03/15/2010 - Who cares about the diagnosis? 03/01/2010 - Feed Them and They Will Come 02/12/2010 - Dealing With (Mis)guidance The most common line to decline surgery in my practice is “Yeah, well … I don't want to put him through this.” To be fair, it probably means different things to different people. The vast majority of the time, I suspect that it means, "There is no way I'm spending that kind of money on this mutt.” Sometimes, it means that the owner is truly concerned about how invasive surgery is. A classic example is amputation. Pet owners invariably unconsciously anthropomorphize and just can't imagine themselves hopping on one leg. Of course, we know better. I have never seen a three-legged patient not walk. Even with DJD in the remaining limbs. I have had my own doubts and hesitations. Colleagues, surgeons and oncologists questioned over the years have all agreed. They have never seen a three-legged patient not walk. Surely, there must be exceptions. The same reasoning applies to mandibulectomies and maxillectomies. They typically sound horrifying to clients (and some referring vets). Yet surgeons are often amazed that their patient will most of the time eat the very next day after surgery. Excellent pain management, appetite stimulants and an appropriate feeding tube may greatly improve the outcome in the rare cases of anorexia, especially in cats. A particularly striking example of “I don't want to put him through this” came in the form of Panther, a 13-year-old obstipated cat who belonged to an elderly client. For two years, Panther had received every conceivable treatment for megacolon: cisapride, lactulose, pumpkin fiber, Metamucil and various diets. Oh, and bi-weekly enemas given by the owner's son. For two years. In Mum’s very own kitchen sink. So let me think. That’s 2 x 52 x 2 or 208 enemas. Ouch. You guessed it. I recommended performing a colectomy to put the poor cat out of his misery. Yet the son said, “I don't want to put him through this surgery.” When quizzed, the son replied that this surgery was an invasive, unnatural, inhumane and painful procedure. Somehow, I can't picture over 200 home-made enemas given to a cat in the kitchen sink for two years as humane. Luckily, Mum knows best. Panther had a colectomy and made a smooth recovery. Without question, our job is not to convince pet owners to do unreasonable or unethical things. Amputation, mandibulectomy, maxillectomy, colectomy, although invasive, are perfectly humane and ethical options. Of course, adequate pain management, patient support and client education are mandatory conditions to reach a happy ending. The most common line to decline surgery in my practice is “Yeah, well … I don't want to put him through this.”The most common line to decline surgery in my practice is “Yeah, well … I don't want to put him through this.”surgery, colectomy, mandibulectomy, maxillectomy, pain management
