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The Lessons of Life

Article by Dr. Janet Riebe

My pets have taught me so much through the years, and I have become a better person and veterinarian as a result of having them in my life. I still remember when I was fresh out of school, giving advice to frustrated new puppy owners on housetraining…I did not have a dog at that time, but I had a dog as a child, and I had read a few books, so I felt qualified. I told the people that it’s simple, you will always know when your dog has to go out by watching carefully for the “signs”, such as circling, agitation, whining, and sniffing the ground. If they are having accidents, you missed the signs… Simple, really.
When I actually got my first puppy, Annie, a beautiful 9-week-old “wild child” of a Labrador Retriever, I started to put all my good advice to work….I still remember Annie inhaling her food at her bowl, she took two steps back, squatted, urinated, and resumed eating! Where were the “signs”?! I realized that the books are a good start, but nothing beats real life experience.

This fact proved to be true as I cared for my pets during several different medical and surgical problems. Early on in my career, I could site statistics and probabilities for response to treatment, and could even provide simple to elaborate treatment plans for any pet for almost any condition. What I needed to learn was that not all pets will cooperate for a textbook treatment, and this can cause such a sense of failure for the pet owner.

My cat, Kate, was diagnosed with cardiomyopathy, which is a serious heart condition. Her best chance for continued good life was through taking daily pills. Unfortunately, as sweet as she was in every other regard, she was one of the most difficult cats to try to medicate. She lived with two veterinarians, and we struggled medicate this cat! She started to avoid us if she thought we had her pills. We had to realize that the “cure” was worse than the disease, especially if it would damage the relationship we had with her during her remaining time.

She lived comfortably for several months, medication-free, and content with the affection we could offer in her last days. I learned to approach the treatment of each patient on a case-by-case basis, trying to take into account the temperament of the pet and the willingness and ability of the family to care for the pet. Just because a treatment is available, it does not mean it is the right answer for each pet. Sometimes, it is okay for life to just run its own course, without intervention by the medical community.
Perhaps the most important, yet most difficult lessons, have been learned during my pets’ final days. I was 21 years old when we euthanized my childhood dog – I had been away at college, so I had a clear perspective of how she was declining, and a detachment since I did not see her often anymore. Her euthanasia was more difficult for my parents, since they were the ones to make the final decision.

Through the years, it has been my responsibility to counsel pet owners on knowing when it is the “right time”. Many times, there is no question that euthanasia is the best choice…but for pets that are slowly declining, this can be a difficult decision. The first time I had to make this decision for a pet of my own, it was not the decision that was difficult, but dealing with the actual loss was grueling.

Roger was five years old when he developed an infection that took over his body within two days. He was in shock, his systems shutting down, so euthanasia was just a means to speed the process of his impending death. Then he was gone. It was so final, and so fast. All I could think was that two days ago he was “fine”, and now he is gone. My first real loss. Thankfully, the flood of tears were always washed away by reflecting on the many memories of Roger – he was a dog that would make you laugh just looking at him! I learned that it is possible to love a pet, lose the pet, and still feel that they are a part of you in memory. There is comfort in the memories.

My next lesson was to be the one I dreaded the most – when is it time to let go of a pet with a chronic condition that it otherwise feeling okay? This one was about Annie, who, through the years, had reclassified herself from the listing of my husband’s dog to “my dog”. While a classic trait of the Labrador is genuine affection for everyone that they meet, Annie was unusual for a Labrador in that she really bonded to only one person. She was my shadow. She would wag her tail for me, her eyes would smile for me. She went everywhere with me. I had one employee that tried so hard to win Annie’s affections that she would give her treats constantly. The employee never got one ounce of affection from Annie, and Annie got fat in the process! Annie even snubbed my husband, John, on many occasions.

When Annie was diagnosed with bladder cancer in March of 2006, I cried for days. As cancers go, it was not one that would make her feel sick – she would just feel a frequent urge to urinate, or would eventually strain to urinate. It was not a cancer that tended to spread to the lungs or other organs, so she was unlikely to develop symptoms in any other system in her body. But still, she had cancer.

The specialists told us she had 3 months without chemotherapy, and probably 6 months with chemotherapy. In this case, the chemotherapy was not associated with a high risk of side-effects, so we decided to try treatment. The cancer responded well to the drug therapy, and she felt good with the treatments. We celebrated when she surpassed the 6 month mark, and thanked God when we reached the one year mark after her diagnosis. Our biggest obstacle was finding food that she would eat, as the drugs seemed to affect her sense of taste and smell.

In May of 2007, she started to strain to urinate, so we took her for a follow-up ultrasound to visualize the cancer in her bladder. Yes, it was growing. Yes, there was another chemotherapy we could try, but there was a higher risk of side-effects. We decided to try one treatment to see if she could tolerate the new drug. She did great, so we repeated a second treatment, and returned for another ultrasound.

Dr.Cole, the internal medicine specialist at Fox Valley Animal Referral Center, gave me the bad news: while the tumor was not any larger, it was not any smaller, either. We could continue with this treatment, or try another chemotherapy. The next day, I spoke with an oncologist at the UW-Madison, School of Veterinary Medicine. We determined we would give this treatment a bit more time. Unfortunately, there would not be an opportunity for additional treatment.

One of the complications of chemotherapy can be suppression of cells produced in the bone marrow. Apparently, Annie’s platelets (clotting cells) were low as a result of the chemotherapy, so she bled into her bladder. The additional cells in her urine prevented her from being able to pass urine through an otherwise narrowed opening. She was obstructed, completely unable to urinate, thirty six hours after her ultrasound. Suddenly,we knew there was no choice. Yes, there was a stent that could be surgically inserted, but it would allow her to urinate normally for only four to eight weeks. It was time.

My mind raced with all the “last” moments: our last walk in the woods, her last romp in the creek, our last car ride. I held out hope that the next time she would squat to urinate, all would be well. It wasn’t. She looked helpless. Her eyes sad, as if pleading for relief.

On July 4th, 2007, as we gave the final injection, there was such an overwhelming sense of peace. It was right. It was time. She was at rest. Suddenly, all the “last” moments faded, and all the memories from her thirteen and one half years flooded my mind. We shared a lifetime together, without a moment of regret. She was, and still is, a part of everything that I do. She reminded me it is okay to say goodbye, and to trust your inner voice when deciding when to try a treatment, and when to know that it is time to stop trying. And while I still cannot tell someone when it is time, I can tell them they will know, if they just listen to their inner voice.

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