What to Bring to Your First Oncology Appointment | Dr. Megan Duffy

[00:00:00] >> Dr. Megan Duffy: This is not a general wellness, simple, straightforward visit. This is, my pet has just received a life-changing diagnosis and I would say, expect us to take at least an hour. It is a lot of talking.

[00:00:20] >> Announcer: Welcome to Dog Cancer Answers, where we help you help your dog with cancer. Here’s your host, James Jacobson.

[00:00:28] >> James Jacobson: Hello friend. Welcome to Dog Cancer Answers. If your dog has cancer, or you suspect your dog has cancer, and you decide to go to a veterinary oncologist you may be stressed out a bit. I know that I am whenever that has to happen, and I’ve had my fair share of that in life. And the thing is, if you come to the oncologist prepared, your visit will go a lot better.

And so today’s episode, we are going to explore what you can expect at an oncology visit and what you can bring along to make it a little bit easier. And to do that, we are joined once again by a veterinary oncologist, Dr. Megan Duffy. Hello, Dr. Duffy.

[00:01:13] >> Dr. Megan Duffy: Hi. Thanks for having me.

[00:01:16] >> James Jacobson: Thank you so much for being on our show.

Now you earned your DVM from Michigan State and your, and you studied oncology at Washington State University, right?

[00:01:27] >> Dr. Megan Duffy: Yep. That’s where I did my residency.

[00:01:29] >> James Jacobson: Residency. Okay. And you are a full ACVIM accredited diplomat of the, uh, veterinary oncology group here in the US.

[00:01:38] >> Dr. Megan Duffy: All the fancy letters.

[00:01:40] >> James Jacobson: All the fancy letters.

So when you go to someone who has a lot of fancy letters, you end up paying a lot of money, and we’ll talk about that in a future episode of Dog Cancer Answers. But if you go and you want to make the most of the investment, and most importantly of the time that you spent to get the, all those fancy letters, and your time, very limited time with the dog, what do you recommend that people do ahead of time to prepare?

[00:02:14] >> Dr. Megan Duffy: I think this is such a good question and has a few different components to it. First and foremost, we will be, or your oncologist will be, calling basically every veterinarian your pet has seen in the last few years to try to get any records, test results, imaging, et cetera, so that when you come to that appointment, I have already reviewed your pet’s records, that I’ve looked at all of those things, gone through and, and already kind of, you know, made some determinations about where are we at, what’s been done so far, what do we know? Uh, so we’ve, we’ve done some legwork beforehand, but by that same token, it is never wrong to bring a copy of records just in case or a CD of imaging because we know that things happen. Or just to say, Hey, here are my records.

What do you have? Do I have that whole picture? And what else I think is, is really nice and really, really cool is, you know, have you done some Googling or research? Obviously Google isn’t the starting point, but, or excuse me, Google isn’t the end point, but it’s a starting point of, you know, what kind of baseline information do you have or thoughts on things that you’ve looked at.

And what I think is really nice is when people do come with a list of questions or things that they’ve heard about, um, maybe they’ve listened to a podcast about a certain treatment or something like that to say, Hey, is this a fit for my dog? Is this gonna be a good choice? Really so that we have a good idea of, well, you know, gosh, what are your goals?

What are your expectations so that I can meet them. And I will actually ask, what are your expectations for this visit? What do you really want to get out of this conversation so that we make sure that we end our first consultation knowing that your needs have been met, essentially.

[00:04:05] >> James Jacobson: Let me tease both of those answers a little bit and we’ll get into some more things to bring.

But, um, the fact that like you or your staff are calling around to every vet that your dog has seen, I guess that speaks to the relative state of electronic medical records. How bad is it? I mean, I know I’ve worked with some veterinarians who – and some physicians – who are like, they don’t know what a computer is.

They’re basically, they they’re just dealing with paper. And then of course, some people are in there with their iPads and their little, uh, Apple Pencils and doing all sorts of stuff. What is the state, or at least what is the, your experience with medical records and how easy it is to obtain that information?

[00:04:51] >> Dr. Megan Duffy: That’s definitely hit or miss. There are some clinics out there that are entirely paperless, they’re fully electronic, everything is integrated in. It’s very plug and play. And there are others where we’ve got 20 handwritten pages that we are scanning in one by one, and we’re doing a little bit of guesswork for what each individual word might actually be.

Um, but that’s okay. That’s, that’s part of the fun in trying to figure things out.

[00:05:17] >> James Jacobson: That’s where the fax machine and the scanners are going in and the, and the deciphering of their handwriting. Do you find that the medical records are a little bit better kept or at least more electronic when it’s from a big practice, or a small practice, or does that not have a bearing?

[00:05:33] >> Dr. Megan Duffy: I think we see a little bit of everything. I’d say there’s definitely been more of a trend toward electronic medical record keeping. And it can be a big switch at first for an individual clinic or hospital, but then it becomes so easy once it’s already laid out and then you can type a couple of things or update a physical exam.

And then I find that they have been more complete than maybe in the past where you see a scribble of healthy pet and that was your only note that day. So it’s definitely gotten more detailed and more complex and integrated in lab work a lot easier that way, I think as well.

[00:06:06] >> James Jacobson: Now speak to bringing the imaging. So if, if your general practice vet has a, you know, sonogram or an ultrasound or something like that, or x-rays, they, you should bring a copy of, of all of that.

[00:06:23] >> Dr. Megan Duffy: It’s definitely beneficial. Um, usually what we like to do is get that imaging in advance, especially assuming that most of it’s going to be digital. We can upload it to our server.

We can integrate it with whatever additional imaging is taken throughout the pet’s lifetime. And then we have that basis of comparison. Um, and that can be really, really helpful. Sometimes though, maybe the pet went for x-rays the day before their consultation with their specialist and perhaps they didn’t get uploaded yet.

So maybe it’s a safe thing to even, you know, bring ’em on a disk just in case and say, Hey, do you have my most recent images? We just updated these the other day. And that can be just a nice way of not having this awkward 20 minute delay while we’re calling for additional records in the middle of your consult.

[00:07:09] >> James Jacobson: And now, I mean, in this day and age, we should know this, but it’s a good reminder. We own our medical records regardless. So if you got your vet to do it and you decide you want a second opinion or a third opinion and go somewhere else, all that data, those files, those images are your property.

[00:07:28] >> Dr. Megan Duffy: Yes. And at any point in time, for any reason, you can request an entire copy of your pet’s medical records, imaging, et cetera, and that will be provided to you.

[00:07:37] >> James Jacobson: Okay. So when you talk about like all the vets your dog has seen, how far back would you go?

[00:07:42] >> Dr. Megan Duffy: I would say, at least in oncology, most things have not been going on for years and years. Usually as a, as a little bit of overlap, we tend to request at least the last two years of the pet’s medical record.

Sometimes it means we get their entire life of medical records. It’s just sometimes easier to click a button and send it that way. And that’s just fine. More information is never a bad thing. Um, but typically we request the last two years.

[00:08:09] >> James Jacobson: And then in terms of the type of vets, because obviously some of our listeners use, uh, you know, holistic vets and some of our, you know, some of our listeners use general practice vets, there’re all types of different vets. Do you want the records and information from all the different veterinarians who may make up the vet team?

[00:08:26] >> Dr. Megan Duffy: Absolutely. Uh, this is interesting. I saw a patient yesterday who had seen their general practitioner, another oncologist, and a holistic vet before they came to see me for a second opinion or a fourth opinion or whatever that ends up being.

Um, but it, it was very useful to have an idea of what’s been going on, how has this all transpired, what have the recommendations or conversations been up to this point so that I’m not jumping in blindly saying, have you talked about this? Have you discov- discussed X, Y, and Z? Where are we at? But it’s a little bit better laid out.

[00:09:01] >> James Jacobson: Okay. And then in terms of the second point, in terms of Dr. Google, and it’s nice when it, when a veterinarian not only recognizes it, but sees its benefit, um, coming in prepared by having obviously listened to all the relevant episodes of Dog Cancer Answers and looked at our blog and, and all that. But, you know, Googling and getting all sorts of information, is there, how much is too much? Because this is, can be a little overwhelming, and how much is, probably not enough that you really could do a little bit more to prepare yourself with the questions so that you can make the best time with your oncologist?

[00:09:41] >> Dr. Megan Duffy: I think a little bit of Googling is very reasonable, especially a truly veterinary website. Um, VIN or Veterinary Information Network does a lovely Vet Partner, which is really geared toward pet owners, um, or things like that.

I don’t expect anybody to have read all of the relevant literature in Pub Med about a given tumor type, that is way overkill and it’s easy to take that out of context. Um, but it is nice to have some sort of an idea of what this might mean or some options. I think it’s very easy to go down this rabbit hole of individual experiences that are not necessarily the worst thing in the world, but, you know, there’s a lot of only very good or very terrible things on the internet. And I think that’s where this is a great starting point. Background information is awesome. We just can’t go too far without kind of reeling it in and making sure that we’re still on track in terms of what is going to be relevant to your pet.

[00:10:41] >> James Jacobson: Okay. And so come in with a list of, uh, do you think paper and pencil is good? Do you want people to record it, or what, what are your thoughts in terms of how to really memorialize and be able to understand what’s going on in that consultation?

[00:10:56] >> Dr. Megan Duffy: I have a lot of families who do come in with a paper and pencil list of questions.

And sometimes, especially if there are family members who can’t be present and they have specific questions, that’s a great way to get them out. Um, I have been recorded, both voice and video and, and all of those things, or had somebody who was not available to come in person be on speaker phone. And that’s absolutely fine.

It’s whatever media you need to get your questions answered and of course the follow-up is, everything we are going to talk about is going to be typed up and summarized for you, emailed to you, and emailed to your primary care vet, just so we have that good continuity of care and we’re all on the same page.

Um, some, some people are very active listeners. They want to write things down. They want to take notes even if this will be provided later, love that, and some people say, great, I’m going to throw away my pen and paper and just listen and soak it in. So no wrong answer as far as that goes.

[00:11:52] >> James Jacobson: Dr. Duffy, we gotta take a break, but, uh, stick around. We’ll be right back. But when we return, we will get into what you can expect that consultation appointment to look like. We’ll be right back.

I want to let you know about an important newsletter. It’s called Dog Cancer News. Now with a name like that, it is not for everyone, but if your dog has cancer, you will want to subscribe. That’s because every issue features articles that will be helpful, such as low carb dog cancer diet recipes, new clinical trials, financial resources to help pay for cancer care, information on supplements, and lots of other helpful info that your veterinarian may not know or have the time to share with you. Also, when you subscribe to Dog Cancer News, you will get a weekly update on the topics covered on this podcast, along with links and resources.

So how much does Dog Cancer News cost? Well, today you can subscribe for free. It’s our gift. For a limited time, you can get a full year subscription for free. No strings attached. Just go to this website to sign up for the newsletter now: DogCancerNews.com. It takes less than 10 seconds to subscribe and it is totally free.

Do it now at DogCancerNews.com.

So what should someone expect from their first visit for one of these initial consultations with an oncologist?

[00:13:23] >> Dr. Megan Duffy: I would say the biggest thing is expect this to take time. This is not a general wellness, simple, straightforward visit. This is my pet has just received a life-changing diagnosis. And I would say, expect this to take at least an hour.

It is a lot of talking and we really want to unpack what is this diagnosis? What does it mean in general? What does it mean for your pet? What are our treatment options? What do those look like in terms of quality of life, time, financial, emotional, and timing investment. What’s gonna be the right fit. And then decide, do we need to do any additional testing, do we need to do anything else to decide if this treatment is appropriate, and then oftentimes then the next step is doing some more diagnostics or starting treatment, things like that. So I would say expect a minimum of one hour of talking in the room before anything else happens.

[00:14:22] >> James Jacobson: So oncologists are recognizing that you’re gonna have a lot of questions and they’ve allocated a time. This isn’t a short 20 minute visit.

[00:14:29] >> Dr. Megan Duffy: Oh, absolutely. This is really your time to ask all of those questions and get a really clear understanding of what’s going on.

[00:14:38] >> James Jacobson: So, what about the concept of like, are there any treatments, are there gonna be like, okay, like a normal, a general practice vet, you go in, you know, and then we’re gonna start this thing, or we’re gonna do this test.

Is that something that can be expected?

[00:14:54] >> Dr. Megan Duffy: Absolutely. And that is one thing where, obviously this is a very emotionally charged visit. Sometimes we just need to go home and absorb the information and think about things. But if you’re coming out of that consultation saying I’m very comfortable, I’m ready to rock and roll, let’s start treatment, it can absolutely happen same day.

[00:15:12] >> James Jacobson: Anything that you might suggest people not bring to the, uh, initial visit?

[00:15:18] >> Dr. Megan Duffy: That has definitely changed a little bit since COVID because depending on where you’re at, you may be curbside and doing this over the phone, you know, on speaker in your car or with perhaps one or two masked people in a room.

And that has gotten away from: please don’t bring all of your neighbors and cousins and extended family and all of their children, and have 10 people in a room asking a lot of questions because that can be really distracting and overwhelming. And sometimes it can make things a little bit tougher. I don’t mind, you know, if you got to bring your kids, that’s absolutely fine as long as they’re, you know, entertained and able to do their own things so that we don’t get too far off track. Other pets sometimes are okay, as long as they’re reasonably well behaved I don’t mind that at all. Um, so the, the other attendees to the appointment, that’s, that’s pretty simple and pretty easy.

[00:16:15] >> James Jacobson: Now this may sound like a stupid question, but I will tell you why I’m asking it later. Do you have to bring your dog?

[00:16:22] >> Dr. Megan Duffy: Yes. That is actually not a stupid question because every so often families come and say, I’m ready for my consultation, you’ve got all of Sparky’s records, let’s roll. And for pretty specific legal reasons, I can’t make specific recommendations for your pet without doing an exam and establishing a relationship. And it may seem silly – you know, "You’ve got all of my dog’s records. Don’t, you know, what, what you’re going to recommend?" And in very vague terms for the disease, kind of yeah. But I need to meet your dog and make sure that whatever we might be talking about is really going to be a good fit based on how they are on physical exam.

If they still have a tumor in place, or if it’s been removed. And how has that scar healed or, you know, how is the dog’s overall health today. So there are so many things that go into it where, you know, gosh, we really can’t do a whole lot unless the dog is physically there at the appointment.

[00:17:20] >> James Jacobson: Okay. Yes, because I know some people have gone to visits without bringing their dog and they’re like, okay, ’cause you have all the records.

‘Cause there’s not much that you can do, you know, obviously just by palpating or whatever. But you’re trying to assess the overall dog’s health and things like, as you say, wound recovery, et cetera. So in terms of surprises that you’ve encountered during some of these initial consults, do you have any that come to mind?

[00:17:48] >> Dr. Megan Duffy: Let’s see. Surprises would be, um, every so often we will get off track and perhaps families will bring a different pet and say, well, gosh, while you’re here, can you look at Fluffy? Can you do X, Y, or Z? And that’s not always-

[00:18:03] >> James Jacobson: A two for one.

[00:18:04] >> Dr. Megan Duffy: -time that’s built in my day or I’m maybe not the most appropriate person to be evaluating Fluffy’s orthopedic condition as an oncologist. It’s just, it’s not the best place for you to spend your time and money. Probably some other things, I think surprises that are not as silly, but are tough are when families have completely unrealistic expectations.

And that can be for a variety of reasons, but, but maybe say, well, I read on the internet that dogs with this condition can live for, you know, 10 or 12 years. And I’ll say, well, gosh, you know, unfortunately our, our typical outcome is more like 10 or 12 months. And something like that, where I’ve completely dashed their hopes just from a misunderstanding.

And that is a little bit tough to recover from. Um, or families who are completely blindsided by a prognosis, which I think that’s where maybe a conversation with your vet or even a touch of Googling on the side can help a little bit.

[00:19:03] >> James Jacobson: So you should come in prepared and, and kind of understand the overall, um, what the expectations and the prognosis is so that you’re not, um, flabbergasted when the vet tells you the news.

[00:19:17] >> Dr. Megan Duffy: It is really nice to have some understanding of: is my dog’s prognosis days, is it weeks, is it months, could this be years… even in really broad brush strokes so that you don’t come in saying, my dog is going to have her normal lifespan and for somebody else to say, gosh, that’s really not the case.

[00:19:36] >> James Jacobson: Can you cover something that we’ve talked about on this show before, but I don’t think we can talk about it too much, which is please define median life expectancy.

[00:19:45] >> Dr. Megan Duffy: Absolutely. And, um, what, we usually speak in median life expectancy, or median survival time, and the best way to think about that is that everybody’s outcome for a given disease and a given treatment exists on this bell curve, and the very middle of the bell curve, that’s the median. So it means that at this point in time, 50% of the patients that we’ve treated are still with us and 50% have passed away. And so, it’s a reasonable expectation if you are that average typical pet. And we don’t use averages because they’re very easily skewed, um, by someone who does really well or really poorly.

So it’s typically medians, um, and medians are a good starting point. They’re a good idea of perhaps what’s typical, if there can be typical in oncology. It also means that for every pet who does phenomenally better, somebody doesn’t do as well. And there still is that little bit of a range of outcomes.

[00:20:43] >> James Jacobson: Because those outliers can really skew things. And if you’re an optimist – or a pessimist – you may stick to hearing those numbers and not understand the math term "median."

[00:20:56] >> Dr. Megan Duffy: Absolutely.

[00:20:57] >> James Jacobson: Which I think is so, so common. Um, we are going to have you back and talk about this in much more depth, uh, on a future episode of Dog Cancer Answers, but let’s talk a little bit about the price tag for this initial consultation.

Now, obviously you are in Minnesota, and I’m sure it’s more expensive in New York or Los Angeles, but what can someone expect in terms of a range for a initial oncology consultation?

[00:21:25] >> Dr. Megan Duffy: I would say for an oncology consultation, again, taking in some, some regional changes, and every hospital is different, I would say you are probably going to spend $200 to $250 for that first consult. And that’s a lot of sticker shock if, if maybe you, you hop over to your local vet and maybe spend $40 or $50 on an exam fee, and that’s your normal. So much of that comes in with the background, the time it takes for us to comb through your dog’s entire medical record, the time we’re going to spend with you in the room and really give you as much information so that you can make good decisions as possible.

So this is not supposed to be a $200 consult that lasts five minutes. This is supposed to be a pretty long process so that it’s not just cost, but also just the value that you get from that visit.

[00:22:19] >> James Jacobson: Dr. Megan Duffy, thank you so much. If you have any final thoughts and look, I’d love you to share those with us, and we’d love to have you back again. But any final thoughts on what to do to prepare for your visit?

[00:22:33] >> Dr. Megan Duffy: I’d say, come on in with an open mind, have your questions ready, and we’ll go through everything and make sure that wherever we go from here, everybody’s really comfortable.

[00:22:42] >> James Jacobson: Dr. Megan Duffy, thank you so much for being with us today.

[00:22:45] >> Dr. Megan Duffy: Thank you.

[00:22:46] >> James Jacobson: And I would like to thank you, listener. A little preparation ahead of time can go a long way towards maximizing the time and money spent on an oncology consultation. And if you were not taking notes, don’t worry, we have made a checklist of all the things that Dr. Duffy recommends getting together before your first oncology appointment.

And you can find those on our website at DogCancerAnswers.com. Other links and resources mentioned in the show are available in the show notes or at DogCancerAnswers.com. And if you’re feeling a little bit overwhelmed, take a deep breath and know that you are not alone. Our support group, which you can find at DogCancerSupport.com, is a welcoming community of dog lovers who are going through the exact same thing as you are. It is a wonderful group of people, and it’s a great place to voice your fears and share your successes.

Well, that is it for today’s show. I’m James Jacobson. And from all of us here at Dog Podcast Network, I’d like to wish you and your dog a very warm, Aloha.

[00:24:03] >> Announcer: Thank you for listening to Dog Cancer Answers. If you’d like to connect, please visit our website at DogCancerAnswers.com or call our Listener Line at (808) 868-3200. And here’s a friendly reminder that you probably already know: this podcast is provided for informational and educational purposes only.

It’s not meant to take the place of the advice you receive from your dog’s veterinarian. Only veterinarians who examine your dog can give you veterinary advice or diagnose your dog’s medical condition. Your reliance on the information you hear on this podcast is solely at your own risk. If your dog has a specific health problem, contact your veterinarian.

Also, please keep in mind that veterinary information can change rapidly, therefore, some information may be out of date. Dog Cancer Answers is a presentation of Maui Media in association with Dog Podcast Network.