Will Knowing the Diagnosis Change What We Do?

My 95-year-old grandfather was recently diagnosed with a brain tumor, and almost immediately, our family was faced with a decision:

Do we biopsy it?

Part of me wanted answers.

I wanted to know exactly what kind of tumor it was. I wanted to understand what was causing the changes we had been seeing in him. I wanted a name for what was happening.

But there was one thing every single person in our family agreed on.

Regardless of what the biopsy showed, we weren't going to pursue chemotherapy, radiation, or other life-extending treatments.

That wasn't what my pap wanted. And it still isn't.

Going through this decision with my own family made me think about a conversation I have with pet owners almost every day.

When More Testing Is an Option

Your senior dog has a mass.

Your veterinarian suspects cancer.

Something abnormal appears on an X-ray or ultrasound.

Suddenly, you're presented with a list of possible next steps.

Do we biopsy it?

Do we schedule an MRI or CT?

Do we put them under general anesthesia for additional testing?

Do we see an oncologist or another specialist?

Do we pursue surgery?

Sometimes, the answer is absolutely yes.

Diagnostics can give us incredibly valuable information. They can identify diseases we can treat, help us choose the right treatment, give us a better idea of prognosis, and sometimes give families the clarity they desperately need.

But there is another question I think deserves to be asked more often:

Will knowing the answer change what we do?

What Will We Do With the Answer?

Imagine you have a 14-year-old dog with a suspected tumor.

You already know that, regardless of the exact type of cancer, you would not put them through another major surgery. You wouldn't pursue chemotherapy or radiation. Your priority is keeping them comfortable for however much time they have left.

Would knowing the exact type of tumor change that plan?

Maybe it would.

Maybe having a definitive diagnosis would give you information about what symptoms to expect or how quickly the disease might progress. Maybe you need that certainty to feel comfortable making future decisions.

Those are completely valid reasons to pursue additional testing.

But sometimes the answer is no.

And if the answer won't change what we do, then I think we also have to consider what we're asking the patient to go through in order to obtain it.

That might mean anesthesia. Hospitalization. Travel to a specialty hospital. Recovery from a biopsy. Stress. Discomfort. And, of course, financial cost.

None of those things automatically mean we shouldn't pursue diagnostics.

They simply belong on the other side of the equation.

Just Because We Can Doesn't Mean We Should

One thing I say frequently in veterinary medicine is:

Just because we can doesn't always mean we should.

Modern veterinary medicine is incredible.

We have advanced imaging, specialists, biopsies, radiation therapy, chemotherapy, complex surgeries, and treatments that would have been unimaginable in veterinary medicine not that long ago.

And I am incredibly grateful that we have those options.

But having an option doesn't necessarily mean that option is right for every pet.

Especially when we're caring for elderly animals or animals approaching the end of their lives, our definition of "doing everything" may need to change.

Doing everything doesn't always mean performing every available test.

Sometimes doing everything means controlling pain.

Helping them eat.

Making it easier for them to move around the house.

Managing nausea or anxiety.

Letting them sleep in their favorite spot.

Giving them another good afternoon in the backyard.

And protecting the quality of the time they have left.

Choosing Comfort Isn't the Same as Giving Up

I think this is one of the hardest things for families to accept.

Declining an MRI doesn't mean you don't love your dog enough.

Choosing not to biopsy a mass doesn't mean you're ignoring the problem.

Deciding against chemotherapy doesn't mean you're giving up.

There is a difference between doing nothing and choosing comfort-focused care.

Hospice and palliative care are still care.

In fact, they can require incredibly thoughtful decision-making because instead of focusing solely on extending life, we're asking a different question:

How do we make the life that remains as comfortable and meaningful as possible?

There isn't one universally correct answer.

For one family, pursuing a biopsy and treatment may give their pet months or years of good-quality life.

For another pet, the burden of getting that diagnosis may outweigh what the information would actually change.

Both decisions can come from love.

The Question I Want More Pet Owners to Ask

When you're faced with a major diagnostic decision for an elderly or seriously ill pet, ask your veterinarian:

"If we do this test, how could the result change what we do next?"

Then talk through each possibility.

If it's cancer, what would we do?

If it's benign, what would we do?

If the test is inconclusive, what would we do?

What does the procedure itself involve?

What are the risks?

Will my pet need sedation or anesthesia?

Will this information help us keep them more comfortable?

And perhaps most importantly:

Does getting this answer align with what I want for my pet?

There is enormous value in information when that information helps us make better decisions.

But sometimes we already know what matters most.

Going through this with my grandfather reminded me that medicine isn't only about discovering everything we possibly can about a disease.

It's also about understanding the person, or the animal, living with it.

Sometimes the most important question isn't:

"Can we find out exactly what's wrong?"

It's:

"What will we do with the answer?"