Episode 20 – Part 2: Understanding Life During Chemo and the Journey Forward with Dr. Kyle Renaldo

In Part 1, we laid the groundwork for what a cancer diagnosis looks like, how treatment decisions get made, and what families can expect from chemotherapy and radiation.

In this second part of our conversation, we discuss pet chemotherapy, quality of life, and end-of-life decisions with Partner’s board-certified veterinary oncologist Dr. Kyle Renaldo.

Dr. Renaldo tackles some of the most human questions in this journey: How do you measure quality of life in a patient who can’t tell you how they’re feeling? What role do owners play at home, and what should they be watching for? And when treatment stops working, how do you navigate the hardest conversations of all, including the decision to say goodbye?

We’ll also end on something we all need a little more of: hope.

Whether you’re in the middle of this journey right now or simply love an animal enough to want to be prepared, we hope this conversation gave you something valuable to hold onto. If your pet was just diagnosed, remember the advice shared today: take a breath, seek a specialist, and know that you have more options than you might think.

[Music]

Narrator:

Welcome back to Did You Know?, a podcast by Partner Veterinary. In this series, we dive into everything veterinary medicine and everything Partner. In each episode, we tackle some of the most common questions we hear — from HR to emergencies and everything in between. If it happens at Partner, we’ll talk about it.

In part one of our conversation, we explored what happens after a pet is diagnosed with cancer—from the first oncology appointment to understanding treatment options, and what chemotherapy and radiation really look like. In part two, we turn our attention to life beyond the diagnosis. What does a good day look like for a pet undergoing cancer treatment? How can families tell if their pet is still enjoying a good quality of life? What should owners watch for at home? And how do they partner with their veterinary team every step of the way?

Dr. Ronaldo also shares compassionate guidance on one of the most difficult parts of the cancer journey: recognizing when treatment is no longer helping, and how to approach the heartbreaking decision to say goodbye. But this conversation isn’t just about endings—it’s also about hope, perspective, and making every day count for the pets we love. Let’s get started.

Jen Mellace:

How do you assess quality of life in a patient who can’t tell you how they’re feeling?

Dr. Renaldo:

Dr. Ronaldo: Probably one of the most difficult things about being a veterinarian is that our patients can’t talk to us and tell us how they feel. A lot of it is based on an owner’s interpretation of what they’re seeing at home. In terms of quality of life through treatment, I focus on three things: appetite, activity level, and pain. Quality of life isn’t going to be good if one of those things is outweighing the other two. If they’re really painful, not eating at all, or very lethargic—any of those can make their quality of life not great.

These are easy things to focus on because they’re easy to measure. For example, I feed my pet twice a day—are they eating both meals? Or do they usually take walks and suddenly don’t want to? That’s easy to assess. Discomfort can be a little trickier, but things like vocalizing, limping, or obvious pain—especially with bone cancer or oral masses like melanoma—are clear signs.

Another method I suggest is to pick five things your pet loves to do. When they stop doing the majority of those things, that’s probably a major problem. Is it going to the park? Swimming? Interacting with the family? Eating? For example, Labradors love eating, so when a Labrador isn’t eating, that’s a big concern. The same is true for Beagles. Cats are tougher, as they hide their signs very well; measurable weight loss is often the first thing owners notice, sometimes before a loss of appetite or other symptoms.

Jen Mellace:

What are some other signs to watch for in cats and dogs?

Dr. Renaldo:

In cats, a sick cat is often a really sick cat. If an owner says, “My cat looks thinner,” that’s a concern, and it’s often more important in cats than dogs, because sometimes it’s the only early sign. Changes in bowel movements—even if it’s not diarrhea, but softer stool, blood in the stool, or dark, tar-like stool—matter. If there’s a tumor on the body, is it open, ulcerated, or bleeding? That can be a source of pain and infection.

Some signs are obvious, like a visible tumor. Others, especially internal issues, are harder to interpret. It really comes down to appetite, activity level, and comfort. Are they uncomfortable? Is something getting worse? Have they lost a lot of weight or muscle mass? One of the most difficult situations is when a patient is eating but still losing weight—owners might think things are okay, but chronic weight loss is a kind of slow starvation, and it matters.

Jen Mellace:

Are there ways to intervene or support pets through these changes?

Dr. Renaldo:

There are supportive medications—appetite stimulants, anti-nausea meds, anti-diarrheals, pain management, antibiotics for infections. There’s a lot we can do to help. But it’s important to determine whether the problem is caused by chemotherapy side effects or the disease itself, and whether the cancer is internal or external. Most cancer signs are chronic and not immediately life-threatening, but there are exceptions, like certain bleeding tumors that can cause sudden, acute decline.

Jen Mellace:

Are there lifestyle adjustments that help pets do better during treatment?

Dr. Renaldo:

I’m generally against making dramatic changes to their diet unless there’s a good reason. There is a cancer-specific diet called Hill’s a/d that can be helpful—it has a higher caloric density, so pets get more nutrition even if they eat less, plus it includes probiotics for gut health. Not every pet with cancer needs this, though.

I’m not holistically or alternatively trained, but I’ve worked with owners and vets who’ve added holistic supplements, as long as they’re not toxic—so no grapes, garlic, or onions. Some cancers have evidence-based, nontraditional treatments. For instance, hemangiosarcoma responds to Yunnan Baiyao, a Chinese herbal supplement that decreases hemorrhage risk and may kill tumor cells in the lab. There’s also a mushroom supplement called Immunity (turkey tail mushroom) that has some anti-cancer effects.

I avoid raw diets due to infection risks like salmonella. Grain-free diets can also be problematic—some are linked to heart disease, and you don’t want to add that on top of cancer. A well-balanced commercial diet is usually safest. Supplements are typically fine.

Vaccinations are another consideration. I’m generally in favor of keeping up with vaccines, even during chemotherapy; studies show antibody production is still adequate. Legally, rabies vaccination is required. For other vaccines, especially in older pets, you can discuss titers or adjust frequency. In cats, there’s a risk of injection-site sarcomas, so we may avoid unnecessary injections if that’s a concern.

Jen Mellace:

What role does the owner play in monitoring their pet at home? What should they be watching for?

Dr. Renaldo:

Any level of concern is worth reporting. I’d rather know if there’s a problem, even if it seems minor. So if you’re debating whether to call, just call. Early intervention can prevent bigger problems, both for quality of life and financially—hospitalizing a pet is expensive and stressful.

True emergencies include anything respiratory—heavy or difficult breathing, extension of the head and neck, blue or muddy gums. The main chemo-driven emergency is infection (chemo-sepsis): if a pet is feverish and unwell about seven days after treatment, get them on antibiotics and to the hospital immediately.

Otherwise, monitor what the tumor is doing, and note any new or worsening symptoms. If the symptoms that were present at diagnosis come back, that could indicate disease progression.

Host: How do you have the conversation with a family when treatment is no longer working or the cancer has progressed?

Dr. Ronaldo: That’s an excellent and difficult question. When an owner decides to treat and treatment stops working, it comes down to whether there are other options—and sometimes there are, sometimes there aren’t. I’m honest about whether a treatment is more for the owner or the pet. Most treatments are for the pet, but at some point, it’s fair to ask: am I doing this for myself, or for my pet?

It’s about risk versus benefit. Some diseases I’ll keep treating as long as the pet feels okay, even if they’re failing treatment. But if they’ve failed multiple treatments and are sick, it’s probably time to shift to palliative care or end-of-life decision-making.

The sicker they are, the less likely additional treatments will help. As you go further down the list of treatments, the chances of success go down, and the risks go up. Drug shortages are also a reality; sometimes the best drugs aren’t available, and we have to adapt.

Treating metastatic cancer in the lungs is particularly hard—it’s very resistant to therapy, and the chance of response is low.

Jen Mellace:

I imagine it’s hard for owners to know when to say, “I’m done.”

Dr. Renaldo:

Honesty is key. Setting expectations up front makes a big difference. Rarely are owners surprised when I say we’re out of options, because I try to be open and honest all along. It’s important to reset expectations as things change.

Jen Mellace:

What does the transition to palliative care look like?

Dr. Renaldo:

It depends on what’s affecting the pet at the time. My motto is “treat the treatable.” If there’s discomfort, treat pain. If there’s GI upset, treat that. Prednisone or steroids are a commonly used palliative option, especially in lymphoma, but also for other cancers. Non-steroidal anti-inflammatories like Rimadyl or Deramaxx are used for pain. The choice between steroids and NSAIDs depends on whether they’re eating—if not eating, steroids can help appetite.

These are temporary solutions. When they stop working, the chance of finding something else that helps is low, and that may drive the end-of-life decision.

Jen Mellace:

How do you counsel families around the decision of euthanasia and how to know when it’s time?

Dr. Renaldo:

I think it comes down to, like I said before, setting expectations. The end of treatment doesn’t necessarily mean the end of life. Sometimes pets are still feeling well and may have some time left. As I mentioned earlier, sometimes the disease progresses more slowly than you think. People often assume that stopping treatment will impact their pet within a week, but sometimes it can be a month or two—or even three—before you really have to make that decision.

I try to counsel people through the process. When discontinuing therapy, we focus on a few things to watch for at home to emphasize quality of life. For example, a patient with a large bleeding mass is probably not going to do as well as a patient without one. Similarly, a pet in a lot of pain is not going to do as well as one who is comfortable. Not all cancers cause pain in the same way, like a broken bone might, but all can cause discomfort. When the medications stop helping, that’s probably the time to make the decision. I always say it’s better to make the decision a little too soon than to wait too long and regret it. I never feel like anyone does it “too soon.” It’s better not to let things become a long, drawn-out process. A day too early is better than a day too late.

I’d rather have an owner in control of the situation than have them end up in an emergency, forced into a difficult decision. In veterinary medicine, we have the luxury of humane euthanasia. I think it is incredibly humane, and it’s generally a painless process for such a difficult thing for people to go through. It makes a big difference—you don’t have to watch a loved one suffer. That’s a huge issue in human medicine. While veterinary hospice isn’t as advanced as human hospice, there are hospice veterinarians out there, and it’s a growing field, which I think is a great thing. At the end of the day, it’s on us as vets to help guide people to that decision and when to make it. We generally lean toward doing it a day earlier rather than a day later.

Jen Mellace:

What do you wish more pet owners knew before a cancer diagnosis?

Dr. Renaldo:

A lot of information on the internet can be helpful, but it can also be damaging at times—especially when it comes to diet. That’s probably the biggest area of misinformation we encounter. I don’t expect people to know the details of every disease or about chemotherapy. That’s not an expectation I have for owners, but I do expect veterinarians to understand the disease, at least if not the chemo itself. Still, it helps if owners have some awareness of what cancer is and a general idea of treatment options. There’s good information out there. Having that background before meeting with an oncologist is nice, but even if you don’t, that’s okay.

One thing I will say, and I say this out of straightforwardness, is that most of the diseases we treat are terminal. There are some that are curable, and some that are very manageable with long-term survival. But many cancers we treat—like lymphoma and osteosarcoma, the big four—are terminal. That’s why quality of life matters so much through everything. Understanding that sometimes the disease our pets have isn’t fixable, only manageable, goes a long way in setting expectations.

I think it’s important not to get fixated on numbers. You can read a hundred papers, and they’ll all tell you something different about how long a pet with lymphoma should live. It’s a bell-shaped curve.

You can treat and get less than the published average, more than that, or you can land right in the middle. There are so many variations. In my own career, I’ve treated many cases of lymphoma. I once had a dog who didn’t relapse for over five years after treatment—less than 5% of patients get that outcome. I’ve had others where you’re lucky to get three months. The average is about a year, but nothing is set in stone. I always advise owners not to get fixated on the numbers—they’re not perfect. We can give you a general idea of what to expect, but at the end of the day, your pet will do whatever they’re going to do. It’s more valuable to focus on their response to treatment. Are they responding, or not?

Jen Mellace:

If someone’s pet was just diagnosed today, what are the first three things you would tell them to do?

Dr. Renaldo:

Don’t panic—sometimes it’s a fixable or treatable problem. Don’t overthink things. See an oncologist if that interests you, gather all the information you can, and then make the most educated decision possible. The goal is to make the best decision with the best information. And remember, treating a pet isn’t the same as treating a person—the drugs may be similar, but side effects are much less. The goal is always quality of life over cure. Most people value quality of life above all, and that’s what truly matters.

Jen Mellace:

Where do you point families for reliable information and community support?

Dr. Renaldo:

This isn’t always available everywhere. Some clinics have social workers, which is great for emotional support, but that’s not universal in veterinary medicine. There are lots of online resources. PubMed is a great resource, and I’m usually good about providing references for owners who want to look further. I don’t expect every client to understand every word of the literature, but reading an abstract can be helpful. The Merck Veterinary Manual online is another solid source for well-written, basic information. I recommend sticking to veterinary-specific resources.

I’d be cautious with testimonials—just because something worked for one pet doesn’t mean it’ll work for all. There are lots of Facebook support groups, including cancer-specific and breed-specific groups. While much of the information is anecdotal, knowing you’re not alone can help a lot. Whatever you’re facing, it’s likely someone else has been through it.

Another underutilized resource is previous clients. For example, I had a client whose dog had a radical surgery for a nasal tumor. That owner was willing to talk to other owners facing the same decisions, sharing their experience. That kind of support makes a real difference.

Jen Mellace:

Would you be willing to talk a little about pet insurance?

Dr. Renaldo:

I don’t know everything out there, but I do think pet insurance is great—especially if you insure your pet when they’re young. Most policies I’ve seen cover cancer treatment and can take a major financial burden off owners. I’ve seen insurance cover entire chemotherapy protocols and radiation therapy, which can be very expensive. I had a client whose dog had surgery, radiation, and chemotherapy for bladder cancer, and insurance covered all but $2,000 of what would have been $20,000 to $30,000 out of pocket. If it makes sense financially, I think insurance is worth looking into. It can make a big difference in what you’re able to do for your pet.

It’s not just cancer—insurance can help with orthopedic surgeries, GI issues, and more. Getting pets insured early can save a lot in the long run, and many policies cover the cost of cancer treatment.

Jen Mellace:

Peace of mind for sure, having them insured. Dr. Ronaldo, thank you so much for taking the time to talk to me and for sharing your thoughts and expertise on this topic, which is both common and difficult for a lot of pet owners. I really appreciate it.

Dr. Renaldo:

You’re welcome. Thank you for putting this all together. I appreciate it.

Narrator:

Whether you’re in the middle of this journey or simply love an animal enough to want to be prepared, we hope this conversation gave you something valuable to hold on to. If your pet was just diagnosed, remember the advice shared today: take a breath, seek a specialist, and know that you have more options than you might think.

“Thank you for listening to ‘Did You Know?’ Is there something about Partner that you want to know? Email us at [email protected]. Who knows? We might turn your question into an entire episode! And you can now find us wherever you listen to all of your other favorite podcasts. Subscribe now!”