Is length the most important thing? (Day -160)

Quality vs Quantity of life in dogs

I’ve recently spent some time within some of the top oncology (cancer) referral vets within the UK and been in consults with people who have to be told that the biopsy says it is cancer. One of the most difficult questions that pet guardians will then ask is how long a loved pet has left – this is an awful question that has to be answered so carefully because we just do not know.

We try to use evidence based studies looking at different treatments when discussing the options – however these studies over use statistics to give averages. Unfortunately within veterinary research many studies only have a small amount of patients which is caused by the way the veterinary industry works. This means that when looking at a study with average life duration from start of treatment of 3 months that some dogs may have died at 1 week whilst others lived until 9 months or a year. I am personally starting to believe that statistics should be limited to use only in sample sizes over a defined minimum limit to improve reliability (I wrote about statistics here).

However what is missing from most of these studies is perhaps even more important and is the second question that most pet guardians ask. That is what the quality of life is like. It is something that may sound strange however it is much easier to quantify quantity of life (i.e. days) than it is quality (i.e. happiness) of a pet.

This is still something in it’s infancy within veterinary medicine – with humans we can explain that it will hurt now but it will mean that they are good later. The first time I saw this discussed was within surgery decision making in the AWSELVA journal in 2014 (J. Yeates & S. Corr) to evaluate treatment options based on the amount of painful time vs the amount of pain free time.

This is something that is difficult though as we need to define how we recognise the quality of life. For example if we consider movement as an indicator as recently there have been studies using accelerometers (step counters) to monitor the activity of an animal. A study just published used this to measure the physical activity in dogs receiving chemotherapy as an oncology treatment which may be acceptable.

However if we look at dogs with neurological problems that may have abnormal circling or pedalling movements then activity may not be the best quality of life. Here is where other techniques may come into play with things such as a seizure diary being kept to record frequency and duration of seizures to allow comparison of good time vs bad time.

Hopefully soon we will have better measures for the quality of life – and be able to apply these when making decisions that may impact animal welfare.

Are you an owner or guardian?

Owner vs Guardian

Something that always makes me sad is that in law animals are considered property. They are lessened to a state where instead of being recognised as sentient being they have as much value as a football.

Whenever I see a patient it is not just an animal, it is a member of a family. If that is wildlife then it is a member of a family outside in the wild somewhere. If it is a pet then it has the family of people that it lives with.

Yet when a dog is taken from a yard it is theft. The family may be devastated, may be broken, yet there is no hunt to get it back. A report is taken by the police. That is all.

When a cat is shot, it ends up on an operating table. There is no manhunt for the shooter. The police take a report. That is all.

Over the weekend a cat rescue was broken into. Some elderly cats were taken from their home. They were tortured and killed with their bodies dumped. What is the charge likely to be? Breaking and entering? Burglary? Criminal Damage?

I hate the word owner. Can you really own a living breathing sentient being that can feel and think? And yes when I say think I mean it – everything up from a snail has been proven to be able to feel and think (now ever plants have been shown to be able to feel as well). You may give an animal a home; however that animal gives you unlimited love. You are responsible for looking after that animal. Yet do you really have the right to own that animal? Or have you just been trusted with guardianship and responsibility to look after it.

What are you? An owner? Or an guardian?

EDIT: South Wales Police released this statement Monday:

“Overnight we charged two males, aged 15 and 18, following a burglary which occurred at Ty Nant Cat Sanctuary in Cymmer, Port Talbot on Saturday 30th July 2016.

The 18-year-old has been charged with burglary and criminal damage and is due to appear at Swansea Magistrates Court this morning.

The 15-year-old has been charged with the same offences and bailed to appear at Swansea Youth Court on 11th August.”

As I guessed – they are being charged with criminal damage and burglary…

Knowing when the time is right, pets and euthansia (Day 128)

Masik R.I.P.

One of the greatest responsibilities of a vet is to be an advocate  for a voiceless animal, to be able to speak for the animal and push for what it is best for that animal. With all the technology and medicine available it is not a case of keeping the animal alive, but one of trying to balance the quality of life. Every vet student wonders how they are going to have that conversation, if they are going to get it right, and if they are going be able to do it. There is no exact science here, experience – which vet students lack – does help however it is still a guessing game, one where the doubts of if it is the right time find their way into the mind.

Euthanasia… The word actually is from the Greek language and means good death. Being able to relieve suffering is one of the vets greatest tools, yet is the one I feel that has most responsibility. Here you are not just a voice for the animal, you are a counsellor for the client who is saying goodbye to their best friend. This isn’t always easy, especially if it is an animal that you liked or a friend or family.

Over the weekend I gave a voice to a friends cat who had deteriorated again, its wasn’t a easy decision to make to raise this option. Not only because I knew how much the cat meant to her, but because I was not sure it was the right time. Clinically it was possible to keep him alive, it wouldn’t have been a good life though as I suspected he had entered end stage renal failure with the toxins in the blood attacking the digestive tract. I took a chance and spoke through this with her, not an easy conversation but one that was essential for my other friend, her cat Masik.

Taking Masik to the vets it was confirmed as renal disease, the kidneys not working, now clinical signs of renal disease do not appear until 75% of the kidney is diseased. Talking with her family my friend decided that it was time and today took Masik to the vets for the last time. Before the final euthanasia drug is administered it is common to administer a sedative and painkiller to ensure a comfortable passing. One of the side effects of this drug is vomiting, and this Masik did showing my friend how it contained blood, his last gift to her saying that it really was the right time.

Masik R.I.P.Rest In Peace Masik my friend.