Doctor, You Aren’t Listening to Me... What if I Do Nothing?
A month ago my sister wanted to know if her Jack Russell Terrier could be sick because he was drinking and peeing all the time. I told her he needed to go to the vet; he could have a simple urinary tract infection or he could have more going on. Inside my head, I was screaming “diabetes” as polyuria/polydipsia (drinks a lot and pees a lot), or PU/PD as medical types call it, is a hallmark for diabetes mellitus in dogs, cats, and people. In dogs, diabetes mellitus rarely responds to dietary changes - unlike some people and some cats - and almost always requires twice daily insulin injections to control the disease.
Having seen clients react to a diagnosis of diabetes, I wondered how my sister and her husband would react if they had to take care of this chronic condition that requires significant planning and scheduling. It’s not for every owner: while it’s not expensive, it requires insulin injections every 12 hours, 7 days a week for the rest of the pet’s life, with no time off for good behavior. It requires considerable commitment, which can be particularly difficult for people like my sister and her husband who work outside the home and can’t drop everything to give a pet medication at the appropriate times. I wondered what they would choose to do if their dog did have diabetes rather than a urinary tract infection.
Receiving a diagnosis of a chronic disease can be difficult to wrap your mind around. During my years in practice, I noticed that there are some pretty universal questions most clients ask.
- “What are my options and what will happen if I do nothing?” When I hear this, I translate this into:
a. How will the disease progress? Will this be a disease that progresses quickly or is it going to be something that is a nagging problem for years to come?
b. How long does my animal have to live if I don’t treat?
- This question is usually quickly followed by “Is my animal in pain?” or “Will my animal be in pain?”
- The third question on their minds is usually “How expensive is it going to be to treat?” This is a valid question since most of us are not independently wealthy, and money has to be considered.
- “What will my time commitment be?” Some chronic conditions only require that medication be given once a day. Some, like inflammatory bowel disease require a lot of testing and veterinary appointments in the beginning but smooth out for the most part once the condition is regulated. However, feeding a dog or cat with megaesophagus requires three to four 20-minute feedings a day, followed by 30 minutes of sitting upright. Dogs paralyzed by a disk extrusion need a cart to get around and must have their bladders manually expressed two or three times a day. For some people, that kind of time, effort, and scheduling is not a problem; for others it is.
- "How am I going to give an injection/pill to Fluffy? He would hate that and then hate me for doing it." We have to remember, not every pet is amenable to being treated, even if it is supposed to be for their own good.
- And last, but not least, “How will I know it is time to consider euthanasia?” or “Will my pet die peacefully in his sleep?”
All of these questions are valid and should be asked by every client facing a pet’s chronic illness in order to help make an informed decision. The answers to these questions, along with the decision to treat or not treat, has led to many disagreements between owners and their veterinarians as well as disagreements amongst owners and their families. This decision is personal and never an easy one to make.
Depending on our life stage, we can be in different places financially and emotionally. When I am talking to a client across the examination table, I have to remember that I am not just talking to this person, but to everyone else in this person's life: kids, spouses, parents, bosses who expect them to be at work on time, as well as other household pets. In most cases, they have more caretaking duties than just the animal on the table in front of us. I have to remember that I am only seeing one small part of their daily life. I don’t know if this owner is taking care of small kids, a spouse with cancer, elderly parents or working two jobs to keep the bills paid. Personal history can be a factor too. Did this client take on a chronic disease in a previous pet only to find that the stress eventually caused them to resent that pet? After all, animals are supposed to bring joy to our lives, not cause stress and resentment. No one wants to start resenting their once-beloved pet! And in the case of the pet who fights treatment at every turn, no one wants their pet to start shying away from them!
If you are faced with a decision about treating a chronic disease, take the time to ask your veterinarian these questions and really think about the answers. Except in an emergency, you usually have time to consider what responsibilities you’re willing to take on and what you’re not. Talk about it with your family and your veterinarian; make the decision based on your time, energy, money, and wherewithal to live with an animal with a chronic disease. Know what you are capable of emotionally, financially, and with the time you have available. Do not discount the emotional difficulty that can occur unexpectedly; many people believe they can handle it, but later feel like they’re drowning when they find their lives being dictated by the needs of this pet or see themselves running up bills that will take away money from their children’s college funds.
Believe me, it is okay not to treat your pet as long as you don’t allow him to suffer. My sister and brother-in-law decided not to treat Buzz, who was diagnosed with Diabetes Mellitus. To quote my brother-in-law, “We will love him and enjoy him while we have him.” And that is okay! Don’t let anyone – including your veterinarian - tell you otherwise. Just because veterinary medicine can provide a treatment does not mean it’s the right choice for you and this pet.