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Medicine versus Mom

Medicine Versus Mom: Knowing When Its Time to Consider Euthanasia

November 30, 2014

MVMEuthanasia

Once again, Carol Bryant from Fidose of Reality and myself, have decided to bring together our experiences in order to give you two sides to the same story. If you missed our inaugural post of Medicine versus Mom, you can check it out here.

 If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, you really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with you even more reasons why Carol is awesome! 

MedicineVsMom

Today we are going to discuss the most difficult subject in veterinary medicine…euthanasia.

This post is very difficult for me, as I unfortunately experienced euthanasia on a regular basis as a veterinary technician and its one of those things that ultimately made me leave. Each veterinarian and veterinary technician deals with it differently, many of us….have regular nightmares. We always remembered our patients, and losing each one weighed heavy on our hearts. Even now, as I hunch over a tear stained keyboard I remember the beautiful faces of some of my most cherished patients. That being said, I am writing this simply to help those who are seeking information, and hopefully to provide some small amount of comfort during the most difficult of times.

There is no right answer to the question, “How do I know when its time?”. Its an impossible question to answer, but I want you to know that your veterinarian and their staff may be a source of comfort and information for you.

Often people feel that they need to make the decision on their own, and they have to show up at the vet’s office with a definitive answer, but that is far from the truth. Many veterinarians are willing to schedule what we call, QOL visits. QOL standing for Quality of Life. These visits give you an opportunity to go talk to your vet, (many people don’t even bring their pet) and discuss all of the options, medical history and current quality of life.

What questions should I ask at a QOL visit?

1. Are we effectively treating the underlying cause of illness? It is important to understand that age is not a disease, therefore pets are not suffering from age, but from an underlying condition that may, or may not, be related to their age. Its important to understand the underlying cause of illness and understand all possible treatments for the specific illness. You and your veterinarian can decide together what the most effective treatment is for your pet, and then decide if the condition is worth treating.

2. Will treating the current illness improve my pet’s quality of life? Sometimes the answer is no. Many diseases require treatments whose risk outweigh the reward. If that is the case, you may decide to not treat, and to let your pet live out their life comfortably. Your vet can be a great resource in helping you answer this question.

3. Are we doing everything we can to keep my pet comfortable? Regardless of whether or not you are actively treating the underlying illness, there are options that can help keep your pet as comfortable as possible. This may include additional medications, herbs, or holistic treatments.

If you have already decided to treat, or not treat, the illness, and you are already doing everything that you can to keep your pet comfortable, and yet their condition is still worsening it may be time to start preparing yourself and your family.

I have been in the exam room when the family realizes that they need to prepare themselves, and then comes the question, “When is the right time?”. As I said before, there is no right answer to this question, but what I believe helps the most is to talk about it, and don’t be afraid to seek comfort in your veterinary staff. I have sat in exam rooms with owners and been a sounding board for their worries and fears, and we talk through the situation to ultimately come to a conclusion that everyone in the family is comfortable with.

When people ask me if their pet has a good quality of life, there are three things I try to emphasize:

1. Are they eating and drinking? Animals have a natural instinct to eat or drink. By nature, they know that they need food and water to survive. Firstly, if they have stopped eating and drinking, you want to make sure that they aren’t having a treatable medical issue that is causing this. If they don’t have a medical condition that is treatable (i.e. a terminal condition) and they have given up eating and drinking, it may be time to consider their quality of life.

2. You know them best…what are the most important things to them? For example, in 2012 my family and I said goodbye to our Rocky. We knew that Rocky was suffering from spinal compression, and it would one day stop him from going to the park, which was the thing he loved most. We knew that once Rocky was unable to make it to the park (even with a wheelchair) his quality of life was not as good as it once was, and at that time we began preparing ourselves. (Despite knowing this, all I could say to Rocky at the end was, “I’m sorry”. I felt like I had failed him. Sometimes, having all the knowledge in the world still doesn’t help….and I know that.)

3. Sometimes….they will let you know. We all have an understanding with our pets, one that can’t be seen or heard, but is real and true. Trusting in that bond that you have with your pet, and trust that they will let you know if they can. Sometimes, no matter how strong your bond, this time will never come.

I also stress to people to discuss this with the whole family. I feel that it really helps to make a decision when every one is on the same page. Making this decision is difficult, and it always hurts, so having the support of your veterinarian and your family can really help.

What can I expect from my vet and their staff?

Your veterinarian and their staff should be there to answer your questions, and help you get through this difficult time.

When we knew there was going to be a euthanasia we wanted to make sure we were prepared and professional. Firstly, we would always lay a blanket down on the ground, or the table, to make the patient feel more comfortable. We would also try to reduce noise in the hospital and would make sure there was enough tissues in the room. I know these things seem small, but being on the other side, it definitely makes a difference.

Many vets provide a sedative and give you a few moments alone with your pet. When the times comes, we always ask if you want to be in the room, each person has a personal preference and we want to make sure that everyone understands what is happening, when it is happening.

Don’t be afraid to reach out for comfort. I have hugged so many people in an exam room because I knew they needed it, and I knew how they were feeling in that moment…and I would give 1000 more hugs if I had to.

As difficult as this process is, don’t be afraid to turn to your veterinarian or their staff, we may be able to answer some of your questions and help you work through your biggest fears or worries.

I hope that no one reading this is at this point in their pet’s life. If you are, my thoughts and prayers are with you and your family, and I wish I could give you a hug.

Please visit Carol’s blog, for her Mom point of view.

Medicine Versus Mom: Why Vaccines are Important and What You Can Do to Protect Your Pet

November 16, 2014

MedicinevMom-Vaccines

Once again, Carol Bryant from Fidose of Reality and myself, have decided to bring together our experiences in order to give you two sides to the same story. If you missed our inaugural post of Medicine versus Mom, you can check it out here.

 If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, your really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with your even more reasons why Carol is awesome! 

Today we want to discuss the importance of vaccines, their controversy, and what you as a parent can do to protect your pet.

Firstly, I want to make it clear that vaccine protocols vary significantly by region and lifestyle. Keep in mind, that I am most familiar with the vaccine protocol in Northern California, and there may be variations from your pet’s vaccine protocol depending on where you live in the U.S, or the world.

Here is a quote from VetStreet that gives you an idea of how complicated vaccine protocols can be here in the U.S., “medical decisions concerning vaccine selection and administration protocols are among the most complicated medical decisions facing veterinarians today.”

Why is this such a complicated issue?

VetStreet sites the following as reasons for vaccine protocols being so complicated and varying:

1) Information regarding knowledge of the immune system is constantly changing

2) Susceptibility to various diseases in different regions can change

3) The increase in “animal valuation” within the family. Here, I think they are implying that as pets become a more integral part of families, it becomes more complicated to provide the correct type of preventative treatment without risk of liability.

4) Animal life expectancies are getting longer and medical records are getting better which provides more information about the effects of vaccines in the short, medium, and long term.

It is important to understand that no matter your stance on vaccines, they do protect both humans and animals against diseases that can be fatal. As a pet parent however, you need to be aware of which vaccines are necessary and which ones you can safely for go.

A typical puppy vaccine protocol includes:

3 Boosters of a DHPP or DHLPP that are given about 3 -4 weeks a part starting at 8 weeks of age, and a 1 Year Rabies Vaccine at 16 weeks of age.

After the initial booster shots of DHPP, I have seen two different vaccine protocols: 1) DHPP/DHLPP is given every year 2) DHPP/DHLPP is given every 3 years. There is a bit of controversy as to how often this vaccine should be given, so don’t be afraid to ask your veterinarian why they believe the vaccine should be given as frequent as their hospital protocol suggests.

After the initial 1 year Rabies vaccine, the boosters are given every 3 years. In my experience, this is standard.

DHPP protects against Canine Distemper, Parvovirus and Canine Hepititis (Canine Adenovirus-2), the L stands for Leptospirosis (which is given based on lifestyle). All of these diseases can be fatal and are very important to the vaccine protocol.

Distemper is a virus that is described as being similar to measles. The scariest part about this virus is that it is HIGHLY contagious, and potentially fatal. About a year ago, In-Sync’s Exotics Wildlife Rescue (who I follow on Facebook for their amazing photos) had a huge outbreak of Distemper in their facility, and they unfortunately lost a few of their amazing animals to this extremely contagious virus.

Parvo is a disease I experienced firsthand. Parvo is another highly contagious disease that effects the gastrointestinal tract and can be very fatal. Many puppies barely survive this disease, if at all. This disease can be extremely fatal and should be taken very seriously.

According to the American Animal Hospital Associations Vaccine Protocol, there are Core Vaccines and Non-Core Vaccine. Core Vaccines include the DHPP and the Rabies Vaccine, which are included in the puppy vaccines protocol above.

Non-Core Vaccines include Bordetella, Lyme Disease, Leptospirosis, Canine Coronavirus, and Parainfluenza

I am most familiar with Bordetella and Leptospirosis.

Bordetella should be given if your pet spends any time at doggy day cares, boarding facilities, or the groomers.

Typically, pets are vaccinated for leptospirosis if they are considered “outdoorsy”. They are exposed to the virus through other animal’s urine, and therefore, when they go hiking with you, or to other outdoor places, it is worth it to add this to your vaccine combo.

Lyme can be very dangerous, and you can read more about it from Buddy’s story, here.

In order to determine the best vaccine protocol for your pet you must discuss with your veterinarian:

1) Where you expect to take your dog. i.e. the mountains, lakes, oceans, etc.

2) What types of activities you expect to do. i.e. hiking, running, swimming etc.

3) Don’t be afraid to ask them their professional opinion on why they believe certain vaccines are necessary.

4) Be aware of what vaccines are most likely to cause a vaccine reaction, and what the signs of a vaccine reaction are.

5) Ask you vet if your senior pet really needs vaccines, or can they simply have titers?

What are your personal opinions about vaccines?

To read Carol’s doggy mom perspective on vaccines, please click here.

MedicineVsMom

Medicine versus Mom: Why Did They Muzzle My Dog?

November 3, 2014

Medicine-v-mom-muzzles

Once again, Carol Bryant from Fidose of Reality and myself, have decided to bring together our experiences in order to give you two sides to the same story. If you missed our inaugural post of Medicine versus Mom, you can check it out here.

 If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, your really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with your even more reasons why Carol is awesome! 

Today we want to discuss a very fragile topic in the animal world: the muzzle.

As a former veterinary technician, I have muzzled quite a few animals in my time (yes, they also make cat muzzles), and I always seemed to get different reactions from pet parents about their dog’s being muzzled. Usually, pet parents fall into one of the following categories:

 They don’t ever want their dog to be muzzled under any circumstance.

They understand that their dog needs to be muzzled under certain circumstances, but they are still not comfortable with the idea.

They know that their dog may need to be muzzled and are indifferent to the situation.

They know that their dog may need to be muzzled and are supportive of the decision.

They know their dog needs to be muzzled for certain situations and they give the veterinarian and their staff that information up front.

Whether or not you identify strongly with one of the above categories, if you are a pet parent who’s dog has needed a muzzle, I guarantee you were uncomfortable with the idea at one point of another, but I hope today to give you information that will make you slightly more comfortable.

Firstly, I want to say that my experience as a veterinary technician has taught me that both cats and dogs only know how to say “Ouch!” in a few ways…one of those ways is biting. Shoot, some humans bite doctors, dentists and nurses, and we have plenty of ways to speak up for ourselves….so I completely understand why a dog would bite someone who was poking them with needles and they didn’t understand why.

That being said, a veterinarian can’t allow their staff to get injured constantly, so the staff must protect themselves in order to do their job, but I can say for certain we always have the pet’s best interests in mind.

For example, lets say that you were at the vet’s office with your new rescue dog, and you know your dog needs a nail trim, but you have no idea how he feels about them. So you tell the vet that he is new to your family and you have no existing information, and they whisk him to the back for his nail trim. You know everything will be okay, but you are very nervous about what happens when they take him to the back.

Once in the back, the veterinary staff will access your dog’s stance and general behavior before proceeding with any procedures.

Firstly, we kneel down (if it’s a big dog), or we pick up (if it’s a little dog) so that we are at eye level and not looking down at your dog and being intimidating. Then we get a feel for how they feel about us…is there any shaking? Nervous tail wagging? Hair raising? Or are they taking treats and being very friendly? Lets say in this example, your new dog is being friendly, but still a little nervous.

Many people think this is where we put the muzzle on, but we always give a dog the benefit of the doubt. If they are not showing signs of aggression, we don’t put a muzzle on. We understand that in some situations, adding a muzzle to the mix will only make things worse…not better.

Once we are ready to trim their nails, we try one of two different restraining techniques:

Restraint1

Photo Courtesy of www.livingart.org.uk

The first and most commonly used restraining technique is putting them on their side and holding their lower limbs so that they can’t spin and get up (see above). Some dogs make it clear that they don’t like this restraining technique by doing what we call, “barrel rolling”. Typically, they don’t like this type of restraint because it is very dominant. (I can say for certain Rooney hates this type of restraint, and I think holding his short legs actually hurts his hips, so I hold him like a baby with his feet up in the air). If your pet has given us signs that they don’t like this type of restraint by being wiggly, but not showing any signs of biting, we still don’t put a muzzle on.

Typically, decisions to muzzle, or not, are made by the technician who is doing the restraining. We communicate to the other staff members involved what type of “feeling” we are getting from the animal. Throughout the visit, there is a trust built between the animal and myself. We get a good sense of how comfortable each of us is in that particular situation.

If the restraining technician is getting the sense that your dog just didn’t like that type of restraint, we move to the horse style technique, which is where we have them stand while being supported from their belly, and we pick up one limb at a time to trim their nails.

If your dog did get “mouthy” with the restraining technician, and show that they weren’t comfortable, we would decide to place a muzzle on them in order to complete the necessary techniques, especially if the treatments are imperative to their health (i.e. a non-nail trim).

If the muzzle makes the situation worse, and your pet is clearly becoming stressed, we will remove the muzzle and let your pet calm down. IF their only reason for being in the back is the nail trim, and ESPECIALLY if this is their very first visit, we will offer to wait until another day and try to give them treats and love to make their experience a more positive memory.

We may also suggest that your pet come back for “happy visits”, where you bring them in and we just give them treats and then they go home. This is a desensitization technique that we used often for dogs who were skiddish.

Sometimes, when we muzzle dogs, it is the solution to being able to provide them with veterinary care. We also make a point to notify the pet parents so that you are aware of the situation, and maybe will be able to correct it in the future.

I will be honest with you, when I first got Rooney I restrained him for nail trims, and he did bite my hand, and so he had to be muzzled. I felt bad that I had to put him through stressful situations like this, but they were necessary. By trying different restraining techniques and providing lots of treats, we are now able to trim his nails at home with no muzzle. This took time, but we were able to work through it.

As a pet parent, I urge you to have an open dialog with your veterinarian, and find a veterinarian who is willing to be honest with you. The last thing you want is to have your pet being muzzled, and you being blindly unaware that they ever felt uncomfortable at the vet’s office. In my experience vets who are open and honest and willing to try new techniques, have both you and your pet’s best interest at heart.

For Carol’s Dog Mom point of view on Muzzles please see her post, here.

 Was this information helpful? Does your pet need to be muzzled? How did that make you feel?

P.S. Medical Monday’s will return next week (sorry for the delay)

Medicine versus Mom: What happens when my pet gets dropped off at the veterinary clinic?

October 20, 2014

Medical-Monday--Medicine-versus-Mom

Carol Byrant from Fidose of Reality and I have matched up to bring you a veterinary experience from a mom and veterinary technician’s perspective. I will be writing from the veterinary technician’s perspective in order to bring you some insight into what happens “in the back” of a veterinary hospital.

Please keep in mind that every veterinary hospital will have its own unique processes and procedures, so this post will be a direct reflection of my experience working in veterinary hospitals.

Today we want to answer the question, “What happens when my pet gets dropped off at the veterinary clinic?”.

For example, let’s say that your dog is being dropped off for a dental including full anesthesia, and possibly 2 teeth extractions. Estimated surgery time is 20 minutes, and total estimated anesthesia time is 45 minutes. The staff will use the additional anesthesia time to clean and polish the teeth either before or after the extractions.

The Drop off (8:00am): When your pet is dropped off in the morning, the first thing we do is weigh your dog, and get them checked in with the standard paperwork. The reason we weigh your pet the morning of surgery is that we want to make sure they haven’t gained or lost a significant amount of weight since their last exam, because that could be a sign of a possible medical issue. We also want to make sure that the anesthesia calculations use the most recent and accurate weight, since doses are calculated based on weight.

If the veterinarian who is doing surgery that day (this would apply in a multi-veterinarian practice) is already in the hospital, they may give your dog a physical exam before we put your dog in a cage. The purpose of the physical exam is to make sure your pet is in good health, and has no signs of any medical issues before we begin prepping for surgery.

If your pet’s physical exam goes well, we will go ahead and calculate their pre-med. The pre-med works as both a pre-anesthetic and a pain medication. Basically, this will start making them sleepy and serve as pain control before, during, and after surgery.

Your dog’s critical information, and reason for surgery will be placed on a whiteboard, and a name card will be placed on their cage. This helps the staff know who is in the hospital, and what treatments they will need throughout the day. Many procedures vary across hospitals, but this procedure of writing patients on the white board was true for every hospital where I have worked.

Pre-Op (9:30am): If your dog is first in line for surgery that day, we might already be in surgery with your dog. However, on any given day we could have 3 or 4 surgeries, so your dog may not be going into surgery until 11:00, or 11:30am. Feel free to ask what time your pet is expected to go into surgery, but be prepared for this time to change, as we never know what the day will bring. Around this time in the morning, we will be placing catheters in all pet’s who need surgery that day.

Placing a catheter can be an uncomfortable process, but we have already given them their pre-med, so your dog will be much more comfortable. At this time, we will also be setting up all necessary items for your dog’s dental procedure.

Surgery (10:00am): A 10:00am surgery time would be typical for a pet who was 2nd or 3rd in line for surgery that day. At this time, your dog will be comfortably under anesthesia, and your veterinarian will likely be performing the teeth extractions. The length of time to extract teeth will vary based on the location of the teeth and the quality of the roots. For example, if your veterinarian is extracting a tooth in the vary back of your dog’s mouth, and the tooth is so rotten that the roots start to crumble as the tooth is being extracted, this may lead to a long extraction time because your veterinarian will want to make sure that all roots have been removed otherwise they could cause your dog issues down the road.

Post-op (11:00-noon): After your dog’s surgery is over, we will start to wake them up. We turn off the gas anesthesia and keep them intubated, depending the quality of their other vitals, we may decide to keep them on IV fluids at this time. Your dog will start to show signs of waking up within the next few minutes depending on how affected they are by the anesthesia. As your dog is waking up from surgery, they are with a veterinary technician the entire time. While waking a patient from anesthesia we are sitting or laying with them in their cage so that they feel comfortable when then wake up.

Anyone who has had anesthesia knows that your initial wake up can be very confusing. So we are sure to be there to let them know that they are okay, and we also assess their vital signs to make sure their body is recovering from anesthesia well.

Normally, this is the time that the veterinarian will give you a call to let you know that your dog’s surgery went well, and they are comfortably recovering from surgery. However, if an emergency walks through the door (like I said you never know), your veterinarian may have to postpone their call to you another 30 minutes to an hour, so patience is key at this time. I always remind pet parents that if your pet were the one with the emergency, you would want your pet to have veterinarian’s full attention at that time.

Post-Op (noon-5pm): Most of our surgery patients get picked up between 4:30pm and 5:30pm. We typically decide what pickup time will be when your veterinarian provides you with your post-op call. During these post surgery hours, the veterinary technician on the surgery will continuously assess your dog’s health. Meaning, we constantly check on our patients. Because we spend significantly less time in rooms with clients than the veterinarian does, and we are always in the back, it is our job to make sure all post-op patients are perky, and recovering with appropriate energy. We make sure to keep them warm and comfortable, and also prepare all of their post-op medications that will be going home with you.

Sometimes we would send a picture of the patient to the client’s cell phone (if they provided the number), with a message saying something like…”Hi Mom! I am recovering well from surgery, and I can’t wait to see you when you pick me up at 5:00pm”. I think pet parent’s really liked this, and I hope other clinics would do the same.

At 5:00pm you get a chance to see your pet, and we update you on their surgery and send you home with all necessary information and prescriptions. We always go over with you the signs of pain or discomfort that you as a pet parent should watch out for:

vomiting

diarrhea

panting

extended lethargy

and other surgery specific symptoms

If you have any questions now is the time to ask, but don’t be afraid to call the next day with further questions. We would rather you ask than worry!

Please remember while your pet is at the veterinary office, no news is not necessarily bad news. Like I mentioned previously, we could have 3-4 emergencies walk in before 9:00am and completely change the course of the day, so please be patient. Your veterinarian wants to update you just as much as you would like to be updated.

Hop on over to Fidose of Reality to get Carol’s perspective of the day as a dog mom!

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