By Karin Cannizzo, DVM, DACVIM
As a veterinary internal medicine specialist, we see tough cases every day, cases that are beyond the care possible by other veterinarians. Our job is not typically about fuzzy puppies and wiggling kittens; it is more commonly filled with critical illnesses, serious traumas and cancers. So what makes me smile when I look at tomorrow’s schedule? M&Ms! But for me, it’s not about green or yellow, these M&Ms melt your heart, not in your hand.
The morning’s M&Ms: Missy and Marley! Missy is a gorgeous tan shepherd we have been treating for about 2 months. I remember the day I met Missy, just before Thanksgiving. Her owners had driven from South to North and back down again to try to find help. Missy had been limping on her hind leg, drinking a lot, struggling with urination, and not eating well. Her primary care veterinarian had identified a large mass in her caudal abdomen. She had already seen 2 vets who said they couldn’t do anything about the mass and they were sorry. Would I have wanted remove the mass? Sure, but if we can’t take the obvious route, can we take another way? We couldn’t do anything about the mass, but maybe that’s not how we needed to help Missy.
See, this story is about tipping the scales in the favor of M&Ms, but not about breaking a New Year’s resolution. This is about my ongoing personal resolution.
When I met Missy she felt bad; she wasn’t happy. We identified that she had anal gland adenocarcinoma and it had spread to a lymph node that grown from the size of an almond to a nerf football. We didn’t have a real hope of making this mass go away, but here comes the important part. Missy’s cancer isn’t my priority- Missy is! If we get past the headline and ask “how is the cancer bothering her?” – it wasn’t the size of the mass. We started on pills to reverse the complication of cancer (high calcium). We have been checking on Missy every 2 weeks and she has her wag and spirit back and that’s how I met Marley.
Marley is Missy’s housemate. He has been coming along to every visit since. He patiently waits in the lobby with his owners while Missy has her blood tests. He’s a mid-sized mix with Papillion-inspired ears and he watches for her to come back to him. I love that Missy’s visits are a family affair because to see her with them is a celebration of her improvement. Missy is back to running and playing with Marley again. Even when treatment stops working, we will never regret trying because Missy and Marley have been enjoying this time.
Missy and Marley aren’t the first M&M’s our lobby has known- not by years! My first taste of the joy that are M&Ms were Midnight and Misty in late 2012. Similar to Missy and Marley, Misty would come along with Midnight for his treatments. Midnight was a handsome 10 year old black lab; and Misty: his striking white shepard foil. Midnight was diagnosed with lymphoma. His cancer would not be cured, but we continue treatment to keep him feeling good until his cancer stops responding. His initial treatment course would bring them to the clinic once a week for 2 months, then every other week for another 4 months. His first remission lasted about 1 ½ years and Misty waited for him each visit, eager for her share of affection during my doctor update with their folks.
One visit, about 3 months into Midnight’s second course of treatment, his owner mentioned that Misty had been losing weight. Misty had a visit with their primary care veterinarian and the most unforgiving lightning had struck again. Misty, too, had cancer. Misty’s cancer was not like Midnight’s, medications wouldn’t shrink her cancer and it had already caused her kidneys to fail. I can be honest in that it was difficult to see Misty and her family struggle because we knew her as a friend before she became a patient. We would work for her happiness, but it was short. Her appetite failed as her cancer took over. We lost Misty within a month of her diagnosis. Her loss was hard on the family including Midnight and we still talk about her a year later.
Midnight will be in late tomorrow afternoon for his treatment, and even though Misty isn’t going to be waiting for him in the lobby, we are always working for his happiness. His cancer has come back 3 times now, and each time he has responded as we change his medications. He is having some trouble with his hind leg strength; let’s be honest, he is becoming an old dog. I hate to see him age, but I am so happy to see him age. We should have lost him years ago. His cancer is typically fatal within 3 months without treatment, and even with treatment, average is less than a year. So I owe this boy 3 years of smiles and I will keep working to keep the scales tipped in his favor.
How do we will keep the scales tipped in favor of M&Ms? The same way we always do- focus on the pet’s happiness. We balance the known, likely, and rare risks against the known, likely, and rare benefits. This balance will guide us to the right choices. For Midnight’s visit tomorrow afternoon, we will see how he is doing and adjust his medications to keep his whole body strong- its not just about fighting his cancer. For Missy, surgery would have been unmanageable risk with limited benefit, so we didn’t consider it. But I was suspicious that her high calcium was behind how she was feeling, and medications could help (low risk, high potential benefit), so we tried when others said not to. Tomorrow, she will have some blood tests to make sure she is doing as well as she seems. Are you wondering if she could really be doing well with that mass still sitting in there? When asked, her owner Patty responded: “She feels like she did over a year ago, before ever being diagnosed with cancer”. I’ll take that every time. Oh, and those other M&Ms: green are my favorite, but they definitely tip the scale the wrong way.