How to tell the vet that we are forgoing treatment on a very sick dog.
January 2, 2014 1:44 PM   Subscribe

It is possible that my dog may be diagnosed with a serious medical condition. We're waiting on confirmation now. Survival rates for this condition, even with aggressive surgery and chemotherapy, are low and measured in months. Although it's not about the money, a full course of treatment will be $10,000 or more. Really though we don't want to see him suffer for months and he is in no pain now. How do we tell this to the vet?
posted by anonymous to Pets & Animals (29 answers total) 2 users marked this as a favorite
Kinetic Jr. is studying to become a vet and she suggests that you tell them just like that. Vets understand finances and that people need to make hard choices sometimes. In her mind, this wouldn't even be a hard choice. Good luck and I'm sorry you're in this situation. You'll do the right thing by your pup.
posted by kinetic at 1:46 PM on January 2, 2014 [9 favorites]

If the diagnosis comes back and it's bad, ask your vet to provide you with options for palliative care. My experience with vets is that they will absolutely work with you on this sort of thing. If yours will not, immediately look for another vet who will.
posted by jquinby at 1:47 PM on January 2, 2014 [15 favorites]

Tell the vet that you have decided not to do the treatment. You would like advice on how to make your dog comfortable, how to judge quality of life for him, and how to judge the best time to put him to sleep.
You do not have to justify your decision. If your vet is not supportive of your decision, find another vet.
This is a very difficult process. You have my sympathy.
posted by valannc at 1:49 PM on January 2, 2014 [9 favorites]

A good vet will not judge you for making this decision. I have made the same one before, and although my vet was very careful not to tell me what to do, I got the impression that he would have gone the same way were he in my shoes. There is no sense in keeping a beloved companion alive a few extra months if they're going to be miserable. And don't feel badly about factoring in the financial consideration. The reality of $10,000 all at once being more than most people can comfortably afford for vet care doesn't mean you don't love your dog.
posted by something something at 1:58 PM on January 2, 2014 [28 favorites]

While extensive treatment might be theoretically more lucrative, I don't think most vets want that particular income badly enough to enjoy putting animals through pointless treatment. They will likely be relieved that you do not expect them to magically make your pet okay.

Ask about palliative treatment, and (if this is what you want) you can also ask them to be for-real frank about how well and for how long you can expect palliative care to be effective. Vets sometimes err too far to the side of caution when choosing their words. It's not because they're trying to manufacture more business, it's because they don't want to be badmouthed or punched in the face. I now do a whole spiel about how I've had many dogs and fosters and hard-luck cases, so do not pull any punches with me, please.
posted by Lyn Never at 2:01 PM on January 2, 2014 [3 favorites]

I've been working in veterinary medicine for years now, and I can say with some confidence that veterinary professionals tend to be more conservative than the average owner when it comes to conditions with poor prognoses. Tell them that you would like to focus on palliative care, and they will totally support your decision.
posted by Rock Steady at 2:03 PM on January 2, 2014 [13 favorites]

Disregarding the money entirely, surgery and chemo isn't something most people would want to put their pet through if the survival rate is as you describe. I couldn't love my dog more, but I would make the same decision you are prepared to without a second thought.

I suspect that your vet would be more surprised by you deciding to go through with the treatment than your telling him you'd rather not. And most likely your vet will also be totally prepared to guide you through making your dog's days as comfortable as they can be.
posted by griphus at 2:04 PM on January 2, 2014 [6 favorites]

My beloved Oscar was diagnosed with a brain tumor last year -- our vets (both at the specialty and our regular animal hospital) started bringing up end of life well before they brought up finances. We discussed early on how to judge his quality of life and how to identify his pain so we wouldn't wait too late. This should be something that isn't difficult to talk to the vet about (are you worried about being judged?) -- and I agree with valannc -- if it isn't, or they are judgy, find a new vet. Having a great vet made losing Oscar much easier.

Although, it isn't what you are asking some thoughts if the diagnosis is confirmed:

1. Enjoy your time with your dog before he suffers, and let him get a little extra enjoyment of life -- we allowed sleeping on the bed, a little more people food, and special doggy trips for ice cream.

2. Think of how you would like to memorialize him -- take a paw print, photos etc. -- I regret that we didn't do this.

3. Keep a journal -- it helps you figure out the baseline to be objective on when it is time.

I hope the diagnosis comes back with something treatable, but I can tell you are good dog parent by your question. Best of luck.
posted by hrj at 2:07 PM on January 2, 2014 [5 favorites]

Two things:
1. Just tell the vet in a straightforward way, just like you told us. Your vet sees this countless times per year, no doubt, so I'm sure he/she will understand. If you are judged for this, then you have a terrible and inconsiderate vet and you should go elsewhere. But as others say, I would bet that your vet would make the same choice you are making.

2. Don't judge yourself. It sounds like you are... but this decision happens in families all the time. And don't be ashamed about it being about the money. We are at this point with a cat in our home. We took her in as a stray after she was hit by a car, and we gave her a very good life. A few surgeries and procedures cost us at least $8,000 in total. Her serious incontinence over the last few years has meant that she has had to live in a large pen (with "supervised release" for attention for a few hours each night), taking up valuable space and costing us money as we have essentially had to rent larger apartments than we would otherwise need. We have probably spent $10-12,000 on this pet over time, beyond just standard food/toys/vet bills.. that's a lot of money.

We agreed that we just can't spend any more money on operations, even though her condition is deteriorating again. She is so old that any operations would be very likely to fail, in addition to being a huge expense. We have given her 10 good years, and we will do what we can to keep her comfortable and happy in her last year or two with us.

You are not a bad person for coming to a conclusion like that. It's ok if it's about the money, in addition to being about quality of life.
posted by Old Man McKay at 2:12 PM on January 2, 2014 [1 favorite]

I made the same decision, except my girl was in pain. It wasn't the money. It was that it felt like anything I did (chemo, radiation, amputation - all suggested) would be for me not her. It's okay to let your pet go and I don't think you'll be judged. At least not by me.
posted by cecic at 2:17 PM on January 2, 2014 [5 favorites]

I have heard that a lot of vets don't even like doing these courses of treatments but they suggest them because their customers want to know that they can do SOMEthing. Your vet might be relieved, even!
posted by small_ruminant at 2:17 PM on January 2, 2014 [6 favorites]

Vets will help you find the best course of treatment for you and your pet. As someone who has lost a few pets in the past, I can attest to that. My vet helped me decide on a course of action, helped me keep my pet comfortable in their last days and was there to support me when the hard choice had to be made. Your vet will give you all treatment options and will not judge your choice. You have to choose what is right for you and your pet.
posted by BostonCannuck at 2:24 PM on January 2, 2014 [1 favorite]

My friend is a vet and says she would be very reluctant to put her own dogs through cancer treatment. Obviously some cases do have a decent prognosis, but if they don't, then it seems more likely that you're just robbing the dog of the few good days it has left. I think most vets understand this.
posted by HotToddy at 2:27 PM on January 2, 2014 [1 favorite]

Vets hear that all the time. This does not make you a bad person. They know that.

I had one of my cats put to sleep years ago. The vet was going over all the options and saying that it was a long shot, etc. etc. and I said that enough was enough. The cat was dying and it was time to end his suffering. Do you know what the vet said?

He said "Thank you."

He didn't want to see my cat suffer any more than I did.
posted by It's Never Lurgi at 2:28 PM on January 2, 2014 [25 favorites]

Nthing what everyone else has said. One of my elderly cats has cancer, and the vet was very upfront about saying, "look, surgery is going to cost $$$, and I still can't promise that she'll live even a year afterwards." She absolutely did not judge me for saying no.
posted by thomas j wise at 2:29 PM on January 2, 2014 [1 favorite]

After my wife of many years divorced me and left, she also left behind two dogs that were 'hers' and a cat. In the following years I took care of them all until they got old or sick and finally died. On each one I ran up a vet bill over $1000 each time, but not once did it extend the life of the animal more than 6 months of misery. After that experience I decided 'never again'.

Your vet will understand and if they don't, find another vet. The palliative care suggestions are the way to go. Do not feel guilt over this. It is mother nature's fault, not yours.
posted by nogero at 2:34 PM on January 2, 2014 [2 favorites]

My own vet said he likes it when pet owners bring this up themselves. He does not like to recommend either way, just provide the information for you to make the right decision for you and your pet.

You could frame it that way, i.e., "I have this information, does this sound accurate to you? If so, then I have made this decision. Please tell me about palliative care and how I can determine when my dog is beyond palliative care (i.e., pain medications not working, quality of life is no longer good) and needs the next step."

This came up with my own vet because I have an elderly kitty. There are many expensive (versus unpleasant for the kitty) options for treatment but I just did not want to put the kitty through all that. When I told the vet this, he said he was so glad to hear that - he did not think putting an animal through a treatment that has only a slim chance of working is a kind thing to do (to the pet or to the owner, who might have false hope). And this is especially the case with elderly animals, as they may not survive whatever procedure.

This came up with my 27-year-old horse, too. He could have a pacemaker for his bad heart, but the idea of sending my claustrophobic horse on a trailer ride for hours... No.
posted by AllieTessKipp at 3:10 PM on January 2, 2014 [2 favorites]

No need to repeat what everyone else has said. I'll just point out that I don't know any vets who got into the gig for the money. Your desire for your dog's comfort is entirely in line with your vet's. And if that's not the case, get a new vet.
posted by colin_l at 3:12 PM on January 2, 2014 [2 favorites]

In my experience in a similar situation last year, all of the vets involved in the diagnosis and longer term treatment of my dog opened the subject themselves at every significant stage in the process. I didn't have to find ways to bring the issue up, the issue was presented to me with a series of options and I only had to choose.
posted by jacquilynne at 3:23 PM on January 2, 2014 [1 favorite]

If it makes you feel better, our dog eventually had three kinds of cancer and a seizure disorder and given both her age and other complicating factors, including the position of one of her tumours, we elected at each stage to do... nothing. I was totally clear with the vet that all I was interested in was the dog's quality of life and that she be pain-free and not suffer. If my vet practice had not been supportive of this -- and I can't imagine a vet practice that wouldn't be -- I would have changed vets immediately.

The dog did amazingly well even after the cancer removed the ability to intubate her and eliminated any surgery, ever from treatment options for random routine dog stuff. With every infection, we discussed euthanasia with the vet team. With "minimise the dog's suffering" as our guideline, we went through several rounds of "antibiotics and pain killers now and if there is no improvement in 24 hours, it's time." Seriously, we probably visited that possibility six times in the last 12 months. She always bounced back, until brand-new spinal pain didn't get better after 24 hours (and actually got worse), and I sent her to sleep on Christmas Eve.

FWIW, I left the vets' wishing we could all go that way. Not to minimise the responsibility in making that decision for my dog or the terrible sadness of losing her, but she went high as a kite, pain-free and completely chilled out, held by her person and in utter contentment. We should all be that lucky.
posted by DarlingBri at 4:00 PM on January 2, 2014 [8 favorites]

This time last year, a cat that I loved so much was dying of kidney disease. There actually was something we could do to make him comfortable and to extend his life, and that was to feed him through a feeding tube inserted in his neck, and to give him medications to control his symptoms. Those treatments would give him a few more months, and he would be comfortable throughout. But it would cost a great deal, in terms of both money and time (the tube feedings were very time-consuming for me).

For many reasons, I was not ready to let my cat go, so I opted for this course. But my vet made it very, very clear that if I had chosen to have my cat put to sleep at the beginning of all this, she would not have judged me at all, and I believe she meant that. She was supportive of me the whole way, and I know that if at any point I had said "enough" (because of the expense and the time), she would have been fine with that.

When it finally became clear that the disease had the upper hand and that we could no longer keep my cat happy and comfortable, then I did have the cat put to sleep. Again, the vet supported me totally.

Maybe I was lucky to have a supportive vet, but from the other answers here, it seems that most vets would be completely fine with your decision.
posted by merejane at 4:15 PM on January 2, 2014 [2 favorites]

I'm so sorry you're going through this.

One thing I did with a sick pet years ago was ask the vet what the options were and she would do in my position. It really helped, because I knew I trusted her, and it turned out that her answer was the same as mine. I said very little about anything about plans in advance, just what my pet was experiencing, so as to not sway her answer.

I have yet to have a vet push for expensive treatment for an aging or ailing pet, but a friend did, recently. She got a second opinion and was much happier with the result. Always remember there are other vets out there. It's important to have that mutual respect to know, years later, that you did the right thing. And often, the right thing is letting go and not having your friend have to go through confusion or suffering.
posted by mochapickle at 4:22 PM on January 2, 2014 [2 favorites]

Physicians 'overwhelmingly' don't want those interventions for their own treatment, and it seems unlikely that vets would be demonstrably different.
posted by kmennie at 4:43 PM on January 2, 2014 [2 favorites]

We lost our little bully a few months back. A week beforehand, we were discussing treatment options with the vet. He said, "well, you can get this surgery done at a specialist. It'll cost you probably $4000 and it might help her for a few months, maybe... but you could help a lot of dogs for $4000."

Most vets know the score. Don't worry about what they're going to think about you choosing not to go to extremes. They've seen enough to know that it sometimes isn't for the best to go all out.
posted by azpenguin at 5:11 PM on January 2, 2014 [2 favorites]

I'm a vet, but of course not your vet. Please, just be as honest and clear as possible. If your vet is pushing you toward a treatment you don't want, or you get the feeling you are being judged you should absolutely feel good about going elsewhere for care. When I give care options as a specialist, there are always many different ways to go... you should be similarly presented with all reasonable courses of treatment. If this vet is a specialist, you will probably want to return to your RDVM for follow up care if you choose not to do surg/chemo.

What I do recommend is that you get proactive about pain management and knowing how to identify when the time comes to let go. You may also want to find out if your vet will do the euth at your home. Having these conversations before your pup is painful will make the process a little less confusing. There are a lot of good, inexpensive medications that can keep him happy and pain free for some time.

You are in my thoughts, all my best to you and your dog. Thanks for being a good owner.
posted by Nickel Pickle at 5:51 PM on January 2, 2014 [3 favorites]

[TLDR at end - this first part is why]

With a recent cat-sickness, if treatment were even a financial option for us - prices quoted were similar - it would have been not likely to do much except 1) maybe prolong her life a bit, and 2) make her suffer an awful lot that she wouldn't otherwise, which 3) would obviously be *very* hard on the people who love her.

Yes, they *were* already aware that we had limited finances, but they made it obvious that with these circumstances - during which they were very gentle and sympathetic - the likelihood that she would survive treatment and return to normal lifespan expectations were very low, even with optimal intervention. Their recommendation - regardless of financial considerations - was that we needed to spend the time loving her and coming to terms with her loss.

There was a slight possibility that, should we get through that crisis (aka, getting the puking to stop, keeping fluids in her, and getting food in her), we might be able to keep her alive long enough for "her" boy to get home to see her, and best-case scenario, should we get lucky, she might last at 2-3 months. After some antibiotics, some anti-nausea meds, and some fluids overnight, we took her home to love her, and told to bring her back if we wished when we felt it was her time to go.

The ultrasound confirmed that there was what we suspected on July 29th, and her boy was coming home Aug. 2nd for a week. I took her home with a bag of fluids and my terror of needles, and learned how to do sub-q. Her tummy calmed down and she ate and ate and ate, and her boy arrived for his week off his summer job. And she got loved on. Lots.

Almost took a turn for the worse when the boy had one more week he had to be gone, but then he finished the job and came home, and while she hasn't quite thrived, she proved she's quite the determined cat. Four weeks went by, eight, twelve...

By mid-Nov, 15-16 weeks or so, I stopped back by the vets, to satisfy our curiosity. Are they sure? Does her hanging on this long, maintaining weight, mean anything? Does it change anything? It's not like we're anxious to be rid of her, but are they sure? Is there anything at all we should be doing different?

They remembered her quite well, and I hung out a few minutes and waited while one of the vet assistants went back and checked with the vet, who asked that I wait a few minutes, then she'd have time to chat.

First off, they were all very surprised that she was still with us - her condition certainly hadn't indicated that. Second, the vet that had done the ultrasound and verified the initial vet's possible diagnosis is pretty much an expert at what he does. It is what it is, and she just isn't ready to go yet. To sum up the conversation:

Treat her like a princess and love her. For whatever reason, you've got some extra time. When she goes, it could be like before, or it could be quick - but as long as she's not in pain or unhappy, just love her and when it's time, let her go. It's what [our vet] would do for hers.

I have no clue why, but we're at 22.5 weeks. I'm grateful, because 2013 was a year of sudden, shocking losses: a close friend's son, three family members, and our other long-time, much-adored cat.


So... do what you need to do to love your pet. Take him home and love him, if that's an option - or if it's not, because it'd result in miserable last days - let him go.

Believe me, they understand. They're (probably) all pet people, too.

posted by stormyteal at 6:54 PM on January 2, 2014 [3 favorites]

I was flooding the ER vet with tears and snot when they told me my beloved kitten could be kept alive only a few more months with thousands of dollars of treatment. It was absolutely my call, but once I choked out an assent to euthanasia, they were 100% supportive.

(Also, hugs. Big hugs)
posted by angrycat at 10:35 PM on January 2, 2014 [2 favorites]

Our Staffy was diagnosed with cancer last year. The vet was very straightforward about the disease & the treatment options, and the predicted expense... but I could see how relieved she was when we said we were not about to put an elderly dog through that sort of thing, and that we wanted to focus on comfort care.

Our girl had a good 4 months in which she was spoiled even more outrageously than usual, followed by a swift decline that we didn't allow to go on for long. She could have spent all those months being sick from chemo instead, but we're all glad she wasn't. I wouldn't have done a single thing differently. And I hope when my time comes, I can go the same way.
posted by Mary Ellen Carter at 4:44 AM on January 3, 2014 [1 favorite]

I'm sorry about your friend, and I must put my oar in here. Eight years ago Duffy was diagnosed with lymphoma. The vet suggested surgery and chemo; we opted for palliative care.

At sixteen years of age he is failing, but he is still enjoying life. The picture was taken in 7/2012.

The idea of giving palliative care is not only humane but can - at least in Duffy's case - be the best outcome possible. Duffy did not have lymphoma but he does need significant supportive care now. He's sixteen years old.
posted by jet_silver at 5:23 PM on January 3, 2014 [1 favorite]

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