kinds of drugs and its side effects

The Frankie Diaries, 9/26: Petside Manner & Hospice Care

stethoscopeI’m just back from the vet, where I went after a weekend panic. On Friday night, Frankie did a weird thing with his back legs when he was outside,  kind of kicking them out like many dogs (but not generally Frankie) do after they poop or pee to stir up dirt. But Frankie didn’t seem quite in control of his movements.

I examined his feet but could find nothing that would have caused him any discomfort, nothing that he was trying to dislodge. It happened only a couple of times, and then Frankie was fine.

It happened again on Saturday evening, again with a quick recovery.

Then on Sunday, Frankie fell inside the house, suddenly losing his balance.

I panicked. I thought about taking him to the emergency vet and called several friends to ask their opinions. We all agreed that since he didn’t have any other symptoms — no vomiting, diarrhea, loss of appetite — and recovered quickly from the incidents, I could wait until the following day.

Which I did, on pins and needles.

The WTF Vet

I called the veterinary office on Monday morning and was told that the first available vet was Dr. M. She would not have been my first choice, and not because I think she lacks medical skill.  What she lacks is petside manner. I don’t expect warm and fuzzy, but I could live without rude; among other things, she once said that Frankie was “weird.” For that reason, I much prefer the equally competent and much kinder Dr. E, who never insults Frankie  (at least not to his — and my — face).

Sure enough, when she came in to the room where we were waiting for her, Dr. M said, “Geez, every time I see Frankie he looks ten years older.”

WTF?  Don’t they teach you in veterinary school — come to think of it, in the human universe — never to say stuff like that?

The Diagnosis

At that point, I was so worried about Frankie that the comment rolled off my back. I was focused on the exam. The ears looked good, so Dr. M.  didn’t think it was a balance issue. And the neurological response tests were normal.

The likely cause of the problem, she decided: arthritis stiffness and pain. The prescription: Metacam.

Whew.

That wasn’t quite all, however. Dr M. said that Frankie’s bottom two teeth look bad. She suggested I get them pulled. But, she said, a regular dental “might break his jaw,” so she advised a veterinary specialist dentist.

That’s general anesthesia and more than $1,000 to treat a dog with CCD? I looked aghast. Dr. M. said yes, I wouldn’t do it either, but it’s my job to  mention it.

You’re Not Sending Frankie Away, Are You?

Mention it, yes — but it would have been nice to mention it in the context of “I wouldn’t necessarily advise it.”  So… “Your dog looks really old, but you might want to subject him to major dental surgery.” Talk about mixed messages.

Again, WTF?

It was clear that there was no way I was going to have Frankie’s teeth pulled, but when I got home it still bothered me. Although Frankie doesn’t have a problem eating, I felt I wasn’t doing all I could for him.

Then I realized that, whether I put a name to it or not, I am engaging in a different type of care: Hospice.  Perhaps a better name is palliative care — making sure your pet is not suffering but not taking extreme measures.

In human cases, hospice sometimes means home care, but more often it means a separate facility with full time nursing care. Not so with pets. As the American Animal Hospital Association puts it:

Hospice is focused on giving pets a safe, caring, intimate end-of-life experience in their familiar environment. As such, it is not geared toward curing a pet’s disease, but rather toward keeping the disease from causing the pet any discomfort. Hospice care focuses primarily on providing pain control and physical and emotional comfort to the pet. To prevent the anxiety of hospital visits and to allow pets and owners the maximum amount of time together, pet owners provide as much care as possible at home.

Frankie is not suffering from a terminal illness in any conventional sense. And, as my panic this past weekend showed, I’m not ready to say good-bye yet. But somehow putting a name on this phase of my life with Frankie, calling it a form of care rather than a form of giving up, made me feel better.

Now if only I can avoid future visits to Dr. WTF…

Update: I realize I am being rather unfair. Dr. M. is more than merely competent; she is very gentle with Frankie and she follows up with me assiduously, calling me in NYC, for example, to discuss a problem that arose while I was away. I’m a slow burn kind of person; it would have been better if I had responded to her insensitivity on the spot. Instead, I’m here venting.

 

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31 Comments

  1. Posted September 26, 2013 at 6:25 am | Permalink

    Thanks. That made me feel better too. Not being able to treat Viva for her DLE, gave me the feeling of me giving up too. Thank god I have a vet, that helps me making the transition from curing to caring. Hope you can avoid this person from now on.

    Glad Frankie didn’t suffer a new issue as well !

    • Edie Jarolim
      Posted September 26, 2013 at 6:37 am | Permalink

      Well, you are treating Viva for DLE by keeping her out of the sun — but of course we all want cures, not just maintenance. I’m glad what I wrote helped a bit. As I wrote in my update, I am being a bit unfair to this vet — but anger is a better incentive to blogging than depression!

  2. KL Lance
    Posted September 26, 2013 at 6:58 am | Permalink

    The very sad thing about living with animals is that we outlive them, always, unless they are parrots or tortoises. I like your designation of this phase of your life with Frankie as “hospice.” I will remember that for when I need it.

    • Edie Jarolim
      Posted September 26, 2013 at 7:03 am | Permalink

      I’m glad that term helped you too, KL. I know that there’s no turning back — now that I’ve shared my home with an animal, I will always want that experience. But right now it seems a bit daft to keep subjecting oneself to the pain.

  3. Posted September 26, 2013 at 7:13 am | Permalink

    That comment would have bothered me too. I’m sorry you had to hear it, but I’m glad Frankie’s neuro tests were normal. Hate hearing it’s pain / stiffness, but I’m glad the motor parts of his brain are OK. I suppose we’re in a hospice situation too, but we are still fighting pretty hard, so maybe not.

    • Edie Jarolim
      Posted September 26, 2013 at 7:40 am | Permalink

      I don’t know that it’s a term that really applies to our situation either, since Frankie doesn’t have an illness that is imminently life threatening, but it helps me to give what I am doing a name.

      Thanks for the empathy/sympathy — as always.

  4. Posted September 26, 2013 at 8:19 am | Permalink

    I’m so bad at not dealing with things in the moment. The comment about Frankie would have been a burr under my saddle, too. The fact is, the woman probably has no idea that her comments are offensive. My mom’s like that and can never understand why people don’t care to be around her. When you try to explain it, she just doesn’t get it. It’s like something is a little mis-wired in there. Confronting the vet would likely have had little impact, other than to leave you feeling uncomfortable. Since she’s otherwise good with Frankie and excellent at following up, I’d try to rack it up to a personal foible and let it go. Scratches to Frankie! So glad to hear this was nothing serious.

    • Edie Jarolim
      Posted September 26, 2013 at 8:38 am | Permalink

      That makes me feel better, Amy, i.e., that it might not have mattered if I called the vet on her insensitivity. You’re right, people who are unfiltered like that aren’t usually aware of it (sorry to hear that your mom’s one of them).

      Consider Frankie scratched!

  5. Posted September 26, 2013 at 9:44 am | Permalink

    We have a vet who doles out every possible option and expects us to choose after her limited explanation. This is why we always choose any 3 of the other vets at the same practice. As my husband often points out, we want answers – not an extensive multiple choice quiz in which the results can cause more harm than good.

    Dear DVM, what would you do if this animal were your beloved pet? If we differ in opinions, then give me the nitty gritty. Or, as you say, frame it in a way that better contextualizes. Veterinary care is (or should be) more than medical science. It requires emotional savvy as well. Lives depend upon this facet just as much as the biological determinations.

    Hugs to you both.

    • Edie Jarolim
      Posted September 26, 2013 at 9:54 am | Permalink

      Good points, Kim. It’s not my job to read the tea leaves — when a professional provides information, you take it seriously. It occurred to me it’s a form of legal butt-covering: I told her about his teeth, so therefore I can’t be held responsible for any future dental problems.

      But maybe it’s just part of the generalized lack of social skills/empathy.

      Thanks for the hugs; I probably appreciate mine more than Frankie does 😉

  6. Posted September 26, 2013 at 10:17 am | Permalink

    Two vets encouraged me to get surgery on Ellie, my elderly white Shepherd mix at 13 1/2 years old. (which is an advanced age for a large breed). Following complications and over two thousand dollars, she soon had to be put to sleep. In retrospect, I feel they manipulated my guilt instead of telling me they wouldn’t have done it. While it’s no consolation, at least the vet who said she told you about the teeth and said she was obligated to tell you about it, told you she wouldn’t do anything about it. No doubt she could have handled it better – it sounded exceptionally painful to hear about.

    my most recent post: http://www.examiner.com/article/creating-a-sanctuary-within-for-rosh-hashanah-and-the-new-year-5774

    • Edie Jarolim
      Posted September 26, 2013 at 1:05 pm | Permalink

      That sounds unconscionable, Diane. I’m sorry you had to go through it. I’m not sure if my vet would have divulged the information that she wouldn’t do it if I hadn’t looked aghast, but I’m glad I did.

  7. Posted September 26, 2013 at 11:32 am | Permalink

    I guess we’ve been lucky to have veterinarians that I would like to have for my human doctor. She must be that untactful to all of her patients. Does she just get the overflow from the kind Dr. E?

    • Edie Jarolim
      Posted September 26, 2013 at 1:08 pm | Permalink

      You’re right, Jan, I can’t imagine she singles me and Frankie out as objects of her rudeness. And now that you mention it, I can’t think of anyone who considers Dr. M. their primary vet; she is the alternative for several people I know.

  8. Rebecca Boren
    Posted September 26, 2013 at 11:36 am | Permalink

    I’m willing to grant that some peeps mistake mean for funny. But a medical professional who knows how deeply you care about Frankie shouldn’t be one of them. Still not giving the very a pass on unprofessional behavior.

    • Edie Jarolim
      Posted September 26, 2013 at 1:12 pm | Permalink

      No, no excuses for her behavior; I just wanted to point out that she has redeeming characteristics — unlike our friend Dr. C, the third vet in the practice. For those who don’t have the pleasure: he is not only rude (he once called Frankie “a bad patient” which is ludicrous) but also rough with him. I will never, ever go to him.

  9. Alison
    Posted September 26, 2013 at 2:10 pm | Permalink

    It’s pretty obvious which vet clinic you go to–we go there too. Edie’s doctor is Dr. C. We love him! He specializes in small dogs, and although his manner may seem gruff, he is very caring. Edie is NOT a good patient, and I know that. She squirms and fights, and won’t even stay still long enough to weigh. But we have gotten good care.

    • Edie Jarolim
      Posted September 26, 2013 at 2:16 pm | Permalink

      Well, you are the second friend who is a fan of Dr. C! You’ve met Frankie — he is shy and not squirmy. And even if he was he would not be “a bad patient.” You can be gruff to me — though why I should have to tolerate that I don’t know — but there’s no way I am going back to a vet who is less than gentle with a shy dog.

      So… do you know anyone whose preferred doc is Dr. M?

  10. Marilyn Sutin
    Posted September 26, 2013 at 3:10 pm | Permalink

    That’s too bad, I think she might be due for a heart to heart talk about her pet side manners. Tell her how you feel and that it undermines her proficiency as a Vet. I must say that I’m lucky, I only wish my personal doctors had my Vet’s compassion. And I like your explanation of hospice for Frankie; it puts my own feelings about Rosa’s care in perspective.

    Who would have ever thought you’d be so devoted to a pet child – I love it!
    M

    • Edie Jarolim
      Posted September 26, 2013 at 4:13 pm | Permalink

      Well, since I adore my primary vet, I will just avoid this one except if I have to. I think Amy, who commented earlier, is right: It probably wouldn’t have much effect.

      I’m glad my perspective on hospice was comforting.

      And, yes, I think you may be the only person commenting here who can say you knew me when this type of transformation would have been unimaginable!

  11. Posted September 26, 2013 at 4:05 pm | Permalink

    Thank you for saying that the treatment we got steering Ellie into surgery was unconscionable – but I will say that complaining does not help, in my experience – I also soon had to switch vets — so if you didn’t say anything at the moment it was probably just as well though, if you can’t get in to see the doctor you prefer, when you need to, maybe you will have to explore another clinic?

    A gruff doctor can be a disaster – vet or human doc – and cause a lot of unnecessary expenses. Case in point: \ when my preferred doctor was out of town, I saw the ‘gruff’ doc – when I asked her why I had a particular symptom that she was ordering a lab test for, she said, oh it could be a minor infection, or it could be cancer. Oh. Let’s just say, one thing led to another, and although the test came back negative – after a very long 10 days – it led to a lot of unnecessary, expensive tests along with my reviewing my will and a lot of unnecessary worry. As it turns out, I am perfectly fine, except for the bills… 🙂 thanks for listening – I guess that’s a little off the track but in a way, not really.

    • Edie Jarolim
      Posted September 26, 2013 at 4:17 pm | Permalink

      I think, in an pinch, this vet is fine. She didn’t push her opinions about getting Frankie’s teeth cleaned on me once I balked.

      And yes, I feel your pain regarding gruff doctors. I’ve been lucky since I moved to Tucson, but in New York I’ve had many experiences similar to yours. No fun. Hey, medical professionals are medical professionals, whether they are treating our pets our us! And they have a lot of power over us when we are in a vulnerable position.

  12. Sharon
    Posted September 26, 2013 at 6:15 pm | Permalink

    Hi Edie…you’ve taken amazing care of Frankie and have nothing to feel guilty about….end of life care is very special and is meant to keep a loved one free of pain and comfortable….that is exactly
    What you are doing and no doubt will continue to do…..and don’t forget to spoil him with treats….! We’ll talk soon….
    Sharon

    • Edie Jarolim
      Posted September 26, 2013 at 7:01 pm | Permalink

      Aw, thanks, Sha. You know, guilt is part of the territory, both here and at Freud’s Butcher, but I try to keep it down to a muted roar…

  13. Posted September 27, 2013 at 4:19 am | Permalink

    I am so sorry you had to see Dr WTF Edie. I could never see someone like her. Ever. How insulting and rude she was to you and Frankie. I love my vet hospital because all of them have a terrific bedside manner. They are sweet and gentle with my shy and fearful dogs and for that I am grateful.

    Yes. I think palliative care is a good way to think about it. Frankie is loved and cared for and gently, helped along when needed, but it is a good quality of life. He is not suffering. He is not unable to function. I think what you are doing is what any pet owner would do – hospice.

    I am so sorry for your experience at the vet. Ugh.

    • Edie Jarolim
      Posted September 27, 2013 at 8:18 am | Permalink

      At this point, it wouldn’t make sense to change but in the, er, future, I would love to find a place where all the vets are kind. I’m so glad that you have that!

      Thanks for the sympathy and support. It makes me glad to get back to pet blogging.

  14. Posted September 27, 2013 at 9:07 am | Permalink

    Palliative care. Exactly. Given recents events in my life, hospice and palliative care seem to be part of my daily conversations. My heart goes out to you and Frankie, although, lucky for him he likely isn’t burdened with self-reflective consciousness, although, who knows for sure. Even more lucky for him he has YOU. I wish when Morgan, unlike Frankie, was in the process of dying from kidney failure, I had had a name for what I was doing for her. It would have helped to focus my mind and heart. I would have understood my ‘job’ better. I, hopefully, would have been calmer, and that surely would have been more comforting to Morgan than my bouts of anxiety. Although there was no hiding my grief. Once again you nailed it for all of us. Whether or not we ever have the opportunity to provide or oversee hospice or palliative care for a person we love, we pretty much can count on such an opportunity when we bring a beloved dog into our lives.

    • Edie Jarolim
      Posted September 27, 2013 at 10:23 am | Permalink

      First, I’m sorry for your human loss, that of your father, and for the difficulty of having to take care of your mother.

      And, yes, words matter. I knew about pet hospice but somehow I felt that was further down the road. Once I realized I was already practicing it, in my fashion, I felt a bit better.

      Which doesn’t mean that I’ve come to terms with this — I haven’t. But maybe I’ll stop petting Frankie and sobbing. I’m sure that doesn’t help him (or me).

  15. Posted September 28, 2013 at 2:16 pm | Permalink

    Holy Woof – WTF indeed. Get some bedside manner?! I’m so sorry you had to hear it like that.

    Frankie is a lucky lucky guy to have you taking such great care of him. This is such a hard time, when you’re not ready to let go and when there is things he kind of needs, but aren’t really the best thing for him at all. You just follow your heart and Frankie’s lead and you’ll do great.

    • Edie Jarolim
      Posted September 28, 2013 at 3:36 pm | Permalink

      Thanks, Jodi. It’s hard to feel like I’m doing enough, no matter how much I do. I’m sure you know what I mean! Of course, if I follow Frankie’s lead I’d be standing in corners half the time — oh, is that mean? — so I hope he’ll give me a clear signal.

  16. Posted October 18, 2013 at 2:28 pm | Permalink

    I can relate to your situation. It was with my cat of 17 yrs. not my dog, that I went through a difficult period. His kidneys began to fail and my vet and I decided for me to give him fluids 3x per week. Eventually it increased to every other day. He was fine for a month or so and then Max did give me a clear signal. He wouldn’t eat. I put down a feast of all of his favorite foods and when I carried him over to his dishes, he crawled away. I understood what he was telling me. At the vet’s he just laid on the table and closed his eyes. He was tired and it was time. My vet agreed. It didn’t lessen the pain and grief, but I had some solace because I felt he gave me a signal.

    When the time comes you to will know you did everything you could for Frankie, kept free from pain, and was with him until the end.

    http://twoearsandatail.blogspot.com

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