The End of Life Sub-Blog 1(1)

How is that for a title? No worries -- nothing is changed here and all dogs are upright and happy, but if you get the Alpenhorn you will know from the article I wrote for the December edition that I believe in end-of-life planning for dogs.

In the minutes after Abra was euthanized -- with me sobbing over her still and warm body - the vet said, "you made the right decision." I know those were intended to be comforting words from a vet I very much like and respect -- but they weren't.

Euthanizing Abra was NOT the right choice -- it was the ONLY choice -- and that made it the absolutely wrong choice. Further, I said from the time she was diagnosed that I did not want to euthanize her -- I know allowing natural death can be gentle and that symptoms can be managed, and that is what I wanted for Abra and for me. But in veterinary care, end of life care is typically euthanasia and when all you have is a hammer -- well, you know...

The choices at the end of a dog's life should not be uncontrolled suffering/symptoms or euthanasia -- that is wrong, and shame on all vets and owners who think that way. I am not morally opposed to euthanasia -- but I am very opposed to a lack of choice. And guess what?! The end of life is not something that happens to other people's dogs -- it will happen to yours and mine -- and doing it well means thinking about it before we are in the midst of a crisis.

Maize's situation this week has reminded me of this reality, and brought back all those feelings of helplessness that I had when Abra's symptoms were not effectively managed and I made the only humane choice I could during that awful day of crisis. I won't go through that again.

I admire and respect veterinarians -- and I often don't, if I am to be honest, which I try to be. The truth is that they are very important consultants in the lives of our dogs -- but they are not the decision-makers -- WE ARE. No professional of any kind can or should make decisions for us because we are the only experts in what is right for ourselves and our families -- two and four legged members.

My experience as a breeder is that owners too often check their brains at the door when they go to the vet with a dog -- vet says do XYZ to the dog, and owner does it without question, research, discussion, thought, whatever. Critical thinking??!!! Apparently the presence of a veterinarian causes otherwise sensible people to lose this important skill, and the train of medical interventions takes off with someone else as the engineer.

Yes, veterinarians have important -- essential even -- knowledge and skills that we should access and consider as part of our decision-making process, but not as the Word of the Almighty. Consider the recommendation to biopsy Maize's lump -- that came from the pathologist and was relayed to us via our vet.

Okay, that could make perfect sense -- we want to find out what this lump is -- who wouldn't want to know? Well, let's slow this train down and think it through -- because the expert in what is best for Maize and our family is not the pathologist; his or her expertise is important and related to diagnosing, but directing treatment plans? That is not his/her job -- the decision-maker in what is best for Maize is me.

My job as the decision-maker is to consider the input of experts, and to place those recommendations within the context of our situation, our lives, our realities. It is wrong of me to abdicate my responsibility as a decision-maker to anyone else, including a veterinarian.

What do I mean by context? Well, for example, Maize's age (10+ years) and her breed create context. The truth is that she is past the normal life expectancy for a berner, and berners are cancer factories and the cancers usually kill them pretty quickly. We likely would not extend Maize's life through aggressive treatment because at this point, we want her to have quality -- not quantity -- of life, and this reality is part of "context". Her blood work suggests infection -- this is part of "context" and contributes to a decision not to do a more aggressive biopsy. Context consists of all the factors that make a situation unique and individual, and it is what must be considered to design a plan that is also unique and individual.

And so I thought about the recommendation to biopsy -- I considered what benefit would be gained from knowing the exact composition of the lump. We have apparently ruled out Lymphoma -- this is important because Lymphoma is very responsive to chemotherapy so if that, we would want to know in order to make treatment decisions. I am aware that very few other cancers are so treatable, and so a biopsy telling us it is one of the "bad" cancers will give us that knowledge -- but we are unlikely to have any real options in terms of treatment.

I like knowing stuff -- I do. But in this case, my need to know is not worth making Maize go under anesthesia and have a surgery, no matter how minor. I guess what I want to say about that is this: it is not about me. I do not get to make Maize suffer/assume risk just to satisfy my need to know something. If knowing doesn't really change outcome -- and it has risk and/or pain associated with it -- well, we just need to live with a curious mind...

An owner has a responsibility to gain knowledge from a variety of good sources, think carefully and thoughtfully about the options and their burdens/benefits, and then make an informed choice -- that is not the veterinarian's job -- it is ours. We have to live with our choices -- not our veterinarian. And so I called mine and told him/her (there are two -- they are married) MY plan for MY dog -- no biopsy now, follow-up appointment to do a physical exam and discuss options on Tuesday, and give the antibiotics a chance to work on any infection.

I have fired veterinarians who are perfectly good practitioners but who suck at understanding that they are not in charge of my dog's care -- I am. My requirement for my vets is the same as for my own physician -- I want to work respectfully and collaboratively towards common goals with an intelligent, secure professional who has good communication skills and tolerates disagreement. Interestingly, I had a much, much easier time finding a terrific physician for me up here in Montana than I did finding a vet for the dogs -- I wish my own physician was also a vet -- she would be perfect!

But I digress -- the bottom line is this: YOU are in charge of your dog's care -- do not check your brain at the door and become like a five year old following the authority figure's orders. Your dog needs you to think critically, find the best veterinary consultant(s) possible, and stay on as the engineer of that train.

I hope that Maize just has some kind of infection, but it is possible she has something else brewing -- we will know soon enough. And I have already been thinking about potential paths, where I will seek needed information, and so on -- this sub-blog will follow all that with a goal of helping others think through end of life care for their own dogs, even if that care is not needed for many years (fingers and paws crossed that it is MANY years!!!).