The Pet Problem

The Pet Problem is the headline of an article in today's New York Times, which of course all of us here at VBB central read cover-to-cover before office hours every day. It is required reading for this blog post, so, go ahead, click over there, and check it out. I'll wait.

No, really. I'll wait.


OK. Hi, welcome back. So, the problem of elderly people and their pets, and the mismatch between their life expectancies, is commonly encountered in the world of general practice companion animal medicine. In my experience, most very elderly pet owners love their pets and prioritize the care of their dog or cat above almost anything else in their life. The subject of what to do if or when the owner expects their beloved companion to outlive them is frequently raised in my exam room - along with the sad subject of what to do if Fluffy is going to die first, and the owner feels "too old" to get another pet. In the latter situation, I have been able on several occasions to match relatively healthy but older pets, whose owners have recently passed away, with recently-bereaved elderly owners whose pets have recently passed away. Talk about a feel good moment all around! But in the first situation, it's very difficult.

I have had owners ask me if I would be willing to euthanize their dog or cat, once they themselves have passed on. Euthanasia of a healthy pet is not something most general practice vets feel good about. Simply because the pet owner is old and dying, that does not necessarily give them the right to decide a pet should die. However, commonly, the elderly pet owner is him or herself feeling the loneliness that comes after one's friends and family have largely predeceased you, and the neglect when the few remaining family members you do have do not come to visit you or even call you to say hello. When your world is so small, and there is no one to see you and give you a hug every day, is it worth it? They may feel that for their pet, there is no chance of finding a new loving home, and therefore want to spare him that loneliness. I can understand that, but I have so far been able to convince my elderly clients that this is not the way to go.

I have had owners ask me if I would personally take their dog or cat. "Dr. VBB - you are so good with Timmy. You understand him. I would rest easy if I knew he could have a place in your home." I appreciate the sentiment, really. But, if I took home every needy pet I encountered, or even if I took home 10% of them, I would quickly find myself living in some kind of "Dogs Gone Wild" meets "Hoarders" scenario. This is not a practical solution.

If the pet is relatively healthy, rehoming through one of the local rescues is often a viable option. If the pet has special needs, it can be trickier, but I do my best to find a place for it by checking in with local colleagues and social networks, in hope of finding a match. Hey, it just struck me - "Veterinarian as Owner-Pet Matchmaker" would be an interesting elective, wouldn't it? Right up there with biochemical basis of disease!

Anyway. Sometimes we see the situation where it seems like the owner and the pet are in a contest - who's going to die first? We take the cat in for boarding while the owner's heart failure is treated in the hospital. The owner goes home, the cat goes home, then the cat comes back in three days later vomiting and dehydrated. It's in renal failure, this happens periodically. We diurese it and we'd be sending it home after four days but oops, owner is back in the hospital with pneumonia. We board the cat for a few weeks, then it gets to go home again. Then it comes back in. It's really sick, hasn't eaten in a few days, hey look, now it has diabetes. We get it regulated on insulin. We send it home only to have it bounce back again a few days later because the home health nurse taking care of the owner, who broke her hip and is recovering at home, can't give the cat its insulin. These situations become very very complicated sometimes. I think the worst is when the owner arranges for us to board the pet while they go into the hospital themselves, and then they die in the hospital, and no one tells us, and eventually, we call to find out what's going on and get yelled at by the grieving son or daughter who answers the phone for being so insensitive as to ask what arrangements have been made for the pet, "at a time like this." Not being psychic, we do not know it is "a time like this" if no one tells us. The guy who taught the Crystal Ball elective at my vet school was on sabbatical during my third year, btw.

I once had a client my own age who came in frequently with a very large dog. The dog was obedient to her and well-controlled by her, but had significant aggressive tendencies and was not safe to be around when the owner was not present. Unfortunately, this client was suffering from widely metastatic cancer. At times, she was not able to care for her dog due to her weakness while undergoing chemotherapy. I took care of this dog for about five years, during which time the owner had at least four or five brushes with death. We were able to board him successfully only by keeping him relatively sedated, which is really not optimal. Eventually, in this case, we did euthanize him when his owner passed away. She had asked me to do it, and I couldn't refuse. I did have to deeply sedate him via IM injection while a tech held him at arm's length on a rabies pole first, though. Very sad situation.

The idea of the pet trust is interesting. I'm not sure there are that many people who have enough of an estate to make this idea that popular. Including a pet in one's will seems like a good idea, although as pointed out in the article, that isn't completely binding.

Veterinarian readers - what kind of solutions have you come up with for your elderly clients who fear for the fate of their longer-lived pets?

The Notebook - The reality version

I have a heartbreaking story to tell.  One that does beg to differ with those who accuse us of doing things only for the money.

I have these wonderful clients who love their dog, Mr. Sweets.  Mr. Sweets does not hurt for food and is overweight.  I used to harp on them about his weight, until one day - only a few visits after I'd first met them - the owner (Mr. Z) pulled me aside and informed me that his wife (Mrs. Z) had advanced Alzheimers, can't remember when she feeds Mr. Sweets, and therefore the dog will not be able to lose weight.  He also informed me that "that damned dog keeps her alive" and that anything else I can do to work with him would be greatly appreciated.

Okay.  Totally new rules to this game, I can see.

So Mr. Sweets secretly takes Slentrol, a drug that can help dogs lose weight.  It doesn't do much other than keep him from being a total ottoman, and it's something that Mr. Z can give in secret without Mrs. Z finding out.

Then I started noticing how often they were coming to see me - nearly every day some weeks.  So again Mr. Z and I had a discussion.  I told him I didn't feel right about charging them for exams every day when there is never anything wrong with Mr. Sweets.  He told me that he knew there was nothing wrong with "that damned dog" but that every time he sneezes, Mrs. Z (with advanced alzheimers) goes into a panic and demands that he go to the vet.  Who happens to be me.

Okay.  So now I really understand the game.

I think about it, and I call Mr. Z and tell him this:  "Mr. Z, you are a wonderful person and I don't know how you make it through your day.  Your wife of 50 years doesn't know who you are most of the time yet you take exquisite care of her and her dog every single day.  I saw you at the grocery store on Sunday and you were buying a whole bunch of beer, I presume for yourself.  So I'm gonna offer you something that I hope helps, and hopefully will make your life a little easier.  You deserve a break."

I told Mr. Z that he is to bring Mrs. Z and Mr. Sweets down as many times as he wants, to see me.  I will do a full exam on Mr. Sweets in front of Mrs. Z so she will know he is OK.  The only condition to be met is that he comes during the hours when I am not slammed with appts - anytime at all between noon and 2pm.

And I will not charge him a dime.  Ever. 

He was so touched that he cried, and of course we saw Mr. Sweets a LOT.   The truth is that Mr. Sweets could come see me at noon, and then go home, sneeze, and then be back in an hour, because Mrs. Z wouldn't remember that he just saw me at noon.  But this made her happy and gave Mr. Z some peace of mind that his beloved wife of 50 years was up and about and still functional to some degree.

This went on for about 6 months.  Then we recently learned that Mrs. Z is now in the hospital and not doing well.  Mr. Z is still by her side, not leaving the hospital.  It is the real life version of The Notebook.

And we are still taking care of Mr. Sweets because that's what we do. 

Family pets

It's funny. There's that saying, "Physician, heal thyself," yet, I'm sure most physicians agree that if there is anything seriously wrong, it's not a good idea to try to treat yourself. Similarly, it's generally considered unethical and inappropriate for physicians to treat family members for serious conditions. Percival's Medical Ethics (pub 1803) addresses the matter, proposing separation of personal and professional identities with respect to caring for family members. There are many reasons for this, loss of professional objectivity probably being the most important. So, anyway, what does this mean to me as a veterinarian? Well, there are no formal rules regarding treatment of one's own pets. It's not frowned upon by any professional societies that I know of. In the absence of a third-party payer system, in fact, most veterinarians I know do choose to either treat their own pets, or simply have an arrangement with a close colleague in their own practice in which they treat each other's pets. For me personally, it's a problem not so much with my own pets (whom I do have a colleague treat, because I find that my own loss of objectivity is so great as to interfere with providing quality care - my own pet once went apneic under my care, and while I did successfully resuscitate her, I will NEVER AGAIN put myself in that position!), as it is with family pets.

Ahhh, family. Gotta love'em, right? I am lucky enough to be surrounded by lots of loving family members, and honestly in the grand scheme of things, I have very few complaints about them. I would love to provide them all with free veterinary care, but - well - first of all, I'm not a practice-owner. There are limits to what I can give away. Information, sure. After all, information wants to be free. Medications, diagnostic tests, other sorts of things, well - those I can sometimes get at cost or cost plus something, sometimes I can't. And while some family members are really understanding about that, others I know think I'm just being mean. Sorry about that, guys. It's especially hard when I know certain family members simply don't have the money to provide the gold standard of care, as much as we would all love them to. On occasion, I've been lucky enough to have a local specialist colleague offer a family member of mine a professional discount. My profession is full of caring individuals like that, who will offer highest quality care at a deep discount, when THEY feel it is appropriate (not when Jane Random Client wants it, which is a whole separate issue). I hope that they can karmically balance out the scummy, corner-cutting Dr. Pols of the world. [And let me just take a moment here to go off on a tangent and add: Dr. Pol does NOT practice high-quality medicine. In one episode, he left a severely dehydrated puppy with hemorrhagic gastroenteritis alone in a cage dying, without even giving it any fluids. Seriously? he also doesn't seem to gown/glove up for surgery, or do any other 'standard of care' type things. OK, moving on...]

So anyway, all of this is really a lead-in to a story I wanted to tell. Details have been changed but the heart of the matter is completely true.


One day at 5 AM, my spouse's cell phone rings. It's a close relative on my spouse's side of the family. She found one of their cats on the floor near a "pool of dark liquid." The cat was "gasping" and when she touched it, "nothing happened." "What should we do?" she wanted to know.

It was one of those moments for me. I have them all the time. Moments when I feel like the person I'm talking to is going to be grossly unsatisfied with my response, no matter what my response is. Moments when I feel like no matter what I say, the person I'm talking to is going to come away with the idea that I'm an imposter, because surely a "real doctor" could do better than THAT.

I was in bed. It was 5 AM. The baby was nursing and I was just noticing that she was in fact running a fever again (the fever had not been present at bedtime). What was I supposed to do, get up and go over there and see that the cat was in fact agonal? Is this what they expected of me? I'd have no access to any diagnostic tools save my eyes, ears, and fingers; nor would I have what was probably the most important thing - Euthasol. Better to send them to a hospital. But which one? They won't go to the local university teaching hospital. They claim the vets there killed one of their cats. We always disagree on that, but it was a long time ago and besides, the cat is dead (ha ha)(sorry) so I can't suggest that. But the local ER sucks. The one my boss refers to - I wouldn't direct them to if they paid me. That leaves the one I almost went to work for, the one with the unreasonable non-compete clause in the contract. So I tell them:

It doesn't sound good. I can't tell what's going on, but you can't do anything at home to help him and you can't do anything at home to end his suffering. He needs to go to the hospital.

Later, I call my spouse to find out what happened. The vet said that the cat was agonal (duh) and she didn't know why. She offered supportive care and diagnostics, with the caveat that whatever they found was probably incurable, or humane euthanasia. The owner elected euthanasia, which is what I would have hoped for. But they declined a post-mortem exam, which was a total let-down for me.

We got together with this part of the family about a week after this event. They told me the whole story, in their own words. I'm sure they didn't mean to make me feel guilty, but when they said "since you couldn't come over, we went to that place you suggested," I heard "since you didn't love us enough to get out of bed, we went to that inconvenient and expensive place you suggested, which couldn't even help us anyway."

It's hard to be a veterinarian in an extended family of pet-owners, is the bottom line. Just wanted to put that out there. Thanks for listening.