor. This means grade cannot be determined via cytology samples. Tumors are typically designed as either high-grade or low-grade. Not all tumors have a specific grading scheme, but for those that do, it’s very important the pathologist assign a grade when they write a biopsy report. This information is one of the main features I will use to make therapeutic recommendations.

Aggressive

Aggressive is a term used by oncologists to describe tumors that are either 1) extremely difficult to remove surgically, 2) highly likely to spread throughout the body, or 3) both. You may think this term would apply to all cancers, but we do know that some tumors, or subtypes of tumors, do not behave aggressively if diagnosed early or found at an early stage.

Remission

Remission typically refers to a description of cancer where we know it still exists in the pet’s body, but all the cancer cells are below the level we can detect it with any available test. Remission does not equal cure, but still represents successful treatment because the disease burden in the animal’s body is reduced well below the level at which we would expect to cause illness or signs. We usually refer to remission when we describe the treatment of blood-borne cancers, such as lymphoma, leukemia, mast cell tumors, histiocytic tumors, etc.

Median Survival Time

The median survival time is usually the best measure I can give owners when they ask me how long their pet is expected to live with or without a particular treatment. Median typically refers to “the middle”, so when we talk about this statistic we usually mean 50% of pets live shorter than that number and 50% live longer. It’s not technically the same thing as an “average” survival time, as the median survival places less emphasis on the “outliers” – pets who succumb very quickly or live a very long time after diagnosis. Of course, we always hope the outcome will be more favorable than the “average”, as generally there is nothing average about any of our patients!

Cure

As morbid as it may sound, I consider an animal cured of their cancer should they pass away from a process other than their tumor, and at the time they pass away, their tumor can no longer be detected in their body. I often use the word “control” rather than “cure” when speaking to owners as I feel it better delineates my goal in treating their pet. I wish to make their pet’s cancer something they live with more as a chronic, but non-debilitating, condition.

I’m aware of how confusing and scary a diagnosis of cancer can be and rest assured; we are here to make this whole process a little less intimidating. I would rather be asked the same question repeatedly than feel as though an owner left not understanding what was happening to their pet.

The words may be unfamiliar, but I guarantee you, we are all speaking the same language. Except usually one of us is just wearing a fancier white coat.

Of Diet and Cancer – Where can an owner find the truth?

In cancer, cells undergo a series of mutations leading to immortality. Cell division occurs uncontrolled, leading to tumor growth. In it’s final stages, cancer spreads throughout the body, ultimately leading to death of the host.

This leads me to think of cancer as the ultimate betrayal by one’s own body. Little can be done to reverse changes once they start, and treatments are designed to eradicate the aberrant cells, while sparing the healthy ones. All of this speaks to a complete lack of control over the disease process itself.

The lack of control extends to what owners feel once faced with a diagnosis of cancer for their pets. Some owners will feel guilty, wondering if they caused their pets cancer because of the type of diet they fed them, or the vaccines they chose to administer, or blame flea and tick medicine. Many want to know what can be done (beyond the surgical, radiation, chemotherapy, or immunotherapy recommendations I make) to slow the cancer progression or reverse the disease process now that it has started.

Some owners search for aspects they can control to help their pet battle their cancer, strengthen their immune system, and aid them through their more conventional treatments. I find the main thing owner’s feel they can control during this process is their pet’s diet and nutrition. They are generally helpless from stopping progressing of disease and they can’t prevent side effects from treatments, but they can control what their pet ingests and they can tangibly monitor things like body weight and the proverbial “ins and outs” of their pet.

The problem is the lack of evidence based information to suggest changing diet and/or adding supplements or nutriceuticals will make a difference in outcome. The other problem is adding too many variables into the “mix” can result in unexpected side effects where we can’t say for certain it’s the cancer, the treatment, or the new diet/supplement/vitamin/etc. causing the signs. The last problem with some of the nutritional aspects of treating cancer is they may work against the more conventional treatments (e.g. anti-oxidants may counteract the mechanism of action of some chemotherapeutics and radiation therapy). When I discuss these aspects with owners, I realize I’m taking away some of their hope and certainly some of their feelings regarding being able to actively change the progression of disease for their pets.

As an oncologist, I also feel the frustration of not being able control cancer. My concerns are different than the average pet owner though – I don’t spend as much time worrying about what caused the cancer to happen, but rather what can I do now to control the cancer from growing, spreading, and ultimately making that dog or cat not feel well. I’m trying to stay one step ahead of a disease we barely understand, and are continually discovering new things about.

It seems the only one in the scenario not concerned with controlling the situation is the actual patient. Cats and dogs diagnosed with cancer have no concept of their disease. They know no difference between today and tomorrow or next week or next summer. They have no desire to control their disease, and cannot comprehend words like “metastases” or “median survival times.”

Veterinary cancer patients live in the moment – enjoying each minute for what it brings. In most cases that is joy and happiness. In some cases it is illness from disease or from the treatment. But there is never resentment or anger, or concern for what the future may bring. They don’t have interest in learning what caused their disease, and it is their lack of understanding about their condition that makes their battle so bittersweet.

I think about the emotional aspects of cancer care a great deal, and I see firsthand the unique aspects related to veterinary oncology and the differences we face as compared to our human counterparts. The more I consider it, the more I think we have a lot to learn from animals and their approach to health and disease.

Yes, it would be great to have better control over our health or to better regulate for risk factors, or once diagnosed with a devastating disease such as cancer, be able to maintain power over progression. But wouldn’t it also be a beautiful thing to still enjoy each moment of each day for exactly what it’s worth rather than dwell on those things we cannot change?

Once again, I think animals have the upper hand in how they deal with cancer. Time and again, I seem to consistently learn more from them than any textbook or research article. Though I’m still compelled to conquer disease, I feel the need to give consideration to relinquishing some of the control for the sake of simply enjoying the opportunity to help our patients and use their “philosophies” as examples. Not an easy task given the field I’ve chosen to pursue, but I have some pretty good role models to look towards for help.

“Could cat feces help cure cancer?”

My eyes widened as they scanned over the title of the website I’d stumbled across.

After pausing for a few moments to recover my composure and swallow a mild wave of nausea, I rolled my eyes sarcastically and thought ,“Yet another misinterpretation of sound medical research written in the name of Internet propaganda for the sake of promoting Dr. Google.”

Yet, as I continued to read further, I found myself intrigued by the concept behind the scientist’ work. The experiments were (thankfully) not designed to establish cat poop as a cure-all for cancer, but rather on using a common intestinal parasite called Toxoplasma gondii to battle tumor cells.

Toxoplasma gondii (T. gondii) is a relatively simple organism found in the digestive tracts of many mammals. T. gondii can cause toxoplasmosis, a disease that is usually not a life-threatening condition, but can result in flu-like symptoms and malaise. In immunocompromised people or animals, toxoplasmosis can be a much more serious problem, and in very rare cases, can even be fatal.

Infection with T. gondii occurs via 4 main mechanisms:

Ingestion of T. gondii tissue cysts in undercooked meat
Ingestion of material contaminated with T. gondii oocysts
Via a blood transfusion or organ transplant
Transplacental transmission from a pregnant female to her offspring.

T. gondii can infect any mammal, but as in real estate for people and single-celled parasites, it’s all about location, location, location. T. gondii thrives in the intestines of cats and it’s our feline friends who are considered the primary hosts for this creature.

Oocysts, which are the “offspring” of adult T. gondii, are shed in the feces of infected animals, including cats. This is the reason why doctors tell pregnant women to avoid scooping their cat’s litter boxes. If they were to become infected by accidentally ingesting oocysts shed in the waste, they could experience a miscarriage.

So what does this all have to do with cancer?

Regardless of the the cell of origin, cancer exists to some extent because the host’s immune system fails to recognize tumor cells as being “different” from healthy cells. Cancer cells work very hard to evade immune reactions and do this by two main mechanisms – they either work to suppress immune reactions or they work to keep themselves appearing as “normal” as possible.

Conventional anti-cancer treatments such as chemotherapy or radiation therapy work by causing damage to cells in a non-specific manner. These modalities attack both healthy and tumor cells with nearly equal fervor. This leads to issues with toxicity and also greatly limits the doses that can be administered safely.

These latter factors have led to a great interest in developing targeted therapies for treating cancer, including options immunotherapy (for example: http://www.petmd.com/blogs/thedailyvet/jintile/2012/nov/how_dogs_with_oral_melanoma_mouth_cancer_are_treated-29501). Immunotherapy anti-cancer treatments attempt to use the hosts’ own immune system to fight off cancer cells in a specific and controlled manner.

The theory behind using T. gondii as an anti-cancer treatment stems from the it’s ability to elicit a strong immune response within the host, designed to fight off the infection. By infecting people or animals with cancer with the parasite, the hope is the patient’s immune system will more effectively primed to battle tumor cells previously hidden from attack.

Research with T. gondii has shown anti-tumor activity in mice with ovarian carcinoma and melanoma. Tumors were confirmed to reduce in size and mice treated with T. gondii developed potent immune reactions. Perhaps the most exciting data showed the mice with melanoma whose tumors reduced in size following treatment with T. gondii maintained their ability to withstand new tumor development when re-challenged with melanoma cells later on.

The long-term goal for the researchers is to develop an anti-cancer vaccine containing the weakened T. gondii organism. Unlike conventional vaccines, T. gondii will be used as a treatment for cancer, rather than a preventative measure.

I do question the efficacy of the vaccine will be in people and/or animals that have been previously exposed to T. gondii. Up to 1/3rd of humans and many household pets test positive for prior contact with the parasite. I would be concerned those individuals would already have immune systems geared towards fighting off T. gondii, and may actually eradicate it before it enough time has passed to stimulate the immune response necessary to kill tumor cells.

Fortunately, treatment with T. gondii does not involve feces, feline or otherwise. Also reassuring is the strain of T. gondii used in the research is a purified and attenuated (meaning weakened) version of the organism that cannot replicate within the host and should not lead to the development of toxoplasmosis.

As for cat-poop being the cure all, I’ve leave you with my parting advice to make sure to keep gloves on and maintain pristine hygiene when your scoop the litter box. And keep on hugging your feline friends with fervor. You never know when you might need one of them to save your life!

Age isn’t anything other than a number… Or is it?

I’ve just completed a particularly lengthy and emotionally charged new consult with a middle-aged couple, and a soft silence fills the room. Ben, their beloved 13-year-old Golden retriever, was recently diagnosed with lymphoma, and they are here to learn everything they can about his disease and what options are available for treatment. Overall he’s feeling fairly well, however subtle signs of disease have started to set in. He’s showing a slight, but perceptible, reluctance to rise from bed in the morning. Meals are still being consumed, but at a less than usual frenetic pace. Ben’s been panting more, and his owners’ noted two instances where he stopped abruptly during their routine two-mile evening walk, where he seemed to “need to catch his breath”.

Ben is currently lying on the floor, with his head resting patiently over his paws, awaiting a cue from either of his owners that it’s time to go home. His soft brown eyes anxiously dart between mom, dad, and myself, yet he remains simultaneously calm. For a moment, likely because the silence is proverbially deafening to my ears, I consider the scene from his perspective. I think about how during his 13 years of life, Ben must have experienced his fair share of veterinarians and exam rooms, but how many times would he have spent over an hour in the same room while a doctor did so much talking? What could he possibly make of his owner’s tears, or their frequent sad glances in his direction? What does he think about the strange scene before him? I’ve always felt animals have powers of perception far greater than anything we humans are even capable of understanding, and I’m thinking about this old dog and what his life at home on a “normal” day must be like when finally Ben’s female owner breaks the silence:

“You know, if he were a 5-year-old dog we might consider treating him, but Ben’s 13 now, and we just can’t see putting him through all of that just for another year or two of time. He’s been a great dog, and we love him very much, but I think we’re just going to let things happen naturally, and when it’s time, we will let him go.”

I’ve heard these words so many times before, maybe not following the exact same dialogue or tone, but I’m familiar with the phrasing. I glance downwards at Ben and smile. “I understand completely”, I state plainly, but inside I’m thinking, “Do I really understand choosing to not treat cancer based on age?”

As a veterinary oncologist, I find it interesting how age factors into the decision for owners to pursue diagnostic tests or treatment for their pets with cancer. Owners often raise concerns about their elderly pets ability to withstand surgery, chemotherapy or radiation therapy. They are worried side effects will be magnified or their pet won’t do as well overall because they are “too old. “ The age of an animal doesn’t particularly influence my recommendations or my opinion of a prognosis as long as the pet is systemically healthy otherwise. I would much rather treat a healthy older pet with cancer, than manage a young pet with diabetes or Cushing’s disease or heart failure. Ultimately, I feel as though I can actually better predict how an older, relatively healthy animal will do with treatment than a younger animal with concurrent health issues.

As in people, cancer occurs more frequently in older animals. In fact, it is estimated that close to 50% of dogs living to 10 years of age or older will die from cancer. Although the average age at the time of diagnosis will vary with a particular tumor type, most cancers occur in older animals. Therefore the majority of statistics reporting efficacy and/or side effect rates pertain most accurately to older pets. When I explain this to owners, I often see relief they are not alone in considering treatment for their elderly companions.

There is certainly an emotional angle when considering treating geriatric pets with cancer. But what I think is most fascinating is how truly double-edged the angle really is. I’ve treated pets as “youthful” as 18 months and as “ancient” as 18 years. I’ve heard owners of young pets say, “We have to give him a chance! He’s so full of life” just as easily as they say “I can’t see him going through so many months of treatment just to have his already too short life cut even shorter.” Owners of beloved senior animals are just as likely to treat their pet “because he was such a great companion for 15 years, I need to take care of him now” as they are to not treat “because he’s too old and frail to undergo treatment, and I wouldn’t want that for myself if I were his age.”

The right choice isn’t always the easiest one for owners, and so rarely would such decisions be defined in black and white. The best I can hope for is to help guide owners through the difficult times and help provide as much factual information and support as possible. Even if my instinct doesn’t agree with their conclusion, ultimately, we all have the animal’s best interests in mind.

Ben’s owners ultimately elected for palliative care for him, and I’ll admit, it was hard for me to see this. I knew despite his advanced age he would probably do very well with treatment, and chemotherapy would likely afford him the chance of being able to enjoy another summer chasing waves at the beach and going for hikes in the park. I also knew it was not my place to pass judgment and no matter how much I wish I could, I am never able to predict the outcome for my patients, and he might not do as well as the “average dog”.

What mattered most for his owners was Ben’s happiness now, not the prospect of his happiness 6 months from now, and that kind of logic, though slightly difficult to swallow, will always remain perfectly acceptable to me.