Wednesday, October 16, 2013

Hershey, Growing Old and Making Plans

It is the perennial cross to bear.

As the resident veterinarian you are going to be asked, (and if the words don't formally ever materialize), be expected to take care of the pets of everyone in your life. Expect it. And for your own peace of mind, embrace it.

I love medicine and animals so much that I am comfortable with the responsibility. I am also now seasoned enough to foresee the potential pit falls before I step in them.

My friends and family are a mixed bag of strengths, emotions, and inabilities, just like all of us. So, when It comes to taking care of their personal pets they know me well enough to know that I am the advocate for their pet first and foremost. When they are looking for a reason to make a hard decision I am the side of the fence that your pet sits on. I will do my best to speak for them. It is important to know each other well enough, and trust each other deep enough, to have very difficult discussions. Those discussions need to be made by all sides, with mutual respect for each other, and always with the interests of their pet at the forefront. I understand that this is not how every veterinarian approaches hard decisions. But it is how I practice. (Before everyone in a white coat gets in a huff and sends me scathing comments I am a person, I do care about people, and I do understand that every situation is unique. So give me a shred of respectful credit. Please).

When my very good friends saw their dog Hershey having a more and more difficult time doing even the simplest, most basic tasks they started to call and visit me at the clinic more often.

We began the delicate dance of trying to mitigate Hershey's challenges, maintain some degree of comfort, and provide a treatment plan that his parents could provide. All of pet care is some degree of give and take. And every pet, client, and treatment plan is a reflection of this. In all cases my job is to try to offer a series of choices. I call it making Plan A through...well..we can revise it as often as needed. Plan A is the optimal. What would be ideal if time, energy, and money were not an issue. Plan B addresses the options if one of those items is not in abundant supply. Plan Z is always what to do in worst case scenario. Life will always hand you a tablespoon of worst case scenario, I prefer to be prepared for it.

Hershey had the typical old lab struggles. Your hips get sore, so you walk less, and that reluctance to move allows your muscles to atrophy. It is incredible how fast this can happen. A dog can lose a significant amount of muscle mass in days. Keeping a dog comfortable enough to ambulate is the keystone to maintaining muscle mass. Often clients call saying that they believe their dog has had a stroke, broken a leg, or won't get up, when in fact they don't have enough strength left in their legs to hoist themselves up. (In cats think diabetes, and in dogs think osteoarthritis or acute catastrophic internal disaster this requires that you GO TO THE VET immediately!).

Hershey was lying around more and more. He could only be convinced to get up from the lawn and leave his post when the sunset and his dad came to pick him up. Once he could get his feet under him he could truck around fairly well. His back legs were stiff, straight, and the toes crossed in front of each other causing him to sort of trip himself up every so often. But he is a head strong determined hard-wired lab. It takes a tsunami to stop them.

We decided a soft bed, a good NSAID, and a simple daily schedule to keep his mind and body happy were Plan A.

Plan A worked swimmingly for about 6 months. Hershey needed his osteoarthritis medication more and more often. Over six months he went from needing it rarely to needing the maximum daily doseage. He tolerated it well and seemed to be his normal resilient affable self on every exam we had.

About two months ago his panting grew more and more persistent. His baritone bellows could be heard 50 feet away. Any degree of stress or exertion and it became a rapid racing drum roll. His parents called me and we decided to keep his schedule as consistent as possible and carry him a bit more so his body wouldn't have to exert itself.

His list of diseases now included hip dysplasia, muscle atrophy, and laryngeal paralysis.

Hershey was in a slow very gradual almost unrecognizable decline. But he was happy as long as his dailt routine stayed just as he wanted it.

Then the last straw hit the camels back and the plan had to be changed.

Hershey's dads' brother died and Hershey for the first time in his life needed to be boarded.

He came to stay with us at the clinic for a few days while the family gathered. We had a long talk about how little time we thought he had left. I promised them that I would watch him and help him with the few days they had to travel.

It was agony. He was so uncomfortable and unhappy. We went through the list of palliative therapies to see if he would respond to any of them. In typical lab fashion his stubborn unyielding demeanor made him refractory to any and all therapies.

We had been waiting for, planning, discussing this day for months. And for whatever reason that life feels is necessary to overwhelm our ability to carry a difficult burden life will throw an additional one at you.

We kept him with us in the bustle of the clinic to be able to provide him more attention.

We walked him outside every hour. He was happier out there, but it wasn't his home, and he wanted home.

I called his parents. I told them that I was worried about him. They knew he was struggling. He had been struggling for a while. They needed to be with their family and I had to be comfortable with the responsibility of Hershey.

They told me what every loving family member needs to tell each other. I trust you and we don't want him to suffer. I needed to hear that. We all need to know that the hard decisions should never be made alone.

I promised that I would do my best to keep him calm and comfortable, but I emphasized that I would think of Hershey first.

Three days later, on the day of the funeral, at the time of their brothers eulogy Hershey's respiratory distress progressed to respiratory collapse. He was quickly given a heavy dose of a sedative and put on oxygen.

His options were now at Plan Z, which required emergency surgery to surgically open up and tie back his vocal chords, OR, placing a tracheostomy tube, OR, placing on a continuous drip of a sedative to literally put him into a drug induced coma, and then doing a surgery...he had no long term options that were fair. If we could turn around his laryngeal paralysis we couldn't turn around his hind limb weakness.

We said goodbye and let him go peacefully.

I called the family and relayed the news.

They returned home from saying goodbye to their brother and didn't have a chance to say goodbye to their very loved family member.

Hershey was always surrounded by people who cared about him. We should all be so lucky.

Our deepest sympathies to my dear friends. You are in our thoughts. I am so sorry that at a time of great loss you had to say two goodbyes.

If you have any pet related questions, or would like to help others with the care of their four legged family members, you can find the place for any kind of pet question at

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