Thursday, June 30, 2011
Animal Companions: Planning for when they're ill
I recently wrote about planning for the care of our animals if we should become ill. The other side of the coin: do we "plan" for our animals' illnesses or deal with the illnesses as they arise? Hand in glove with this: have you considered before-hand what is a reasonable v. unreasonable amount of intervention to give a sick animal?
When my Wee Bonny Lass was10 years old, I discovered she had a serious case of bladder stones. In fact, she had developed so many stones that she became incontinent, needing to wear a doggy diaper. Bonny was not all happy with the diaper or with the loss of control. My vet explained that the only option was a surgery that would cost more than I had; the vet however was willing to take payments on the surgery.
I was torn. As a Schnauzer I knew Bonny had a life expectancy of approximately twelve years and she was nearing her 11th birthday. I knew she could not live the way she was and the vet explained that she was very uncomfortable, so my choices were surgery or euthanasia. Given the cost, her age, my limited income logic told me I should let Bonny go. At this point an interesting event happened.
I was not actually in town with Bonny when this happened. I was traveling across the country and Bonny had been left in the care of my sister/housemate. My sister and Bonny had an interesting relationship that included verbal arguments where my sister would shout, "Quit barking!" and Bonny would respond with a low growl. The two of them would then go on like this for up to ten minutes at a time.
"I mean it! Not another sound."
"What did I say!"
"Okay, I really mean it. Shut up."
Low muttering growl.
"Oh my God, would you stop!"
When I arrived back in the city late at night, I was prepared to make the hard call. My sister met me in the hallway. "Her surgery is tomorrow morning," my sister said before I could say anything.
"I don't know...."
"No, I'm telling you," my sister insisted. "I've already made arrangements with the vet. I'll make the payments. Bonny is fine...she can still live just fine, she's not in any other pain. I want to do this."
My sister understood how important Bonny was to me. And she and Bonny had their own unique bond. Normally I would not have let someone else make a decision like this in my life but in this case...Bonny's illness had been so sudden and unexpected that I, at a distance trying to make difficult decisions was like a stranger arriving at an accident scene and finding a loved one in the wreckage. I sat back and let my sister keep control of the situation. True to her word, she took care of everything with the vet and Bonny and I were able to concentrate on her recovery. Which happened very quickly and sure enough - Bonny was good as gold for nearly two more years, two years I've always considered a gracious gift from my sister.
Then Bonny met a fight she couldn't win. Congenital heart failure. Although the vet and I tried a few expensive meds, in a matter of weeks it became obvious that they weren't able to give Bonny total relief. I could have kept Bonny alive a brief while longer than I did - perhaps another month or two- but I had seen a beloved family pet in my childhood struggling to breath through one miserable night when her heart started to fail. I vowed that this would not be Bonny's end. I planned the best day I could give her and then, trying to act like we were having just another stop by the vet to pick up meds Bonny was given her final injection while I held her. Staying with her to the end was the last thing I could do for Bonny.
I have had to accompany many animal companions to this final vet visit. It is never easier. Unfortunately, I have only had two pets who were granted death in their sleep. The rest have had to be quality of life calls made by me on behalf of those who rely on me. The elderly cat who stopped eating all but a spoonful of cat food a day; the Boxer whose mind faded; the Rotti who developed a neurological disorder. At what point is enough enough?
I believe owners have to first consider an animal's comfort level. I have seen too many people keep an animal going because the person is not ready to say goodbye. Dogs live in the moment. When they have too many uncomfortable moments in a day then they have lost the quality of life they ought to be able to expect as our faithful companions. We can provide pain relief and other medical interventions. We also must balance what we can do, however, with what we ought to do. Sometimes, every possible measure is not the right choice for the animal.
Cost also is a consideration. I may not be popular in taking this stand and I certainly do believe that when it comes to how an individual chooses to spend their money, he or she has the right to choose to spend it all on an animal companion. I however believe that in a world where too many children go to bed hungry, my money ought to be spent on more than just myself and my companion animals. I do not choose to travel a great deal; I choose to sponsor children and care for sometimes unwanted animals. Each of us has to balance our own moral and economic scale.
My Lab puppy Lil for example, could have an expensive surgery; the results of the surgery are questionable at best. I will pay for Lil to be on joint supplements for the rest of her life. This keeps her comfortable and mobile and seems reasonable and responsible. I have a desire -- and duty -- to make her as comfortable as I can. I do not feel I have a duty however, to give her every medical opportunity known to veterinary medicine. So she will not have this surgery on her leg joint.
The vet and I agree Lil is very comfortable as she is, happy, healthy, and growing well. As long as I can maintain her in this status I will do so. I also recognize that as a Labrador with a joint injury at a young age, Lil may not be comfortable into as old an age as I had originally hoped. I will therefore have to continue to balance her quality of life with the options that veterinary medicine give me and my own sense of what is reasonable care for a non-human member of my family. As someone who has studied medical ethics I assure you, I extend a remarkably similar rule of quality balance in my own life and medical choices for myself. I am not interested in nor will I accept all potential medical interventions.
As with our own health, with our animals' health we cannot foresee all possible illness and accidents. When I went out of my way to add a Lab with healthy joints to my family, I had hoped to avoid the very reality I am living with - a Lab puppy who will always live with a problem joint. The best laid plans of mice and men....
There are several things we can control however. First of course, we can try and be proactive. Keep your pets healthy: annual vet checks; vaccinations particularly for puppies until they develop stronger immune systems (the discussion about how often to vaccinate and what to vaccinate against I will leave for another day); fresh clean water; good food; exercise; socialize. Mental well being is important to animals just as it is to their care givers.
Next, it behooves all of us to set some money aside for the unforeseeable emergencies that will happen to our animals. Some people use pet insurance --read the policies carefully, they don't include regular proactive health care--others have saving accounts. Not all of us will be lucky enough to have a vet who will take payments if something fixable should happen to our beloved companion and we are short of funds. Just as much as I am uncomfortable seeing people spend a fortune on a lost medical cause, I hate to see an animal's life endangered because of a temporary shortage of owner-funds in the face of non-traumatic injury.
I think it might also be important though, in an age where we are faced with so many possibilities in pet care, to think about what we believe. Should our animal's care be at all related to cost? Should it be strictly a matter of what degree of quality of life our animal is enjoying? This is a personal decision that I would advise thinking about before you are in an actual state of needing to provide emergency or end of life care. Also, what standards have you set for yourself so that you are recognizing the signs that an animal has lost their quality of life? For example, when Bonny started to loose interest in chewing things, I knew she was loosing her zeal for life. We need to be honest with ourselves in recognizing those signs that let us know our faithful companions are loosing interest in the things that mean most to them. Bonny was always glad to see me; that wasn't her only purpose in living though and when the other things that mattered to her in life were gone, so was her quality of life.
Lil on the other hand, lives happily in the moment. She doesn't know or care that her one leg is not as mobile as other dog legs. She runs, plays, eats, and sleeps like every moment in the day is the most important. She is a happy puppy. My goal is to keep her as happy, content, comfortable as possible in each stage of her life and to enjoy as many moments with her as life blesses us with. And then to have the grace to recognize when I have once again reached the final life stage with a beloved companion.
This is the best we can do for our companions. To treat them as ends in themselves, never as just holders of our own happiness. They are beings in their own right and deserve the dignity and respect that comes from being a living being with feelings.
I have often found it helpful and comforting to discuss these choices with other people who love animals and who understand how hard decisions can be related to traumatic and end of life care for pets. If you have your own thoughts, ideas or want to use this blog as a sounding board for such discussions please do so.