Quality of Life

When it comes down to making medical decisions for a loved one, the veterinary field tends to lean towards having owners consider the Quality of Life a pet will have as opposed to the quantity of life.  This is due to a few factors. 

Firstly, we care about your pet, and you by default.  We want you to make an educated, ideal decision for your pet.  This is likely to be the most difficult transition you make in your life, and we cannot stress enough how we are here for you.

Second, we cannot ask the pet what s/he would like to do.  It's all in the movies that animals talk to their doctors.  You know your pet so much more than we do, and you know how s/he usually behaves.  You will know best when it is time.

i don't even want to know....

And third, we want to do everything we can to make your pet as happy in health as s/he can be.  If your pet is suffering, we need to know what we can do.  As a clinic and as medical staff, we CAN  do everything.  But it isn't always financially or humanely feasible.  We need to be able to reach a happy medium with your abilities and comfort level of treatments.

Technically the fourth reason is that we want to not be sad or helpless when it comes to the decision you've made. More than once, I have been sobbing uncontrollably because a human made an inhumane decision for their pet, and there was nothing I could do about it.

These are things to consider when looking at your pet's quality of life:
1. Activity
How active is your pet?  For older pets, it is understandable that they slow down.  We all do.  Whether it is due to pain, endurance, or desire is not usually crystal clear.  But if your pet chooses not to move around a lot, this is decreased quality of life.  Sometimes this can be fixed or assisted to improve quality of life with medication from the vet.  Does your pomeranian get winded just by barking at the cat? 

this pig can fly

2. Mobility
When your pet does move around, how easily does s/he do so?  Are the joints stiff and painful?  Is there a limp?  Does s/he stumble or miss a jump s/he has made thousands of times before?   Is your pet in need of pain medication, or is this truly a decreased overall quality of life?

d'awwwwwwwww

3. Appetite
Does your darling pet eat as much as before?  More?  Less?  Does s/he eat with the same vigor as in the past, or has it become more of a chore? If your pet can't get to the water or food dish, dehydration can occur and cause a rapid decline in health.

4. Pain Scale
The same pain scale you use can be used for your pet, but objectively instead of subjectively.  You've seen your pet pain free in the past - any pain above a 4 (on a 0-10 scale) is a poor quality of life in my book.  Fix the pain, or else your pet is suffering needlessly.

ouch

5. Attitude
Does your baby greet the day with the same enthusiasm as before?  Does s/he frolic alongside you, chew on or play with toys with spunk, or lie there listless?  Does s/he growl at people s/he would normally be affectionate with?  Does s/he appear to be going senile?

hygiene is important

6. Hygeine
 Decreased appetite or food intake can be due to dental issues.  Inability to get up and walk outside causes fecal balls, also known as dingleberries, to form.  Some fecal balls obstruct the anus and the pet can become impacted.  Does your pet have a funky smell?  All of these are contributors to a poor quality of life.  Urine dribbling can cause a scald on the skin, causing pain and infection.

7. Good Days vs Bad Days
 For elderly and terminal patients, this is the most heart-wrenching part of the Quality of Life story......because it means we are reaching the very end.  This is the point when I request that the owner start a journal.  Each day, before bed, write down your view of how the day went.  Good or bad, then elaborate.  Did s/he piddle in the house today?  How much did s/he eat?  And at the end of a single week, maybe two....see how many good days and bad days your little Puddin pop has had.  When bad days outweigh the good, it is time to make a decision.

8. (if surgery is an option) Recovery and Pre-op QOL
 The biggest thing to consider in a surgery is whether it is improving the pet's life or if it is prolonging the inevitable.  For a cat who has had a few urinary tract obstructions, surgery will be beneficial in the long run.  If you can afford it, surgery for a PU is an excellent plan.  However, the Saint Bernard with metastatic osteosarcoma getting two legs removed when the dog is already 11 years old is not ideal.  A 200lb dog that has massive arthritis shouldn't be put through a surgery and six week hospital stay knowing the dog will never walk again.  The same is true for the 12 year old Cavalier King Charles with congestive heart failure that needs a splenic mass removed.  The quality of life before the surgery is poor, and the surgery will do nothing but cause more suffering and cost you thousands.



Consider whether you are keeping your pet alive for THEIR benefit....or YOURS.  If it's for YOUR benefit.....try to love them enough to let them go.  Talk to your vet, your vet techs, your vet assistants.  Go on the internet.  Heck, you found this article.  You can find more. 

Patch Jackson.  Deaf as a post, but it didn't stop him.

This article is in memory of my favorite patient ever, Patch Jackson.  And a close second, Jax.  I hope y'all come see me at the Rainbow Bridge when I cross over.  Jax....please don't bite me, and I won't draw your blood.  Promise!

Low Posts

I have been having major internet problems for a month....but I am having Uverse installation tomorrow.  Hopefully that means I will have better, more reliable internet service and I will not be so angry at the internet when I go to post.

please bear with me and don't forget me.  I'm awesome.  i swear.,

Songs for Veterinary Staff

Like many people, I love music.  And I like to use music to define how I am feeling.  I also incorporate music into my work.  I like to sing when I am feeling happy, stressed, sad, etc. I especially enjoy singing to patients when I want to comfort them.  This usually happened on the overnight shift, after surgery, or when a patient was being fractious.  Here are my favorites, and those of the people I have worked with.

1. Ramones - I wanna Be Sedated - For huskies...oh, god, huskies.....and seizure patients.  Oh, and this one very huge English Mastiff that
2. Survivor - Eye of the Tiger - sang this to any coworker that was having a difficult time with a client, patient, or doctor.
3. Dr Sheldon Cooper - Soft Kitty - when petting feline patients until they fall asleep
4. Peter Wolf - Lights Out - every time Dr Dre would prepare for an endoscopy.  She's a card.
5. John Denver - Sunshine (on my shoulder) - when I was feeling in the mood to snuggle a critter that was feeling particularly bad.  Like a feline hepatic lipidosis case. (also, a

coworker would sing this but replace 'shoulder' with 'catheter' when she gave Acepromazine IV)
6. Mary Poppins - Spoonful of Sugar - when giving pets medications, especially bitter stuff.
7. Justin Timberlake - Cry Me A River - when a patient was being just the biggest douche and I got done what needed to be done....
8. Bette Midler - Wind Beneath My Wings - just because it has a soothing and uplifting melody
9. Edwin Starr - War - except I would sing, 'Ace!  Huh! Good god y'all!  What is it good for?  Absolutely everything....say it again now!'
10. Hush Little Baby - for those little dogs and cats that are just so upset that they need a little soothing.  More than one critter fell asleep to this song, including my children.
11. LL Cool J - Mamma Said Knock You Out - a coworker sings this when she is inducing anesthesia to her surgical patients.
12. Barry Manilow - Copacabana - when a patient's name is Lola.....and there are WAY TOO MANY FUCKING LOLAS.  We all now know that she was a showgirl with yellow feathers in her hair and a dress cut down to THERE.
**side note, if a patient has a name from a song, someone was always singing that song.  And there are many songs with Lola in them, but they aren't as catchy as Copacabana**
13. Rebecca Black - Friday - my coworkers told me they sing this sometimes, and I can see why....
I also have a dental assistant friend who sings 'Fillings....nothing more than fillings....' what a silly girl.  :)

What do you sing in your clinic?

Ten Days Into the Study

I began a research trial study thing on using a traditionally utilized antipsychotic medication, Cariprazine.  I have clinical depression and anxiety.  This medication is being researched to see if it has any positive effects on depression and anxiety.  I am here to say that, in ten days, it sure does!  BUT for people like me (no specific type, just those similar in some ways I am not aware of), there are shitty and painful side effects.

adverse effects for antipsychotics

At first, I wasn't aware I was suffering the side effects.  I thought I was just having effects related to insomnia.  I felt achy and tingly and had trouble sleeping.  Nothing new for a girl with depression and anxiety.  But it got worse.  I started feeling as though I was in withdrawal from my effexor, only not quite.  With withdrawal, I feel as though I have static electricity in every nerve, as I can literally feel the synapse receptors sucking up the serotonin and norepinephrine.  I get nauseated and dizzy and exhausted.  I sleep easily, though.

am i NOT already taking enough meds?!?!

With this medication, I feel pain....not static.  I feel lit up, not buzzing.  I am edgy yet complacent.  I want to move but I run out of breath within a few steps.  I began to clench my teeth hard when I wasn't paying attention, and my back became so tight that I couldn't walk more than ten feet without my lower back giving out and excruciating pain.  I began to shake with any sort of effort of movement.  Holding my phone left me wondering if my phone would suffer Shaken Baby Syndrome.  I still didn't think it was the medication, but it was.  I couldn't sleep more than a couple of hours for an entire week. I couldn't focus to save my life.  And typing, texting, and moving at all made me very nervous due to the acute increase in pain that did not abate after stopping the movement.  And finally I spoke to my research lady, and she said one other participant had the same adverse effects of the medication.  So I was to come in and she would write me a Rx for a medication to combat the pain.

She did offer for me to decrease my intake from 3mg to 1.5mg, but I figured that with the decrease in dosage, I would simply get a decrease in the pain and it wouldn't disappear entirely.  So i opted for the script.

Tomorrow, I pick up the script and start taking it.  Lets see how it goes, shall we?  I am excited.

For the record - I have NOT experienced crippling depression since taking the Cariprazine.  I had a near anxiety attack on one day, but that was due to being awake for 30 hours straight, I am sure.  I was also in a public, crowded place.

I have felt more 'with-it' on this medication.  No days spent in my bed-fort, wallowing in dreams of work.  No cloud over my head.  I shower every day.  I get up and outside.  And it isn't just because I think I should.  It is because I WANT TO.  If you haven't had real depression....clinical, chronic depression....you don't know how AMAZEBALLS that is. 

Here's hoping.