Convenience Euthanasia

This week has been full of sensitive topics. In the game world, there are sexual assault victims coming forward about a well known player. It is a difficult topic to discuss, and everyone coming forward to share their experiences is incredibly brave. And I hope it prevents people from being hurt in the future, and I am heartsick that people had to go through those experiences in the first place.

I am lucky. I have never experienced a similar situation. My heart goes out to the brave people coming forward to prevent future cases.

In the vet world, I came across the following article. I can't appear to get a link working- so here it is: https://www.facebook.com/haoting.chow/posts/10158955082305572


I'm not sure how well that links, but below is a piece from a veterinarian on a sensitive topic- aggressive pet euthanasia and convenience euthanasia. I have never performed what I consider a convenience euthanasia, but I have euthanized animals for treatable conditions. In some cases,  even with  treatment they had a poor prognosis. In some cases, the condition was treatable but the treatment would be tough, or was expensive. It's a fact of being a veterinarian that you will euthanize something for a treatable condition due to finances. In my cases, that particular experience was a GDV, which can have a poor prognosis and a number of GVDs end up euthanized on the table when you see the extent of the damage to the stomach and intestines.

I have been asked to perform what I considered a convenience euthanasia as a vet once, and as an assistant to schedule one by a client once. That case was someone moving who did not think her adult cats would adjust to living with anyone else and did not want to surrender them. We did not schedule her. The case where I was the veterinarian was scheduled as dog with malformed legs, owner requests euthanasia. It sticks in my mind rather vividly, since it was my first time encountering this as a vet.

It was a mastiff, with normal conformation, who had really bad flea allergies. The owner was also complaining the dog wouldn't eat anything, but when we put canned food in front of him he gobbled it up. And she said "well of course he'll eat canned food" but she refused to try changing his food at home. She claimed he had lost 20 pounds due to lack of appetite- records we had showed a 3 lb weight difference. I refused to euthanize, and that was the first time I really felt supported at that job as my boss told me she would stand behind that decision. The owner refused to surrender (I worked at a shelter at the time and we would have taken him and treated), and agreed to try treatment. Came back 2 or 3 days later screaming about how I don't have to live with the dog peeing everywhere because of the steroid we put it on, and how they can't just let him stay outside because their neighbor will feed him even though one of their complaints was the dog wouldn't eat. She eventually left after we refused to euthanize a healthy dog with a treatable condition that we were willing to take on.

That is my line for euthanizing treatable conditions- am I willing to take this case on if the owner will surrender it and find it a home or keep it myself? If I can't conceivably treat the case, how can I expect the owner to?  I suppose the best example of this is diabetic pets: I discuss (more with dogs than cats, due to the nature of the condition in the different species) with all new diabetic pet owners euthanasia when the diagnosis is made. If you can't treat this, I tell people, consider euthanasia. Dying of diabetic ketoacidosis is not a kind way to go. I would rather euthanize before they get to that point than have an owner willfully not treat.

My other line for euthanizing is aggression. I have an aggressive German Shepherd myself. She is great with me, and will let me do anything to her, but she will try to bite strangers. I give her medication before company comes to my house. I put her up if I can, avoid the issue altogether. I muzzle her if she has to come to work with me. And in the past, my family worried that we would have to euthanize her.

I have never felt unsafe around my dog. She has never shown aggression towards me or my family. But if did, I would euthanize. I am not sure I could do it- I have not been a vet long enough to have to euthanize my own pets, but as they get older I know that day is coming and I still don't know what I will do.

But on the issue of aggression- I love animals, but human lives are just as valuable. If a dog is showing aggression towards people, and I refuse to euthanize, and it goes on to maim a child- I feel like that would be on me. That is the one case I will euthanize even a sweet, seemingly healthy animal. I will certainly ask some questions- what was the situation, do an exam to see if the pet is painful and the child hurt it. But I have euthanized a young, physically healthy dog while the owner sat there with bandages on her arms crying because she was unpredictably aggressive. I have euthanized a physically healthy pit bull in the shelter who just would not allow anyone to safely handle her even with slow, careful attempts and much time spent trying.

And I believe that while these dogs may be physically healthy, they are not mentally healthy well adjusted dogs. And these are some of the hardest euthanasias to do, and some of the hardest decisions their owners can make. It's easy to euthanize a physically sick dog, when you can see how bad of fit is.. It is so much harder to make that decision for a mentally sick dog who is physically healthy. But living in fear of your pet, and for a pet to live in potentially isolation if that's the only safe way to handle it, is no kind of life. I have worried about having to euthanize my own dog for this reason, and cried over it multiple times. I have not had to thank God, but I can understand where the decision comes from. And it is the one case where I will euthanize physically healthy patients.

Euthanasia is the toughest decision you cam make for your pet. There are all kinds of quality of life scales designed to help people come to that decision. And all kinds of clients who want me to tell them it is time. And that is something I cannot do. I will honestly tell people if I think their pet is suffering. But I also tell people we can throw money at diagnostics and potential treatments for a long time before getting there. And is a temporary suffering that the pet may recover from like an episode of CHF that is improving a reason to euthanize? Getting past that episode may be more than some people can afford to spend though, and that is understandable. Or a broken limb- that's certainly suffering, but a healable injury for sure. Anyone who comes to be after making the serious decision to euthanize I will evaluate. It is not an easy decision to come to.

But as I told the woman with the mastiff- I have to be able to live with my decision to euthanize. And as she yelled back at me, I don't have to live with the pet I refuse to euthanize. (though she didn't have to either- we offered to take him) But that is the question I ask for every treatable condition- can I live with this pet, if the owner can't? Thank goodness a lot of them have no idea we can treat their pet's issues and are willing to try when they find out we can.

But I cannot kill a perfectly healthy pet because the owner just doesn't want it anymore. A lot of  my cases stay with me. I sometimes forget their names- I very often forget the owners. But I can see the brown shih tzu developing heart failure and the older woman who can barely afford the exam fee to see me, much less the ~$100 /mo of medication alone her dog would need, not even talking about the blood work monitoring.  And the 13 year old dog with GDV who has been having issues for days. And the older lab with a hemoabdomen, We waited for their adult children who grew up her to get there before she was euthanized. All potentially treatable, but unlikely to have a good prognosis. 

I could go on and on. I don't remember every pet I euthanized- I don't even remember the number. Some stick with me more than others. My goal is always euthansaia- a good death. A peaceful passing for the pet and owner, the best final gift I can give my patients. And I dread the time for so many of my patients, and  thinking about this is making me treat up. Though I have been especially emotionally  unsteady lately- lack of sleep + bad diet = teary and / or easily angered Nala.

At one point I seriously considered a job in palliative care and home euthanasia. I am not sure I am cut out for such a position at this time in my life. But I still put a lot of effort into my euthanasias.

As I re-read what I wrote, I keep thinking of more and more cases- some heartrendingly sad, some sweet. This has dragged on way longer than I meant it to, but I wonder if I should write the stories down somewhere.

Work Changes

A little bit of change at work this week, the new doctor started. I call her new, she just transferred from out of state. She's not a baby doctor or anything. Seems nice enough. Still getting used to the other new doctor who transferred a few weeks ago. We went from 2 full time 1 part time doctors, to 1 full time (me) and 4 part time. Part time at our location, they're all splitting time with other hospitals. It's a change, trying to get used to it. It doesn't help that we're still opening an hour later so I don't get time to get there a few minutes early, look at the schedule, get a game plan.  I'm hopeful we'll be back to our normal opening time soon, but there's no end in sight yet.

My current work/life struggle is being managed. We've been pretty busy- I've heard a lot of vet clinics have been slammed, and there have been some ERs turning people away. It's been crazy. Some of it has been normal things that people just never noticed and didn't realize were normal- like the male dog nipple ticks, saliva staining on paws not blood (though not normal, not an emergency) and smegma. It just makes it worrisome that the real emergencies won't get treatment in a timely manner. Though you can't help people who won't seek treatment because they don't want to pay the ER fee.

In WoW news, we killed Drest, yay! Not a fun fight to heal, everyone is so spread out. And my innervate-giver swapped from druid to hunter so I have to play a little more conservatively with my mana.

We had a bit of raid drama. Some people have been swapblasting other people to their deaths. I've been a victim of my boyfriend doing it since Blackrock Foundry, and it annoys the shit out of me, so I get it. Other people started, someone got pissed off and left. In return, someone got upset at him for leaving and swapped the crap out of him the next night. And I just want people to be adults and move on. We should not need to have a discussion about not being a dick to people in raid. We are all adults. But I suppose it fits in with my work-mandate professional development plan- this year I am working on communication skills. 

I failed at communication there. I knew there was a problem and took no action to stop it. I made a few passive comments about it, but didn't really do anything. I probably should have. Maybe I should read that fierce conversations book that was recommended to me.

I've been in another negative downward spiral- little things are really getting to me. I'm not really trying the healthier thing so much right now. Stress hits and I go open a bag of potato chips or ice cream. That's probably contributing. And being so busy at work I have to constantly be moving, planning, doing something in the most efficient manner possible to keep on track has been wearing me down. I like being busy- I hate being overwhelmed. It has made me snappy and overly sensitive to things I would normally shrug off. 

Here's to trying to be better next week!

Brain Problems

I had a really good day on a number of levels, but I still let the bad thoughts win today. And I wonder why my brain is primed that way.

I saw 2 of my favorite patients today. A sweet dog and a really nice cat. And instead, I focus on the 5 bad dogs I saw. I did really well today, kept on schedule even though we were busy- I had an awesome team today, 2 of my favorite co-workers. One of them, at one point, I thought should be fired for a toxic attitude and some poor work performance. But that's another story. We get along well now, and I think we work well together now that we have figured each other out. Makes me think of that Anne Bishop quote, some people need a hard lesson and some people are the hard lesson. I have had to learn a lot about how to get along with co-workers, and how easy going I am apparently not. I always thought I was...

But, back to my main thought: Nothing objectively bad really happened today. Sure, we had some difficult to work with dogs, and one kind of scary dog, but things went well. Raid, where some things did go poorly, was well after this point in my day. Why was I so down on what should have been a good day?

I'm working on being healthier- trying to feel my feelings in stead of eating them (which is what this post is about), sometimes trying for  more sleep. That one is tough, so many of the people I do things with are more nocturnal than I am. And I end up staying up way later doing things I don't need to do. So many of the things I am reading and listening to now talk about the mental side of things. Shaping your thoughts to get the feelings you desire, or stepping back to the facts and figuring out what you are feeling and thinking about them.  Mindful meditation, taking care of yourself.

I feel like some days I am too busy to have time for this stuff. Then I wonder if I'm a workaholic- I just went down a day on my schedule and immediately wondered if  I should pick up ER relief shifts for extra cash. I constantly worry about debt repayment- student loans are killer. I went down a day for my health, and mental well being so at this time I have not started looking for another part time job.

But veterinarians have a higher suicide risk than you might expect. And I am aware of that, and sometimes it pops into my daily life. A colleague walked out of the building with her drug box and committed suicide in a car. Not one I know personally, but works for the same company. We have to, as part of our AHAA accreditation, have information about suicide prevention on our controlled drug boxes. And when I hear stories like that, I want to be a healthier person- physically and mentally.

I would like to be able to feel like myself again. I hadn't realized I had stopped feeling that way until I suddenly felt normal a few weeks ago. I've been talking a lot with a friend about depression, and how it can affect your personality. I've often wondered if I need outside help. But then I feel like I have not time, and continue to tackle it all myself. Until I give up and go eat my feelings again.

I don't know why my brain focuses more on the negatives than positives. Always on the mistakes, not the good.  I think I'll start with a small effort- I have a hard time telling other people they are doing well when they are doing the minimum I expect them to do- their job. Looking for good things, complimenting people, might give me  a reason to look for the good outcomes, see the bright side, instead of focusing on the bad things that I may not be able to affect. Or help me recognize the things I can actually fix.

If you've read through this long- here's a picture of my dogs:


And here's a tidbit of vet knowledge: there is no best dog food. Some foods are better than others, but in general if your pet is eating it well, normal stool, nice coat and no itchiness or other skin issues the food is probably ok. Though I do recommend making sure it is AAFCO certified, ideally food trial tested- it will say somewhere on the bag. I get that question a lot from people.