Saturday, February 11, 2012

A Call From The Governor

Clients always ask me if euthanasia’s are the hardest part of my job? It is a difficult question to answer because  it is most often being asked as I am standing next to their pet, tears streaming down their face, grief evident in every mannerism of their face and body, and I know they are asking me to seek commiseration and companionship at one of their darkest hours. And I feel obligated to respond “yes,” as a small kind gesture of my empathy.
It is in truth a very hard part of my job. To be present and surrounded completely in someone’s pain and to try to be strong and supportive with them at such a difficult time. But for these parents I understand and want to be helpful in ending their loved ones suffering. That is what I feel my job is; to help their pet not suffer any longer. In most cases this is by treating them and getting them better. But I know that death must be a part of life. It keeps us from wasting a day, from worrying about things we cannot control, and it reminds us to be humane and compassionate. 
I take every pets' euthanasia to heart. I will only participate in it if I feel it is warranted. I hold the ability to end a life as a responsibility and I am prepared to answer every single one of my actions to a higher power should I be called to testify on my own behalf. I have to live with my conscience for the rest of my days and I have to want to wake up tomorrow morning and come back to work. I have refused to euthanize more than 1 pet in my life for reasons that I could not deem warranted, and I have given away many a euthanasia to people whose pets were suffering and could not afford to pay for this service.
I have also interrupted a euthanasia in progress because I was afraid there were options that hadn’t been laid out for the parents whose pet was brought in to be put down.
Here is one of those cases.
Di is a mature, plump, peppered, black Dachshund owned by a young couple who appeared to be hard working reserved country folk. They arrived holding their weathered aged, un-animated dog Di and sat quietly but obviously upset in the waiting area. Any parent bringing their pet in to be put down is placed as fast as possible into an exam room so that they do not have to try to remain emotionally composed at a time that is so emotionally difficult. We quickly moved them into the exam room that was set up for them. The next time I saw Di was when she was in the treatment area for her intravenous catheter. She looked grey and older but not sick or suffering.
I asked the doctor attending to her "What she was here for?" 
She told me that "Di had a large tumor in her ventral neck area." She then proceeded to remove the hands of the technician who had the tumor covered which revealed a very large, firm mass that encompassed the entire left side of Di's neck. The tumor went from her left side of her cervical (neck) spine all the way down to the inside of her two front legs.
“Oh, I see.” I said. 

These pictures were all taken on 1/16/2011. the day before Di started Kinavet.
She went on to explain that this mass had been surgically removed a few months ago and the biopsy results had revealed it to be a mast cell tumor.
Mast cell tumors are invasive difficult nasty buggers. We, unfortunately in veterinary medicine, see them frequently. Veterinarians try to remove as much tissue as we can on our first mass removal surgery because our hope is that the first surgery will remove enough of the bad tissue (tumor) and not leave any tumor cells behind to re-populate and allow the tumor to grow back. Many vets will recommend that the tissue we surgically remove be submitted for biopsy. This means that a veterinary pathologist will examine the tissue under a microscope to identify the cells that make up the mass so we can diagnose the tumor type. I always remind clients that without the biopsy, and the pathology report I cannot diagnose your pets tumor. I can make "an educated guess only." Without a diagnosis it is harder to make a treatment plan.
Thankfully for Di’s parents we had done a biopsy. But the diagnosis of MCT (mast cell tumor) was not what we had hoped for. Tumors are also “graded.” Di’s MCT was a grade 2. The scale ranges from grade 1 to grade 3, 3 being the worst.
When Di’s tumor came back it came back fast. It grew much faster this time than it had originally and now it was so large it was affecting her desire to eat and interact with her parents. Her parents brought her to us this day because they believed her quality of life had diminished to the point where she was suffering. A catheter was being placed in her leg to allow the attending vet to give her the euthanasia injection.
“What about Kinavet?” I said. “Have you offered them this?”
She looked up at me questioning what I was referring to?
“Kinavet, the new MCT drug. We had the meeting on it on Friday.” She had not been present for the meeting and I had not yet given her my notes summarizing the meeting about this new drug.
“Do you think it will work?”
“Well the drug manufacturers say that she would be the ideal candidate for it. But I am not sure that they give us unbiased advice? We have never used it before, so I can’t give them any advice other than what the drug  rep claims.”
She looked at me like “how the hell am I supposed to go back in there and mention this?” I knew exactly what she was thinking without her having to speak.
So I offered, “would you like me to go in and discuss it with them?”
She said “yes” before I finished my sentence.
Into the exam room I walked, Di still in the treatment area. Di’s parents were huddled together sobbing on the bench. I introduced myself and said that I had spoken to the vet taking care of Di and I had met Di and seen her tumor. I told them that I was sorry to interrupt and I didn’t want to be disrespectful of how hard this decision was, but that I had just been to a meeting that discussed a new drug for Di’s tumor. I told them that we had not used it in the clinic yet, but there were neighboring clinics who had used it already and had had success with it. I discussed the details that the rep had gone over with me. I told them that the new drug was a pill that the owners give at dinnertime, and that based on Di’s weight it would be about $100 to try.
As I spoke I was very relieved to see that they were letting me continue to discuss this new drug. I am always afraid that my butting in is going to be met with hostility and angst, (understandably.) I mean who the heck am I to jump in with a new plan in the last play of the game?
After we had finished the talking and question and answering time they looked at each other and smiled.
“Talk about getting the last minute call from the Governor!” Di’s dad said. We all erupted in nervous relieved laughter.
Di went home with a new plan and a second chance.
One week later she returned. Her mass had shrunk by more than half. Her parents said that she was acting like the dog she was 2 years ago. They were so grateful to have their dog back, and they said they were happy to be our first case.
Di has been back weekly for the last four weeks and there is almost no trace of that nasty bugger left.

We wish her great success!
These photos were taken on 2/6/2012

 These were taken at her weekly check-up on Weds 2/21//12. You almost can't see any mass on her neck anymore! Congratulations to Di and her family.


Kinavet is sold by MWI and available through veterinarians.

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