Quality of Life — Black & White or Gray?

I have been on both sides of the veterinary table when it comes time to make tough decisions. My pets are extremely important to me. I suffer great pain at their loss. Additionally, I have the perspective of a veterinarian making an independent assessment of an animal’s quality of life as the aging process progresses.

The Diabetic Dog

I very clearly remember being in veterinary school and learning about managing the canine (or feline) diabetic. In school, all of the variables that can affect blood sugar were described. Of course, food is the primary variable. However, exercise, excitement, other medical conditions, client compliance and a host of other factors can, and do, affect the success of diabetic management. In school, it sounded fairly easy. Educate the client, frequently check blood sugars and Buddy will do just fine. In real life, it isn’t that simple.

I had only been out of veterinary school for about a year when I encountered my first clients with a diabetic dog. This couple were A+ clients. They did everything I asked them to do and were very diligent in monitoring and treating their dog. No dog owner could have done a better job of trying to manage a young, diabetic dog.

But the dog was a dog! Not a kid who could say, “Mom, I had an extra cookie at lunch.” Or, “Mom, I ran extra laps around the playground today!” After a year of struggle, these folks were out of gas. And I couldn’t blame them, as I was equally frustrated. This scenario didn’t unfold the way they told me it would in veterinary school. This was definitely one of those “gray area” situations.

Pepsi

When I first started practicing veterinary medicine, I was living with a dog I had rescued from veterinary school. Her name was Pepsi. A year after I graduated, she started regurgitating her food. A fluoroscopic exam at the veterinary school showed that her esophagus wasn’t working correctly. The rhythmic muscular contractions necessary to get food from her mouth to her stomach were random, inefficient, or entirely absent.

I began blending her food, feeding her in an elevated position, and feeding her small meals throughout the day. (Now there is the Bailey chair for dogs like Pepsi, but this was not an option in the ’80s.)

Twice she developed severe aspiration pneumonia. I was running out of ideas to keep her nourished and it tore me up to see her out in the yard, regurgitating her dinner and trying to eat it again… I didn’t want her feeling hungry or wasting away to skin and bones before my eyes.

At one point, we had a hole dug in the yard but opted to keep trying. Finally, I scheduled my vet friend to come to the house to help me send Pepsi over the Rainbow Bridge. But she was a horse vet, and it was spring foaling season, and she was busy. Although we scheduled a time, I hated the lag between the decision and the deed.

After a particularly rough Sunday morning, I couldn’t take it anymore and went to the clinic to get what I needed. Pepsi is the only dog I ever owned that I personally put to sleep, and had she not been a 65-pound Collie I doubt I could have hit a vein through my flowing tears. But she was a rescued research dog that hated needles and hated the clinic. She trusted me, so I did what was best for her.

Lyndee

Around the same time, I owned a Cocker Spaniel. Within a few years of losing Pepsi, I lost Lyndee. Over a 24-hour period, I noticed she seemed to be drinking exessively. She had an accident in the house, which was very unusual. But I was a busy young mother and not in “medicine mode” at home and it didn’t really register. However, I soon noticed that she had ascites, meaning her abdomen was filling with fluid. There is nothing good that causes ascites.

I scheduled an appointment for her back at the veterinary school (it was an hour away). My mom went with me to the appointment. There were 3 or 4 potential diagnoses that were tossed around that first day, and none of them were good.

The next day I took her back to the vet school by myself for further testing. During the test, she crashed. They rushed her into surgery. I sat in the office of one of my previous professors while another of my professors opened up my dog. The next thing I know, the surgeon is telling me that my dog is riddled with cancer and not recoverable. I took her home in a box.

Black and white or gray

Those two personal experiences taught me the pros and cons of a relatively quick, black & white diagnosis versus the long, uncertain gray area of a chronic condition. From start to finish with my Cocker, it was about 5 days. Not much time to prepare, but not much question about what I needed to do.

With Pepsi, it was months. I am certain I “robbed” her of some “good” days, but I also saved her from some very bad ones. Both were extremely difficult scenarios, and they played out in different ways. I have drawn upon those experiences over the years as I have counseled clients on the tough decisions they face.

This is the first of a series on quality of life and options available to animals and humans. I have also written a series discussing euthanasia. Here is a link to Part One.