Friday, November 15, 2013

The Painful Truth About Coercing Your Client. Heidi's Story.

As a veterinarian there are so many talks that you discuss so many times that you feel as if it might just be a whole lot easier to video tape the discussion, push play when the next appropriate patient presents, and pop back in the exam room to discuss the final details of the treatment plan.

Wouldn't it be so simple? You bring your pet in, I diagnose the problem, tell you how to fix it, and then we schedule it the following day.

No wasting time, no idle insignificant chit chat, no silly feelings about your pet "not wanting to go through any procedures," or ridiculous excuses about “sparing them from the hardships of recovery,” etc. etc.

It can be frustrating to feel as if I need to repeat the same thing over and over.  And yet, I’ll do it tomorrow, and the day after, and the day after,.Its my job. To tell you what disease, condition, ailment, need, etc., that your pet has and how I suggest it be treated.

How do I keep myself from feeling like a broken record? Well, I employ my clients to serve as future character witnesses, provide their own personal experiences, and pass it forward.

Here is one story I find myself repeating often. It is about bone tumors.

In large breed older dogs that present to me with swelling, lameness and intense pain at the site I will place a bet that your dog has a bone tumor. The diagnosis is usually pretty easy. OK, well, I should back track a bit and clarify.

In the earliest stages of bone cancer it can be difficult to pin the diagnosis exactly. Because your pet knows before the x-ray does that there is a problem.

The typical presentation of a bone tumor is a progressive limb lameness that persists.

On the first trip to the vet we corroborate your suspicion; The leg hurts and the pet is limping.

The normal course of events after that first trip is to prescribe an NSAID, (a non-steroidal anti-inflammatory) and monitor for response to treatment and resolution of clinical signs, (they stop limping). These work very well on pain and inflammation associate with osteoarthritis (OA). Most older dogs, just like most older people, have some joint pain because their joints get sore after years of wear and tear.  A response to treatment is a quick, cheap, easy way to help confirm a diagnosis. If we are right, and if it is just OA, then the medications lessen the inflammation which in turn will help alleviate the pain. If we are wrong then the owner will call back in a few days/weeks and report that the lameness is worse, or no different.

Trip number two is for a re-check and x-rays. Depending on the degree of bone destruction we may or may not have visible evidence on the x-ray. (One little tip here from a weathered vet; take the x-ray of the whole foot..shoulder /hip to toes. It makes you look like a bone head when you miss the big lytic (destruction of bone) lesion in the foot because you cut the film short).

If there is a lytic lesion on the bone it is most likely a bone tumor, and the most common bone tumor is an osteosarcoma.

Osteosarcomas are incredibly painful aggressive tumors. They essentially eat away at the bone until it crumbles. They also spread fast! Those little microscopic cancer cells will hijack a ride through the bodies internal highway system (blood stream or lymphatics) and land in remote areas where they then lay down roots and begin to eat away at another part of the body.

After you and I have gotten to this point the waters get muddy and the navigational gear gets all screwy. The dance of the decisions, the debating, the doubt, the second guessing, hesitation and indecision begins.

Here’s where I want to take the conn and remove you from the bridge. What I really want to say, “OK, I got the wheel. I am steering the ship. Here's what you need to know: The estimate for surgery is $800 - $1000, average lifespan after surgery 6 months. But, trust me, your pet will be happier because they will no longer be in pain."

At which time you say, “OK, thanks doc, see you tomorrow for surgery.”

Now, I understand there is a lot to discuss. But remember I have had this discussion about 300 times before you, so in truth, I’m not looking forward to number 301.

Here are the arguments and points of discussion that pet parents have;

Number One: 
“I don’t want to put my dog through that.” OK, I’m going to put on my best “be nice” face. Your dog is in an immense amount of pain. That pain is manageable only for a short period of time. At some point we will be putting your dog down because they refuse to move, or eat, or do anything because they are in so much pain. SO, if you are telling me this I will remind you that not taking that leg off is not wanting your pet to be pain free. Be honest. I think that most people use this excuse because they don’t want to put their wallet through the procedure.

Number Two:
“He will be unhappy with three legs. I can’t do that to him.” My response; Your dog is already three legged. They are just three legged with one additional painful rotting limb stuck to them. Another important point to remember is that at some point the cancer will eat away so much of the bone that it will fracture, or crumble.

Number Three:
“The recovery will be too much on him.” Like the current excruciating minute to minute with no chance of relief in sight is better?

Now, I understand that I am not being subtle. Here’s why. I cannot stand seeing an animal in pain if there is anything that can be done about it.

So get over your phobias, and cosmetic disfigurement, and get that damned leg off!

Here is a story of a patient of mine. Her name is Heidi.

Heidi was an older mixed breed dog who presented with the above scenario.

Her dad is one of the most devoted genuine guys around. He is direct, honest, and not at all uncomfortable making you uncomfortable when it comes to his pets. I like him all the way around. We are kismet. I get him. I don’t mince words, and he doesn't tolerate it to begin with.

When Heidi first came to see me she was lame, exceptionally lame. She was in pain all the time. He knew he had to do something and he was leaning towards putting her down. When he said this I started to pull out all of the tricks of my medical bag.

There was arm wrestling, and some somewhat questionable, unethical promises. I also pulled out the “past experience” card. He was so stubbornly stuck on not being able to put her through surgery that I had to double down and confided to him that “if Heidi was my dog I would take her leg off.”

Now I’m going to be really honest. I hate when vets do this. It is coercion in my opinion. We should never ever use this as a way to persuade. While I’m being so honest I will also admit that I do say this. For my friends I feel OK saying it.

Before I convince you to take a bad terminal leg off, do your due diligence. A pet that is a candidate for amputation should have a full bloodwork and urinalysis done. They should also have a full 3 view set of chest x-rays. If everything is clear and normal I recommend amputation. If there is evidence of metastasis to the chest than the prognosis is poor and the floor is opened up again for discussion and debate.

I have some distinct advantages to being so sure footed here. I have years and years of cases to use as my precedence. I have never had one owner tell me that they regretted amputating a leg after they did it. Every single pet a week later was a thousand times happier than they were the day before their surgery. Taking pain away from a pet is giving them back their life.

When I told Heidi's dad that I wanted to write about her story he sent me the following;


Please find attached several pics of Heidi.  She's such a house girl that oftentimes when she's outside...and this was long before her surgery...she looks sad and bent-out-of-shape.  

Here's an impromptu paragraph on Heidi:

Heidi was found wandering in the street on a summer afternoon near Lake Redman, PA.  As I already had two dogs, I coaxed her into my truck and drove straight to the York County SPCA.  After checking on her over the course of a week, I was told that since she hadn't been adopted within a two week period, she was likely to be euthanized at any time.  I couldn't allow that and immediately drove up there to adopt her.  I then had three dogs for a short time until one of my "kids" died after 15 years of blessing me with her company.  

I must confess that Heidi, almost from Day 1, endeared herself to me.  I've had many, many canine kids through my 61 years, but Heidi, for whatever intangible reason, became my favorite of all time.  Then, after she developed a "limp", which after several weeks I finally realized wasn't the result of her stepping into a gopher hole somewhere on my two acres, I brought her to my long-term veterinarian, Jarrettsville Veterinary Center.  Initially, I was devastated when I was told that her diagnosis was Sarcinoma (you'll have to help me with this, Krista).  I also struggled with mixed feelings about whether Heidi would have any kind of fulfilling life when I learned that she would have to have her leg amputated up through the shoulder area.  After several days of tormented feelings, I decided to go ahead with the amputation, hoping that her cancer could be excised.  I might add, that financially that was a hardship at the time, but I felt as if I had no other choice that I could live with. 

Within 24 hours of her amputation, Heidi was remarkable.  I brought her home, using a towel sling to carry her into the house.  What did she do immediately after I released pressure on her towel sling? She took off on her own accord across the house to go to her water bowl and then down the hall to her bed.  We were moved beyond words by her strength and resilience. 

Within several weeks, she began to exhibit a deep, horrible cough.  We thought the worst, as we read online about how cancer when it spreads to the chest is often accompanied by such a cough.  Initially we put her on cough medication to suppress the cough.  When that wasn't real effective, we were able to obtain an antibiotic medication and her cough went away.  That was more than six months ago.  Her operation was almost ten months ago.  

Heidi had been my "special" child now for those ten months.  She's doing well.  She's not the same alpha dog that she was back before her illness.  These days she's a sweet, trusting, loving survivor.  I am so happy that's she's in my life!

Update, 12/1/13.
Heidi passed away at the clinic with her dad and I on 11/24/13. She was unable to hold herself up anymore. Before her surgery her hips were weak and arthritic and the additional stress and strain her body had to carry with the loss of her front leg made the hip stress more pronounced. Her dad bought a special harness for her with a handle to help her get up and provide an extra point of stability. The harness was also the way that her dad could help carry some of her weight and keep her from slipping or falling.

This was the email I received from Heidi's dad on November 21. 

Heidi has really taken a turn for the worse.  Her back legs sway and are wobbly...she's unable to cintrol her bladder...acts as if she is in a daze...takes one or two steps and stops...pants a lot more..and in the last few days has had little appetite.  We're thinking that her quality of life sucks and that it's time. Are you going to be there at all this weekend?

I saw them on the 24th, and it was time to say goodbye.

A week later her dad sent me this.
Happy Thanksgiving!  Now that a week has passed, I was finally able to log on to read the "Heidi" blog.  Thank you so much for being so candid and forthright.  I had wanted Heidi's struggle to end on a positive bend.  I'm grateful to you for being that enabler.  

I also want to say to all those who might know of many conflicting emotions that the "journey" with Heidi encompassed...I would do it again in a heartbeat!  Heidi taught me about compassion, perseverance, strength, and how to love more deeply.  

Thank you, Krista.

Heidi's "Dad":)

For related stories;

Related Posts;

Donner. My three legged cat's story.
A new Immunotherapy for canine osteosarcoma yields promising findings so that perhaps amputation is no longer indicated?

If you have any pet related questions you can find me, and a whole bunch of amazing people at

Or you can find me on Twitter @FreePetAdvice.


  1. Great story, Krista. Our Becca had osteosarcoma but could not have her leg amputated due to other orthopedic issues. We did radiation to ease her pain and it helped. Then we tried chemo, but she got sick right away and we stopped. We euthanized her shortly after. It's so hard to understand and accept the pain they are likely in. Dog are so stoic, and Becca was exemplary at it. Thanks for this article. I hope I don't need it again, but the truth and straightforward assessments are always best.

    1. Hello!

      So nice to have you visiting,,being such an incredible advocate for pets health, and for sharing Becca's story.

      Wishing you all the very best and keep up the good work!


  2. Love this story Krista. We had a boykin spaniel, Dixie. When she was 9 years old, we discovered that she had pancreatic cancer. The doctor told us they could do surgery to remove the tumors at a significant expense, and she would probably have no more than 12 months of quality life before passing. It wasn't a hard decision to make. It was a small price to pay for keeping our beloved girl another year. The surgery was very difficult, but she made it through and lived another 4 years. I've never let price decide what I do for my pets. However, I have had doctors tell me what they would do if it were their pet, and I listen :)

    1. Hello Kathleen,

      Many thanks for reading, writing and sharing Dixies story. What a lucky dog to have beaten the odds and lived such a long full life! A true testament to having good parents, doctors, and faith!.

      Wishing you and your dear Dixie (who is always with us in spirit) my best!


  3. Great job, Krista. I fell in love with Kermit (our 3-legged boy) when he came in with a very deformed left front leg through a rescue when I was working in Hagerstown. It was so painful that he needed an amputation within a few days of arriving at the clinic. I had Bob come in and meet him and he told me he just couldn't imagine us having a 3-legged dog. He couldn't go hiking, he couldn't be active, blah, blah, blah. Then, a week or so after Kermit's surgery, I had Bob take him on a walk on the C&O canal with me. He fell in love with our boy on about mile 2 and we took him home for good that day. Now, almost 7 years later, neither of us can imagine life without our tripod. He's a blessing, not to mention an inspiration to everyone he passes when he's hiking on the AT :) He's helped me convince a few clients that amputating a leg matters much more to the person than to the animal.
    Keep the great articles coming Krista!

    1. Hello,
      Thank you for sharing your story about Kermit! How inspiring he is to all of the four legged pups out there, and their parents!

      Thank You so much for sharing your story, his incredible triumph over his bad leg, and for finding a place in your heart for a dog with his own set of challenges.

      With best wishes,

  4. I read your blog entry and it brought back memories. I totally get where you are coming from, but sometimes things are not what we think they are. When my dog Nicki was 13, she all of a sudden developed a swollen elbow the size of a small plum and started limping and stopped using this leg. Now, she was a 10 pound Yorkie, so this lump was huge. The vet took x-rays and osteosarcoma was the likely diagnosis. He took more x-rays to see if there was any metastasis, but everything else was clear. The diagnosis was devastating, especially since we had just lost our 14 year old Yorkie who had suffered from diabetes a few weeks ago. Since we are in MD, and there is an orthopedic specialty clinic nearby, we felt it would be best to see a specialist. Immediately we were told that it was probably osteosarcoma or a bone infarct, but to know for sure we would need an MRI. A week later we drove to VA for the MRI. Our vet at the orthopedic clinic called me to tell me that they thought it was osteosarcoma and that we should amputate. I could not wrap my head around it. Deep down, I did not feel that it was osteosarcoma. He told me that we could do a bone biopsy to make absolutely sure. I needed time to think. I got a copy of the radiologist’s report and must have read it a hundred times. I am German, so I even translated every word to make sure I absolutely understood what was said. I could not see in there where he said that it was osteosarcoma. It was inconclusive. Most likely inflammation from arthritis, maybe osteosarcoma. So I spent the entire weekend on the internet and my veterinary books, and came to the conclusion that I would follow my gut and that she had arthritis. My regular vet said “well today we say she has arthritis and we’ll see what tomorrow brings” (or something like this). He wanted to put her on Metacam and he thought she would have to be on this for the rest of her life, but I was too concerned with side effects. I decided to treat her homeopathically. Within 6 weeks the swelling was completely gone and she was running again like nothing had ever happened. She died this year at 17 years and 3 months of heart failure. She had a few “minor arthritic episodes” after that first initial event, but it was never that bad again. Every time she would limp again, I would give her the homeopathic remedy and she would recover in a few days. Honestly, when all this happened, I felt that the veterinarians that diagnosed Nicki so quickly, failed us. They are human, they do not know everything, and sometimes the diagnosis can be a result of “I have seen this a hundred times and this is what it is.” Sometimes it is not what it seems to be. Ultimately, I have to follow my gut, but I make sure that I learn whatever I can to do what is best for my furry “children.” Nicki had a great life up until the end, and I am grateful for that.

    I love reading your blog and thanks for being such a caring vet!

    1. Hello Petra!
      Thank you so much for sharing your pups story!

      How amazing and lucky she was!! Certainly medicine is a bit of experience, a bit of detective work, and then a whole lot of mystery and miracles!

      I do believe that we should never ever underestimate the power of the will to live, and the glory that hope and faith can deliver!

      Thanks for visiting! and fore reading!

      All my best!