Differences in Opinions Between Vet & Client!

[mustangtrailrider]

How do you handle a situation when you have a difference of opinion with your vet regarding the care of your animal?

For Instance:

Older dog not doing well overall. Older dog is in pain due to unkown cause/s. Dog is losing interest in food. Dog is grumpy towards packmates and other farm animals. Dog hates going to vet. Client feels that it is time for dog to be euthanized but vet wishes to do further diagnostics to determine cause/s of current situation of dog. Client refuses any diagnostics and treatment, but client is feeling frustrated at this point wishes aren’t being respected.

What does client do? How is this issue resolved? What can be done in future to insure clear communication regarding care of animals?

I try to provide my pets the highest quality of life that I can. Just because a treatment can be done doesn’t mean that it should, IMO. I do not wish to prolong the inevitable but want to keep the animal comfortable as long as possible. Sometimes, pain medicine and a case of benign neglect are wonderful. Sometimes, treatment is needed depending on situation. Emergencies are one thing. Major, invasive treatment is an entirely different subject.

I am pondering this because my views differ than most people with animals, I think. I know my small animal vet prefers full diagnostics to determine root cause and treat accordingly. I agree with that as well. As long as the animal can return to a full quality of life without much in the way of pain and suffering, I will do most things. There are times, however, that I feel euthanasia is more humane for my pets.

Is it possible to convey this to my vet without offending vet?

[HPFarmette]

I don’t think you’re that different from me.
Example: I had an elderly dog that I felt was nearing the end of “quality of life” and was using a group practice where you see different vets depending on what day you go in.
First visit: Doctor “A”…says, We could try this, that and the other thing (tests etc.)
Second visit: Doctor “B” looks at dog and then looks at me and says “How far do you want to go with this?”
That is when I learned that I am the one who knows my dog best and the decision is ultimately with me. But that vets vary in their “bedside manner” with the client who is in that situation.
May I tell you that until recently I made it my “ministry” to bring home elderly unadoptable dogs with chronic illnesses who still had a year or two of quality life possible (I work at a shelter). So I have been through this 12 times now. I give them as much time on my little farm as they can enjoy.
If you feel that your animal’s quality of life is over, then why put them through more testing/surgery whatever? I can’t imagine a vet being offended by this (unless it were a different situation, such as an owner who wants to euthanize a young animal because of a treatable condition). Personally if I had a vet that didn’t see the sense of my decision making I would probably change vets.

[Canaqua]

That shouldn’t be happening. Client’s animal, client’s decision. Personally, I’d be looking for a new vet.

I’m also disinclined to put an ailing, elderly, animal through all kinds of tests and procedures when it’s quality of life is clearly declining. Fortunately, my vet feels the same way. I have an elderly, very arthritic, Cattle Dog mix. Vet discourages doing lots of imaging to find out exactly what’s going on and rule out hip dysplasia, etc…it’s not like we’d do surgery on a 14 year old dog. She’s lame, Adequan and aspirin help, that’s really all we need to know right now. This is a grumpy old dog and she’s a bit nasty (always has been, this isn’t new), so she has to be tranqed for x-rays, etc… no one wants to put her through that. So, vet helps me manage her symptoms with medication and lifestyle and we’re in agreement that when she becomes so uncomfortable that she can’t get around or is clearly very unhappy, she will be humanely euthed. We’re not there yet, but we discuss it at every visit.

I’d wonder whethere a vet who pushed diagnostics on an older animal, against the owner’s expressed desires wasnt:

1. looking for money
2. wants to know what’s wrong out of intellectual curiousity/further educating themselves
3. has some emotional involvement in the decision that is not appropriate for a professional

Any one of those three would send me looking for a new vet, because not one is in the animal’s/owner’s best interest and they are the client.

[Paddys_Mom]

I have been in this situation once and I am about to go there again.

I took my aged anti-social indoor cat to the vet and they diagnosed diabetes and ordered all sorts of tests and insulin, etc. I declined. I switched her to wet food and her symptoms are reasonably controlled on this. They told me I was killing her by not treating this. Thanks for your support.

It is now two years later and the same cat is now indiscriminately peeing. I want to take her in but I am afraid that the new vet (certainly not going back to the old one!) will give me grief too.

I will opt for treatment that does not stress my anti-social cat, beyond that it is euthanasia.

[Canaqua]

And, HPFarmette, what a nice thing to do! Taking in elderly animals, giving them some good times and then making the hard decisions that no one likes to make. Awesome.

[Nauset]

I am a vet tech in a pretty big general practice hospital. If your vet isn’t getting it when you explain that you aren’t wanting to do all kinds of diagnostics (very reasonable!), but would rather keep the animal comfortable if possible and if not, euthanize, I would find a new vet.

[HPFarmette]

Thank you Canaqua. I do love giving them a place in the sun. I don’t do “extraordinary measures” unless I’m quite sure they can have quality of life. Example: took home 13 y/o rat terrier 7 years ago. His only problems: heart murmur and fearful attitude. Last year, had to get all but 4 teeth removed, very rotten and probably painful. Went ahead and got it done cuz he’s a feisty little dude. He’s still kickin’, (barking, growling) but he’s enjoying life. But I was at a decision point with him, either do the extractions or euthanize. Because of his age and heart murmur, the vet was VERY hesitant. But I told her, it’s either pull the teeth or euthanize. I figured if he didn’t pull through the surgery, same diff. A year later he’s doing okay, loving the top quality canned food! Yeah, expensive but in his case it made sense to try.

[Canaqua]

Years ago, I had a stray kitten/borderline cat I took in…some kind of big, black, likely Maine Coon and Angora mix something or another. I lived in Boston at the time and Angell Memorial was the closest veterinary hospital to me. I took him there to be neutered and they found a heart murmur on the pre-anesthesia workup. This is a teaching hospital, like going to Mass General for people ;). They talked me into an x-ray and said his heart was enlarged and they wanted to do all kinds of extra testing and they thought he wouldn’t live very long if I didn’t do something about his heart. I was young, didn’t have any money for testing, there was no such thing as pet insurance at the time, I’d found him on the street, etc…so I said “no” and decided to take my chances on only having his company for a short while.

That cat lived to be 18 years old and was ultimately euthanized because of a malignant tumor in his jaw that started encroaching on his ability to eat (vet and I were watching it for two years, he was in no apparent pain)…nothing to do with his heart.

[mustangtrailrider]

Thank you very much all! I feel much better now! I just need to stand firm and stand my ground.

I have an American Bulldogge that I need to take to the vet and have his hip evaluated and see what is going on with him. I suspect hip dysplasia. He is a pound puppy and weighs 95 lbs! He is 3 years old and the neatest fellow I have ever had the pleasure of having in my life. Beyond a joint supplement, exercise, and weight control, I am not interested in pursuing treatment. He is active, happy, and loves life. I feel no need to treat it…he is otherwise happy. Until something needs to be done, I will leave him as is.

Rescues are the best. I have lost two in the last couple of years. Older Bassets that spent a lot of time at the vet’s office.a Unfortunately, despite a lot tests and treatments, I lost both of them. Now I am hesitant to put an animal through a lot of treatment when the outcome might be the same. I often wondered if Euthanasia would have been more humane.

Just ponderings. I have decent communications with my vets.

Thank you!

[Casey09]

I think that sometimes you just have to explain your viewpoint to your vet. I had a dog that was 14 and not doing well. One vet in the office was encouraging me to all sorts of things. Luckily the other vet in the office was more understanding. This was a dog who had always had obsessive care, but she was terminally ill with heart failure. I couldn’t see the point in prolonging her life when I lived with her and could see that she wasn’t doing well. I would not want excessive treatment for myself if I were terminally ill and on limited time. If your vet can’t understand that, then it might be time to look for a new one. And I say that as someone who has spent a lot of money on oldsters (and youngsters), so it isn’t necessarily the money as much as it is that you know when it is just their time.

[paulaedwina]

I’d also say though that sometimes the vet has a better perspective because he is not so close to your animal. You see your animal, for example, getting older, stiffer, grumpier, and you think it’s time to let him go. Your vet observes the same thing and thinks an aspirin a day will make him a different animal, or what you see as crisis is simply aging. So I don’t discount the vet’s opinion at all.

Your concept of, “you just know when it’s time” may be flawed. It may be that it’s your time, not your animal’s (you are not putting him out of his misery, you’re putting him out of your misery because it is too hard to watch him age).

Keep in mind that your, just euthanize like I want, takes a toll on the vet too. He has to do the killing and probably would prefer it happens when it’s the right thing to do.

Paula

[Casey09]

Paula,
I think that can be true, as well. Some changes are age related and normal. The last dog that I had spent about a year as what I would have considered an old dog. He stopped going on long walks, but still went on short ones. He ate and drank and loved to be petted. He didn’t like doing some of the things he loved when he was younger - like going on car rides. He seemed happy to me. He had lots of treatment for his joints and I spent a fortune on that last year, but I did it because I felt that he was happy.
The dog that I was referring to had fainting spells due to the heart failure and lost interest in food and water, and one vet in the office was pushing more tests. The other vet said not to pursue it - there was nothing that they could do if they found anything. In the OP, the client has an older dog that is in pain. If the client isn’t going to treat, say cancer in a geriatric dog, then there may not be any point in the tests. I don’t expect to euthanize whenever the client wants. Some vets do, others don’t, but it is a professional, individual decision. I do think that sometimes reasonable people (and reasonable vets) differ in deciding when it is time.

[Chall]

I don’t know, sometimes I think it is a dance, sometimes the vet and I are in perfect synch and sometimes not. Vets are humans too, and subject to bad days, or depressing cases or whatever, including money, that make them suggest what they do. I don’t hold it against them. It is though, your pet and your decision.

[MunchingonHay]

Your pet, Your checkbook, Your pet’s quality of life, Your decision.

I had my first dog diagnosed with Cushings when he was 8ish, could have been 7. anyway, I did what I could do (full time/non-full time job = not a lot of extra cash)

I treated him holistically, vet wanted to do the shots/bloodwork/western way of treating Cushings. I got another 3 yrs out of him and when he stopped eating/lost interest in food; and believe me I offered everything, MY DOG made the decision.

I feel that perhaps this vet is stringing you along for some $$$ in treatments.

[paulaedwina]

Your pet, Your checkbook, Your pet’s quality of life, Your decision.

That’s oversimplistic.

If this were the case why go to the vet at all? Why not just diagnose the animal on your own? Why? Because you do give the vet’s opinion some credence.

You’re right it’s your animal and your money and you can do what you want with it, but the vet is a human being and has to kill your animal for you. You’re not actually doing the dirty work are you?

That is not to say of course that the vet is always right or always wrong, but let us not resort to pithy statements that may not have much basis in practicality.

JMO
Paula

[iechris]

My friend has a VERY old (almost 17 years) dog. Dog has not been doing well for a while now and after a really rough spell with dog not eating for days, had to be carried outside and back in (24" dog btw) and some other issues, she took the dog to the vet and wanted the dog put down. Vet talked her out of it because “dog is still really healthy and they won’t euthanize a healthy animal”. So… now dog is blind, deaf, in kidney failure, still not eating well, still losing weight, incontinent, refusing to go outside and probably a few other things I forgot. Last vet appt. vets now want to euthanize but friend has decided it isn’t time yet.

The entire last year of my first dog’s life I spent wondering if I should put her down. Some of the same issues, incontinent, basically lifeless indoors, had to be carried in and out of the house due to severe arthritis that pain meds did not help much with (again, this is a 24" dog). She finally had a stroke and after an initial improvement at the 5 day check up my vet told me she was basically mentally gone and her body was shutting down. He said I could take her home for a week but that she would most likely get pnumonia and die. I put her down that day and never ever second guessed myself.

My vet is excellent about telling you a variety of treatment options and not judging you based on what you choose. My dog above with diagnosed with cancer at 13, he offered chemo but I wasn’t going to do that for a 13 year old dog. He never judged that decision.

[SLW]

Not knowing the exact age of the dog it’s a little hard to chime in but I’ll toss this out. It is all about two way communication and from there, it’s your choice. Perhaps the veterinarian is explaining all the options available before allowing a euthanasia. State clearly something to the effect of “I understand that diagnostic options A,B &C are available from you. Because of the advanced age of my dog and it’s intolerence towards exams I would like to select the option of a humane euthanasia. I will sign off that I have refused additional testing & diagnostics for my dog.”

At their core, a veterinarian wants to heal an animal. In the case of the dog being discussed it might be as simple as a daily pill to relieve inflamation. OTOH, it might be a case of $$ for the owner- spending $250 in diagnostics might be a stretch right now. This is where the vet-client relationship and history together is so important.

If after clearly stating your want/needs the veterinarian is not able to help you then you would have to find another one who supports your view of the dogs condition and future.

[Marshfield]

[QUOTE=SLW;6098417]
Not knowing the exact age of the dog it’s a little hard to chime in but I’ll toss this out. It is all about two way communication and from there, it’s your choice. Perhaps the veterinarian is explaining all the options available before allowing a euthanasia. State clearly something to the effect of “I understand that diagnostic options A,B &C are available from you. Because of the advanced age of my dog and it’s intolerence towards exams I would like to select the option of a humane euthanasia. I will sign off that I have refused additional testing & diagnostics for my dog.”[/QUOTE]

I am ethically obligated to make sure an owner is aware of their options. This doesn’t necessarily mean that I’m in favor of them. If I see a dog that I’m 90% (or better) sure has a nasty liver tumor, I’m still going to make the owner aware that they have the option of pursuing a further work up with ultrasound or via referral to an oncologist even if I know euthanasia is the most likely decision. I do preface it with advising them that I have to make them aware of their options but that it doesn’t mean that I am pushing for them to see the specialist, etc. And then once in awhile, I do have someone who needs to see the specialist and know for certain that there really isn’t more they can do for their pet. For every person I encounter who is ready to say good-bye, I see someone with an equally ill pet who is desperate for one more day.

[Kryswyn]

I had to find a new vet when I moved to Long Island and I’m relatively happy with the two women vets at the practice I use. When I brought my elderly girl in knowing she had a heart problem I just said it flat out, “I want to keep her comfortable for as long as possible, but I don’t want to do extensive testing. When it’s clear her quality of life has gone, I’ll put her down.” 2 years later that’s what I did (2 dislocated hips later) and they had no problem with that.

But if you’re unsure about your vet’s reaction, I’d look for an older vet. If I’d known that the vet I used (and loved) back in the early 80’s was still practicing, I’d’ve gone back to him in a heart beat.

[vacation1]

I think it’s best to have an early conversation with your vet about your philosophy of care, then repeat that over the years as your pet ages. It’s good to be on the same page, or at least, find out if a vet is able to reconcile their own opinion with your to the extent that you don’t find yourself feeling ignored or judged. Personally, I WANT to know everything, every option, and would be very angry if my vet tried to second-guess my finances/comfort/happiness and present only the most affordable or reasonable.