Exercising the Privilege of Euthanasia

One of the sad tasks that I perform as a veterinarian is euthanasia. The loss of a life and the loss of the companionship of a friend is a sad event. As I remind owners, euthanasia is never meant to be an easy decision or an easy procedure to perform. I am glad that my profession has the privilege to end suffering.
Clients will often ask if their pet is suffering. For me, as a clinician, suffering occurs when a patient is experiencing pain and distress with no hopes of recovery. These are exactly the patients that deserve the right to be relieved of their burden. Clients often take weeks or months with their chronically ailing pet, making sure that their decision is made carefully and at exactly the right time. In other instances clients are faced with acute illnesses or traumatic events that lead them to consider humane euthanasia.
There are times when I feel that euthanasia is inappropriately utilized. An example is when it is used to control healthy populations in shelters and at humane organizations and then there are the instances that we at our hospital call 'convenience euthanasia'. I was presented with a convenience euthanasia just this past week. It was an older dog, he was brought in through our emergency service, he had severe dental disease and some other mild, chronic issues. He was walking and alert, he was eating and drinking. He desperately needed a dental, but otherwise he appeared healthy and stable. I had never seen this pet or these owners before so we had no long term relationship to use as a reference. I explained to the owners that I could not euthanize such a healthy individual. I offered teeth cleaning and other management options. They were irate saying that I was taking advantage of them since I felt I could make more money off of treating their pet than euthanizing the little dog. They stormed out of the office in search of another veterinarian to assist them.
It certainly is true that treating illnesses is my business and it is more profitable to make a patient well than to kill it. But that is not my motivation for my decisions and I take grave exception to those that think otherwise. I feel it is more ethical and humane to make a pet well rather than to euthanize it. That is why I am a veterinarian.
Fortunately, the vast majority of the patients that I assist in passing are owned by conscientious and well informed owners that take care in making the tough decision to allow their pet to pass away peacefully. For those clients I can be there for them and their pets.

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Not All MRI's Are Ceated Equal....

I have been performing MRI's on my patients since I left my residency in the early 1990's. Back then we utilized human facilities when they were closed. The trips to an MRI facility were clandestine events, in the dark of night, entering at the back door or loading dock of the facility. Basically the MRI's that we performed were run by skilled, trained technicians and they were of the same quality as the MRI's that were being produced by the facility for people. All the MRI'sd that I had the experience of performing were of excellent quality. The techs would even joke that they preferred our patients over the humans, because our patients were, in general, much easier to deal with! Then, over time, the human MRI facilities became so busy that they began to run 24/7 and there was no time to squeeze in the veterinary patient during off hours when no human patients would be bothered.

In a way it was a relief to not have to get up at 3 AM to deliver a patient to the MRI facility and manage its anesthesia then to arrive back at work to start my clinic day. But along with all that extra sleep time there came a new problem, where were we going to take the patients that needed an MRI? Slowly, facilities developed that provided MRI and CT to veterinary patients, we began using The Lawson Imaging Institute , www.MBVS.CA. This facility is awesome. It is run by a group of individuals that are devoted to providing the highest quality images and patient care. I can say that I have never had a bad experience or customer complaint about their services except that they are along drive away in Mississauga , Canada. These folks have the very best equipment and they price their studies (including anesthesia and interpretation) at about $ 1,500 US. Many members of this operation are scientists, engineers and physicists. They understand the way that the MRI works and the need for the best quality equipment to achieve the most acurate study. Although I would love to have a MRI within our facility, I have always said that we would only consider it if we could provide a similar service to the one provided by our colleges in Canada and for a similar cost. Otherwise, sending my patients to Mississauga, where they can get the best study for the best price, is the right thing to do.

As time went on otherlocal hospitals got MRI's. These were small mobile units or even less powerful machines that were far inferior to what was provided across the border and they were charging 2-3 times more. Colleagues were impressed by these other hospitals providing a MRI service, but very few were able to appreciate, or they didn't care to address, the differnces in study quality.

A few months ago my partner forwarded an article from the New York times explaining how how MRI machinary can vary and the quality of studies can vary to such an extent that misdiagnosis' can occur. Take a look at this article entitiled 'The Scan That Didn't Scan', http://s.nyt.com/s/NbdAuJZ. I was very pleased to see that someone was trying to eduacate the general public regarding the differences in MRI services. I hope that over time veterinary clients too will become more informed consumers. Just because a tool is in a hospital it does not mean that it is the newest or best quality and sometimes you do not get what you pay for!

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The Changing Face of Family Medicine

It has been a long time in the making, but we have officially kicked off a new phase to our hospital. We call it a family medicine service or a wellness clinic. The focus of VCS Pets First is to provide the routine, day to day, veterinary care that all pets need within a facility that houses an emergency service , a specialty hospital and hopefully, in the future, many other pet orientated services. This gives the client and the pets access to some incredibly skilled individuals, both doctors and staff, as well as access to the hospital 24/7 and all of its advanced equipment.
What is really exciting about developing this service now, are the chages that are occuring within our industry. We are setting the foundations for a service at the same time that our profession is realizing that vaccines are not necessary every year or even every other year. We are starting to see that the annual visit should be a time to focus on wellness, physical examinations, early diagnosis of health issues and, in general, preventative medicine that really, only includes vaccines as a minor aspect of patient care. This is exciting to me because I have always felt that we as a profession had made a fatal error in trying to use vaccines and dispensing drugs as the focal point of general practice and its revenue. Veterinarians are so much more than administrators of shots and drugs and we had been, in my etimation, selling ourselves short.
I recently had an opportunity to attend a lecture about vaccine protocols in veterinary medicine. It was great to hear that our professional organizations like ACVIM, AAHA and even the drug companies are recommending vaccines every 3 years after the 1 year -old cat or dog receives its booster and that after 7 years of age our cats and dogs may only need a rabies vaccine every 3 years. It is quite possible that we will learn over the next few years that we will extend the interval between vaccines even further.
Don't think that that means your pet should visit the veterinarian less often though, its those regular visits and examinations that will keep you pet healthy and make you aware of health issues that you might not have noticed if it were not for t he annual wellness examination with your family veterinarian.

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Wildlife Stories

With spring around the corner, we begin to prepare for the wildlife that needs our care every year. A recent car commercial, extolling the silence of its interior, had a mother badger, her sleeping babies and a person locked in the car. The point was that the car was so quiet that the babies and mom remained comfortable and sleeping rather than attacking the unfortunate human test subject. It reminded me of some young wild animals that were presented to our hosptal a few years back. Mother nature runs a limitless account with us and we try to do what ever we can for sick and injured wildlife and then get the animals to a rehabilitator.

One spring we had wind storms, whole nests of squirrels were being blown from the trees and ending up at our office. Around that time we got a call from a very excited young woman who explained that she had found a nest of squirrels in her back yad , they were crying and in great distress. We encouraged her to bring them to the hospital, since the nest had been destroyed they would have to be hand raised. A short time later, three women arrived with a swaddle of blankets and within the nest of linens was a jumble of small , brown, rodent-like creatures. The technician accepted the squirrels, took the requiset information and placed the babies in an incubator.

One of the technicians bottle fed the youngsters and shortly after feeding they were crying, actually screaming - a blood curdling cry. There was something primeval about the sound, distinctly un-squirrel like. I peered into the incubator to find 5 dark brown whirling dervishes. They were in constant motion, their long bodies moving like eels on stimulants. These were not squirrels, if they were there was something terribly wrong with their neighborhoods’ genetic pool.

After a quick consult with the wildlife expert we discovered we had baby mink! About 30 years ago, a mink farm in the area closed and all the mink were released. This resulted in a large, wild (and really, what mink are tame?)mink population. the hyperactive crew was quickly turned over to the rhabilitator. I would not want to be trapped in a car with them!

The responsibility of having a pet or caring for animals should never be taken lightly. Animals are ours to care for. They are solely dependent on us like the mink. Shirking our responsibilty can have far reaching consequences, not just for you and the animal, but for the ecosystem and the communities within. Mink are extreemly agressive and can push out or destroy other species that inhabit an area. The rehabilitator had to work hard to find an appropriate area for the little devils!

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A note from bluebears owners

Bluebears owners email:

Dr. Hass,
I have attached two pictures of our 7 year old Siberian Husky Bluebear (she’s the larger black and white one) that you recently treated. Blues problems were getting worse and worse for the last year with several episodes of vomiting blood. After your office ran the tests and biopsy it was determined she suffered from food allergies. Since late October we have changed her food to the allergy brand you recommended and the difference has been remarkable. Her energy, eating habits, and overall disposition are better than ever. We can’t thank you enough and never would we have thought we were making her sick just by feeding her. Thank God for sweet potatoes and fish!

Thanks again,
Jim and Denise Crews

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You are what you eat

While performing my residency in Neurology I began to suffer from some vague health problems that my physician attributed to stress. The problems escalated and culmonated in some serious gastrointestinal upsets. Eventually, I was diagnosed with a food allergy. As long as I avoid the allergen I am sensitive to, I am no longer plagued with those health problems. Once I was on my new diet, it amazed me how much the allergy had affected not only my digestive tract, but my energy level and my general sense of well being.

Recently, I was presented with a 7 year old, Siberian Husky, Bluebear, who had a one year history of episodically vomiting blood (hemoptysis) and acting lethargic. Each time Bluebear was rushed to the ER or her general veterinarian and each time she appeared to respond to supportive care. Then 2 or 3 months later Bluebear was back in the hospital.

When Bluebear arrived in my office, she was depressed. She had been vomiting, her coat was dull and lack luster, and she had been refusing to eat for days .Her owner was at wits end. After a careful examination I explained to the owner that endoscopy (the use of a fiber optic device to visualize and collect biopsies of the interior of the esophagus, stomach and proximal duodenum) would be our next step.

I performed the endoscopy. No ulcers, no tumors, but a very red, irritated gastric mucosa (the interior of the stomach). I collected biopsies and Bluebear was discharged to her owners care the next day.

The biopsy results returned about four days later. The diagnosis was lymphocytic gastritis with an eosinophillia. One of the possible causes for the histopathologic changes would be a food allergy.

After discussing these findings with the owner, I explained that although we could use many different medications in hopes of managing Bluebears illness, it would be attractive to try to treat her with a hypoallergenic diet. Certainly, medications will be available to us in the future, but if a diet change is sufficient it would be a healthier option in the long run.

Bluebear had always been fed a high quality diet. Her problem was not the quality of her food, but the type. Finding the allergen that triggers a pets allergy is not easy, but fortunately there are a number of prescription foods as well as one commercially available diet that can provide the necessary nutrients while avoiding common allergens.

Bluebear was placed on a commercially available hypoallergenic diet. She was not allowed to eat anything, but the diet and fresh water. Not even a rawhide.

At one month post-diagnosis Bluebear returned to my office. She was energetic and her owners were extatic. They reported that they were now surprised by how much her energy had been so dramatically affected by her illness, she was a new dog

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Simon

Ethical and moral dilemas abound in the practice of medicine. One of the most challenging questions I am confronted with is what to do for stray, injured animals. What do you repair, how far do you go? If it is an obviously aged animal, does that influence your decision? And who will take care of the animal once or if it recovers?

Financial concerns weigh in as well. Believe it or not, veterinary hospitals run on a slim profit margin, atleast ours does. My partner says that is because we take care of dogs like Simon.

Simon was one of those dilemas. He had been hit by a car and spent the night in someones backyard. He could not be easily moved and after a panicked plea from the home owner, my partner went out to their house and returned with Simon on a stretcher.

Two broken legs, the pelvic leg fracture was open,that means the bone was protruding out of the skin. The thoracic limb fracture caused the paw to flop about in a very disturbing fashion. And Simon’s tail wagged.

His collar had his name and owners phone number printed on it, but the people that answered the phone had never had a dog before.

What to do? Simon was gentle, alert and his tail was still wagging. He had survived the night in the elements. He appeared otherwise healthy, but thin.

We took radiographs of the injured limbs. The fractures were bad (like there is ever a good fracture?). They would require a surgeon, I certainly could not repair them. A veterinary surgeon, a friend visiting, reviewed the radiographs - yes the fractures could be repaired, a plate on the radius, some pins and external support to the tibia. Short work for her, but she would not be able to stay and help. Simon’s blood work was normal, heartworm test negative. He received intravenous fluids, antibiotics and pain medication.

I struggled with the decision, surgery? None of us could conider euthanasia. Simon had beaten the odds, he deserved a chance.

I called a local surgeon, no good samaritan work ~$1,500 quote for one fracture to be repaired.

Simon’s tail wagged. My partner and I disscussed options, Simon’s options. We called the surgeon.

The repair of the radius went well. The tibia repair was then attempted by one of the ER docs with the surgeon’s advice. A letter to the editor in the Milford Times brought some generous financial contributions.

On Thanksgiving Day, Simon’s owner called. She had been in the hospital with a serious illness and her husband, who had suffered a stroke, and required assistance, was at home. Family members were watching the home, Simon and Simon’s master. Simon slipped through an open door and was gone.

Simon had been the families solace through some very tough times. When Simon saw his family he suddenly was a different dog. When they left he barked for hours!

Simon is home now, we are still unsure if the tibial fracture will heal. An amputation is still possible. People are still sending donations to his care. The donations will not pay his surgical bill, but it will help. I am so happy we made the decisions we did. Simon definitey needed to stay with his family and help them out for a while longer. ¼/p> Simon and his master

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