How Do I know?

I'm trying to give these things more structure, less stream of consciousness/verbal diarrhea.

So this week's post- one of the tough ones. Rarely do people come out and say Doc, how do I know when it's time? But in a myriad of little ways- I don't want my pet to suffer doc. I don't want to pursue needless testing. I don't want to put them through painful treatments. I don't want to wait too long. I don't want to give up too soon.

I am an eternal optimist- and it's a flaw. I try to be realistic, but one of the truths of the world is there are very few absolutes. So when people ask me- is there any chance? I say yeah, a slim one. But I've heard the cases, the one-in-a-million's that live past the expectations. Of course, I've also heard the apparently benign turned out to be terrible and died young, but they don't stick out as often as the other. So sometimes I feel like I give people more hope than their situation warrants.

This has been something I've been pondering a lot lately, because the last week the thought of my own dog's euthanasia has been heavy on my mind. Lina, the last dog I had to euthanize, still weighs heavy on my mind. I didn't know as much, I didn't know what else I could do- and I feel I failed her.

Bella, who has been with me since undergrad. VA Tech and NC state (I did not subject her to Grenada- the plane rides would not have been fun for her), my first job, my current job, all 3 boyfriends- is getting old. And it is showing. She has an arrhythmia and arthritis. She has some pretty bad muscle wasting in her hind limbs, and is starting to have trouble getting around. She is currently on 2 arthritis medications, 1 heart medications, a joint supplement and prescription joint food. And I do acupuncture on her, perhaps not often enough. I've tried other medications, and I am considering swapping hers up a bit more, but I also realize that no amount of medication is going to make her run up the stairs again.

There are a variety of resources out there to help people decide. Lap of Love,  an in-home hospice and euthanasia service, had an app, Grey Muzzle. The Ohio State University has it's own thing. And I'm sure there are others.

A lot of my information I provide to clients I repeat so often it sounds like a rehearsed speech. Vaccine reactions, heartworm prevention, my pre-euthanasia "this is what is will look like" talk. I don'r have one for this. How do I know when it's time? It's different for every pet and owner, and truth is sometimes euthanasia is a viable option that I discuss with clients, for treatable conditions. And those are the toughest- because yes is is the right decision for this pet and this client, but that doesn't mean it isn't hard or I don't wonder "if only we did this" or had tried that.

But back to the question- how do I know when it's time? Some pets make it really easy, and come down with something that will kill them. It sounds harsh, but that's how I recently phrased something to a client: you will have to decide when it is time for your pet because what she has now will not kill her but it will make her really painful and affect her quality of life. The ones where it's deadly and I can give you an estimated life expectancy are in some ways easier- then you have a goal. This will kill my pet, so when I start to see bad days, it's time.

The others are harder- the this won't kill my pet but it will make them miserable, and painful, and require a lot of supportive care to keep them in a reasonably comfortable state. And that's where Bella is at.

So where is my line for her going to be? I still have 2 or 3 medications I can try. I can increase acupuncture frequency. I can send her to physical therapy. I still have some options.

But when those run out? She's a lab, she'd wag her tail and eat something for me until the end. Is my line going to be she can't walk on the slick floors? She can't stand up unassisted? She can't make it the 2 inch step outside to go to the bathroom?  Or is it going to be subtler- she's panting and grimacing in pain occasionally now. If I can't get that expression off her face, is that my sign?

It's the hardest choice you can make as a pet owner, and sometimes the kindest thing you can do for your pet. And it's rarely easy, and always heartbreaking. And my job as a vet is to guide people to these decisions, but I can never pull the trigger. I get asked all the time, what would you do doc? If this was your pet? And I answer as honestly as I can, but I do tell people I'm in a different situation. That's sometimes the hardest question to answer- what would you do if this was your pet?

And writing this, I hope I know it when I see it. Another vet, somewhere on the internet, once said she's heard a lot of clients say they waited too long, and not as many say they gave up too soon. Once I do make the decision for Bella, I'll have to decide- am I going to be the vet for my dog's euthanasia, or the client?

Tough Days

This back end of this week was full of tough days.

Thursday was a tough day- for multiple reasons. I woke up, before my alarm, to a text from one of my techs asking if it was OK to bring her dog in for some bloodwork +/- euthanasia. That turned into just euthanasia. It was absolutely warranted. And she thanked me afterwards,, and her wife brought us all smoothies afterwards. And being thanked for euthanasia is hard.  I don't feel like I did a service there. She made the decisions herself, I just agreed it was warranted. She placed the catheter. I just pushed drugs and left her alone.

And there was another euthanasia that afternoon that felt pretty similar. Older golden, long time client, close to most of the staff. I don't usually cry during euthanasias, but I was getting teary during that one.

They also thanked us for the euthanasia. And it's always hard for me to hear. I try, I try to make euthanasias as smooth and painless a process as anyone could want. But people thanking me for it is still hard to hear. I never know how to respond.

And the schedule wasn't overly packed, but decently full, and we were down a person. My tech had been scheduled to work and of course we weren't going to have her work after that morning. No way. Work the day you euthanasize your pet? No. I can't imagine.

Then Friday, that was a hard day physically. The schedule looked easy- cat dentals go really quick if the teeth are healthy, and 2 of my 4 scheduled were cats. These teeth weren't healthy. I tell people when they ask if I really have to remove the teeth I recommend that they say "it's like pulling teeth" fora  reason because that is NOT fun. 3 of my 4 dentals (both the cats) needed 3 teeth removed, each of them a canine tooth too. It's great when you flip through the book for a reminder on how to do the gingival flap and the first sentence calls it the most difficult tooth in veterinary dentistry to extract. Feline lower canine teeth. I have referred in the past, for fear I might break a jaw when removing one, but I felt confident that day. I definitely undercharged for my time and the procedure, but I wanted the pets to get these teeth out, they were painful. I've been working on picking up dental skills. We did not get a lot of training in school. Not nearly enough to be proficient- but really that's the way school is. They teach you enough so you can learn the rest on your own.

Well, sort of. That's not the best description- they teach you what you need to know, but there is so much you need to know. So a lot of things they touch on enough to get you started, and give you places to look for the weird, specific stuff that comes up. Because you can't see everything in school or you'd never be able to finish. That's one of my favorite things about my career- there is always more to learn and grow and do. And one of the scariest things coming straight out of school- there is so much more to learn. 4 years out and I still feel like a new grad some days.

Saturday was good though. A holiday, the emergency that came in actually resolved well, left apparently healthy. The sick pet I fit in had a possible cause of her problems and we started treatment. I hate the, what one of my teachers called "nebulopathies" the something's wrong but we don't know what so we're making educated guesses on what to do while we continue to work things up. Here's hoping she gets better on the medication.

And that brings us to Sunday, where I work at my vaccine clinic job. Which was when I started writing this post, about to comment on how it's an easy job. And then I jinxed myself. It was as bad as it I'd said the Q-word. I stayed an hour and a half late, and saw double the pets I normally do. Luckily at least a third were adorable puppies, but it was exhausting.

And then Monday and Tuesday decided to get in on the action in small ways thankfully- our internet was down on Monday morning so no one could clock in, and on Tuesday our pet care software was down- no histories, no ability to take payments or check anyone on or see the schedule. Luckily it came back on after an hour, but my first client was a brand new pet we would have to take payment from- well, we would have. If I had been able to examine the dog- he was too aggressive for me to get near, lunging/barking. I did a free exam coupon and sent them with a script for oral sedation to get at a human pharmacy and some guidelines on muzzle training at home. Here's hoping it goes better in 2 weeks. Who decided I was the angry dog whisperer at work? It can get rather stressful somedays. Plus we were down a person. 

In WoW, I've come to the realization that I'm not as good as I think I am. It comes up every few months when I try to do something, struggle, and fail. It hit me hard this week since it started on Thursday and continued through Friday. I've been making changes to my UI, trying new things with healing mythic plus, trying to do the damage I see other healers do. And I'm failing. And it just made me pretty down on myself this past weekend. I'm back on the upswing of not caring and still having fun now, so yay there.

I'm also struggling with what to say to someone who has a profile picture in discord that is not appropriate for our discord. But this guy popped in once for 10 minutes then left. He has an alt in the guild, just 1, and barely plays in the guild. So how do I approach that? Still trying to figure it out.

But I was the one who felt it was inappropriate, who felt I needed to talk to the guy. I just feel, with all the stuff that comes out, if I allow things I think are demeaning to women to stand without a comment now I am contributing to the issue. Right now I'm waiting to see if he's going to be more active in our discord before really saying anything. And I still don't know what to say. It's a work in progress.

And now, 6 days off in a row! Without having to go to any continuing education- though I will be catching up on some online. I'm excited for the break, even if a trip to New Jersey is not my ideal vacation, but family is family. See ya later!