Diary of a Real-Life Veterinarian: Heidi

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;

Krista,

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;

three stories of three heroic three legged dogs.

Cesar Milan's story on three legged dogs.