Pet Cancer: What Most Owners Don’t Know About Diagnosis, Treatment, and Quality of Life

What happens when your beloved pet gets diagnosed with cancer? In this episode of the Call the Vet podcast, Dr. Alex sits down with board-certified veterinary oncologist Dr. Nicole Leibman for a candid, myth-busting conversation about cancer in our furry family members.

From the most common warning signs and why early detection matters, to breakthroughs in treatment (including cutting-edge immunotherapies!), Dr. Nicole shares insider expertise and heartwarming stories from her work in New York City.

Whether you’re worried about a lump on your pet, curious about chemotherapy side effects in animals (hint: it’s not like in humans!), or just want to understand how specialists and general vets work together, this episode is packed with practical insights and empathy.

Plus, you'll hear about a revolutionary in-home nursing service that's changing the way pet care is delivered.

If you love your pets and want the best for them—don’t miss this heartfelt and eye-opening chat!

Dive deeper into the topic over in the full show notes - https://ourpetshealth.com/info/pet-cancer

Love the show? Sharing this episode or leaving a review helps others know it's worth a listen! - https://ourpetshealth.com/review

Transcript

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I always tell people this is not a big decision. It's a little decision. All you have to decide is if you want to try. If you don't like it, we stop. No one's signing a contract. No one's holding you to anything. It's one tiny little decision to give one treatment. That's the only thing you need to decide if you wanna keep going after that. We'll keep going. Each week we get to ec, decide what we're doing. Welcome to the call the vet show, the podcast that helps pet parents understand and optimize the health of their furry family so they can live the full and happy life you want for them. And here's your host veterinarian, Dr. Alex Avery. Hello Kiara, and welcome back to another episode of the show. You know, cancer is one of the scariest words a pet parent can hear, but it's also one of the most rapidly advancing areas. Of veterinary medicine, you know, the, the rate of improvement in the care that I'm able to offer my patients has improved hugely over the last 20 years that I've been in practice and the field of oncology. So that is. The, the study of cancer and its treatment is an area that has just exploded with a lot of different options in terms of diagnosis, in terms of treatment, in terms of best caring for our pets, should they be struck down with the Big C. And in this episode, I'm joined by the wonderful doctor Nicole Lieman, who is a board certified oncologist. So she is a cancer specialist, and we are going to talk. All about what you need to know about cancer in dogs and cats. We're going to talk about how common cancer is. Is this changing over time and why that might be the case. We're going to talk about recognizing the early signs of cancer, how that diagnosis is made, what the treatment options are, depending on the type of cancer, depending on your outlook, depending on your budget, depending on your pet. We're also gonna talk about owner considerations. Balancing costs, balancing quality of life, balancing just your capability to transport, to give medication, all of that good stuff. And then we're going to wrap everything up by talking about how you can get the best support. So no matter what you choose for your pet, they can get the care that they need and you can get the help that you deserve. Here's this episode's expert interview. Doc Nicole, it's wonderful to be talking to you and welcome to the show. Thank you so much. So happy to be here. So you are a board certified oncologist, a cancer specialist, and I guess the obvious place to start is I'd love to hear what kind of attracted you to, to that area of work. Hmm. Well, it's a good question. I mean, like most people, you know, I wanted to be a veterinarian my whole life, uh, since way back when, when I can remember, in fact, when I was four years old on Christmas, my German Shepherd, who probably had Hermando sarcoma, right, he collapsed in the street and we took him to the animal medical center where I have. Spent my entire career. I knew at four years old that I wanted to work at this hospital. And um, so he went there and things did not go so well. And, uh, I just said, I want to come back here when I grow up and I wanna work here. And I did. And I didn't know I wanted to be an oncologist, of course. Uh, but I. I was in vet school and I had a lecture my third year from a guy named Jeff Klausner, who actually was, ended up being the dean at the University of Minnesota and ultimately came and was the CEO at the Animal Medical Center. And he was just a wonderful man and so inspiring and smart and gentle and kind, and I just, I wanted to grow up and be just like him. So I decided I wanted to be an oncologist. That's amazing. I guess it's a common, it's a common theme, isn't it, that people knew from a very early age and, and often it's that personal family pet that that really triggers that, that interest and that that desire to, to go and help other, other animals. For sure, for sure. You know, it's all for me, it's definitely about the animals, but I think the older I get, it's really about the human animal bond, right? Yeah. We take care of these animals because they take care of their people and you know, it's living in a big city like I do, where you know, there's so many people, but there's so much loneliness and so many people live alone and there's so many. You know, there's so many elderly people and disabled people and their animals are really their lifeline. So for me, that's why I do what I do. Yeah, absolutely. And, and how people open up to us in the consult room can be remarkable sometimes. You get that whole family history and, and become their, um. Yeah, they're confidant as well. Try, try living in New York City. Yeah, it's uh, never a dull moment. I bet. Um, I guess like, so, so with cancer, cancer impacts, that's your, your bread of butter. How common is, is cancer, I guess as a, as a top line question. Um, 'cause it's the, the, I guess the diagnosis that every pet owner dreads. And, and do you feel that has changed with time or how has that changed with time? Yeah, well, you know, the older our pets, you know, the longer they live, the, you know, their DNA repair mechanisms get lazy and we see more cancer. I mean, 50% of dogs over age 10 will develop cancer, one in four dogs during their lifetime and one in five cats. So it's, I mean, I'm booked, you know, I'm booked for months and months and so there is no shortage, sadly, of, of pet cancer out there. Yeah. And, and really, do you feel that it's that aging population that's, that's maybe driving the, the increased rates?'cause I know there's a lot of noise out there online that may suggest, you know, different reasons. Oh, I think it, it absolutely, I mean, listen, do I see younger animals? I do. And. Terribly sad. I have a 3-year-old Bernie's mountain dog. Now I have a 4-year-old cat with really progressed lymphoma. But you know, that's not the common Yeah. Theme. And mostly when we see it in younger pets, it's it's breeds that are overrepresented or they're feline leukemia positive. There's a reason generally not always. Why we see cancer in younger animals. Um, but the vast majority are older. They're geriatric, and like I said, you know, their bodies are just not working like they used to be. We've done such a great job in controlling infectious disease. The animals in New York City are, are indoor animals, or they're leached animals so they don't get hit by cars and they're, you know, they're well protected and well cared for. And so they live a long time. And when you live a long time, you're at greater risk for cancer. The same situation in people. Fantastic. I mean, that's a, that's a, a great insight and, and I, I guess quite pleasing to hear because there's a lot of scare stories out there, but that certainly my, my impression as well, we've got a lot more older dogs and cats and, and unfortunately that age brings, brings with it, with it problems. Um, in terms of that early recognition then, or, or the signs of cancer, I mean, it's a, it's a bit of a difficult question to answer. I appreciate because there's so many different types out there, but what are the common. Things that people should maybe be thinking about or maybe should be watching out for with their pet, that that might be a, a bit of a red flag, that there is something a bit more sinister underlying. Yeah, I mean, you know, it's, it's anything that feels not right. You should trust yourself, right? Like, we should never wait. There's never, ever, ever a reason to wait on anything with yourself, with your pet, with your kid, with anything. And so any lump or bump or change in urination or defecation or decreased appetite or vomiting or you know. The hair coat looks different if there's a smell to their, an malodorous, you know, smell to their breath. If they have trouble urinating, if there's discolored urine. A anything, you know, I could go on and on and on and on. Any sore that hasn't healed, especially at the nail bed, in the mouth, you know, anything. Anything that feels abnormal probably is. It doesn't mean it's something serious, but you know. We know that the best way to treat cancer is to prevent cancer, um, or early detection. That that is a universal rule no matter what's, whether it's an elephant or a child, or a pers, you know, an adult. Sure, sure. And I guess, yeah, that early, that early. Seeking help at an early stage is really important. I guess people will often Google symptoms and pretty much any symptom will come up with a potential cancer diagnosis. So people can get very scared and I've certainly seen that where they've, they've googled the symptoms ahead of time and they've come to me convinced that there is cancer. And actually more often than not, thankfully it's not the case. But if it is and we get it early than there's so much more that we can, we can be doing. Absolutely. In terms, especially with the solid tumors, right? Like Yeah, you know, the hematopoietic malignancies, like the lymphomas and leukemias, those are diseases that generally come on very quickly. But the solid tumors, you know, like breast cancer and you know, bladder cancer and you know, anal gland cancer, those are tumors that when they are identified early on, you know, they can have high cure rates. Sure. And with those, with those solar cancer, I guess that's a good place to start with diagnosis. How, how are we reaching that diagnosis of, okay, there's a, a lump that we've found or there's a problem that we've identified, and how are we transitioning then to achieving that diagnosis? I mean, I think it depends on the situation and, and who you're seeing. But you know, in, in my opinion, and from my perspective, you know, you never watch and wait. It, it's just, why, why would you watch and wait? You know, if there's a mass, it should be aspirated. You know, everything. You can stick a needle in anything. And so that's what should happen. And that should always be sent out, right? Like there's a, there's a law in. In New York, in New York state where anything that comes off the body has to go to a pathologist by, by law, that's in people, not in animals, but we try to, to, um, work at the, at the level and the standards of, of human medicine. And so, you know, um, no, no generalist, no oncologist, no surgeon. Is a is a clinical pathologist or an anatomic pathologist. And so whatever you do, you should send off and you should have the people that do their jobs do it best and we should see what, if it's a lipoma, great, we're done. And if it's not, then we have to proceed further. But any lump or bump should be aspirated. There is no question. Absolutely. And it's something that is. Very, it's a very simple technique. It's something that, I mean, it depends on where it is in the body I guess. But if we're talking skin lumps, then that's which are, are the most common. Certainly in my experience. It's not something that needs sedation. It's something that's very, you know, very quick, very noninvasive and, and what a wonderful way to be able to. To achieve a diagnosis without having to run a huge plethora of tests. Absolutely, absolutely. And there's so much you can do, right? There's so many, you know, from a specialist perspective, which, you know, we don't need to spend a lot of time here, but there's so much you can do with that sample. You know, you can look at it under the microscope. You can do, you know, you can, I don't know if you've heard of a test called Vim. But it's a, like a, it's a genomic analysis test, which, you know, is obviously, it's mostly cancer specialist surgeons that are using it. But you can look at, you know, certain genetic markers on that tumor. And then based on that, you know, certain, you know. Therapeutics, um, are, are recommended based on targeted therapy. And you can do that just on an aspirate. Like it's, it's remarkable what we can do now. It is amazing and I mean, I guess you are in the, the parts of the world where all of these tests are really readily available. I know where, where I am in New Zealand, it's often a case actually of sending samples. To the states, um, which can be challenging from a time and logistic and, and cost point of view. So, um, yeah, I guess there is that, that variety there. Um, I wonder how much some of the increase, just going back to the, the, the incidence of cancer, how much that. Potential increases just'cause our ability to diagnose is so much better as well. I mean, that has to be part of the story. You know, I, I, it's hard to measure that, but it Sure. I think it's a combination of they're living longer, people are more committed, right? So they're living longer, but people are also more educated. Uh, they can access information readily. Um, pets more and more are, are treated as family members. And our diagnostics have gotten better and quicker and more easily accessible. So I think you combine all of those pieces of the pie and you have a higher incident slash prevalence of cancer. And so, you know, um, good news, bad news, right? Yeah. It's, yeah. Well, I mean, you can only, you can only treat what you know is there as well. So if you don't know it's there, then how are you specifically treating it? So it, it can't, I guess, be a bad thing once that, um, Dr. Nicole, once that cancer diagnosis has been made, I guess. Um, people might hear a lot of terminology, different terminology, cancer terminology thrown their way when it comes to grades and stages and metastasis and benign and malignant. Um, I'd love for you to be able to break down some of those more, more common ones for us. Sure. Um, you know, um, you want me to talk about a specific disease or just those terms? Just those terms in general, I guess.'cause that's gonna, you know, otherwise it's varying by cancer. I think. I think people confuse them. You know, very commonly everyone comes in and wants to know, like. What, you know, they, they, they interchange the words grade and stage, which are very different. Right? Stage tells us where the tumor is and if it has spread, you know, in the body. And grade is what the tumor itself looks like under the microscope. So they're two, you know, very different, uh, terms and. But what's generally most, most interesting to people is, you know, what stage is, you know, and, and we, we glean that information from the human arena, you know, 'cause people are very, are very familiar with colon cancer and breast cancer and lung cancer, you know, the most common cancers in people. And so they want, you know, they wanna label, they wanna understand. You know, the, the problem with that is that the most common cancers that we see are lymphoma in the cat and the dog. And those are not, we sage them, but it's, it's not, it doesn't change things much, especially in the cat. Most cats have abdominal lymphomas. Of the intestinal tract, of the liver, of the spleen and staging it doesn't, doesn't offer us, you know, that much more information. And in dogs, you know, they usually have their, their peripheral lymph nodes under their chin, by their shoulders behind their knees. Those lymph nodes get enlarged and yes, we stage them and we like to know if it's in the liver or the spleen. Um, but it doesn't. You know, it, it doesn't change really how we treat them. So it doesn't offer us that much more information. It's much more, um, you know, prognostic when we talk about oral melanoma, right? So that's an important tumor to talk about stage, and that's all based on how large the tumor is and whether it has. Spread to a local lymph node, or it has gone to a, you know, a, a distant organ like, like the lungs and that that holds true for breast cancer, for urinary tract cancer. Um, and any, you know, any sort of solid tumor staging them and talking about what stage there is much more prognostic. Yeah, sure. So I guess for clarity, that stage is, is. Where, how, how much it's spread in the broadest sense of the word and grade is the behavior of that particular tumor. So we can have like a low grade mast cell tumor, which is potentially less likely to spread to other parts of the body versus a high grade, which is much more aggressive. Exactly. Yeah, exactly. I saw a little, a little pug today. Such a cute little pug. And, um, he, uh, you know, all the pugs in the United States were overweight. It's just like an epidemic in pub, not just in the United States. Um, and this one was intact, so he had a lot of circulating testosterone, which made him very, very handsome and, and, and quite. In shape and he, um, only four years old and had already had six mast cell tumors. Right. But, but the good news is that they were all low grade, right? They all looked, you know, very what's called well differentiated under the microscope. They resembled normal tissue as opposed to, you know. Less resembling normal tissue, which means that they behave, you know, they're malignant, but they behave in a more controlled manner. So he's only four. He had all these tumors, they've been removed. He will continue to get tumors because there's a syndrome in pugs called mu multiple mast cell tumor syndrome, but we pay very close attention to the grade and how we treat that. Yeah. I've got a boxer who's a patient of mine who is a little bit older, but we have. Done numerous surgeries and they keep coming, coming up, but we keep doing what needs to be done and doing very well as a result, what, what we usually do with, with those kind of dogs is we save it up, right? Yeah. We're like, okay. Surgery three times a year. Save 'em all up. Yeah. And then we'll go and we'll take 'em off. Yeah. Otherwise you need that weekly appointment. Yeah. Um, so, so ca so I guess, I mean that's a great way of saying that some, some cancers we can. Uh, very easily in inverted comm is cure with surgery. We are removing them. We are removing them in their entirety. Uh, what other options do we have in our cancer treatment arsenal? Sure. I mean, there's, you know, there's, there's the basics, right? So most, um, solid tumors are amenable to, you know, surgery is the treatment of choice for most solid tumors. And when I say solid tumors, I mean tumors that you can. Sort of actually put your hand around, even if it's, you know, internally and surgery is the treatment of choice for those, it doesn't mean it's always possible. Sometimes these tumors are too invasive or too large or too vascularized, and in that case then we have to seek alternative therapies. Um, the other two, um, sort of mainstay, you know, treatments are chemotherapy. I'm a medical oncologist, so you know, I'm a chemotherapist. We use all the, you know. Common types of chemotherapy that are used in in people. And then we have a few that are veterinary specific and then there's radiation therapy. And for those of you know, in the audience that don't know what radiation is, it's like, it's a very, very strong x-ray. That's given generally daily or weekly on a regular basis to try and damage DNA of cancer cells, just like chemotherapy does, and as opposed to surgery. That is a physical sort of treatment that removes the mass itself. Sure. Sure. That's, that's a great summary. Uh, are you finding that there, 'cause I mean, I've, I guess what oncology is one of those disciplines where I feel that there has been a huge amount of change and improvements in the 20 years that I've been practicing. Um, but especially now that you're getting more and more, much more targeted treatments, are they, something that's being rolled out are kind of immunotherapies and more novel treatment options. For certain, for certain. I mean, we're still in the infancy when it comes to this, but they're, but we're getting there. You know, immunotherapy is certainly, um, um, on the rise and, you know, we're. A decade behind where they are in people where, you know, it's remarkable. I, I do work with, um, the folks at Memorial Sloan Kettering, which is a large, you know, cancer center in New York with the people at Cornell, um, and NYU and, um, you know, they've, you know, metastatic stage four melanoma in people that used to be a death sentence isn't anymore. And it's because of this class. Of drugs called the checkpoint inhibitors, specifically PD one inhibitors. And, um, it's remarkable, right? Like if in our lifetime that we've seen, you know, such a, um, change and advancement and, you know, there, there we're, we're getting there. There's a, there's a drug now called Gil Vab that is a PD one inhibitor. Um, there's very little data out there. We don't know much at all, but we're hopeful. Um, you know, it, it's, um. Intended for use in melanoma and mast cell disease. So we'll see. It's exciting. There are immunotherapies out there, there are autologous vaccines where we take a patient's own tumor and then combine it with their cells. Um, there's one, you know, indicated for osteosarcoma. So there there is, there is immunotherapy out there. There's. You know, the melanoma DNA vaccine that's been around for a long time, and that's been shown to be very effective. So we have some treatments out there and hopefully we'll have more and more as we keep going. And our diagnostics are advancing too, where we're able to, um, you know, identify different genetic mutations and, um, and then, you know, use targeted drugs to those mutations. It's just, yeah, it's just wonderful what can be done, done now. I guess that's, that's, um, a, a nice transition maybe is to then say, because it's been, there's been such change and it's very challenging for us general practitioners to keep up with, with, with everything in, in every different field. And I feel oncology is, is is definitely up there in, in challenge. When is the va when should people be thinking about being referred to an oncologist? If that is something that is available to them. Yeah. And you know, it's such a good question and you know, it's, it's such a funny sort of thing, referral in veterinary medicine and I, I don't really know why it's that way. I think in, in human medicine, you know, there's, there's so much surveillance and so, you know, people sort of. You, you know, generalists a don't wanna deal with it. They, they don't know how to deal with it, and they just, they send it as, as they should. Veterinary medicine is different and, you know, um, and it depends on where you are and how you practice. Listen, I know some amazing mixed animal people that treat. You know, large animals and small animals, and they're in rural places in the United States and, and they do everything. And I, I applaud them for that. And that's, you know, you have to work with what you have. Um, and I, I help them, you know, I have mixed animal practitioners that call me and ask me, you know, can I give this dog, you know, you know, VIN Christine for this, or, and I help them because, you know, they need help. And, and that, that's my job. And that's. That's what I should be doing. And then if you're in an urban, you know, setting where you have access to, you know, specialists and subspecialists, then it's a different situation. And I think, you know, it's, we have to be good advocates for ourselves, for our pets. And you know, if you have taken on the responsibility of having a pet. I think you have to advocate for that pet. And if you feel that something doesn't seem right to you and you want more information and you haven't been offered referral, um, you should ask. One should ask for a referral. Everyone deserves that opportunity. It's not for everyone. Not everyone has the money or the desire, and I think that's okay. Also, we just, we can't let our pets suffer. That's the most important thing. Specialty medicine is not for everyone. We just don't want anyone to suffer. Sure, sure. And I guess that referral can, well, like you say, that can take a number of different, um. Play a number of different roles. So it might just be that phone call to say, Hey, I've got this, is this okay? We don't have a, a specialist oncology service near us, but we will often consult actually with the oncology service in Australia where we're able to send results, um, send our findings, send that history through, and get a bit of a treatment plan formulated so that we know that. For us personally, who aren't necessarily dealing with easy on a daily basis, um, we know what challenges might be faced, what to do in the event of complications and know that we're all doing the best for our patient or for your pet. Uh. Without necessarily racking up the, the potential costs of a, a, a full referral as well. I mean, you, you know, we have to, we have to support each other in, in this community, right? Yeah. So I work for a nonprofit, so, I mean, even if I didn't work for a nonprofit, but I do, and I've spent my career at a nonprofit, and so I feel that it is my duty and responsibility to help people all over the world. So, if. People call me and they, I've done, you know, consultations in Russia, in Australia, all over Europe. You know, I feel that that is my duty to do that, you know, especially as a specialist, because there's not that many of us out there and. Sometimes the animal's not referred because of what I've told them. And, and that's great. And sometimes I've pushed the referral and it's, and it's happened. So, you know, those of us, especially those of us at, at big teaching institutions, it is our responsibility to help, you know, the generalists out there, you know, um, yeah, a small, trying to figure out what, what's, what's best. And I think the other thing, and you know, I, it's not. I don't have, so I don't have that much power in this arena. But, but you do. And, and I try for the next pet in the family. It's, it's, we need to make sure that our. Our families and our patients have insurance. So they have the, they have the ability to be able to have the finances to, to pursue further treatment. Right. I mean, it's so bad in the United States, I think 3% of pet parents have insurance. It's terrible. Here up, I think it's 80% in Sweden. Like it's remarkable that the difference. Yeah, for sure. I mean, in the UK where, where I'm from originally it was pretty high or 50 50%. Eight to, yeah, 60% maybe as a guess, when I first came to New Zealand, uh, people would look at me with two heads if, as if I had two heads. If I asked if their pet was insured.'cause it was something that. You know, no one had ever heard of. But now we've def, you know, I've definitely seen a, a reasonable increase. There's still a long, long way to to go, but as we're able to do more, all of these amazing treatments, and we spoke about those, those novel treatments that are, are on the horizon from a human point of view. They cost mega bucks that no one's going to be able to be afford without insurance. And that's not anybody's fault. It's not your vet's fault. It's not a conspiracy, unfortunately, it's the reality of the technology that we're dealing with. Absolutely. But you know, I, you know, I'm seeing it more and more and, you know, it's always such a relief to me and I can, I can breathe better when, when a family comes in and, and tells me they have insurance and it's like, well now I don't, I we don't have to negotiate. You know, today I saw lovely mother and her son and it, this was a young dog also with cancer. And, um, you know, I just, it. It broke my heart that they didn't have insurance and they couldn't afford anything. I cooked up some scheme so they could be able to afford something where I took some funds that, yeah, I don't know. I'm always trying to work something out in the back door.'cause, you know, we feel terrible when we can't help these, these people and their pets. So it's, it's stressful, I think, for veterinarians when they can't do what they feel is indicated. Yeah, I mean, I, I can, it's, it's stressful for all of us. I can imagine in your field, especially because we are dealing with some very serious, life threatening, life ending conditions. Uh, I guess that Dr. Nicole, those costs are a really important owner consideration. What other things do people need to be. Thinking about, I guess when we think of chemotherapy, you know, we've got our picture of human chemotherapies or your hair falling out. You're vomiting your ra, you're feeling absolutely horrendous. And, and, and sometimes that reaction that you get, even a nonverbal reaction when you mention chemotherapy, um, says it all. Yeah, I mean, you know, it's almost never, I have met a few, which is always remarks me, almost no one. You know, hasn't had some experience with cancer, right. A friend, a family member themselves. Um, every once in a while I'll meet someone who says they, they've never met someone with cancer where I'm like, are you living, you know, under a rock or something? I, I, I never understand that. So I'm like, you do, you just don't know. You do. But, um, you know, chemotherapy is very, very different. In animals than it is in people. And, and that's why I'm a veterinary oncologist and not, uh, a pediatric oncologist. I did consider that, um, strongly, but I, there's just no way I could manage that. And, um, I actually did a, an out rotation at. Slow Kettering in New York on the pediatric sarcoma team. And I was like, this is not a life for me. It's just that was, that was rough. And you know, kids know, even young kids know, but animals don't. And that is the beauty of what we do. Right? Like there's no psychological impact, which is gotta be the hardest part of all of knowing you have, you know. Likely, ultimately a fatal disease. And even if it's not a fatal disease, it's, it's a lot to go through. And our animals don't know that. And that's the beauty of it. And you know, they wake up every day and they don't, if they're, if they've had their leg amputated,'cause they have bone cancer, they don't say, you know, I used to have four legs and now I have three legs. They just don't know. And that's, it's, so, it's really kind of beautiful that we get to, we get to do this. And as far as chemotherapy. You know, just to put things in perspective, there's a drug that we use called Doxorubicin, which is a drug that is indicative, it, it's, um, indicated for bone cancer, for lymphoma, for, for solid tumors and in people, the dose is 70 milligrams. Per meter squared, we use 30 milligrams per meter squared. So, you know, it's, it's quite a reduced dose. And the reason we do that as a community, and it's not just the oncology community, it's that, you know, dogs have a very abbreviated lifespan compared to people. And so not one of us thinks it's appropriate for, you know, them to spend a year. You know, sick, not feeling well. You know, even if it led to a cure. Their lifespan is only 12 years, so to spend 10% of their life not feeling great is not appropriate for a child to spend a year not feeling great, to live 60 more years. That's appropriate. And so, you know, we do everything we can to try to induce, you know, efficacy without any, you know, minimal adverse events. We're not always successful, but if we see an adverse event, we lower the dose, we replace the drug, or we stop. Because at the end of the day, quality of life is the most important thing. Yeah. Rather than focusing on that cure. I mean, listen, there's people who push, right? So it's not one size fits all. Yeah. There are people who, you know, are willing to accept some toxicity for, you know, longevity, but, but most aren't, you know, most really are concerned with quality of life. Yeah, absolutely. And, um, but, but that's not to say that we don't necessarily achieve really good long term. We do results and remission. I mean, I guess one thing, and, and you'll have to forgive me if my figures are vary out, but, um, you know, lymphoma in cats where we think, okay, well the, we embark on a course of chemotherapy and the average life expectancy is nine months, but there's what, 20% are still alive at two years or something like that. You know, I, this is the way I always like to, to sort of present this to my, to my interns and residents. You know, lymphoma is a constellation of diseases, right? It's not just one disease. It's sure it's that way in people. It's that way in animals. And so there are bad lymphomas. There are good lymphomas. There's good. Good outcomes and bad lymphomas and vice versa. And so, you know, the most typical lymphomas we see in cats are small cell and large cell. Small cell is a, is a great disease. Many of these animals live for years, years, three years, four years on, on prednisone alone, which is a fantastic life. And you know, they live longer than cats that are in heart, you know, have heart disease or diabetes or kidney disease. And so when you have that kind of cancer. Not so bad when you have large cell lymphoma, that is a much more aggressive disease. But as you just said, you're right. 20% of cats are long-term survivors and that can be years. We just don't know who they are and so we have to treat them. There are prognostic factors, you know, ones that feel better, you know, rather than worse, do better, but it's very, it's unpredictable and so, you know, we can, I always tell people. This is not a big decision. It's a little decision. All you have to decide is if you want to try. If you don't like it, we stop. No one's signing a contract. No one's holding you to anything. It's one tiny little decision to give one treatment. That's the only thing you need to decide if you wanna keep going. After that, we'll keep going. Each week we get to red decide what we're doing, so I think people. You know, get very overwhelmed and stressed and, you know, I don't wanna do this to my, to my animal. Well, you don't have to do it. You can try it. And if you like it, great. And if you don't, then we'll stop. Yeah. Absolutely. I think that's a wonderful Yeah, wonderful dis discussion to have. We, we can overcomplicate things, we can make that decision too, too big. Uh, uh, something that's not oncology based, but that, that springs to my mind when you were saying that is people whose cats, uh, diagnosed with diabetes and okay, we've got a few different options now, but there's a real fear of giving that insulin injection and you are making that this, it's this huge deal in your head, but I always say, look. Just try it. You know? We just give one or two goes, see how you get on. I've never had someone come back and say to me, no, this is too difficult. My cat really doesn't tolerate it. It's just taking that first step makes it much smaller. Event. You know, I'm gonna segue for one second and just tell you that that's a big passion of mine is, is cats, especially because they're difficult, they're difficult to medicate. We, we all know that cats are difficult. You know, your Labrador will walk up to you and just take the pill right out of your hand, right? They'll eat anything. Um, and so cats are complicated. And so I actually started a business with my best friend from eighth grade. Who's the former CEO of Petco, and he had stepped down from the company after bringing it public. And he said, I wanna stay in the animal world. And I said, good luck. I work seven days a week, leave me alone. And he's like, no, no, no, no, no. Don't we gotta do something. We gotta do something. I said, I don't know. You know, you're the rich one. I'm the smart one, but you know, I don't have any money. I work. And he's like, no, I'll pay for it. We're gonna do something. And so we started this home vet tech services business, kind of like a visiting nurse service, but for animals. And I have to say, the animals we see the most are cats. We teach people how to give insulin. We teach people how to give. Subcutaneous fluids. We teach people or we do it, we pop in. You know, especially my cancer patients that need prednisone every day or anti-nausea meds. We pop in for five minutes. We give the med, we walk out then, then there's not this. This sort of, you know, we don't, we wanna preserve the relationship between the pet parent and the animals. So, you know, if they have a year left to live, we don't want them to be angry or hide from their, from their pet parent. We want them to have this really beautiful relationship. So we've been doing that and focusing a lot on hospice care and the right to say goodbye, you know, in, in one family's very own special way. Yeah. Yeah.'cause I, I mean, bringing it back to oncology, that's a huge, huge part of things that, that optimizing that quality of life, that providing that end of life care to ensure there's, there's no pain, there's no nausea, there's, there's comfort and, and we can say goodbye on our own terms without our pet suffering. And I guess that service that you're talking about there, it provides as well as providing that care to the, to, to the pet. It's, it's taking that emotional load away from the owner as well. Yeah. I mean, you know, it's so painful to go through. You know it, and it's not only end of life, it, you know, let's say your pet has had knee surgery, it has a cruciate tear and it has a. TPLO, which is a $20,000 surgery in, in New York. And it's like, okay, bye. See ya. And it's like, what? Like first of all, I have to go to work tomorrow so I can pay for this surgery. And you know, I built this company so there's a nurse that can stay with your, with your pet while you go to work. So you don't have to feel like you've been thrown to the wolves, that you have support that someone's there to, and, and it's a, it's a bridge. It's a bridge between the veterinarian. And the pet parents. So, you know, we all know as veterinarians we are stretched to the max. You know, no one wants to not call back the pet parent. No one wants to not be available. But there's only so much that we can do. And so if, you know, uh, we've been doing a lot of, you know, postoperative support and care and hospice care with the direction of, you know, the primary veterinarian, which I think helps everybody. Yeah. For sure, for sure. That's amazing. And with the, with the, the shortage of Yeah. Vets, which is across the world, but I believe is particularly acute in, in the States. Um, yeah, this, it's a huge bridge and a really valuable one. Yeah, I don't know. People don't wanna be veterinarians anymore. You know? It's not so fancy. It never was fancy, isn't it? Yes. I mean, that's a conversation for a different day, isn't it? But I think a lot of people don't, don't last in the profession. Unfortunately. The, the dropout rate is ginormous. Yeah. It's rough. You gotta, you gotta really want it, you know? It's, it's going to be your passion. Yeah. Yeah. So, so that, that, that service doc Nicole sounds amazing. Um, it's, it's pad is the name, is that correct? Yeah, so, uh, pa it's Pad, home PET Services, and, um, you know, I'm really, it's. I didn't wanna do this. I was very honest about it. But the truth of the matter is I was doing it anyway by myself for free. I got really into it during COVID because, um, you know, it was really hard for people to leave the house, elderly people with disabilities, and it was heartbreaking to me. So I would go and take care of these cancer patients at home. Because people couldn't leave. And, um, I, one particular patient that really inspired me was this golden retriever that had a, a tumor of its upper jaw of its maxilla and, um, her name was Pepper and she, you know, the tumor was necrotic and dying and she had had radiation. That helped for a little bit, but I went there. Every week. And I did a deep cleaning of the tumor, you know, through the nose and opened the mouth and really cleaned it out and gave her antibiotic injections every two weeks. And she lived another three years. And Wow. It's remarkable, right? And it taught me so much. It's like. If we had, you know, the manpower womanpower on, on the streets to do stuff like this, we could have these patients live with good quality of life for a lot longer. You know, none of us have the bandwidth or the space or the time, and people aren't gonna do it. They're not gonna come every week. And so that's why. I, you know, we developed this home nursing service to be able to, to care for pets at home when it's appropriate home, but certainly they need to be at. The vet clinic, you know, to have the direction of the veterinarian. But whatever we can support at home, we should, and again, especially for cats who are terrified to leave their, their homes. Yeah, yeah. Just the act of being put in a cage and in the car or the subway or whatever is, I can't even catch their cat. I couldn't, I couldn't catch my cat yesterday. So if I can't catch him, I mean, like, I, I don't know how other people do it. I've been dealing with exactly the same thing. My cat, Molly has, um, been quite unwell and I mean, if she would stay still. My wife's a, a large animal vet, but she won't stay still enough for me to blood sample her at home. So she has to have a trip with me into the clinic, and she really doesn't enjoy it. Um, so we're all, we're all in the same boat and we know what people are, are experiencing because we have it. The same with our, with our pets. There's no question. There's no question. And we want to, um, you know, we, we wanna do the, the right thing and, and keep them comfortable and, and happy. You know, in that think how many times we maybe abbreviate the lives of these animals by, by demanding that they come back and forth for these treatments where if we could just all work together and, and organize what can be done at home, you know, everyone could. You know, the, these animals could live longer in a much more comfortable fashion. Absolutely. Absolutely. Well, Dr. Nicole, this has been a wonderful conversation. I, I mean, we could talk, uh, exactly the same thing about every individual cancer, um, but I'm sure people have got a huge, huge value from, from hearing the, the, the kind of the birds, bird's eye view in terms of finding out more about you and the work you do, um, with pad. Um, why can people, where can people head, oh yeah. So that, thanks for, for bringing that up. So my business is pad. PAD like paw pad and your pad at home, um, pad home pet services.com. So you can just, you can Google us and, um, we're, right now we're only in the New York area, but, um, people that are much smarter than I am, um, business wise, um, are very interested in, um. Pursuing this business further, you know, all across the country. So hopefully we'll be around to help, you know, more people and their pets soon. But right now we're in New York City and, um, we're, we're growing quickly and we're proud of that. And, and totally separately, I run the Cancer Institute at the Animal Medical Center, so that's the largest nonprofit. Uh. Veterinary teaching hospital in the world. So I wear a couple of hats. You're a very busy lady. Well, thank you so much for the, the work that you do, and thank you for taking the time to share your expertise with us today. Uh, it's my pleasure and I'm always, you, you have my email now and you know, I, I'd like nothing more than to be able to support, you know, the pets, the cancer pets in New Zealand too. So you let me know if you have any questions or concerns. I'm always happy to help. I absolutely will. Thank you so much Dr. Nicole. Okay. Such a pleasure. Take good care, helping your pet live the happy, healthy life they deserve. I really hope you found my conversation with Dr. Nicole as interesting and informative as as I did. Uh. It's packed with so much useful information. It's such a great overview of the subject of cancer, which is such a huge topic, and as we discussed, it's very easy to get overwhelmed. These basics, though everything we discussed in this episode is going to stand you in fantastic stead if you ever find yourself face to face with this condition and will also stand you in good stead to act early and to recognize. The problem early, which will give you the best chance of a successful outcome. As always, you'll find further information over in the show notes. So the link to that is in the description to this podcast episode along with the link to pad and more information about the services. That they offer, remember to, to hit that subscribe or follow button on whatever app you're listening to this on so that you don't miss out on any of my future episodes. And until the next time, I'm veterinarian. Dr. Alex, this is the call the vet show. Because they're family. That's it for this episode of the Call the Vet Show. Be sure to visit. 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