Tuesday, October 12, 2010

Making Tough Medical Decisions For Your Dog: Lily's Story

This story is an excerpt from Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life by Dr. Nancy Kay. I chose this story because it particularly touched me, as it is quite similar to a situation we've been through with Jasmine.

I have already told you that this is the The Single Most Important Dog Book You Will Ever Read and I meant it. If you haven't read it yet, stop making excuses and get to it. Trust me, I would give a few years of my life if I could had read it when Jerry walked through the door with the cute ball of fluff that was Jasmine.

When No One Knows What's Truly Best for Your Dog

Shortly after her thirteenth birthday, we noticed our Lily girl [a Golden Retriever] slowing down in the food department. If you are familiar with this breed, you know that this is a serious symptom—in fact, most Goldens would quit breathing before they'd stop eating!
An abdominal ultrasound showed that Lily had a large mass within her liver. We obtained a biopsy using a nonsurgical ultrasound-guided technique, but the pathologist couldn't be certain whether the mass was benign or malignant. My family and I were faced with a monumentally difficult decision. Dare we ask our beloved 13-year-old to endure major surgery in the hopes that the mass was benign and could be successfully removed? Or, should we simply provide her with supportive care, keeping her as comfortable as possible for as long as possible?

Surgical removal of a liver lobe is no walk in the park for any dog, even one much younger than Lily. What if her life ended as a result of surgical complications? How would we feel if the mass turned out to be cancerous and couldn't be removed? How would we live with ourselves knowing that we'd subjected our dear dog to such an invasive procedure during the last few weeks or months of her life?

We thrashed around with our decision for days, looking at it from many different angles, and discussing all the pros and cons. We spent time, lots and lots of time, observing and “talking with” Lily. We studied her demeanor and expression—especially what her eyes were telling us. Did we sense that she was ready to “throw in the towel,” or was she game to take that giant step into the surgery suite?

No one could predict whether surgery would do her more harm than good. When such uncertainty exists, I encourage you to work through what I refer to as a “peace of mind exercise.” My husband and I used this exercise to make our decision for Lily.

Here's how it worked in our case: we were considering two options. The first was surgery in the hopes of successfully removing her liver tumor. The second was to forego surgery, and use supportive measures (special diet, antinausea and pain medication) to keep Lily as comfortable as possible, for as long as possible. Although we felt, based on her overall health, Lily was a reasonable surgical candidate, we had no way of knowing which of these two options was truly in her best interest.

The first step in the “peace of mind exercise” is to play every option out to both its negative and positive  conclusion. In other words, decide what the best possible outcome and the worst possible outcome are for each. When my husband and I did this, we came up with the following:
  1. If we opted for surgery, the best case would be that her disease would be cured and her normal good quality of life restored. In the worst case, the surgeon would be unable to remove the tumor, and additionally, there would be significant surgical complications, perhaps resulting in death.
  2. If we went with the supportive-care option, the best scenario—even if the mass was benign—would be that Lily's symptoms would progress slowly, and she would have another few months of reasonably good quality time. The worst imagine outcome would be rapid progression of her symptoms resulting in the need to consider euthanasia within a few weeks.
Step two of this exercise is to determine which set of outcomes would best serve your peace of mind. With Lily, our goal wasn't to find an option we “liked” (impossible under the circumstances), but rather to determine which we could most readily live with. This was the key to making our choice about how to proceed.

My husband and I were fortunate in that we found ourselves on the same page—not always the case when more than one decision-maker is involved. The process certainly wasn't an easy one. It took a great deal of thought, investigation, introspection, and yes, it required “discussions” with our deal old dog. When we made our choice, did we know with certainty that it was correct? Absolutely not! We did know it was well-informed with nothing but the best of intentions for our sweet girl. No matter how things turned out, we doubted we would have regret; sadness and disappointment perhaps, but no regret.

So, what ever happened to Lily? We decided to take the more aggressive approach. We asked a board certified surgeon to attempt to remove her liver mass. The surgery lasted almost four hours, and thank goodness, the mass was removed in its entirety. And, it turned out to be benign rather than cancerous—the icing on the cake! She took a considerable amount of time to completely recover, but within a few weeks we had our Lily girl back. Her next three years were spent in Golden Retriever bliss (good food, good company, and the opportunity to swim on a regular basis).

Lily lived to the ripe old age of 16! We felt extremely fortunate with the outcome of our decision, but knew in our heart of hearts, that had surgery not turned out well, we would have had peace of mind knowing that we'd done our very best, and stayed true to our good intentions throughout the decision-making process.


DR. NANCY KAY wanted to become a veterinarian for just about as long as she can remember. Her veterinary degree is from Cornell College of Veterinary Medicine, and she completed her residency training in small animal internal medicine at the University of California—Davis Veterinary School.

Dr. Kay is a board certified specialist in the American College of Veterinary Internal Medicine and published in several professional journals and textbooks. She lectures professionally to regional and national audiences, and one of her favorite lecture topics is communication between veterinarians and their clients.   Since the release of her book,
Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, Dr. Kay has lectured extensively and written numerous magazine articles on the topic of medical advocacy.  She was a featured guest on the popular National Public Radio show, Fresh Air with Terry Gross.

Dr. Kay is a staff internist at VCA Animal Care Center, a 24-hour emergency/specialty care center in Rohnert Park, California. As a way of providing emotional support for people with sick four-legged family members, Dr. Kay founded and helps facilitate the VCA Animal Care Center Client Support Group.  She also facilitates client communication rounds for VCA Animal Care Center employees.

Dr. Kay was selected by the American Animal Hospital Association to receive the 2009 Hill’s Animal Welfare and Humane Ethics Award.  This award is given annually to a veterinarian or nonveterinarian who has advanced animal welfare through extraordinary service or by furthering humane principles, education, and understanding.  The Dog Writers Association of America selected Dr. Kay for two awards.  The first was the 2009 Eukanuba Canine Health Award recognizing
Speaking for Spot as the publication that best promotes the health and well being of dogs. The second award was for the Best Blog of 2009 (www.speakingforspot.com/blog).

Dr. Kay’s personal life revolves around her husband (also a veterinarian), her three children (none of whom aspire to be veterinarians) and their menagerie of four-legged family members. When she’s not writing, she spends her spare moments in the garden or riding along the beach atop her favorite horse. Dr. Kay and her family reside in Sebastopol, California.


  1. There are no rights or wrongs in these situations. It is just a matter of doing what you think is best at the time with the information and resources you have in front of you. These resources of course include time and money which most people do not have in abundance.

    So as long you duly consider these factors and keep the best interests of your dog front and center, you will make a good decision.

    Btw, huge liver lobe tumors often carry a pretty good prognosis, though they can look terrible on scans and in surgery. They grow slowly though and can take years to grow back even if not completely removed. :)

  2. Hi Chris, thank you for stopping by!

    Well, from our own experience, I think it would be easier if there WERE right or wrongs. At least that way one would know exactly what to do. Wanting to do what's best for your dog but not knowing what that is can be quite agonizing.

    It's not like buying the wrong stock, the life of one's best friend is on the line.

    When Jasmine was "one foot in the grave" all we wanted to know whether she could recover and regain her quality of life. The emergency hospital didn't think so! But we still wanted a second opinion. We got her quickly transferred to our teaching hospital, their diagnosis was totally different and came with hope.

    So in hopes that she can get her life back we decided to go through with all the treatments she needed.

    We are very happy now, as she did fully recover and her life is as good now as it was before all that happened.