Between a rock and a hard place

Dear Dr. Forsythe:  Our 11-year-old terrier was recently diagnosed with diabetes.  We are going back to the vet soon to get insulin and more information on this disease.  I wanted to know your opinion regarding quality of life issues with pets who have diabetes.  My boyfriend and I do not want to prolong “Woody’s” life by giving shots twice a day and feeding special food unless we can expect him to maintain a good quality of life.  Do you think it is worth putting him through these shots.  Do they hurt? – N.G., Napa

Dear N.G:  In my opinion, dogs and cats that are diagnosed with diabetes usually enjoy a high quality of life once we regulate their disease with proper insulin injections and improved nutrition. Getting a diabetic pet “regulated” means making sure that their blood sugar is controlled as well as possible so that it is as close to normal as we can make it for the majority of each day.  Insulin shots are administered via a very tiny syringe with a needle that is very thin.  I imagine that the shot itself hurts less than a flea bite. However, I always caution clients with a newly diagnosed diabetic animal that they may expect increased veterinary costs in the future and that all pets respond differently to treatment.  Some pets (dogs in particular) become well regulated quickly and easily, while others (more often cats) can be more difficult to get to a steady state.

Diabetic pets are prone to urinary tract infections as well as developing other complications such as cataracts.  It is a big commitment to “Woody” to take on the duty of seeing that he gets insulin administrated twice daily (at the same time each day) and eats a diabetic appropriate diet for the rest of his life.  While this an adjustment that will impact your family, the reward will probably be huge when you see Woody start to feel better and will continue to enjoy the vast benefits that come from having a loyal family pet.  As long as you have realistic expectations and you are willing to elevate the level

of veterinary care he may need in the future, I suspect you will be very glad you moved forward with his diabetes treatments.  I have many happy patients who have been dealing with diabetes for several years, and in practically every case, the clients are so grateful to have their beloved pet with them living a happy life.  I hope this information has helped, and that Woody will do very well in the future. – Dr. F

Dear Dr. F:  Can you please tell me what “hospice” care means in veterinary medicine?  I have a 12-year-old Cattle dog who was diagnosed with a cancerous growth in her stomach.  I can’t afford the operation to try and remove it, and besides there are no guarantees that the doctors would be SURE they could remove it all.  Besides, we just didn’t think it was fair to put her through a big involved surgery at this age.  So we decided to take the veterinarians advice and give her hospice care.  What exactly does that involve?  I remember with my late mother it was pain medication while we waited for her to pass.  Is that the same thing I can expect for my dog?  I don’t want to put her to sleep because she still seems happy and I also don’t like the thought of doping her up as her condition worsens.

I guess I’m between a rock and a hard place.  I just want to do whatever is best.  Do you agree with hospice for dogs?  Sign me – Between a rock and a hard place

Dear Between:  I haven’t had personal experience with a human loved one going through a hospice situation, but I do provide this service for pets, and

I think it is a really useful topic for veterinarians to address, so I’ll tell you what my thoughts are on this delicate and difficult time for both your pet and your family.

Hospice is regarded by many veterinarians as a point at which “there is nothing more we can do.” This can mean that the veterinarian feels very limited and only has the option of sending home pain medication and tranquilizers with the hope that it will help.  I see hospice in a completely different way:  I feel it is an opportunity for me as a veterinarian to provide the best comprehensive help to a family and their pet through what is clearly a difficult transition in the pet’s life.  In such cases, it is important to lay out a comprehensive plan for the pet which his owners can implement in order to take into account their furry family members’ mind, body and soul.  This means addressing any medical aspects as painlessly and inexpensively as possible.  In addition, it means addressing the pet’s nutritional needs, reducing stress, and making sure the pet is receiving the highest level of love and interaction with his family.

Depending on the severity of the mortal condition a pet is dealing with, there is ALWAYS a way to deliberately and proactively make the final time he will have left in this world as worthwhile and joyous as it can be.  The important thing is to remember that you are NOT between a rock and a hard place but rather making a reasonable choice to provide the best end-of-life experience as you possibly can for your dog.  Once you make that choice, my opinion is that it was the RIGHT choice for you to make, so I suggest

you see the potential to spend the remaining time you have with your dog as a phase in which you are there for her when she needs you most.   I hope that as her condition progresses, you will be able to use some of what I’ve said – not only to make her feel better, but for you as well.  So in my mind and heart, I will now revise your signature to be “helping my pet when she needs me most”.  I think that is a much better way for you think of yourself.  Good luck and my best thoughts are with you now. – Dr. F