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 been out of school for a year when I had my first canine diabetic. The owners were dream clients. They listened carefully and followed all of my instructions to the letter. The trouble was, their dog wasn’t necessarily a cooperative party to the new rules!We struggled for a year to manage that dog, but he would get out and run around (increasing the need for insulin) and eat the neighbor’s garbage (increase the need for insulin) and not tell Mom or Dad how far he went or how much he ate! He was doing what normal dogs do…. being a dog. He was young and active and very hard to regulate. After a year, the young parents came to the conclusion that they couldn’t manage him. Today, it would be easier as the insulin products are better and the tools to monitor are better. But it is still very hard and not necessarily anything like it was represented in academic life.
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.
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 excessively and 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. But the next 24 hour period I noticed 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) and my mom went with me. There were 2 or 3 potential diagnoses that were tossed around that first day, and none of them good. The next day I took her back to the vet school by myself. She underwent a diagnostic test. 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 previous professors opened up my dog. The next thing I know, he’s telling me my dog is riddled with cancer and not recoverable. I took her home in a box.
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. Check back every Wednesday for the next installment!