If you were to see Chloe walk in our front door, you’d first
notice the 12-year-old yellow Labrador’s protruding ribs and pelvic bones. Then
you would see her tucked-up abdomen and sunken cheeks. After the shock of seeing her emaciated body,
you might think: How cruel of these
owners to keep this old dog alive! How
selfish of them.
Last summer, Chloe’s people noticed an unexplained weight
loss. After tests were run and an
ultrasound performed at Veterinary SpecialtyClinic in Buffalo Grove, the presumptive diagnosis was cancer. A definitive diagnosis would require surgery,
and treatment would probably involve more surgery and chemotherapy, with no
guarantee of a longer life. So owner Jaquelyn
and her husband reasonably decided on palliative care.
In veterinary care, many of the considerations near the end
of life are markedly different from those made at other stages of a pet’s
life. We need to determine such things
as when treatment is futile, the doctor’s duty to the patient, the emotions
involved in the situation, and who should decide what the patient’s best
interests are.
Most of our clients determine their pet’s best interest based
on the degree of pain the animal is living with. However, in the Netherlands, where euthanasia
of humans is accepted, two studies found that only 5% of those who ended their
lives reported that pain was their sole motivation. Similarly, our patients can
be distressed by other conditions, such as difficulty breathing, nausea,
profound weakness, and feeling sick and toxic (as in liver and kidney failure).
So we help our clients answer the question “what are the
patient’s best interests at this time?”
Some owners have no trouble determining the answer; others are
profoundly confused and agitated. We
veterinarians can assist uncertain owners by helping them assess their pet’s
pain and other causes of discomfort or suffering.
In our hospital, if our collaboration with the pet’s owner
determines that it is in the patient’s best interest, we focus on palliative
care for life-threatening illness. Our
goal is to enhance the pet’s comfort and give him or her the best possible
quality of life. There are many ways of
achieving that goal, including drugs for pain, loss of appetite and anxiety;
physical therapy; acupuncture; and therapeutic laser.
With regard to Chloe, although her illness suppressed her
appetite, most of her discomfort was from her arthritis, not her cancer. She gets special homemade food, takes a
cocktail of drugs for her decreased appetite and arthritis, and comes in once a
week for an acupuncture and therapeutic laser treatment.
She clumsily marches that skinny body straight to the
counter where the Pup-Peronis are kept and stares at the jar with
anticipation. And she doesn’t grab that treat with any
finesse — I still have to watch my fingers!
So if the casual observer harshly judged the person at the
other end of Chloe’s leash, they would be wrong. They didn’t pick up on Chloe’s bright, alert
eyes that still reflect some joie de vivre.
Jacquelyn and I assess her
quality of life weekly, and we feel that we’ll both know when the moment to let
go has arrived. But for now, it’s not
quite time to say goodbye.
