No doubt we all like a good solid excuse to make life’s long
list of chores a bit less burdensome.
But an excuse to skip washing the dishes is a far cry from the dismissive pass on seeking resolution to disease or discomfort when the patient is
elderly.
In some cases I suppose I am guilty of being age biased myself.
Just the other day I had a client sobbing in an examination room. She arrived with the whole family to put her Doberman down. Seems a fine needle aspirate of the dogs inguinal mass came back as “consistent with sarcoma.” The dog also had a swollen knee from an old cruciate injury and subsequent mild lameness. The owner believed that these were the first signs of the impending downhill decline and was seeking relief before disease could inflict suffering. I hadn't been the veterinarian who had done the aspirate, or spoken to her about the results, I was just the poor schmuck to get the euthanasia appointment. But here before me sat a happy, bright, active, healthy looking pup. If she was dying a terrible death from cancer no one had enlightened her to that fact. As with every appointment I reviewed the file, examined the patient and sat down to assess the plan. As I spoke to the family and rubbed their dogs belly to a wag only bliss can elicit I treaded carefully.
Just the other day I had a client sobbing in an examination room. She arrived with the whole family to put her Doberman down. Seems a fine needle aspirate of the dogs inguinal mass came back as “consistent with sarcoma.” The dog also had a swollen knee from an old cruciate injury and subsequent mild lameness. The owner believed that these were the first signs of the impending downhill decline and was seeking relief before disease could inflict suffering. I hadn't been the veterinarian who had done the aspirate, or spoken to her about the results, I was just the poor schmuck to get the euthanasia appointment. But here before me sat a happy, bright, active, healthy looking pup. If she was dying a terrible death from cancer no one had enlightened her to that fact. As with every appointment I reviewed the file, examined the patient and sat down to assess the plan. As I spoke to the family and rubbed their dogs belly to a wag only bliss can elicit I treaded carefully.
“Aren't we just buying time?” the mom asked.
“Well, aren't we all trying to do that?” I replied. “And she’s only four years old?” I muttered.
There I was using age as reason to rethink a treatment plan, (none had been discussed after the cytology results). Age does matter. It does influence our decisions, as much as it influences a presumed diagnosis and presumed prognosis. Thing is I hate guessing if guessing is going to be a death sentence. Who the hell am I? The All Knowing One? Nope, I’m still just that little 10 year old girl who wanted to go to vet school to save pets still trying to get you both another day.
There I was using age as reason to rethink a treatment plan, (none had been discussed after the cytology results). Age does matter. It does influence our decisions, as much as it influences a presumed diagnosis and presumed prognosis. Thing is I hate guessing if guessing is going to be a death sentence. Who the hell am I? The All Knowing One? Nope, I’m still just that little 10 year old girl who wanted to go to vet school to save pets still trying to get you both another day.
Disease is disease, and some diseases are even curable. Age, well, age
is just a number.
 |
| Savannah. There isn't a day that I don't miss her. |
...and for those of you who would worry, (like I do)... there is a happy ending here.. stay tuned.
Pawbly.com is a free place to ask, answer and share pet information. Please stop by and visit.
You can find me on Twitter @FreePetAdvice, or in the clinic, Jarrettsville Vet, in Jarrettsville Maryland.
Pawbly.com is a free place to ask, answer and share pet information. Please stop by and visit.
You can find me on Twitter @FreePetAdvice, or in the clinic, Jarrettsville Vet, in Jarrettsville Maryland.
Wow, what a story! I don't envy the position you were put in by this uneducated pet owner. For those of us who try every treatment available to keep our older pets with us for even one more day, this story is hard to read. I can't wait to read how you handled the situation.
ReplyDeleteHello! Thanks for reading! The pup in this story was a difficult exam to walk into, discuss, and I'm very glad to say that she is doing very well today. Her mom was puzzled about what to do, what her options were and whether her dog was in pain or an eventual decline that would be too difficult for her to watch.
DeleteWe spent a long time talking and thankfully she left with a new, thorough, treatment plan that she is responding very well to.
They also have my cell phone and email so they don't feel alone or unsure about what to do if her condition changes.
Medicine is a group effort. You just have to extend a helping hand, maintain a compassionate heart, and sit down and talk. Oh, and I would add you have to know who you are the advocate for.
Thanks for visiting!
This actually made me cry. To us it's always been about quality of life. Though some decisions might be considered differently given a particular age. For example, when Jasmine busted her first knee and the second one wasn't doing great and we were told we should do TPLO (or other knee surgery) for the bad one and eventually for both knees, I was thinking hard. She was 5.5 years old. The rehab after each surgery about six months. Did I really want to take away a year from her life? I was very hesitant to do that and was clinging to a non-surgical solution for quite some time. But then, in order to give her as much of an active life as possible, we did decide to go with the surgeries (though not TPLO)
ReplyDeleteWhen she almost died and was in ICU for a week, our only consideration was whether or not she was going to recover and what her quality of life was going to be. She was 6.5 then.
When her body betrayed her and the prognosis was grim and she was suffering, we decided to set her free. She was 9.5 then. But it had nothing to do with her age, it had to do with the prognosis.
Hello,
DeleteThanks for reading and for sharing your experience. I know that many people grapple with which decision to make and how to proceed among many factors. I also think that sharing personal experiences helps others understand that they are not alone and that you can get through the tough calls.
Your pup was very lucky to have such devoted parents.
Sincerely,
Krista
Glad the dog is doing well. Very interesting story, but I am curious. Are you trying to say that age doesn't matter? It seems kind of relevant to me as an owner. It matters for humans: chemo for the same type of cancer might make more sense for a 20-year old than an 80 year old, same with surgery.
ReplyDeleteWhen my then-13 year old cat got IBD (or lymphoma) though the clear layers on an ultrasound were more consistent with IBD (as the internist vet who did it said) I opted not to do the biopsy to know for sure fearing she'd not survive. If she had been 5, I would've likely decided to do the biopsy. Given that she went into congestive heart failure within a week of starting prednisolone and subsequent testing revealed pre-existing heart condition (a valve defect of type more common in dogs) made me more convinced that not subjecting her to surgery was a correct decision.
Then a year and a half later when she developed pancreatitis and stopped eating (in spite of appetite stimulants - she gradually needed more and more of them throughout last few months) I opted not to go with hospitalization/feeding tube as I didn't want to subject her to it. If she'd been a 5 year old with acute pancreatitis from eating something I'd have done it. Now, yes, there are other factors like progressive disease that got worse vs something acute that can be taken care of, but I think that age does matter - it affects ability to survive procedures, as well as how many years of life a treatment may buy.
Hello,
DeleteThank you for reading and for sharing your thoughts.
I agree that many things influence the treatment making process, and that yes, for many, age is a factor. But I am not sure that it always should be? How many of us can foretell the future? And how many of us would want decisions made for us based on age? If the same degree of reasoning applied to people that many of my clients apply to their pets we would would have about half the number of life saving procedures that we do now.
When it comes to our pets we decide for them, when it comes to our life, I'm sure most of us would like to decide for ourselves.
Age is a factor in assessing statistical outcomes of courses of treatment, but it shouldn't be the reason we decline discussing or investigating them.
Sincerely,
Krista