Saturday, November 27, 2010

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!!!).


  1. Thank you for this post. I couldn't have said it better myself! Having recently gone through the end of life process with my beloved Tucker (Weim age 12) I fully agree with your position.
    When my boy was found to have "tumors all over" even our second-opinion Vet recommended ultrasounds, biopsies and some other rather invasive stuff. I looked at my boy and how happy he was and decided that was what matttered- much more than satisfying the question of exactly what was going to kill him.
    In the end, we did have to euthnize Tucker. Without any outward sign, his lungs had surrounded by fluid and his strained breathing had caused him to swallow air- he bloated.
    I could never thank our Vets enough for helping my family through that horrible time. I discovered the bloat at 7:45 on a Thursday night (of course they close at 8!) Instead of referring me to the local emergency clinic, they saw him and let us say goodbye to him in as gentle manner as they could. The entire staff stayed far past closing and did not rush the process at all. I am forever in their debt for caring not only for the patient, but for our whole family.

  2. Thank you for your comment -- I am very sorry about Tucker :( It sounds like not only was he loved in life, but that his illness/death was also handled in a loving, kind, and respectful way -- that is truly the best any of us can do in that awful situation.

  3. Mary-Ann, thank you for writing this post. I am taking it to heart, and I want to forward it to everyone I know, too. There's an allure to deferring to authority because the person has a title behind their name, even when its not appropriate. I've been searching for the kind of power-sharing vet you describe since we moved to Salt Lake City, but have not found that vet quite yet at University Vet Hospital (the vet techs are awesome, though!).

    You're so right about doing end of life planning, before the actual end of life time. I wish I had read this post or knew you before we had to euthanize our 15 year old pug a few years ago, Mr. Bentley. I still, to this day, feel powerless about having to euthanize him, especially when I visualize holding him in my arms as he crossed over to the Rainbow Bridge. It all happened so fast, and we had to think quickly about each decision we made at the end of his life. Having a plan in place, or even a list of various critical questions to answer before making that ultimate decision would have allowed us to feel more solid in our final decision.

    Anyway, thanks again. I always learn and reflect on your words. Today's post especially pulled at my heart strings (and my brain!).