The Dog Cancer Survival Guide (87 page)

In the end, the decision about how to finish your dog’s days cannot be made by anyone but you. The calmer you feel as you make the decision, the more confidence you will have in it.

If you are ready to stop focusing on treating the cancer and start focusing only on your dog’s quality of life, dog hospice might be a good choice for you. There are several practical things you can do for your dog to make him comfortable in his last days. First, I want to tell you about a fascinating phenomenon described in the
New England Journal of Medicine:
human cancer patients may both live longer and live better with palliative hospice care.

In a study that looked at human patients with non-small-cell lung cancer, those who received early palliative care with reduced chemotherapy treatments lived an average of almost two months longer than those who received standard chemotherapy treatments alone. Other studies, which looked at breast, prostate, colon, pancreas and other cancers, revealed that patients who received palliative care along with standard treatments lived longer than patients who received just standard treatments – with gains ranging from averages of twenty to sixty-nine days.

Palliative care attempts to shore up quality of life. Longevity is not the main goal; the emphasis is whether the patient feels good physically, psychologically and emotionally. While I recognize that this research has all been done in humans so far, I think that we can safely make the case that palliative hospice care may be very helpful to our dogs.

From a conventional mindset, stating that palliative care can extend life doesn’t make much sense. However, when we look at this from a Full Spectrum mindset, it does. Chronic pain creates a lot of unhealthy circumstances in a dog’s body. If you’ve ever had a headache that just wouldn’t quit, you are familiar with the emotional, physical and psychological stress that accompanies this kind of chronic pain. As you’ll remember, stress may suppress cancer-fighting white blood cells, like the natural killer and cytotoxic T-cells. Aggressively relieving pain, as is done in palliative care, may relieve that stress and allow more of these helpful cells to flourish and do their jobs.

Sometimes guardians worry that starting palliative care is giving in to cancer, or giving up on their dogs. Maybe, in light of this research, it is the opposite. It might be helpful, at a certain point, to stop trying to “fix the problem” of cancer and allow the body to just feel good.

To start palliative hospice care for your dog, shift your focus away from life extension and move it toward providing comfort and pain reduction. There are several areas to address:

If your dog isn’t both clean and dry, she is probably uncomfortable and at risk for developing skin irritation and even sores. If your dog soils herself, make sure to give her a gentle sponge bath with slightly warm water and a soft cloth, to remove urine and feces. If incontinence is a routine problem, she might need sponge baths two to three times a day.

Most dogs in hospice care cannot move easily and spend most of their time lying down. Unfortunately, staying in one position for a long time reduces circulation to the part of the body in contact with the ground. This can cause ulcers, or bedsores, which are painful and hard to heal (this happens most often in larger breeds). To prevent bedsores, make sure your dog is lying on a thickly padded surface and rotate him from side to side so that he doesn’t lie on one side for too long. At least every six hours, gently gather his legs to his belly and roll him over onto his front, and then onto the other side. (Do not roll your dog onto his back, particularly if he is a deep-chested breed, because this can cause a condition called gastric dilatation and volvulus (GDV), also known as “twisted stomach” or “bloat.” GDV is a veterinary emergency.)

Pads in the shape of donuts can also be helpful: secure them to sensitive, high pressure areas like the elbows and knees with light tape.

Some dogs in hospice care have completely lost their appetites and refuse most food. Appetite stimulants, like B-complex vitamins, prednisolone, mirtazapine, MegAce (megestrol acetate), Winstrol (stanozolol) and cyproheptadine are sometimes used, although they may not help that much. Many dogs, however, will still be tempted by food that seems interesting. Throw away all of the rules you learned about what to feed your dog with cancer and give him whatever his heart desires. Whether it is meat, broth, angel food cake, junk food or cat food, go ahead and tempt your dog with anything that moves him to take a bite (the only exceptions are the foods that we know to be poisonous for dogs: chocolate, onions, grapes and raisins). Indulging your dog’s remaining appetite is an important life quality treatment.

“Your book gave me hope and the knowledge of what and how I could help Kristi in her final days. Every morning we would pray together then we would go back into time and remember our life together. From the first day I met her, carrying her in my arms, training her every day, playing ball and catching Frisbee, we were inseparable. She would listen and lick my face, wiping my tears away. Remembering and talking about it with her, made the sad moment turn into happy times. It would even perk her up and we’d play for a while. (Her memory will never die.) She was a puppy at heart and would wonder what was wrong with her. I explained why she would get tired so easily and couldn’t run and play like she used to. I told her about the place called heaven and there would be endless fields to run in. When the time came for her to go, I told her she would get all her strength back and could play again, but I wouldn’t be there. Papa would be waiting for her, and one day, we would all see each other again. As much as I tried, I couldn’t hold back my sadness and turned to wipe away the tears. When the time came to put her down, she knew it would break my heart, so she gave me one last gift, a gift of love. We played tug of war with one of her favorite shredded, busted up toy one last time, and then Kristi passed away quietly in her sleep the next morning. I am so glad that we had that and many other moments to share and the time to remember our lives together. Thank you!”

- Lois Boesing, Ewa Beach, Hawaii

Dehydration is both painful and dangerous, so prevent thirst and entice your dog to drink about one ounce per pound of body weight over a twenty-four hour period (for example, a ten pound dog would drink ten ounces over twenty-four hours). If plain water does not tempt him, try using chicken or beef broth, soup, or any other liquid. If you can’t get your dog to drink, you can try using a turkey baster to squirt fluids into the back of his mouth. If even this isn’t working, injecting subcutaneous fluids may be your best bet. You can get fluids from your veterinarian, who will show you how to administer them at home by injecting them under the skin.

Pain management is a priority in palliative hospice care. In addition to the pain measures outlined in
Chapter 17
, you might consider sustained-release oral morphine. Some dogs don’t like it and get whiney. If your dog tolerates it, it may be his new favorite pill.

Fentanyl patches can be used for a few days of pain relief. It is important to ensure that the patch is not chewed off and consumed, or a dangerous dose of Fentanyl may be absorbed. Usually these are placed in an area that is hard to reach, or covered with a bandage, and an Elizabethan collar may be needed. Your vet or oncologist will help with the application of the patch.

We veterinarians have just started to explore the idea of using medical marijuana in dogs. We don’t yet have studies about its use in dogs, but we do know that about 25% of the dogs who take the prescription gel-cap form, Marinol, become quite agitated and vocal. It’s very expensive, and using it in dogs is very “outside the box;” if this is something you want to explore, your vet may be able to prescribe it, depending upon where you live.