Josh, a 15 year old Cavalier King Charles Spaniel who has liver cancer.

Claire clearly remembers meeting Josh: he was a tiny puppy in a big cardboard box, gazing up at her with his brown eyes. Claire was only eight years old, in second class at National School, and the puppy was a present for her first communion.

Fifteen years later, Claire is studying for her Masters in Biomedical Science in London. She comes home as often as she can, and Josh always has a warm welcome for her, wagging his tail and squealing in delight as soon as he sees her.

For much of the past five years, Claire has been living in the UK, and she’s had to say many tearful goodbyes to Josh. Cavalier King Charles Spaniels are not renowned for their longevity, with many only living to twelve or thirteen years of age. Whenever Claire has headed off for a new term at college, she’s given Josh a final cuddle before stepping out the door, thinking to herself that there was a chance that she might not see him again. Up until now, Josh has defied the odds, remaining in excellent health at all times, and showing few signs of the advancing years.

Last week was the first time that Josh had a health crisis. He suffered a digestive upset, and he became dull and unresponsive. He didn’t want to get out of his bed, and he wasn’t interested in his dinner.

When I examined him, there were no initial signs of any significant underlying disease, so I wondered if perhaps he had just eaten something that had disagreed with him. I gave him general supportive treatment overnight, hoping that he’d pick up by the next morning. In fact, he deteriorated dramatically, still not wanting any food, and now refusing even to stand up. It was obvious that there was something more serious going on.

Josh was hospitalised for more intensive investigations and treatment. Blood tests, x-rays and a detailed ultrasound examination pinpointed the cause of his problem, and it was not good news: Josh had a tumour on his liver, the size and shape of a golf ball.  What should be done now?

I gave him general medical supportive treatment for liver disease while Claire’s family considered the options. In theory, a radical operation to surgically remove the liver tumour was possible, but even then, there was a chance that it was malignant, so an operation might not be curative. And there was a risk that he could die on the operating table. Would it be kinder to consider euthanasia, quietly and painlessly bringing his life to an end? And what should they say to Claire, who was away in London at the time?

Luckily, Josh responded well to the general treatment. He perked up, starting to eat again and recovering his normal zest for life. Claire arrived home for a weekend visit, and she was filled in on the details of his illness. A joint family decision was made to continue to give Josh palliative medical treatment for as long as he continues to enjoy life. Surgery is not a realistic option in this situation: very few Cavaliers live beyond sixteen years of age, and if Josh was saved from liver cancer, there would be another health crisis in the near future.

After another sad goodbye this week, Claire went back to London to continue her studies. Her beloved little dog has defied everyone’s expectations up until now, and she’s hoping that he’ll do it again. Claire will be back later in the summer, and she’s hoping to see Josh’s cheerful face looking up at her. Will he make it? Only time will tell.

Tips

  • A diagnosis of cancer does not necessarily mean “the end”
  • Palliative care can ease many of the signs of cancer related illness
  • Some pets can live with cancer for months or even years

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