12/21/2009 - Would you have euthanized this patient? 12/07/2009 - Spay a pet, save a life 11/16/2009 - How (In)competent Are You? A local colleague, Dr. L, generated quite a stir in our referral community. Her dog Ursula, a 9 -year-old golden retriever, was recently diagnosed with hemoabdomen, widespread liver cancer and pulmonary metastasis, probably all due to hemangiosarcoma. Strangely, Ursula never missed a meal, and her liver values were normal. There wasn’t much to do, besides making her comfortable. I suggested to my referring vet that she look into Pawspice. Remember, dear reader, Pawspice is the concept developed by oncologist and Veterinary Practice News columnist Alice Villalobos, DVM. Pawspice is hospice care for terminally sick patients, whether they have cancer, liver or kidney or heart failure, or the owner can’t afford treatment. Dr. L was mentally prepared to euthanize her right away, but Ursula perked up. After some research, she decided to give IV fluids, steroids, vitamin C, coenzyme Q10, a chinese herb called skullcap (aka Scutellaria baicalensis or baical), claimed to have some anti-cancer properties, and even an equivalent of reiki. Unfortunately, Ursula’s health declined. She likely had another bleeding episode, and after 10 days, she was euthanized. The story could end there. But you don’t know Dr. L! She really became interested in the Pawspice concept. Once a month, I host a “case discussion” meeting with some local colleagues over lunch. We decided to explore how we could offer Pawspice in our area, the Lehigh Valley of Pennsylvania. Reactions were mixed. Here are a few quotes from the audience: • “Every practice could incorporate this concept into their clinic and offer it to clients. As with almost everything we do, client acceptance and demand will dictate whether it becomes a part of any given practice.” • "Every profession has its components of science and art. Veterinary medicine has generally focused on science and finding a cure. However, the non-science aspects of Pawspice are a crucial part of the art of our profession." • “Euthanasia is one of the blessings of veterinary medicine. Any of us who has watched a human loved one suffer and die with a terminal illness can attest to the horrors of this prolonged fate -- even with a supposedly adequate control of their pain.” • “In many instances, an owner may feel that they want to euthanize their pet and they have that closure. Yet here we are, confusing that decision by placing our scientific minds in the mix.” • “We all do hospice-type care for many of our patients to some degree, but we don’t have a formal, standardized protocol.” • “I doubt my clients can afford this kind of care in this economy.” To which another colleague replied: “On the opposite, we need to offer Pawspice because of the poor economy. Many people are unable to do everything for their pets, but they want to do something.” How do you feel about the concept of hospice care for pets? Do you think it’s too much trouble? Too much time? Too extreme? Do you think Pawspice is ethical or unethical?
