“What would you do Doc?”
Dr. Peter Maguire
DVM, MS, Diplomate ACVIM-Neurology
“What would you do if it was your dog?” I get that question a lot. And unless I’m on an airplane, or talking to a relative, it’s not just a question of when to spay, or what vaccines to give, or how to best house break. Usually they are questions regarding Magnetic Resonance Imaging (MRI), surgery or radiation therapy for the spine or brain. Not just what are they, how much do they cost, but should I pursue these things for my pet or not. They are issues that involve significant expense, risk, and ultimately the quality of life or death of a pet, a family member and a friend. The questions of what to do are posed in the face of life threatening illness, and perhaps more importantly, quality of life threatening illness. You’ll be shocked to realize, there is never a ‘right’ answer, a clearly correct decision or path to follow. The decisions would be easily made in that case. With just one glaringly obvious path for which the benefits clearly outweighed the risks and the costs, decision-making would be easy. It’s rarely easy.
The problems in pets for which my services are sought include spinal problems causing paralysis, weakness, wobbliness and/or pain. Brain issues causing vertigo (vestibular dysfunction), seizures, disorientation, coma. These are big problems, difficult to definitively diagnose without the help of expensive tests like MRI, CT scan and myelography (precision injection of contrast around the spinal cord enabling its visualization on plain x-rays). Treatment options for these problems are sometimes medical, but are often surgical (like spinal surgery for “slipped disks”). For cancerous tumors of the spine or brain, sometimes radiation therapy is the only optimal treatment alternative. So the combination of serious quality of life threatening or life threatening problems, expensive diagnostics and high risk costly treatment options begs the question....”what would you do?” A question born in the throes of emotion and indecision.
Tucker was my dog. A tail thumping, stuffed animal nursing, easy going, lover of all things in general, and food in particular, Chocolate Lab; a sage in a dog’s body. He was my companion, friend and mirror for almost 14 years. He went through Vet school, internship and Neurology residency with me. We spent time living in 5 different states and twice as many homes---one of which was a tent for the entirety of two different summers (Colorado and Alaska). He went everywhere with me, and knew me better than I knew myself at times. At the age of 12, he fell over in the yard one day, literally rolling and could not right himself. The event lasted less than a minute, and then it was over; no ongoing signs. The problem was clearly (to me) a vestibular event (vertigo), but unusual in that it was so short and seemingly completely self-limiting. I waited and watched; concerned, but no alarms going off just yet. A month and 2 more events later I took Tucker for an MRI of his head.
Why?--”What would you do if it was your dog?” His signs told me he was having intermittent vertigo. Vertigo is common in dogs and cats and there are a variety of causes, some serious, some completely self-limiting without intervention. The intermittent, yet persistent nature of Tucker’s vertigo was atypical. I chose to do MRI because I needed as much information as possible with which to make subsequent decisions. I needed to ‘know’, rather than guess.
I had decided that if he had a brain tumor, I was unlikely to pursue radiation therapy, but I needed to know, and a brain tumor was not the only possible explanation of his signs, no matter what statistics told me.
The MRI showed a rare primary tumor (cancer) of his skull, not his brain! It was growing into the back of his brain, not outward where I might have seen or felt it. The pressure on part of the ‘balance center’ of his brain was causing his signs. The options were to do nothing (just give medications to help him maintain some quality of life living with this growing cancer), put him to sleep, or surgery; at that stage, his balance was so often bad, that his quality of life was not good. Surgical removal amounted to removing the back of his skull, from which this tumor was growing. It would be high risk and it would not cure him. The goal would be to restore his quality of life for as much time as possible.
When his quality of life deteriorated, I decided on surgery. It was either that, or put him to sleep. I contacted the very best at UC-Davis and at Colorado State’s Vet school, but ultimately decided to do the surgery myself. I wanted Tucker’s fate to be in my own hands. I decided that I would have regretted it any other way if he did not live through surgery; an accepted and very real risk. I would be prepared to euthanize him on the surgery table if I did not think he could recover to a good quality of life. He was at a point where he could no longer function.
I had one more great year with Tucker. Surgery had gone well, although from that time on he always had a bit of a surprised look on his face---so much tissue removal from the back of his head and my less than optimal plastic surgery skills left him with a bit of a face-lift. What the heck, the tail was thumping again. The extra time was invaluable to me. He was happy, and I had another year to help prepare me for the inevitable goodbye. It was a good decision.
For me personally, “what would you do if it was your dog” is a fair question to ask your vet. Many people seem to ask it sheepishly, reluctantly. As if they are asking for something they are not entitled to. It is a simple question...what would I do...I welcome the question, and I give an honest answer. I also make it clear that circumstances are always different (usually there is very little or no cost when treating my dog---big difference).
There are more variables than you can imagine which influence a person’s course of action for their pet. This is one of the biggest challenges I face daily in my exam room. The medicine is not hard. Although far from perfect, and constantly changing, the medical choices are finite, the algorithm not hard to follow. The decision making, which path to choose, that is the hard part. There is so much medicine we still don’t understand, so many questions for which my answer is “I don’t know”--I also know, no one else knows either. An owner stated it simply for me once...”I always envisioned medicine as a science, but its really much more an art”. What I would do if it was my dog, may not really have relevance, but it is a fair question, and I give an honest answer. If it helps with your difficult decisions, then its purpose is served.