Thursday, April 03, 2008

A Season to Every Thing

Bill, my neighbor up the road, gave me a call. Could he come over? Sure, I said, wondering what he wanted to talk to me about.

It turned out he wanted to talk to me about Ginger, his dog. Ginger was a 40-pound terrier-mutt that he had picked up at the D.C. pound about 10 years earlier. Bill always ran the dog heavy, but other than that it was well-loved, and well-cared for. Now it had health troubles.

The veterinarian said the issue was a cruciate ligament problem. He said they could amputate the leg for $1,500 or do cruciate surgery for $3,000. What did I think?

Well, I explained, to Bill, there was another option: do nothing. How's the dog feel?

Bill said she was limping and seemed to be in a little pain.

Right. I told Bill the dog was probably in more pain that it was letting on, but that cruciate ligament issues were often quite a bit less serious than modern vets made them out to be. I printed out a copy of The Wall Street Journal article that immediately follows this post -- something he and the wife could read.

Back to the dog. I reminded Bill that he ran the dog too heavy and that was probably part of the problem. That said, I would not amputate the leg or have joint surgery just yet. Cutting off one leg would only stress the other joint, and he could easily end up with no dog at all.

As for joint replacement surgery, it was not guaranteed to be just one leg that would need that surgery before it was all over. Properly understood, this was not a $3,000 question, but a $6,000 one.

My recommendation was to put the dog on Rimidyl for a few weeks, take it out for very short gentle walks every couple of days, and otherwise see how it worked out in time.

And cut back on Ginger's food -- losing 10-15 pounds would not hurt that dog a bit, and might be curative in its own right.

And that was that.

I saw Bill again a while later when I stopped by, and he said that while Ginger was not running around like a puppy, she was also not limping anymore, and she was off the Rimidyl entirely. She seemed fine, and indeed she was happy to see me, standing on her "bum" hind legs to put her full beefy body up against mine.

All good.

About a year later Bill called again, this time from the road. He was on vacation with his family in New Hampshire, and he had kenneled the dog at the veterinarian's. Ginger had come down with some sort of urinary tract issue the day before he went on vacation, and the veterinary was now calling to say she had cancer all through her body. They wanted to do more tests and they could operate.


"There comes a time Bill," I said. "And you know it, and I do too. This sounds like that time. The dog is 11, and she has two major issues. The cancer is pretty far gone from the sound of it, and there is still the leg issue as well. You can throw the entire kit of veterinary medicine at this cancer, and they will run the bill up to the ceiling if you let them, but in the end you are still going to have a dead dog."

And that was it.

Bill knew I was right, and when he brought up the issue with the veterinary, they agreed straight away that it was the right choice. They had seen the x-rays, of course. They knew exactly how bad it was.

Yet, they had not brought up the the issue of euthanasia to Bill. Instead, they had brought up the prospect of very expensive surgery; the kind of thing you do if your veterinary practice is focused a little too much on the bottom line, and not enough on what is a good outcome for either dog or owner.

And so Ginger crossed over to the Other Side, as we all will some day.

Later Bill told me that all-in-all it had actually been a good family experience to have it occur while he, the wife, and kids were all jungled up in a hotel on vacation. The circumstances enabled them all to really talk about it, and in short order everyone was on the same page.

Did I tell you that Bill is a good father? He is.

I tell Ginger's story as a small caution; her last gift, if you will.

Ginger's story is a reminder that veterinarians are not always operating solely in our pet's best interest. Often they are making recommendations that serve their own financial interests above all else.

Cruciate ligament surgery was the wrong answer for Ginger, and I think it was malpractice for the vet to suggest that the only choice in this circumstance was between expensive amputation or even more expensive joint replacement.

Clearly it was not.

By the same token, I think it was unethical for the veterinarian not to present the euthanasia option when Ginger was later diagnosed with cancer.

Leaving logic off the table while leaving guilt, misery, and expense in the center had only one purpose; to get my friend to spring for expensive treatment that would not benefit the dog, but would financially benefit the veterinarian.

This is torture for profit as far as I am concerned, yet it is a very common veterinary practice today.

As I noted in a previous post entitled Veterinary Trades Say It's Time to Rip-off the Rubes, business consultants are rather pointed in their advice on how veterinarians should treat their customers:

"Don't let the client make choices about animal health. Your job is to offer the best only. Use the weight of your authority and knowledge."

And never mind the dog. Never mind common sense. Never mind results-oriented health care.

The advice of these consultants is exceedingly simple and can be boiled down to a set of ABC's: Always Bill the Customer as much as you can. And the customer is not the dog or the cat. It is the human. Limiting the options, and maximizing the guilt, are how veterinarian's can effectively maximize their income.

The second point is that death is something every pet owner needs to make peace with.

Death is not something you can prevent. If your relationship with your dog or cat is such that you are willing to spend anything and do everything to keep your pet alive, then you will ultimately do a very serious disservice to your pet.

As the Bible says, there is a season to every thing, and there is a time to die as well as a time to live.

If your dog or cat is healthy now, take the time to live with it. Take your dog with you to forest and field, play ball with it, take it on long walks, and comb it out twice a day if you must.

But don't overfeed the dog, and don't treat it as if it's a surrogate child.

A dog does best if it is run thin, and it does best if it sees you as pack leader.

And, of course, a dog does best if it is allowed not only the dignity of a good life, but also the dignity of a good death.

Don't let a veterinarian's greed, or your own fears and inadequacies as a pet owner cheat your dog out of a good death.

If you are the kind of person who reads blogs and books about dogs and cats, there is not much chance you will rush your pet to a premature death.

But there is a very real possibility -- indeed a probability -- that you will spend too much money on "Hail Mary" veterinary care at the end of life while failing to "cowboy up" and take decisive action to meet your moral obligation to the dog or cat.

The good news here is that Ginger had a good life, and as far as I can tell she had a good death as well.

But the veterinarian was no help in the matter. His advice was self-serving. And while it might have been good business, from his end of the exam room, it was bad health care from Ginger's side of the table.

Caveat emptor. That is Ginger's take-away message to us all.
In her honor, let's try to remember it.



Anonymous said...

My now gone big guy tore his cruciate running on the ice after rabbits and I had it fixed. Followed the post-op instructions to the letter and he made a full recovery.

I don't feel at all bad for spending the money and I would do it again. I don't want my dogs suffering for no reason.

My surgeon put in two ligaments - an autologous and a synthetic because there is a risk of rejection for each type.

As for the cancer story, that's different. I've always said if it's something snippable, fine, but if it's sytemic or metastatized, forget it - it's not fair to drag them through therapy, even though their response is very different from ours.

Anonymous said...

Thanks for posting this (and for adding us to your blogroll!) It speaks to the need for all pet owners to take time to search for the right veterinarian to care for their pets. Too often, IMO, people choose a clinic because its cheap or because it's located conveniently to work or home -- not because it provides the level of care they are looking for.

We have three different vets. A local vet that I have a wonderful rapport with who takes care of day to day issues, a large clinic we visit only rarely for the 'oh crap' stuff, and a holistic vet/chiropracter we see as needed. Together, they provide us with the level of care we want.

And remember - unlike is often the case in human health care - with vet clinics we have a CHOICE.

Thanks for reminding us to use it wisely.

Matt Mullenix said...

Patrick your point about enjoying the LIFE of the dog instead of shunning the death of it is well taken. I would hope to apply the same philosophy to marriage and parenting.

Make it good while it lasts.

kabbage said...

Going through the cancer thing now. My dog is almost 14 and was Dx'ed a couple months ago with cancer -- either breast or skin. Yes, if the growth was removed they could be sure what kind of cancer it is. Fortunately all the vets involved have been content with my decision not to remove it. Dog has a leaky mitral valve and is sensitive to anesthesia. Why risk losing her on the table at her age when she still feels good and is happy? I'll lose her soon enough, well, too soon, anyway.

I have been impressed by the vets' reluctance to do the removal surgery -- their reaction has been much more along the lines of "well, we *could* remove it, but it's high-risk for low gain at her age."

Anonymous said...

Thanks for this post. Watch carefully and do nothing (and, if applicable, cut back on the weight) helps in many dogs. Basic dog husbandry, at home, is done too little by too few people. Thanks for this and other posts on this matter. Happy hunting.
Melissa Stagnaro