I’ve recently seen several patients with complicated problems. Second opinions are challenging, and ofter rewarding. Most of them come from “busy practices” where “busy doctors” may not have the time to thoroughly examine the patient and discuss the particulars of their pet’s condition with the owners. A thorough physical exam, some lab tests or radiographs, often give us the answer. It just takes some patience and client education to control or resolve a pet’s medical problem. In the end, isn’t that what we all want?
I never cease to marvel at the bond that forms between people and pets. And it forms so quickly….truly love at first sight. So it’s no wonder that when faced with obvious and serious congenital problems (birth defects) many of my clients choose to see their pets through extensive and expensive diagnostics and treatments to help them. Thankfully, many of the medical problems we see in newly acquired pets are not too serious. However, once and a while we do see a serious congenital heart defect or other organ problem that may impact the longevity of that pet and therefore how long he or she may actually be a family member. I’m in awe of the people who say, “I don’t care. We just want to keep him as healthy and happy as long as we can, even if only for a few short years”. This is only at the start of “the bond”. Wait until that bond has been set for a year or more. People will ask their veterinarian to move the earth, moon, sun and stars to do all possible to save their beloved pet. Sometimes, however, to a fault.
My dear friend Sue and her husband David recently lost a beloved family member. Here are Sue’s memories of that last day of Pyewacket’s life.
Last night our 20+ year old Siamese Pyewacket (or Piggy as he was more affectionately known) passed on in my arms. He was a lover and a fighter till the end.
While we were away for three weeks this past May I got daily reports about how he was cruising along just fine in his usual way. When we left we said goodbye and reminded him (and the others) we would be back as usual – he was use to our going and coming. We returned on June 1st to find him his usual tottering self.
Then just over a week ago (about a week after we returned) his typically slow eating became almost no eating. By Saturday when he stopped eating entirely and could no longer get himself all the way up the basement stairs (his last trip up on Friday night took him 10 minutes and he had to stop three times along the way) I started hand feeding him small amounts of food and water throughout the day in hopes that he might regain his strength in a few days. David helped by walking him and holding him up so he could get to the water, bed and litter (mostly) on his own. For a bit it seemed that with good nutritional support and a little endless care he might spend some more time with us. He seemed to get better and then worse. It was clear he was not ready to leave and so we gave him the best support we could.
Yesterday when it became obvious that he might no longer be able to ever regain his strength I called a feline veterinarian I work with and asked him to come to our home to examined Pye (Piggy hated the vet office and I didn’t want him any more upset if it was going to be the last minutes of his life). Our veterinarian explained that Piggy’s heart was very weak and could no longer pump the blood he needed to have any real quality of life. And so with a heavy heart David and I kissed him goodbye and I held him as he was put to his final rest.
Piggy was a character. Not only was he an apple head Siamese (round and not pointy) but he had the most beautiful chocolate point markings.
From the first time he arrived here in Hempstead, over a Christmas holiday in 1988, to find this was his new home, he brought his own unique view of the world to my life. And almost all who spent any time with him fell under the charming spell of his big blue eyes.
All he wanted was to be pet and fed. He would constantly walk under foot and inevitably be caught by a toe or two as he tried to get that endless attention he craved. In the last few years (after we saw the Producers’ Musical) we began to call him “Hold Me Touch Me” because no amount of petting, brushing or (until this last year) feeding was ever enough – he was a bottomless pit of need – but that pit also returned a endless supply of love.
In his younger days, when he was allowed outside, he loved to eat slugs, roam the neighborhood begging for food, and rolling around in the nastiest stuff he could find. He always looked like a dust cloud was trailing along with him. But through all the muck his big beautiful blue eyes always shown like a beacon. I have many memories of him as a young cat sitting with me in the garden as I tried to plant and weed around his ‘helping me’ – once I would finish planting a seedling he would mark each spot – watering as he went.
He also believed himself a great fighter and he did have the war cry if not the skill. He always led with the left side of his face. And so in those early years I cared for many abscesses cause by his desire to dominate the neighborhood. As he grew older his war cry became the signal that the younger ones were trying to gang up on him and it was usually enough to remind Sunny and Dante that he was not their personal chew toy. He even would nip them with the few teeth he still had – reminding them what a great warrior he was.
He had a voice unlike any other cat I have ever known – though all Siamese are known to bray – when he got a good wind up you could hear him from the basement up to the third floor bedrooms. I was often concerned neighbors might think we were hurting him as he told his stories to the world. These last few days he made very little noise and his loud motor like purring stopped.
I am glad to have had this last week to hold him. While I fed and sat with him and while we exercised him in an attempt to encourage a possible recovery we talked with him and let him know how much we did appreciate his being a part of our lives. I hope all that attention made him feel loved and that he knew we were honored to have him in our family (even though there were days…)
He was laid to rest next to Nicky (who we lost at 21+ in the Fall of 2006) and alongside Purdy and Timmy (all of whom he shared part of his life with here in Hempstead) in our yard – the yard he loved to patrol and water.
I know he is on the other side with the rest of our gang (and his first pal and love Jeffrey) braying loudly as he tells them all his final tales. He and his voice will be missed and remembered in our home.
Every so often, we get a flurry of common mistakes that pet owners make that could easily have been avoided. So, as a public service, I’d like to take a moment to offer a practical tip to pet owners who might read this. When your veterinarian gives you instructions regarding your pet’s care, FOLLOW THEM! In the past 2 weeks, we’ve had 3 pet owners violate that rule. As a result, their pets had to undergo procedures they otherwise would not have needed. Simply stated, their pets had surgery and were discharged with Elizabethan Collars designed to prevent them from mutilating their surgical sites. They were also given specific instructions not to remove the “E Collar” until we instructed them to do so. Unfortunately, pity got the best of them and they decided to remove the collars anyway. Within a very few moments, sutures were chewed apart, incisions opened and contaminated, and painful scratches inflicted on corneas. All of these poor animals needed to have remedial surgery to repair the damage their owners permitted them to inflict upon themselves. So, PLEASE, PLEASE, PLEASE, follow your veterinarian’s post op or home care instructions. It will save your pet unnecessary pain and discomfort, allow him or her to heal normally, and save you unnecessary expense.
I received this in an email from a colleague. I think it pretty well sums up what all veterinarians find so heartwarming about out profession. Read on and savor the sage advice.
WHY DOGS DON’T LIVE AS LONG AS PEOPLE
This about sums it up!!!!!
Being a veterinarian, I had been called to examine a ten-year- old Irish Wolfhound named Belker. The dog’s owners, Ron, his wife, Lisa, and their little boy, Shane, were all very attached to Belker and they were hoping for a miracle.
I examined Belker and found he was dying of cancer. I told the family there were no miracles left for Belker, and offered to perform the euthanasia procedure for the old dog in their home.
As we made arrangements, Ron and Lisa told me they thought it would be good for
the four-year-old Shane to observe the procedure. They felt as though Shane might learn something from the experience.
The next day, I felt the familiar catch in my throat as Belker’s family surrounded him. Shane seemed so calm, petting the old dog for the last time, that I wondered if he understood what was going on. Within a few minutes, Belker slipped peacefully away. The little boy seemed to accept Belker’s transition without any difficulty or confusion.
We sat together for a while after Belker’s death, wondering aloud about the sad
fact that animal lives are shorter than human lives. Shane, who had been
listening quietly, piped up, “I know why.” Startled, we all turned to him. What
came out of his mouth next stunned me. I’d never heard a more comforting
explanation.
He said, “People are born so that they can learn how to live a good life — like
loving everybody all the time and being nice, right?” The four-year-old
continued, “Well, dogs already know how to do that, so they don’t have to stay
as long.”
Live simply. Love generously. Care deeply, Speak kindly. Leave the rest to God.
I thrive on the excitement I get from learning new answers to the dark secrets we face every day. Veterinary medicine is a constantly evolving profession. So, when I make my annual pilgrimage to Orlando for The North American Veterinary Conference, I go having wrung out my spongy brain , making it ready to “soak up” everything I can take in. Leaders in every discipline from all over the world convene once a year to lecture over 10,000 veterinarians from not only the United States and Canada, but some 60 other countries. So, I always go to this conference (my 20th year I might ad), seeking the counsel of the best and the brightest about some of my patients’ more challenging cases. I wasn’t disappointed.
Ear problems in cats are among the most common, yet frustrating problems we see on a daily basis. “Tigger” has been suffering with a chronic external ear infection for months. Even the most aggressive medical therapy can’t seem to alleviate his problem. Now the inflammation has migrated from his outer ear (otitis externa) into his middle ear (otitis media). But, this is a rare and unusual form of otitis media. “Tigger” is producing mammoth quantities of mucoid discharge from his middle ear. After listening to 2 lectures on precisely this condition, no one addressed this rare form. Having vowed not to leave the conference without at least another option for “Tigger”, I cornered my two colleagues and pressed them for more information. One leaned towards a surgical cure, an invasive and risky operation into the middle ear. The other suggested a novel and unusual medical therapy he has used several times in this particular disease. Instilling a potent corticosteroid directly into the middle ear and continued medication at home for 2-4 weeks. I began treatment 2 days ago and can’t wait to see the results at recheck in 2 weeks.
Each year many veterinarians continue their educations so that they can deliver the latest and greatest cutting edge diagnostics and therapeutics to their patients. We do it to help our 4 legged friends, and also to energize ourselves in the profession that challenges and rewards in currency only a veterinarian could understand. That currency is the emotional and professional gratification we derive when we see something new and revolutionary and say “Wow!”. I love the wow factor….it gives me a warm fuzzy feeling inside and sometimes chills down my spine. For me, continuing education = WOW!
Yesterday, Mr. and Mrs. Gold came to the practice for the first time with their aged cat, Mike. He was a tough 20 year old who had forgotten that someone had invented something called the “litter box”. For the last few months he had been using the living room, bedroom, and any room as his never ending potty. Now, having lost 4 pounds (1/3 of his body weight) and drinking and urinating as if the floodgates were opened, they decided in their own minds that it was time to do something about it.
It was obvious that this elderly couple spent the last few days agonizing over what they had decided that morning when they scheduled their appointment. They weighed the fact that they would shortly be going to Florida for the “Snowbird” season. Normally, they left Mike with a friend for the three months. However, they knew that would not be possible now. I explained what the possible causes were for their old friend’s behavioral change and symptoms; the diagnostics involved and potential long term aftercare. Leaving them alone in the exam room with Mike to discuss their options, I couldn’t help but feel their anguish and appreciate the difficulty they faced in choosing the “right” option. Both of them in their late 70’s, they could easily identify with this old kitty. They could see themselves as he was; aged, failing, with no hope for any long term good quality of life. I came back into the exam room and saw the tears in their eyes. Mr. Gold spoke softly. “Dr. Wyler. I first want to thank you for taking the time to give Mike the most thorough exam he ever had. I wish my doctor would take the time to be so thorough with me. But, even more, I’d like to thank you for taking the time to talk with us and explain Mike’s situation. You’ve made a difficult decision a bit easier to make. We know that it’s time for us to say goodbye to our old friend. We feel comfortable that you are the doctor we want to help end his suffering”.
I’ve learned throughout my career that once the decision to euthanize a pet has been made, I have two primary obligations to my patients and my clients. First, to perform the euthanasia peacefully and painlessly, for both the pet and the client. Second, to make the client feel that their decision is the correct one. With an elderly client and an elderly patient, I can easily appreciate how they identify with their pet. They must be asking themselves, “Is this going to be my situation in a few months or years?” Having said their goodbyes, I took Mike from them, and proceeded to sedate him first, then administer the euthanasia injection. He died peacefully, painlessly, and quickly. I asked Mr. and Mrs. Gold if they wanted to say a last goodbye. They did. Each one gently caressed his motionless body. Tears in their eyes, they started to leave. But, before exiting the treatment room, Mr. Gold took me aside. “I’m sorry we met you only at the end of our kitty’s life. You spent more time with us today than our old vet spent with us during Mike’s entire lifetime.” With a warm smile and firm grip on my arm, he continued. “You’ve made a very difficult moment in our lives more bearable. We’ll miss him. But, we thank you for easing not only his pain, but our’s as well.” I thanked Mr. Gold for his kind thoughts, knowing that we will most likely never see each other again.
After they left, as I finished writing up my chart, I thought about what just happened. Although most of what we do in veterinary medicine helps prolong our patients’ lives and alleviates pain, we do have to consider euthanasia as an option for a small number of patients. It’s a procedure I take very seriously and do not perform solely upon request. I have to believe that it is justified. I stopped counting how many times in my career I’ve been through this similar scenario. It reminded me that ultimately, our profession has the profound ability to help people as much as animals, even if it means ending our patients’ suffering with euthanasia. I love my profession more than ever. I can’t imagine any other profession that has such a positive impact on both animals and people. I’m truly a lucky man.
As 2007 comes to a close, I’ve had many joyous and many “less than joyous” moments to remember. Fortunately, the happier moments outnumber the tearful ones. The loss of our Bernese Mountain Dog, Lily, most definitely stands out as the most tearful and heart breaking experience I’ve gone through not only this year, but perhaps in my entire career. She was a love, a mush, a totally devoted member of our family. No matter how ill she was, she always greeted us at the door, smearing her slobbery mouth and face against the glass with pure joy and happiness. We’ll miss her always, but are thankful for having had her for 10 years. People often forget that I’m not only a veterinarian, but I’m a pet lover, too.
