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JULY 18th, 2008

Ouch. Hits home on this, my Sophie’s first week of radiation for her brainstem tumor. This article was emailed to me by a dozen or so supportive parties, some shocked, some impressed...
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Well said. I agree.

For me, Lottie's care comes down to what I want for myself and my husband....regular dental care, check-ups, tests, healthy diet.....etc. When it comes down to cancer and other prolonged terminal illness issues, I am personally not a proponent. But that's because I am very much PRO assisted suicide. I believe all creatures deserve to die free from suffering, pain and with dignity. Myself included. If I felt I was prolonging my animals suffering or discomfort, I could not live with myself. It's a very, very fine line that only a compassionate owner and family member can discern.
# Posted By Creature of Habit | 7/18/08 12:39 PM
It's a very tough, personal question, to be sure. I also consider the age of the pet. If my Westie has a life span of 12-15 years, comes down with a very expensive disease at 11, I'm going to weigh whether getting an extra couple of years out of her is worth the pain she'll go through and the emotional torture I'll go through, as well as the cost. To eke out a few more months for a pet that has already run through the vast majority of its life expectancy just doesn't make sense to me, especially when the pet likely is going to die soon anyhow. In that case, I think I would do what I can to treat the symptoms to allow the pooch to live as normal of a life as possible, and then do the right thing.

It's a tough, tough call, and in my opnion, a completely different one to make if the pet is very young and ordinarily would have years of life ahead. I'd have to reconsider in that case.
# Posted By Shasta | 7/18/08 12:50 PM
No one has the right to question how you spend your money. Your earn it, so you get to decide. If you bought a $50k car or a $3k flat screen TV most people wouldn't be shocked or criticize. But if you want the best for your loyal companions, somehow this is seen as over the top. I've never understood this - especially in a nation of so-called animal lovers.

The only time I have a problem with expensive treatment, is if its not going to provide the animal with a reasonable quality of life. But I feel the same way about treatments for me. If its going to prolong my life, but leave me totally incapacitated and in pain with no hope of improvement, I've instructed my family to pull the plug.
# Posted By 2CatMom | 7/18/08 1:29 PM
I opted for expensive surgery when my little terrier slipped a disc, and so many people felt the need to comment on it. Like CatMom mentioned, a lot of those same people spend ridiculous sums on new cars, fancy road bikes, designer clothes, big tvs, etc. But for some reason, they thinks it worthwhile to point out what I've chosen to spend my money on. My mom mentioned even how far that money could to help other dogs.

Here's the thing that rubs me the wrong way. I give a lot more money to charity than those people who criticized me . Since the surgery, I adopted a horribly unsocialized chihuahua. Now I'm fostering two more. They spend their money on big houses and stuff to fill them. I live below my means to a certain extent so that I can save and help others. I don't think that I'm alone. I would be tempted to say that other people who make the choice to save their animals are more likely to be caring people who give to charities and help others.
# Posted By Jen (SLC) | 7/18/08 1:58 PM
What someone chooses to spend on a pet, whether it's vet bills, toys, a new car to maximize the pet's comfort or even the purchase costs of the pet in the first place is the business of the pet owner and maybe those financially dependent upon them.

If your about to lose your home and you are single and opt to spend the month's mortgage on your pet then that is your decision. If you have a spouse and little kids, the decision about where the money goes will need to be considered differently.

But it's not a stranger's, a friend's or even a non-dependent family member's business. (yep, that would be my mother-in-law).

I have a friend who has an amazing kennel/Taj Mahal set up, shows and breeds a rare large breed of dog and takes impecable care of her animals. When asked recently how many dogs she had by a woman who clearly thought that more than one or two must make a person either a hoarder or insane, she very sweetly replied "51"

"Oh my God, you have 51 dogs?"

"oh my no, I'm sorry, that was the answer to the other inappropriate question, my age."

Yes it's an old joke but she really did say it and it shut the other woman up.

I think it applies to this subject very neatly as well.
# Posted By JenniferJ | 7/18/08 3:00 PM
Jennifer - That may be an oldie, but it's also a "goodie," and one I'm going to file away for future use. We have 8 cats and 2 dogs. While I don't recommend it for everyone, our animals are all very well cared for, loved, and do not bother anyone else. Nothing irritates me more than to have someone make horribly negative comments about the number of animals we have and what this must mean about us. Next time that happens, I'm going to pull out that gem of a reply!
# Posted By Lisa Powers | 7/18/08 3:07 PM
Jennifer - that's a gem!

And I totally agree with your sentiments. I opt not to own a car and use public transportation, and I swear, if I one more SUV driving, McMansion owning friend or relative comments on the fact that I buy my cats $1.49 per can cat food, or that I have a nice cat tree and lots of toys for them, I just may run them over with a CTA bus!

OT- my favorite criticism of all time happened a few years ago at my annual holiday party. I use papergoods, cause I have a buffet and about 30-40 people stopping by. When a pregnant mother of two told me how ecologically irresponsible I was, I just said that I was sure the space my paper plates were taking up in the landfill were considerably less than her kids' poo-poo diapers, and I would be happy to give up using paper plates when she started using cloth diapers that she washed herself.
# Posted By 2CatMom | 7/18/08 4:05 PM
How can you condemn anyone for caring and loving an animal "too much." I wish I had $20,000 extra dollars to spend on my sweet little cat who is suffering from chronic renal failure. Sadly, I don't think any amount of money would change the course of this horrible disease. As she struggles through this I have had to consider that there may come a time when I have to chose to end her life. I cannot bear the thought. So I am doing everything I can to help her recover. Mostly, that means refusing to give up on her. It also means feeding her by syringe three times a day, administering sub-cutaneous fluids twice a day.

None of it is expensive but it is certainly emotionally taxing and time consuming. When I called in sick one day last week to stay home with my cat because she was vomiting, my boss said to me the next day: "It sounds like it's time to put her out of her misery." She isn't a mean or unkind person. But someone who has never loved an animal can simply never understand those of us who do...I feel so blessed to have this beautiful creature in my life. And I feel an enormous sense of responsibility for her well being and happiness. For many of us it's not a question of how much is too much. The question is, What else can I do to help my beloved pet recover?
# Posted By Deborah | 7/18/08 9:18 PM
These questions come up in human care as well. How far should someone be allowed to go to solve an issue that is really no one else's business is something many dealing with infertility, cancer, etc. hear about themselves - let alone how they want to help their beloved pets.

People judge when it is not anyone else's business. You have the right to do what is necessary in your mind to help your pet - whether it is a fish, dog, cat, or llama.
# Posted By MLO | 7/18/08 10:02 PM
"my paper plates were taking up in the landfill were considerably less than her kids' poo-poo diapers"

This is just classic!

To comment on the subject of the post - our clinic is in a relatively low income rural area. You wouldn't believe the number of people who balk at the cost of a DHPP vaccine! "Just rabies. I only want rabies. It's just a dog.", they say. Then they go out that weekend and cruise around from bar to bar on their $4K 4-wheeler or snowmobile. The whole things makes me sad!
# Posted By Michelle Schwab | 7/19/08 7:53 AM
http://petinsurancereview.com/

My insurance plan provides $20,000 per year in coverage at less than $200 per yea premiumr. Most plans appear vastly overpriced. Hopefully bad insurance plans will be weeded out.
# Posted By Erich Riesenberg | 7/19/08 11:06 AM
I hope you'll all excuse me when I respond to the article at hand with the following simple response:

BULLSHIT.

Catmom, you hit the nail on the head.

A dear friend of mine owns 12 Rogers Wireless stores (and hence has ridiculous amounts of money to burn) and collects Ferraris. He recently purchased his first Formula 1 car for just over $1,000,000. This is a car that he will never actually race (his wife won't let him for obvious reasons) and is not street legal. They own several homes, more vehicles than I can count (anything that comes out new, he has to own it, from a Prowler to a Carrera to a Smart Car). He drives them for a year, gets tired of them when they are no longer the "new" thing he gets rid of them or adds them to his permanent collection, Jay Leno style.

After all that (and by the way, no one bats an EYE, other than to drool over his new four-wheeled acquisition) for anyone to DARE to criticize how ANYONE cares to spend his/her money is beyond reproach. Dr. Khuly, don't you feel guilty for one second spending money on Sophie. The only reason to feel bad is when it interferes with things that should take moral precedence. For example, spending your son's college fund on Sophie's treatment? Not exactly the same thing. Catch my drift? Spending your own damn money on a vacation, a house, a car, a donation, a cat clone, a surgery for a goose/rat/snake/amoeba/tarantula/earthworm/insert other absurd incident here, well quite frankly it's no one's business but your OWN because no one earned the money but YOU (and maybe the nice people at VISA or AmEx... lol).

Would I personally spend $20,000 to mend a dog of mine? I can be totally honest and say that no, I would not. Ten years ago, I would have, in a heartbeat. But after ten years of rescue, I know how many dogs I can personally save with that $20,000, and while you can NEVER put a price on a life, I would rather leave a legacy in the name of a dog I love than simply buy time. Can I understand why someone would choose the other way? ABSOLUTELY. At the same time, I don't feel it's anywhere approaching my right to make an opinion one way or another. It's not my dog (or goose!) it's not my situation, and it's not my decision.

To hell with those who would judge. There are those people who judge interracial couples, or handicapped reproduction... the list goes on and on and on. You can't turn around without someone having an opinion that you could have done it better, or worse, shouldn't have done it at all.

To all of you out there (and boy, do you know who you are!)... get a hobby!
# Posted By kim | 7/19/08 8:33 PM
My cats are as much a part of my family as my adult daughters - who each have a pet which they consider part of their family. In fact, since neither has any children yet, my younger daughter suggested a few years back that her cat, Wally was my first grandchild from her. Hmmmm. I guess that would follow logically.
# Posted By Diana | 7/19/08 11:52 PM
Many of us struggle with this question. My foster cat was diagnosed last week with lymphoma, and she also has early CRF and diabetes which came out of remission around the time of her lymphoma DX.

She started chemo on Wednesday, thanks to the amazing rescue who "owns" her. She is one of two cats who they have in foster that are undergoing chemo on their dime.

Some people told me to "just put her down." Well, I have some input into the decision, but it's not mine. Even if it were, and I had the resources, I would be doing the chemo.

She's only been out of a cage for the year she's been with me, and as much of her life at the end she can spend out of the cage, the better as far as I can see. I am sad for her that on top of her other conditions, she gets this fatal diagnosis never having found a "forever home." I guess I'm it by default.

But how far do you push it when the diagnosis is ultimately terminal? It's a hard line, and I try to base it on what I think is best for the animal, but it is a gigantically subjective thing.

I can't behave differently with a pet than I would a person. Just can't.

Took me a long time to come to peace with the fact that I am a quality of death euthanizer, not a quality of life euthanizer. But now that I understand that about myself, I struggle less internally.

When there is hope for a better day ahead, I will exhaust my resources and become a nurse. When there is hope to stablize things I will do the same.

It is only when the animal is suffering (pain, not diminished quality of life, because by sacrificing much of my own quality of life, I can generally prop up quality of life for a sick animal) and there is no hope of stabilizing the disease to allow them to enjoy some things in life . . . or if the dying process has begun. That is when I can euthanize.

I can't euthanize just because my pet has gotten a terminal dx if they are still feeling OK or at least not suffering.

Lots of people are judgmental about this because we all have different philosophies about what constitutes acceptable quality of life and appropriate end of life care, and different tolerance levels for hospice type care. Also, some people think that allowing your pet to have to live through anything less than their usual, prior normal quality of life is "cruel." I guess that means we should all off our grandparents, too.
# Posted By Stefani | 7/20/08 2:53 PM
Dr. Khuly, I am sooo glad you blogged on this article, I happened to read it, along with a few co-workers.

I had to ask myself several questions. The article states that Boswell has about 6 months left to live. The devoted owner subjects his goose to radiation treatments that causes discomfort & declining quality of life (after about $20,000). Then the Tuft's oncologist suggests a "switch" to chemotherapy.

One can only ponder:
1. is the owner making rational, well-informed decisions with all faculties?
2. does a goose (who's life is shorter than many species) tolerate pain and suffering ?
3. is this possibly a client funded experimental treatment in a " bird" species?

The article does go on to list more examples of successful treatments with dogs & cats at both Tuft's & Angell Memorial, in stark contrast to the highlighted "Boswell the goose".

And the story does not inform the reader what the final outcome is. I'm also curious why amputation of the leg was not considered. And I just can't help but wonder about the compassion & kindness to the bird.
# Posted By Barbara A. Albright/New Hampshire | 7/22/08 3:11 AM
All valid points, Barbara, but the article does not give particulars on how uncomfortable this goose really is, it merely sets the stage for our understanding of why someone might want to provide this kind of care to a goose, just as for any dog or cat. With the limited information provided I feel I'm in no position to wonder whether Boswell is suffering.

Radiation treatments are not uncomfortable except for the anesthetic portion (masking or IV catheterization). Indeed Sophie fairly skips out of her treatments and now that she's used to the drill she skips in there as well, apparently looking forward to the attention of those who care for her there. She comes home and eats big happy meals and, except for some sleepiness immediately afterwards, she's none the worse for the experience.

As to amputation, geese don't do so well. Two legs is tough, especially if you weigh as much as a goose. I've seen ducks do OK with prosthetics but the other foot is constantly at risk of bumblefoot and other problems as a result of inappropriate weight distribution.
# Posted By Dr. Patty Khuly | 7/22/08 7:43 AM
Dr. Khuly, I am in no way offering a comparison to Sophie with Boswell's treatments. The article refers to a single leg with bone cancer (unless I misread that) and does refer to pain/decrease of quality of life as reported by his owner after a course of radiation, thus the Tuft's oncologist suggests the option of continuing with chemotherapy in lieu of radiation.

We never learn the outcome, but it is mentioned that the treatment is hoped to provide approxiamately 6 more months of life.

Treatment is a personal decision, but in this case as in many others , one truly should be advised of all the options and risks. I don't make this comment lightly and find it just as applicable to humans. As evidenced by a clinical trial my own Mom participated in with a newly touted & approved chemotherapy, it was hers "and" her oncologist decision to discontinue--- with her longevity equal to the remaining participants and with much higher quality of life. Yes, perhaps not always the usual or intended outcome.

I also compare this, to many within the Scottish Terrier breed that either opt for highly aggressive treatment versus conservative supportive treatment, often with the same end results and the latter perhaps the preferrable.
# Posted By Barbara A. Albright/New Hampshire | 7/22/08 3:04 PM
My dog is my child and the question coming to mind is: would I want my human child to be euthanized because of terminal disease? Of course not, then why should I consider euthanasia for my dog, my cat, or any pet I have and consider it a child? For me, hospice care will be the only alternative.
# Posted By Fotini | 7/23/08 1:02 AM
Fotini: Everyone arrives at that decision differently. Mine is the reverse of yours: I'd like to have the alternative of euthanasia for myself and my loved ones.

Interesting point. Thanks.
# Posted By Dr. Patty Khuly | 7/23/08 8:15 AM
Oh, and I do offer "hospice" as an alternative. We can provide it at our hospital or we teach you to do it at home. It's a perfectly valid approach as long as pain is controlled and suffering absolutely minimized. But some cases just don't lend themselves to home care--respiratory cases, for example.
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# Posted By wewrere | 8/2/08 3:55 PM
Hello,
I agree that how you decide to spend your money is a personal decision and if it means doing everything (within reason) that you can for your animal, then so be it. I recently lost my 11yr old Choc Lab to lymphoma. She had chemo at NEVOG on Waltham, MA for about 8 months and while the cancer was not reversible, it kept it in check and she had great quality of life. She contracted pneumonia shortly after a treatment and unexpectedly passed away at the vets while being treated. I actually have had a Pet Memorial business for 5 years and have spoken to hundreds of grieving pet owners and hear the stories of what lengths the went through to help their pets - some are just incredible. Bottom line, we love our pets and should not feel guilty for trying to save them - as long as it is the best course of action for the pet and they maintain a quality of life.
# Posted By Steve Mondazzi | 8/12/08 10:52 PM
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