Sometimes pursuing a diagnosis or treatment may not be in everyone’s best interests
I call this dilemma the “Just because we can do it, should we?” phenomenon.
As much as owners like answers and veterinarians like to fix things, sometimes pursuing a diagnosis or treatment may not be in everyone’s best interests. There are almost as many reasons why wandering down the diagnostic and treatment trail might not be ideal as there are ways to get down that path.
Some of these reasons include:
- The disease is chronic/incurable: Some things can't be fixed.
- The patient is near end of his life span
- Financial restrictions
- Invasive or painful diagnostics
- Low-return diagnostics
- Treatment that doesn’t enhance quality of life or actually lowers it
- Patient or owner cannot comply with treatment
- The condition itself is not currently problematic, but treatment might be
- People will love the animal and enjoy him as long as they have him.
None of the above points is an absolute reason not to take action, and there’s a fair bit of overlap between some of them.
I had a cat whom I adored and everyone else thought was crazy even by crazy cat standards. Bandy was a smart, playful dog in feline clothing. However, he had one definite cat trait. He HATED to be messed with on any terms other than his own. He was a snuggly boy who would sit on my chest and lick my nose as a morning alarm clock, but any sort of manipulation – pills, brushing, nail trims – brought out the caged tiger. The aforementioned tiger would demonstrate his displeasure with life by peeing all over the house and biting random bystanders.
When Bandy grew old and began to deteriorate, I didn’t even do blood work.
I can hear you now: “WHAT??? YOU TERRIBLE EXCUSE FOR A VETERINARIAN, HOW COULD YOU??”
Based on his age and signs, I had a fair idea that his issues would be chronic. There were pills and needles in Bandy’s future. Could I have afforded the medications? Yes. Could I have administered them? Sure. Would the outside-the-litter box activity have adversely affected my familial relations? Totally.
But the main point in the equation was Bandy himself. I could have bought him a longer life with diagnostics and proper treatment, but I knew my cat and I had a fair idea of how he measured quality of life. In the pre-Pill-Pocket days, having something shoved down his throat at regular intervals would have made him miserable (the hide-it-in-food trick never worked with him), and he would have viewed the subcutaneous fluids for his kidney disease as a violation of the Geneva Convention.
I still have a bit of guilt knowing Bandy could have lived longer, and probably healthier, if I’d made a different choice, but then I ask myself would I have been extending his life for him or for me?
I had a combination of factors to consider. He was old. The conditions affecting him could be managed but would require treatment for the rest of his life. He was what is referred to as a non-compliant patient, in the way that a fire-breathing octopus might be non-compliant. Even without treatment, he was generally happy, active, playful, and had a good appetite until very near the end.
Does my choice for Bandy mean that I think that owners shouldn’t bother to treat any old, crotchety, or chronically ill pet?
Nope. On the flip side, I present my “nephew,” a 13(ish)-year-old pit bull with cancer. Niles is quite possibly the sweetest dog on the planet and is vying for the title of King of the Ginormous Veterinary Record. In his lifetime, Niles has had two knee surgeries; been treated for a stick-vs.-eye injury incurred while playing fetch; had his tail padded with sanitary napkins because he beat it bloody on the hallway walls; ate a special diet because his delicate system rebels with noxious fumes and vomit at even a molecule of the wrong ingredient; and I think a couple of surgeries I’ve forgotten. He is taken to the clinic for every sniffle, wheeze, bump, or burp. Niles travels everywhere with my sister and brother-in-law and has a better wardrobe than my children.
When lymphoma first became suspected for Niles, my sister and I had a long 'treat/don’t treat/how much of a diagnostic workup is reasonable’ conversation.
Ultimately, my sister and her husband opted to pull out all available stops in diagnosing Niles’s illness and treating him. Over a year and substantial amounts of chemotherapy later, Niles is still rocking his “active daywear” (don’t ask).
A friend of mine had a dog just as beloved as Niles - though less sartorially resplendent - with the same diagnosis. Unlike my sister, my friend has three children who require clothing, school, etc. Though it tore her emotionally, my friend opted not to pursue treatment or repeat diagnostic testing. Her dog lived his few months, his pain was managed medically, and he was euthanized at home when the cancer caught up to him.
If you were to ask me who made the right choice for her dog, I would say “Yes.” Sometimes our circumstances dictate our choices, and one size rarely fits all.
I’ve known owners of pets with a terminal diagnosis who wonder if they should repeat diagnostic tests every time the pet’s symptoms deteriorate. Again, one choice isn’t right for everyone, but I used to ask my clients one question when they faced this saga. “What will we do differently based on the test results?”
If changing treatment isn’t an option due to the nature of the disease, the temperament of the patient, or family circumstances, it seems relevant to ask what difference new test results will make. Sometimes, especially when clients are looking for that flag that signals the end of a quality life for their pet, test results can be helpful. However, if the outcome isn’t likely to change what you do for your pet, why put her through it? What will you do with the results? It’s always good to ask, “Just because we can do it, should we?”
We all make decisions based on our needs and the needs of our family at the time. Sometimes, it's hard to accept that someone else's choice may be different from our own -- those differences make us question our own decisions. But acceptance is exactly what is needed in these situations. Whatever your choice would be, inflicting guilt on someone who made a different decision doesn't help anyone. And it is important to remember that any treatment or diagnostic plan is ultimately YOUR choice; so long as your pet is not suffering, your veterinarian can’t and won’t MAKE you do anything.
Ultimately it helps to consider a few points before embarking on a long journey of testing and treatment.
- If you do it, are you doing it for the animal or yourself? Be honest with yourself about why you are doing it.
- Sometimes we cause ourselves a lot of pain trying to avoid the pain of loss; in the end you will still have a loss, but what emotional/physical pain can you spare yourself, your family, and most importantly, your pet?
- Don't worry about what he thinks of how long he has to live; animals don't think of the future, but only the here and now.
You know your animal and your family’s situation best. If you think treatment is something you want to pursue, talk with your veterinarian about expected costs and realistic probable outcomes so that you and your family can be prepared. If you are overwhelmed by the thought of treating something long term, or you don’t feel that your pet is a good candidate, ask about ways to monitor and minimize your pet’s pain so that you can enjoy the remaining time together.
When push comes to shove, it all boils down to using your heart and head.
Dr. Teri Ann Oursler contributed to this article.
September 18, 2014
August 26, 2014
VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email firstname.lastname@example.org.