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Articles, Videos, & Training on Pets & Veterinary Medicine

Cherie Buisson, DVM, CHPV

The Quality of Life Question We All Should Be Asking

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In 2016, I lost my dachshund, Muggle, to Cognitive Dysfunction. This brain disease of “doggy Alzheimer’s” is one that steals not only our pets, but our own peace of mind. Just like in human medicine, we tend not to give brain diseases credit for being diseases. Even as a trained hospice veterinarian, I kept thinking things like “I can’t euthanize a healthy dog because he’s acting weird.” I fought with myself, convinced that I was only considering euthanasia for my own convenience. After all, he was still eating and running around after a bath. How could I take that away from him?

Yet, this same dog who had once spent every possible moment glued to my side would snap if I tried to pick him up. He would try to run away. He would sleep all day and then pace relentlessly from 5 p.m. to bedtime. Sure, he had arthritis and the typical dachshund “bad back,” but really his body was in pretty good shape and was being treated for discomfort. I agonized over the best choice to make. I instituted every treatment in my toolbox to help his disease. I cried a lot. I felt alone.

A week before his euthanasia, I tried talking to myself the way I would to one of my clients. I was compassionate and gentle with myself (for once). As I let this conversation go on in my head without fighting it, the question popped up out of nowhere:

“What will he be missing if he’s not here tomorrow?”

The answer turned out to be food. Because at this point, he really did nothing but eat, sleep and pace. The only joy he showed me was when he gobbled up his breakfast and dinner – and any snacks in between. I was working so hard to keep him comfortable so he could have less than five minutes of true enjoyment a day. He was isolated and alone (by his choice), just like I felt. We were both suffering for no good reason. I made the choice to say goodbye later that week. My husband would comfort me each time I broke down, saying “We don’t have to do this, Honey. We can wait,” but I knew we couldn’t.

That Friday night, I phoned a veterinarian friend on my way home from work. “Please tell me I’m doing the right thing,” I said. “Please tell me he’s not a normal dog, and I’m not a selfish jerk for doing this.” She assured me I was doing the right thing, and that it had been coming for a long time.

We said goodbye on a fuzzy blanket in the living room. I fed him forbidden foods he’d never had, and I swear he gave me a grumpy “you’ve been holding out on me” look right before he started to snore from the sedative. When it was over my husband looked at me and said, “Oh, God, we should have done this weeks ago.” And the hole in my heart started to heal.

Since that day, I’ve been asking clients to ask themselves this question – and include both good and bad things in the answer. My purpose is not to encourage or discourage them in their decision making, but to put the focus where it belongs – on their pet. Too often we get so tied up in how we are feeling and our reasons that we forget our agony comes from a place of love. We are trying to do the right thing and afraid we are making selfish decisions. I also tell them that we don’t have to wait to say goodbye until there are no good things left on the list. It’s OK for a pet to pass on a good day.

If you are facing the loss of a pet, please don’t feel like you have to do it alone. There are resources out there to help. I’ve listed a few, and there are thousands of others. This is never an easy decision for anyone – even a veterinarian who does this for a living. Give yourself a break and allow yourself to lean. And remember, some of the worst grieving happens before you say goodbye. Having support before, during, and after you lose a pet makes a huge difference.

Pet Loss and Grief Resources
There are many local groups that are just an online search away:

  • Your veterinary team is there for you to answer questions and to guide you.
  • pethospice.com (Help with determining your pet’s quality of life)
  • IAAHPC.org (International Association for Animal Hospice and Palliative Care)
  • APLB.org (Association for Pet Loss and Bereavement)
  • daybydaypetsupport.com (Day By Day Pet Caregiver Support)
  • inhomepeteuthanasia.com (Directory of veterinarians who provide home euthanasia)

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

The Toxic Relationship Everyone Is In Right Now

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You know how people say that they have a “work wife” or a “work husband”? Well, I have a “work Mom”. My accountant has absolutely no problem hitting me between the eyes with financial truthiness. She’s everything I could possibly want in an accountant: wise, analytical, invested in me and my business. But she’s also protective and very, very patient. I am rarely more vulnerable with another human being because the math of business is my nemesis.

Last year, I brought her my year-end and 4th quarter paperwork. She asked me how things were going, and we talked for a long time. I told her how I was struggling because things had been slow the last month. EVERYTHING seems to be due in December and January, exactly when I’m trying to make ends meet for the holidays. Just when I think I’ve gotten on top of things, I end up having a mess to sort out.

She gave me one of those accountant looks – like she maybe just transformed me into a pile of numbers and was about to organize me into columns.

“I’d like you to make a New Year’s Resolution,” she told me. “I’d like you to give Cherie a break and be nice to her. Because I like her, and you’re being mean to her”.

I just stared at her for a minute because this is precisely what I say to other veterinary professionals all the time! Only, I’m not usually on the verge of tears or on the receiving end of it. I think there’s no more toxic relationship than the one we have with our imperfect self. I have high expectations of the people around me, but no one gets held to a higher or more impossible standard than me, myself, and I.

You would think that an internal struggle wouldn’t be visible to those around us. Although many of us are almost catlike in our ability to hide self-loathing, we can show it in unexpected and unpleasant ways. Some veterinary professionals turn those feelings outward and bully their colleagues (or clients, or perfect strangers for that matter). I think more of us absorb it and concentrate our energy into being kind, using our words, and comforting those who have made mistakes. We try to make everyone else happy so no one looks too hard at us or asks us too many questions about how we’re doing.

As we approach the home stretch of 2018, I am asking all of you to take a second and turn some of your amazing compassion onto yourself. Be nice to the person who lives in your head. Be nice to the body that houses your magnificent brain and gentle soul. Being kind to those around you and being kind to yourself are not mutually exclusive. I promise, you can do both.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Perfection and Feedback Don’t Mix

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I can’t really express in words how much I hate to be criticized. Speaking as a human being, there is little I hate more than being told I’m doing something wrong. Deep down in my heart I detest feedback that is anything but positive. Like most veterinary professionals, I am a perfectionist, and having my imperfections pointed out is always a throat punch.

As a veterinary professional (and if I take all the emotion out), I should cherish feedback.

Sorry, choked on that a little.

No, really. Feedback is how you grow. Feedback is how you learn to be imperfect AND accept that you are imperfect. It’s good for you like local anesthetic, like a prostate exam, you know – stuff that feels nasty and you avoid like the plague.

Like so many things in our profession, criticism is something we have to deal with from both sides of the table. So how do we get the most out of something we all wish we could do without?

Make yourself listen. I know. BELIEVE me, I get it. But do it anyway.

Listen and search for the lesson. If what’s being said is 100 percent not true, don’t take responsibility for it. But usually, even badly presented feedback contains something to make you better.

When you are the one giving feedback, remember just how lousy it feels.

Deliver your words with kindness and truth. If the other person gets defensive, resist the urge to jump into an argument. Acknowledge that getting negative feedback hurts and assure them that you are enjoying delivering it about as much as they are enjoying receiving it. So, how about you agree that you fix the problem together so you don’t have to talk about it again?

Feedback needs to be delivered in a timely manner.

Don’t wait until the annual review to bust someone’s chops for something they did 5 months ago. You hate hearing that a pet hasn’t eaten in two weeks, right? Address problems immediately so they don’t blow up into a catastrophe. When you see improvement – make a big deal out of it. If you aren’t seeing improvement, talk it out and be clear about consequences.

Feedback needs to be specific and something that can be acted upon.

“Your attitude sucks” is about as helpful as “I hate your face.” Document specific examples and bring the other person into the discussion as to how that situation could have been handled better. If you are receiving vague feedback, ask for more specific examples. If your supervisor can’t come up with any, they are not doing a good job. Let them know that you can’t fix a problem that is so nebulous. Be sure you document these meetings as well and go up the chain of command if necessary.

Feedback includes both negative and positive.

If you can’t find a single positive thing about an employee, you need to fire them or yourself, because one of you is doing a terrible job.

Pull on your big-kid scrubs and face the fire. If you’re receiving criticism, step up to the buffet and pick out the yummy bits that will help you grow. If you’re giving criticism, ask yourself what presentation would make it most palatable. This horribly uncomfortable situation has the potential for big rewards on both sides – don’t knock it till you try it.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Why We Should Stop Trying for a Perfect Euthanasia

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Talking with other veterinarians about hospice is something I do every day. I’m in a Facebook group online called Veterinarian Palliative Medicine, and I can be happy for hours comparing notes and techniques with my colleagues, knowing they will understand my struggles.

Recently we had a heartfelt discussion about getting over the anxiety of providing home euthanasia for clients. We agreed that we all want every single one to go perfectly smoothly for the family and that when the inevitable “difficult” euthanasia happens, it makes us feel horrible. It makes us feel like failures.

The Bar’s Pretty Low

Veterinarians tend to be perfectionists, and we are harder on ourselves than anyone else in our lives. Euthanasia is one of those times when we really have unrealistic expectations. The good news is, most of our clients DO NOT have the same expectations. In fact, many of them have had such terrible euthanasia experiences that “I hope you don’t have to wrestle him to the ground” or “I hope he doesn’t scream” is the very, very low bar they have set for us.

Death isn’t pretty. It isn’t smooth. It’s nothing like the movies. A natural death can be downright terrifying, especially if there is no hospice assistance to lend peace to the transition. So, if God, Mother Nature, and all the Saints and Angels can’t guarantee a peaceful passing, then I’m letting you all off the hook.

Here are the things that most concern your families:

  • Am I making the right decision or selfishly killing my best friend?
  • Is it going to hurt?
  • Will you be giving sedation first?
  • Should my kids be present?
  • Should my pets be present?
  • Can I handle being there?
  • How do I know that I’m only getting my pet’s ashes and not someone else’s?

“How good a phlebotomist are you?” has never come up.

Here’s What a Good Euthanasia Looks Like

Here’s how to make euthanasia as peaceful for your families as possible:

Set expectations – don’t give them every single possible side effect or issue, just the things you’ve seen multiple times or things you suspect might happen due to this particular pet’s disease process. I tell clients up front that I sedate so if I don’t get the vein on the first try, it doesn’t hurt. If they are in a hurry, let them know you will do the best you can, but that if it takes longer, you’ll support them the whole way.

Validate their feelings – it’s OK to cry, it’s ok to be scared, it’s OK to doubt your decision… It’s just OK.

Take the burden off their shoulders – I’m here to take care of you. I’m not here to judge. Cry as much as you want. Tell me what you need. I’ve got you. Hang on tight.

Focus on the pet and help them focus on the pet – give them homework to find something tasty and forbidden to feed their pet on his last day. For what it’s worth, watching a dog eat an entire sheet cake is the BEST. THING. EVER. You can’t help but smile through the tears. As a bonus, they don’t tend to notice the sedative injection when they are horking down a cheeseburger and donuts.

Above all, stay calm. They are looking to you to see if they should be more alarmed and upset than they already are. Keep your voice steady, reassure them, squeeze their hand, and tell them everything’s going to be OK. And then silently tell yourself.  And in case that’s not enough, I’ll tell you too.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

What Appliqué Taught Me About Teaching Students

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Every year at my week-long quilt retreat, I meet up with friends and indulge in my favorite pastime. Even though I am a doctor, and you’d think nothing about quilting could be scary, there are things I’m reluctant to try. Appliqué (APP-lik-ay) was one of those things. I had made a star quilt for a friend’s baby, and because of a mistake in the instructions, it couldn’t be sewn together with squares at the corners to make a quilt top. I asked one of our more experienced quilters for help.

Martha is a retired teacher, and she is brilliant at explaining things in a non-intimidating way. She suggested I appliqué the piece onto a large square of fabric, thereby removing the problem of the not-quite-90-degree angles. I hemmed and hawed. I wasn’t really looking to try something new.

“Come here, Darlin’,” she said in her no-nonsense tone. “Let’s get this done.”

She walked me through the process. She was always there to answer questions when I was stuck. She never made me feel stupid or like I was bothering her.

That’s the kind of teacher I try to be.

I don’t know what makes people think that the best way to teach someone is to humiliate and insult them. I can’t fathom why we want students to absorb something and determine that the most prudent course of action is to make sure they are sleep deprived before imparting information. The most common “reason” I hear is “that’s how I had to learn it.” If only I could cough and say the word bullshit at the same time in writing.

I talked to a vet student from Iowa State this week, and we found we had the same passion – wellness for students. Obviously, it would be easier if we could start wellness as children, but if we can’t, then starting with future vets and techs is the next best thing. I know that school is hard (I’ve been there), but there are things we can do to make learning better and help us turn out resilient, healthy students. If we are turning out brand new veterinary professionals that are already riddled with burnout and compassion fatigue, why are we congratulating ourselves?

I’m not suggesting trophies for everyone or not using red pen so as to preserve everyone’s feelings. I’m saying that we need to provide support while having the goal to turn out self-sufficient, confident veterinarians and technicians who either know the answers or know how to find them.

The professors, staff, and students in school who bully and torment others are not a secret. EVERYONE knows. When I was in school, there was a professor who picked a favorite and least favorite student and proceeded to lift them up and stomp on them, respectively. And we were warned ahead of time that this would absolutely happen. That kind of crap needs to stop freakin’ yesterday.

Are we professionals, or are we a fraternity running a hazing? You know how everyone freaks out and destroys campus groups when they do something stupid that results in a death? Maybe we need to look at school the same way. Veterinary professionals are contemplating and dying by suicide at an alarming rate. We need to make sure that as teachers, we aren’t contributing to the problem.

It is said that we learn the most from failure. This is true. How we learn and recover from failure is directly related to how we and those around us react. If shame comes from within (as it always does) AND without, then we don’t have a hope of recovering in a positive way. For instance, I once attempted to spay a male cat. When I discovered the mistake, I went to my boss in tears. He chuckled and said, “If you haven’t tried to spay a male cat, then you’re either new to this or lying.” Then he sat down with me and we created a protocol to ensure this never happened again.

He emphasized that while it was also my job to check, the staff had missed this, as well. He also walked me through what to say to the owner and was nearby while I called and spoke to him. Had he yelled at me or written me up, I probably would have been too afraid to attempt surgery again for a long time.

Some lessons have to be harsh so they are taken seriously. But vet medicine has a natural harshness built in: if we screw up, our patients may die. That should be the hardest lesson we have to learn – and every single one of us will learn it the hard way.

Congratulations to the schools making wellness a priority. Thank you for putting your students first. Thank you for remembering these students are, in fact, your customers. They are paying you large amounts of money (in some cases hundreds of thousands of dollars) and treating them like dirt shouldn’t be an option. In fact, I’m guessing if they aren’t left with scars from your school, you might actually get a donation from them when you come asking.

I’m challenging everyone who teaches to decide what kind of teacher they want to be. Will you leave impressions or scars? Will you build up or tear down? Will you be remembered with gratitude or as a traumatic experience? The choice is yours, and I hope you make the right one.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

5 End of Life Myths About Pets – BUSTED

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Veterinary hospice and palliative care is my calling. That isn’t something I ever thought I would say, but there it is. I’ve devoted a large portion of my practice to helping pets at the end of their lives. Along with pets, I also support their people through the worst part of pet ownership. As I’ve spent more and more time with pets at the end of their lives, I keep hearing the same myths and misconceptions. Let’s bust those myths and help our pets stay as happy as possible for as long as possible!

1. They’re not in pain because they’re not crying

This bothers me so much that I started using #DontHaveToCryToHurt on @HHPHospice to try to get the word out. I’ve seen pets walking on broken limbs and not crying. The majority of pets with chronic pain don’t cry. They change their behavior far more often than they complain. They don’t want to jump, they don’t climb stairs, they don’t want to get up, they have accidents.

THEY LIMP. Limping is pain until proven otherwise. If I’m limping, it’s because I hurt. If my foot falls asleep, I do the crazy limping limb-shaking dance because it hurts, even for a short time. If you see your pet limping, please assume they are in pain and take them to the veterinarian for an examination. When in doubt, treat for pain and see if the problem goes away.

2. If pets are eating, they have a good quality of life

Yes, appetite is one of the ways that we assess quality of life. Pets in quite a bit of pain will often still eat. Pets with nausea may try to eat and walk away or only want to eat certain things (like treats!). Many of my patients go to the Rainbow Bridge eating delicious food. It’s not necessary or advisable to wait until they stop eating to say goodbye. If your pet has a decreased or nonexistent appetite, ask your veterinarian to try some medication for nausea. Just like us, pets will refuse to eat rather than eat and vomit.

3. There is a perfect time for euthanasia

I feel so badly for people trying to hit this impossible target. There is no such thing as the “perfect” time. There is a zone between “too early” and “too late” – we try to land somewhere in there. As human beings, that’s the best we can do with patients who can’t tell us for sure when they are ready. With veterinary-guided hospice care, that zone is a far more comfortable place to be. If your pet passes naturally, you have the added benefit of having everything you need to ease any distress they may have. There are veterinarians (like me!) with special training in not only keeping your pet comfortable at the end but also supporting you and your family during this difficult time. You can find them at IAAHPC.org

4. Once a large dog is “down”, it’s time for euthanasia

Well, yes and no. It really depends on a lot of factors. Large dogs are commonly euthanized for end-stage arthritis – when they are too weak and too painful to get up on their own. Sometimes owners help them up or even carry them for a long time before they decide to let go. So many patients I see have never been on pain management, and that’s really a shame. A good pain protocol with several different therapies can be a literal life-saver for these dogs. It’s best to start these treatments early, but some “down” dogs can be given a second chance with the right treatment.

5. Pain medicine is dangerous

We need to stop being afraid to treat patients for pain. I’ve had so many clients tell me they’d rather their pet be in pain than be groggy. I don’t know about you, but I’ll take sleepy over painful any day. Since your pet doesn’t have to drive or go to work, what’s wrong with a temporary increase in sleep? Obviously, if they are staggering around the house or falling face-first into their water dish, we need to make a change. It’s hard to see your pet lethargic or “acting like a zombie”, but letting them suffer in silence is far worse. In many cases, this lethargy is temporary and well worth the reward of having your pet happy and comfortable.

NSAIDs (non-steroidal anti-inflammatory) are a mainstay for the treatment of arthritis. Like any drug, they can have side effects. Damage to the kidneys, liver, or gut is possible. These aren’t inevitable complications nor are they always irreversible. Working closely with your veterinarian and paying attention to changes in your pet can allow you to use these drugs safely for the benefit of your beloved companion.

The field of veterinary hospice and palliative care is growing, and with that growth comes the opportunity to give our pets a longer, happier life. Pet owners and veterinary teams need to jump on the bandwagon of providing excellent end-of-life care. Our pets are worth it!

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.