Diagnosis: Cancer

I thought my 13-year-old miniature schnauzer had pancreatitis. He had it once before, and the symptoms seemed the same this time. But it wasn’t pancreatitis, his veterinarian told me. Or leptospirosis. After doing bloodwork, urinalysis and X-rays, the doctor wasn’t sure what was wrong with Jack, my “first-born baby,” who had been with me since he was 9 weeks old. But it was clear something was wrong.

That morning, Jack had gone from his normal self to terribly sick in a matter of hours. He was so ADR — “Ain’t doin’ right,” as patient notes sometimes read — that our veterinarian sent us to Wheat Ridge Animal Hospital, a 24-hour emergency and specialty hospital near Denver.

“Oh, poor baby,” the client service representative said as I carried Jack’s sturdy 25-pound body through the emergency doors. It was a cold February day, and I had wrapped him in a blanket.

Stacy D. Meola, DVM, DACVECC, a Wheat Ridge criticalist and associate medical director, carefully examined Jack. Her recommendations included an abdominal ultrasound.

A little while later, Dr. Meola delivered the bad news as I waited with a sleeping Jack, who was full of fluids and pain meds.

“Jack has multiple masses on his spleen and liver,” Dr. Meola told me. “They could be benign, but we won’t know for sure until we get the results from the pathologist tomorrow.”

Dr. Meola sat close to me. She looked me in the eyes. She possessed a matter-of-factness but also genuine kindness. She seemed sad delivering the news to a woman sitting with her schnauzer in her lap, mascara running down her face. Dr. Meola’s steadiness and confidence helped me stay calm and composed.

It felt like Jack and I were all she cared about at that moment. Like she didn’t have other patients to see or clients to talk with. Like she didn’t need to grab a bite of dinner or hang up her stethoscope and head home. She was the warm blanket I needed wrapped around me.

The next day, Dr. Meola’s call confirmed what I feared most: Jack had cancer. According to Dr. Meola, the pathologist believed it was histiocytic sarcoma, an aggressive cancer.

Jack was at the end of his life, but how Dr. Meola communicated the diagnosis and our options helped soften the devastating news and left me feeling empowered to make the best choice for Jack and our family.

Jack after his cancer diagnosis.

Here are six client communication tips to keep in mind when a patient has cancer.

1. Be Direct and Honest

“I’m very direct with my clients,” Dr. Meola told me later. “I feel that’s the only way to get across the gravity of the situation in most cases. I also like to make sure they understand that we are a team, and as a team, we will make the best decision for their pet emotionally, spiritually and financially.”

Because Dr. Meola, who often diagnoses cancer multiple times a day, is direct and honest from the start, clients trust her when she delivers bad news. She has long conversations about the pathophysiology, diagnosis and client options. At Wheat Ridge, one wall in each exam room is finished with dry-erase paint so practitioners can use the wall to help educate clients.

“It’s not uncommon for me to fill an entire wall with information during a consult,” Dr. Meola said. “Giving them all the information and explaining their options brings them alongside me in making the right decision. They feel they understand what’s going on and that they made the decision, not that I told them what to do.”

When Stephen Cital, RVT, noticed his deerhound-greyhound mix, Diego, limping in August 2021, he called a close friend and colleague: Mountain View, California, veterinarian Cheri Nielsen, DVM, MS, DACVS.

“She’s straightforward and direct, and I think that’s kind. You’re ripping off that Band-Aid right away so the pet owner can process the situation more quickly,” Cital said. “She only gives you the practical and fair options for the animal, which I love.”

2. Don’t Give Too Many Options

“It’s like when you go to a restaurant that has a 15-page menu,” Cital said. “You’re like, ‘What am I going to do?’ Don’t give pet owners so many options that they feel that way.”

Cital recommends narrowing the options to the best three or four.

Dr. Meola offered three for Jack. She said we could try chemotherapy but:

• His type of cancer typically doesn’t respond well to chemo.
• The treatments would cost $6,000 to $8,000.
• Chemotherapy might buy him only six to nine extra months.

Option 2 was hospice care. We could put him on a steroid, pain medications and an anti-nausea drug and monitor his quality of life.

The third option was euthanasia.

I chose hospice care and set alarms on my phone so that Jack wouldn’t miss a dose of his medications. Within a couple of days, he was back to normal. He wanted to eat. A lot. He got excited about his walks. He jumped to catch tossed popcorn. He seemed like a puppy again.

3. Record the Conversation

For many pet owners, the shock of a devastating diagnosis might turn your clear, well-thought-out words into something resembling the voice of Charlie Brown’s teacher. Assume that pet owners will hear and retain only about 25% of what you say. Therefore, record the conversation — or better yet, encourage them to record on their smartphone — so they can listen to it later or replay it for a family member.

4. Provide Educational Information

As soon as your clients stop crying, they’ll Google their pet’s diagnosis. Follow up by sending accurate educational information before they stumble upon potentially inaccurate statements online.

5. Check in

After Jack was diagnosed with cancer, Dr. Meola called me the next day to ask how we were doing. Jack’s primary veterinarian, Margot Vahrenwald, DVM, the owner of Park Hill Veterinary Medical Center, followed up regularly.

Dr. Vahrenwald sent a quality-of-life guide and links to home hospice and euthanasia companies she trusted. That way, I’d have the information I needed when the time came. She also sent unexpected emails asking how we were doing.

Her support helped tremendously, and she’ll have a client for life.

6. Offer Timely Referrals and Virtual Visits

Cital’s Diego was 13 years old and a large dog with arthritis in his back hips, so amputating his front leg, where the tumor was located, wasn’t practical. Instead, Cital began looking for a palliative care veterinarian to prescribe pain medications.

“Everyone was so busy,” Cital said. “They’d tell me they could see us in three weeks, but my dog was in pain. ‘I don’t want to see you in three weeks. He needs you now.’”

Telemedicine could have helped. “There are creative ways we could provide this service … during a dire situation,” he said.

Instead, Cital, a certified veterinary pain practitioner, came up with a pain management protocol and discussed it with Dr. Nielsen, who sent digital prescriptions to a pharmacy near Cital’s home. The medications worked for a while, but then Diego started having breakthrough pain that Cital couldn’t control. In September, a month after Diego’s cancer diagnosis, Cital said goodbye.

In my case, I wanted to get Jack a bath and haircut before he died. It had been about six weeks since his previous grooming, but his groomer was booked out for at least a month, and other groomers weren’t taking new clients. I knew Jack didn’t have much time.

What a fantastic service, I thought, if veterinary practices could offer access to a network of service providers for clients’ sick or dying pets. I’m talking about groomers, photographers, palliative care veterinarians and other professionals with whom a practice has established relationships and who could provide end-of-life services.

Unfortunately, about a month after Jack was diagnosed with cancer, the prednisone that gave him a new lease on life seemed to stop working, which was what Dr. Meola said would happen. On Saturday, Feb. 29, 2020, with a belly full of Freddy’s steakburgers, Jack crossed over the rainbow bridge as he lay next to me on the couch. I was sad, but I was thankful for the team of veterinary professionals who took such great care of Jack before and after his diagnosis.

VALUABLE RESOURCES

PetCure Oncology, a network of six treatment centers, manages a free communication tool that allows any licensed veterinarian to live-chat with a board-certified radiation oncologist, request a therapeutic image review or schedule a patient telehealth visit. Learn more about the Portal for Collaborative Cancer Care at bit.ly/3QMuXW7. In addition, PetCure Oncology has a Pet Advocate Team, a cloud-based call center staffed with oncology veterinary technicians dedicated to helping pet owners and veterinarians navigate the cancer care journey.