When a four year-old Golden retriever comes in with a generalized lymphadenopathy and my aspirates are consistent with lymphoma, I don’t ever mess around. I send them to the oncologist ASAP. I’m sure most of you with ready access to oncologists do the same. But do your clients consistently take your advice?

If your practice is anything like mine, it’s about 50-50 –– as in, 50% will go all out with the now-standard six month chemo protocol or even the new-fangled radiation technique. The other 50% might go for one dose of Elspar, but most of my chemo deniers elect steroids and/or euthanasia.

The question is: Why so many in the chemo denial camp? To be sure, a great deal of it is financial. Even so, that only explains about half of those who refuse to treat. The rest of these are solidly opposed on humanitarian grounds –– which drives me crazy!!

Money wasn’t much of an issue for my first lymphoma patient of 2012. Her owner had plenty of it. It was more that the concept of chemotherapy weighed so heavily on her that she’d been intractable on the subject: “No chemo for Missy. I won’t do that to her! I don’t want to put her through it! It’s not fair to her!” And plenty of other iterations of the theme.

Much though we explained that chemotherapy patients in veterinary medicine experience fewer, less serious side effects and that any untoward effects tend to be less dramatic than the current effects of the cancer most of our newly-presented patients are currently experiencing, this client was convinced of the inherent evils of chemo. Her mother had suffered terribly from the side effects of chemotherapy before succumbing to breast cancer and she was terrified of seeing Missy go through the same.

Which all of us can absolutely understand. We all know how difficult the memory of chemo can be for both patients and their caretakers. I still recall how one of my classmates in vet school, fresh out of chemo for his non-Hodgkins lymphoma, claimed he’d rather die than go through chemo ever again. The irony is that today he’s a veterinary oncologist who prescribes chemotherapy every day of his life –– which, to me, is a sure sign as any that veterinarians don’t treat pets like people.

But it’s not just the side effects that weighs on my clients. Lots of it is the time bomb factor, as I call it. Living with an animal who might as well have an expiration date imprinted on his forehead can be challenging for some people. I get that. But the same is true of so many diseases that I can’t help wondering why it is we address highly treatable, chemotherapy-amenable cancers so differently from thyroid disease or Cushings, for example. What’s so freaky about chemo?

So what’s a veterinarian to do in the face of such fervent denial?

I believe pet owners facing the chemotherapy decision should always be introduced to the concept that veterinary medicine differs fundamentally from human medicine and that we do NOT treat pets like small humans. Here’s how I couch it:

Because animals do not have a conception of their own individual futures, asking pets to shoulder the burden of prolonged suffering (as many humans do with chemotherapy) would be considered cruel. Since they’re unable to understand the need for their discomfort or envision a future free of their current state, we try never to undertake interventions that involve significant periods of pain, sickness or stress.

Sure, that means we’re less likely to “cure” a pet’s cancer than merely keep it at bay, but it’s a reasonable concession –– especially given that a pet’s lifespan is considerably shorter than a human’s. After all, one year of survival for a pet is equivalent to seven to ten for a human. So thinking about it from the pet’s POV, even one year of comfortable life is a wondrous thing.

But this “too complex” rationale wasn’t working for Missy’s owner. She elected to go the “natural” route using some internet snake oil she’d ordered. (I know it’ll come as a shock but not everything you read on the internet is true.) So instead of watching a sick pet get better after just one injection ... instead of being granted the ability to spare her those final days of anguish, we spent the first week of this new year witnessing the agonizing decline of a wonderful dog. 

Yeah, sometimes being a veterinarian just. plain. sucks. But I don’t really blame Missy’s mother all that much. Though most of us like to think we’d do anything to save our pets, not everyone agrees on the value of each and every kind of therapy. We all draw our own lines for all kinds of reasons –– rational and irrational, alike.

Sure, I’d never have let my own pet die like that –– few of us would –– but what’s a veterinarian to do? Ultimately, we’re only capable of offering our medical advice, providing educational opportunities anyway we can, arguing our case as convincingly as possible, and letting the chips fall where they may. 

Do I wish Missy’s would’ve fallen otherwise? I do. But, contrary to popular opinion, the veterinarian doesn’t always have the last word on how a dying animal goes down.