15 | October | 2009

I saw 3 critically ill dogs on Saturday.  I euthanized #3 today.  And my husband doesn’t understand why I consider my job to be highly stressful.

The two dogs that died Saturday were 6 years old.  I’m sorry, but 6 is not an age at which a dog should die.  That is prime early middle age in a pet as far as I’m concerned.  That should be the age at which people consider dumping their pet insurance because their pets are just so darn healthy.

Dog #1 was a super cute petite Basset Hound named Bailey.  I saw her for the first time about two months ago because she had lumps under her throat.  Throat lumps on the appointment schedule (especially in Golden Retrievers) always send a little chill down my spine because more often than not, they are lymph nodes.  More often than not, those nodes are full of lymphoma (cancer). 

Sure enough, this sweet, sweet pretty little girl with the super nice young owners has an ugly, nasty cancer.  I always send the samples to a pathologist for confirmation, and there it was:  Lymphosarcoma.  Often pathologists waffle, they don’t want to give you a straight answer when you send them a sample.  But, usually with the lymphoma dogs, they call it. 

So we had to have “the talk”.  Without treatment, lymphoma dogs live about two months.  With just prednisone, maybe three or four, max.  There are several chemotherapy protocols, usually ranging from $ 3,000-$ 6,000.  In general they buy you anywhere from 6-18 months from the time of diagnosis.  So, “the talk” is especially difficult, because, essentially, you’re putting a price on when exactly you want to say goodbye to your dog.  The end result is the same, the dog is going to die of its cancer, you just have to choose when it’s going to happen. 

So these clients opted to just let her live life without drugs and excessive vet visits.  At the time of diagnosis, she was totally asymptomatic.  She wasn’t sick at all. 

Over the course of the next month or so, she did fine.  Then she developed diarrhea, and grew weak.  A strange odor started to come out of her mouth and she was losing weight. 

When I saw her Saturday, the cancer had spread.  All her nodes were huge, and she was having trouble breathing.  It was time to let her go. 

In the middle of all that, another 6-year-old dog (Dog #2) came in.  She had acutely collapsed.  She was a yellow lab who had been having some vomiting and diarrhea for maybe a couple of days.  Her bloodwork drawn the day before showed she was possibly in liver failure. 

So, I had to keep leaving the euthanasia room to try and save the collapsed lab.  (Who, ironically, also has lovely, nice young owners).   Thankfully, Bailey’s owners were super nice and understanding.

This lab had acute liver failure.  You can’t live without your liver, even though it’s function is not as noticable as that of your lungs, brain or heart.  The liver does lots of stuff, it synthesizes protein and sugar.  Helps produce the stuff to digest fat.  Filters blood of toxins produced by the GI bacteria and other functions I can’t think of just now. 

The Lab showed up while Bailey was falling asleep.  She had neurological signs that I’m pretty sure were attributable to hepatic encephalopathy.  A condition where the liver fails to do its detox job and ammonia builds up in the blood.   She didn’t seem to be able to see, she was alternating between stiffness and profound weakness and she seemed to be in pain.  So I set about getting her started on IV fluids to try and flush out some of the toxins.  Gave her a myriad of drugs to try and reduce brain swelling, relieve her pain, etc.  

Eventually 12 o’ clock rolled around and I sent the Lab and her people to the ER.  The picture wasn’t good, but we decided to give her a chance since she’s only 6 years old.  Her owner said she’s been trying to prepare herself for something like this (the dog had had other major health issues on and off). 

 Causes of liver failure include, toxins (Tylenol is a biggie for animals and humans alike, watch those drug labels…accidental overdose of Tylenol is a big cause of liver failure in folks in their 20′s and 30′s because they take various cold remedies along with Tylenol that all contain acetomenophen), mushrooms, sago palms etc.  There is also a newly discovered genetic cause of liver failure in Labradors.  I have a feeling this is what happened to this one. 

I usually start screening Labs for liver disease around 7 or 8 years of age, but I think I’ll start sooner than that so Lab owners: get ready for the bloodwork speech around age 5. 

In between caring for the Lab, I finally euthanized Bailey.  Her owners, as I said were soooo nice.  The “mom” in particular was so sad, but at the end, she had the presence of mind to steel herself and stand up and inform me that Bailey was truly a wonderful dog, she had traveled with them half way across the country and she was perfect,  and that her middle name was Marie.  It was such a sweet tribute. 

Meanwhile,  Nancy the AMCOP tech was especially worried about the Lab and asked if she could call and check on her. Well, I got a text from Nancy around 9pm that the Lab had died.  Dr. Rogers texted me shortly thereafter with the same news.  Her ammonia levels were three times normal, and it was just too much for her.

The last critical case of the day was a cocker spaniel named Frenchie that I have known for years.  He moved away for the last 3 years or so, but he was back.  In 2005 I treated him for a weird gallbladder thing (cholecystitis) and Immune Mediated Hemolytic Anemia.  He hated me for years, then when he got so sick, we had to see him almost weekly and he finally got so that we didn’t even have to muzzle him anymore.  There used to be a time when we had to take him to the back, away from his owner because I think he felt like he needed to protect her, tooth and nail.  He was vicious to us, but not to his mom, who loved him like crazy and had tears in her eyes many, many times when he was so sick.   He got so where he wouldn’t eat so she cooked for him to keep nutrition in him.  Ultimately, I think she cooked for him for maybe the rest of his life….

Frenchie pulled through all that and was doing great until he got into the trash last Thursday.  He’d been vomiting like crazy and stopped eating.  Bloodwork revealed what looked to be severe pancreatitis.  I started him on meds and an IV and sent him to the ER for treatment over the weekend.

Monday he was looking better.  He went home overnight and came back Tuesday.  That day, I was examining him and Kim, my tech, noticed that he had a hard spot on his side and asked me if that was normal.  I felt it and it was definitely not normal.  What she felt ended up being a large abdominal mass.  It didn’t show up on the previous X-ray because there was too much inflammation in his belly, and I couldn’t feel it before because he was too tense and painful.  I got a second opinion from Dr. Sharp because the LAST thing I wanted to do was break THIS news.  We had thought he was getting better.

X-rays from different views confirmed the mass, it was big, ugly and painful.  I sent the dog home with his mom for the night, it was too big a decision to make this quickly (his options were risky exploratory surgery or euthanasia).  I dosed him up with Morphine for the pain, but it didn’t cut it.  The next morning, his mom called me, and we decided it was time.  She had never had to put a pet down before.  Thank God her sister, and niece and boyfriend were there for her. 

After I gave him the sedative, his breathing slowed down and you could totally tell he wasn’t in pain anymore.  He died peacefully.  His mom was a mess, but the family stayed for a long time.  Reminiscing about him and telling stories.  As euthanasias go, it actually was nice to sit with them and hear about his escapades.  Apparently he was an adept and stealthy food thief.  The dog would take the boyfriend’s spot in bed every morning,  his head on his pillow (he was there first after all!)

I did a post mortem on the dog per the owner’s request.  He had horrible, horrible pancreatic cancer.  It had to come on fast because he hadn’t really lost weight or acted sick until this point.  But at least we could all rest a little easier knowing there was no other choice. 

So there you go.  3 dogs.  3 family members gone.  All 3 families were young folks with no kids, these were their fur babies (as one of my clients adeptly put it).  All 3 clients showed tremendous strength and presence of mind in these horrible situations. 

My heart goes out to all of them…

Somebody asked me last week: How can I do this job if I love animals?  The euthanasias aren’t the hard part, the animals are suffering, and I’m ending that suffering.  It’s the poor people who have to struggle with the decisions they have to make that’s the hard part.  Helping them through that process is exhausting, it’s hard not to take on some of their heartache.  Maybe it’s a girl/mom thing, I want to try and make it better, but ultimately, I can’t.  They have to make the decisions, they have to feel the loss. 

And that, dear hubby, is one of the many reasons vets are stressed…