My Bella

 This is probably the hardest post I've written. I started with the title and am already in tears.

Bella was my dog- not originally, but she became so. She was given to my mom as a gift from my step dad. She was about a year and a half old when he was in a car accident with my brother. On Christmas Eve, to make things more dramatic. They were in a small, 2 door coup, and a truck came around a corner and ended up right on top of them. My brother was unharmed, luckily, but my step dad had his foot and knee crushed. His heel was completely broken, and after multiple surgeries he ended up pretty much wheel chair bound from then until his death last year. 

I ended up with Bella after the accident- I was at Virginia Tech at the time, and my parents did not have a fenced in yard. The dogs had to be walked to go to the bathroom, and they had 2- Bella and Kenzie. M<y step dad was going to be in the hospital for some time, so I offered to take whichever dog would be harder for my mom to walk by herself to help out while I was at school, and that was Bella. She was always a strong girl, physically- well, until the last year of her life. 

She was very much a lab- food motivated, would eat almost anything. My niece handed her rocks and she tried to eat them. She loved trying to chase birds and squirrels- she would try to climb trees to go after them, running up to the base and jumping up, nearly falling over backwards. She was also not the brightest bulb in the box- on the occasions she escaped, she would sometimes get lost or stuck if she didn't run back the way she ran away.  And she hated having her nails trimmed. She used to love car rides, and travelled back and from first from Blacksburg to Poquoson, then from Middleburg. Though at one point she got really anxious and chewed 2 seatbelts before I realized what was happening, and boy are those more expensive to replace than you'd imagine. Because of that nervousness- and the fact I lived on campus- she did not come to vet school with me. Instead she stayed with my parents, and when she heard my car come home she would wait by the door- the would have to let her out to show her it wasn't me there. She came to recognize my suit cases, and would whine and cry as soon as they came out. 

The last time she made it upstairs was after she saw the suitcases come out, and she came upstairs, whining. It was July 2020. We went to visit my boyfriend's family for his mother's first chemo treatment. Shortly after we returned home she had a bad bout of diarrhea, was not walking for a few days, and just really struggled to come regain her strength. I seriously thought I would have to euthanize her. That was what sparked her rehab therapy. This is her the first day well after that episode:

 

She came home from a day of fluids at the clinic, and walked on her own. Her rehab therapy went great- when I kept up with her exercises. She got so much strength back, though she never came upstairs again.

I've been writing all this, trying to think about the good times, before I think about the worst time. Bella developed a cough- and being a vet's pet, and having a heart murmur I waited to get her in. She had a cardio appointment coming up in a few weeks, she was doing OK- it could wait, right? Seemed to be in the mornings right after she ate. No big deal, not bothering her. Then it became more frequent. And she had trouble breathing.

I took her to work, and took rads, and she had pleural effusion. Our wonderful mobile ultrasonographer came out the same day, fitting her in as a favor, and diagnosed a mass around her heart and pericardial effusion. We took some of the fluid off her chest, but not from around her heart. Based on the location of the tumor, the most likely diagnosis was hemangiosarcoma- or so I thought at the time. I called the oncologist treating Kenzie, and they were able to get her in the next day to start treatment for hemangiosarcoma. And the day after that, I had a cardiologist look at her with the idea of tapping the fluid around her heart. And I felt I made a terrible mistake- he said the mass was in a different location, more likely to be a benign chemodectoma, than hemangiosarcoma. Sampling heart based masses is not commonly done, and the locations are usually pretty pathognomonic for diagnosis. On the plus side, she did not have enough fluid that he felt tapping was worth it. And a benign mass! A much better diagnosis. 

But I had rushed her treatment, concerned for hemangiosarcoma- and I feel like that was a huge mistake. Bella did not do well with that dose of chemo. It started with a decreased appetite, and diarrhea. Then she couldn't stand up with out aid- weakened from losing fluids with the diarrhea, and not eating. I did fluids under the skin for her at home, but she was not improving. She stopped walking without aid, and stopped urinating on her own. I had to express her bladder, and it was difficult to do- but she couldn't go days without urinating- I let her go 1 day before I started the expressions, and I gave her 2 days to improve. And I feel like that was the second mistake I made. Maybe if she had been male, and I could have placed a urinary catheter to empty her bladder, I could have tried longer. But she was a 70 lb lab, and she couldn't walk without aid, or even stand unassisted, and expressing her bladder was tough- on her, and me. My arms were killing me after 1 day of nursing care for her.

I always tell clients that I hear people say they waited too long and their pets suffered, and they wish they had euthanized sooner. And I try to be really supportive of euthanasias no matter how things may look, because once someone has made that decision, it needs to be taken seriously. I have only refused to euthanize in 1 case,  where it wasn't medically indicated in the slightest. Euthanasia is the most difficult choice you can make for your pet, and support from your veterinarian is important, in my eyes.  

This time, I was the one who had waited. My dog suffered, because I made poor choices. Rushing her chemo before having a cardiologist see her and better localize the mass. Not having insurance on her. I have it for my youngest dog (my brother's, actually) but not Kenzie or Bella- I always figured I could treat them myself. I did not realize the lengths I would go to for them, and the financial constraints. And how much the cost of treatment for some things has gone up- geez, is the protocol for lymphoma more than twice what I was told in vet school! If I had any idea the lengths I was willing to go to, I would have had insurance. Heck, if I had just gotten insurance after I started Kenzie's chemo, for Bella... But anyway. My mistakes: starting chemo too early, before letting a cardiologist look at her. Not going to a tertiary referral center like Virginia Tech or NC State, though there are downsides to that- incredibly expensive very quickly, not able to be with my dog (both because you can't in an ICU setting and COVID was in full swing) and not being able to stay in the area because I had to go back to work. Bella really only  got so much care and time those last few days because I happened to have taken some time off to use up PTO, just some random days that looked good on the calendar to me in January (this was all happening in April/May).

And my final mistake- waiting too long. Letting Bella's last week be miserable- she seemed interested in food, sniffing at it, but unwilling to eat. Suffering with diarrhea- bed bound, unable to move out of it, just oozing out of her the last few days, not improving with medication. And since she was not eating, she had to be pilled at the end, and she HATED it. She hated the appetite stimulant I tried, she fought getting pills, she was developing fecal scald around her back end. Her last week on earth looked like misery to me, and it was my fault.

This is her, at the end- getting SQ fluids, laying on a bed on a tarp incase the diarrhea leaked off the towels and puppy potty pads we had her on. Help em up harness left on her front end so we could get her to stand- I would attach the back end when we got her up, or just use a towel. Those SQ fluids- a full liter- went into her super quick, in minutes, she was so dehydrated.  And I made her suffer. I made the decision to euthanize her on Sunday, but was unable to do so until Monday, since I was not allowed into the hospital over the weekend, and I debated transporting her to another hospital to euthanize her, but I wanted her last moments to be at home, as comfortable as I could make them. 

So I woke up Monday morning, and told my mom it was today. She wanted to be there too, but needed to go to work for a bit. So I put a catheter in Bella, having some supplies left over from her issue in July the previous year. Then I waited, a few hours, until my mom was able to get off work. And when the time came, I pushed the drugs myself. I had considered, but never really knew, if I would be able to do it myself or if I would have someone else do it. I had wondered, would I want her ashes back or not? In the moment- I wanted to be her vet in her last moments, as I had been most of her life- and be with her at the end, even though I felt I had failed her. And I found I did want her ashes back, though I also understand keeping memories over momentos of time with pets. 

And I don't cry any more, when I do a thing and look for Bella to be there, waiting- for an ice cube when she hears the freezer, to be waiting for me at the bottom of the stairs in the morning, to greet me when I get home. 

I try to remember Bella like this- trying to trade me her kongs for part of my sandwich, happy. 

And that is the story of what I feel is my personal biggest failure as a vet, for my own pet. I am hoping that writing this, getting it all straight in my mind, will help me move past it. Never forgetting, but accepting my mistakes and learning from them, so I don't fail other pets in the future. 

It's been a while

 It has been some months since I have posted. A lot has changed in my dog's lives- the biggest change is I elected to euthanize Bella. 

And I though I was going to write a post about that, but just typing the words has made me tear up.  That will be a post for another day.

Rehab was well worth it to me, though I did not keep up with the exercies.

Kenzie, my other dog, was diagnosed with lymphoma. She is almost done with chemotherapy, and has done really well overall- I will detail her story another day.

This is a brief post before I start attempting to push some keys, killing time writing while we wait. My WoW update so far: we're giving it 2 weeks to try to kill mythic Council, then we'll stop, either with a kill or without, and break until 9.1 for the main raid. We've lost some people, gained some new people.

And our tank is now available- will update later, sooner than this one came!

Bella's Rehab - Introduction to Bella

So, I have a dog. I actually have 2 dogs, but this is about Bella. Here's a picture of the two- Kenzie, the shepherd lying on the really expensive bed I bought for Bella, who is ignoring it and lying on the floor, as she often does:

 

Bella is a 12 year old female spayed yellow Labrador Retriever. She was originally my parents' dog- my step-father got her as a Valentine's day gift for my mother. At the time, they lived in a place without a fenced in yard, so the dogs had to be leashed walked to go to the bathroom. Bella ended up with me after my step-father was involved in a car accident on Christmas eve. He was injured pretty badly. It actually ended up really screwing up his foot. He never walked normally after that, and really only had a few months of good walking and use out of it at all.  But anyway- my parents had 2 dogs at that time, and I was home for Christmas break. I offered to take one dog back to school with me, whichever was harder for my mom to handle alone. And I ended up taking Bella. She came back to Virginia Tech with me, she was with me for my internship at a warmblood breeding farm in northern Virginia, she was with me at NCSU for my last year of vet school. She did not come with me to Grenada, I did not think plane rides would be good for her- plus I lived in the dorms, no dogs allowed. A different regret I have is not taking the chance to live on a tropical beach when I had the opportunity, but I felt safer on campus, and didn't have to worry about anything but a food bill. 

Bella is a very sweet girl. She has been having progressive hind end weakness the last year, and some weird popping of her hind end (probably knees) I could never localize or re-create. She was actually a large part of the reason I wanted to learn acupuncture- to help keep her comfortable as she ages.  In July, she had a bad bout of diarrhea and vomiting, and was on fluids for 2-3 days, and got very weak. She has recovered mosty from that, but her hind end weakness took a significant jump forward. She now noticeable struggles to stand, and sometimes can't stand unaided if she falls over because she tried to walk backwards. I decided to seek out a rehab place to help keep her as strong as we can. I am able to life her when she goes down, but my mother can't, and she's the one who is usually he first one up with the dogs, feeding and taking them out. 

And I found PAWS  for Rehab about an hour away from me. Bella has had 3 sessions there, and I thought I would document her progress here. The plan is twice-weekly visits for 6 weeks. So far, I noticed an immediate improvement in energy after her first visit and laser therapy session, and am seriously considering a laser unit for home use. Laser therapy is used to aid healing and help with pain and inflammation in pets. It isn't suitable for all conditions- for instance, you don't want to use it over areas with tumors- but it is often used in arthritic patients as an additional modality for pain relief. I'm running out of reasonable drug options to try- I have a few left I can switch to if needed, but not a lot so any non-medication pain relief options are of interest to me. I am also looking into Asissi loops but that will be in the future, after her rehab. 

Her first session was underwater treadmill and laser, the second visit they showed me exercises to do at home, and today was massage (and maybe something else-  I pre-paid for all 6 weeks, so I forget).

Bella is really eager on the car rides there. I think she also misses riding shotgun, since she used to for our car trips until I got this car. the leather seats are too slick for her, and the floor is further down from the seat, harder for her to put her front legs on the floor and sit in the chair like she used to.

She tends to sleep a little more on the ride back- the excitement of getting there and seeing people wears her out.

I forgot to take pictures the first time there, so these are the car ride from our second trip. She wears the Help 'em up harness for car rides so i can catch her and lift her into and out of the car easier-. She still tries to jump in and out, though it doesn't end well for her without help.

I did get a picture of her being really pushy and demanding a walk after her first visit

Our current homework is 4 exercises to strengthen her back end and core muscles. I am trying to figure out the best way to work doing these 2-3 times a day into our schedule without just taking a huge chunk of time to do it all at once, which doesn't really give the best benefit. They're fairly simple exercises to do, it's just remembering to do them throughout the day. Tomorrow is my first full day back at work since I was given the exercises, so I am planning to split things up into 4 or 5 chunks of time- first thing in the morning, ideally with a walk if I can wake myself up that early, when I get home for lunch and before I leave from lunch to go back to work, when I get home from work, and before bed. That is my tentative plan at the moment, I will update as we go along with progress and pictures. I can say, one of our exercises is standing on the stairs with her front paws for several seconds. She's already showing some improvement there- mostly that she realizes I am not trying to make her go up the stairs, which she has not done since early July. She's extremely food motivated, which helps a lot. 

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!

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!