Euthanasia

Leveraging AI to Improve Clinical Care in Veterinary Medicine

August 31, 2023 by Andy Roark DVM MS

Dr. Jen Chatfield (aka Dr. Jen the vet) joins Dr. Andy Roark to discuss how clinicians are already using AI and machine learning in practice, and how these tools can be leveraged to improve clinical outcomes.

Cone Of Shame Veterinary Podcast · COS – 220 – Leveraging AI To Improve Clinical Care In Veterinary Medicine

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Chats with the Chatfields: https://chatfieldshow.com/

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Jen Chatfield (aka Dr. Jen the vet) is a national thought-leader in infectious disease and conservation medicine. She’s been a practice owner, a relief vet, worked in public health, serves as a member of the National Veterinary Response Team, and is a Medical Reserve Corps member. She serves on the advisory board for DVM360, PetVet Magazine, and VPNextGen and as an Associate Editor of the Journal of Zoo and Wildlife Medicine. Dr. Jen is one of the most popular speakers at the largest veterinary conferences and has been quoted in national magazines including Better Homes & Gardens. She was selected as a Future Leader by the AVMA and has been awarded 2 Gold Stars for contributions to veterinary medicine by the Florida Veterinary Medical Association. She loves French bulldogs, Himalayan cats, the dirtiest of vodka martinis and basking on Caribbean beaches.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I’m your host, Dr. Andy Roark. Guys, I am here with Dr. Jen Chatfield. She goes by Dr. Jen the Vet. She is a lecturer, she is a podcaster, she is a YouTuber. She has a show called Chats with the Chatfields. You can find it at chatfieldshow.com. Things like that. She is doing a webinar for VetFolio that I saw and thought was really interesting about leveraging AI to improve clinical outcomes. So I wanted to bring her in and talk about that.
We have an interesting conversation. It kind of goes all over the place. She defines AI very broadly, and so you’ll hear us talk about that. Mostly, we end up getting into talking about things like radiographic interpretation using AI. Things like that, that are right around the corner. Things that she’s already using in practice. I just think that’s really interesting.
So if you’re interested in artificial intelligence, how rubber is going to meet the road, and what we’re going to be seeing in practice as far as getting better patient outcomes, this is a really good episode. But anyway, it’s a fun conversation. I hope you guys will enjoy it. Let’s get into this episode.

Kelsey Beth Carpenter:
(singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:
Welcome to the podcast, Dr. Jen Chatfield. How are you?

Dr. Jen Chatfield:
I’m fantastic, Andy. How are you?

Dr. Andy Roark:
I’m great. I’m so glad to have you here. I’ve already been enjoying talking with you, because you do a lot of the weird things that I do. You have a YouTube show called Chats with the Chatfields. I became aware of you not from Chats with the Chatfields, but because I saw a presentation you were doing through VetFolio. You were talking about using artificial intelligence to improve clinical outcomes.

Dr. Jen Chatfield:
Yes.

Dr. Andy Roark:
I looked at it and I looked at the walkthrough, the agenda, the points that you were making. I was really impressed with how practical and pragmatic your approach was when you were talking about something that tends to be a lot of hand waving right now.
A lot of people are really excited about it, but you actually had insight as far as use cases and ways that people could immediately pick this up and actually make their days better. That’s what I wanted to bring you on today and talk about. Can you open up for me? Just at a high level, how do you look at artificial intelligence as a veterinarian? What is your larger picture or philosophy? Is it a tool? Is it a partner? What is it? Where are we going?

Dr. Jen Chatfield:
Well, I hate to disappoint listeners. Because that was a super high-level philosophical question right there.

Dr. Andy Roark:
That’s kind of how I go.

Dr. Jen Chatfield:
I was very deep and intense, and I’m not necessarily that person, to be honest with you. If there is any tool, piece of equipment, piece of information or philosophy that can help me raise the standard of care that I’m able to provide … I’m for that. I guess I approach it like that. “How can I be a better vet?”

Dr. Andy Roark:
No. I like it. Well, that’s it. I kind of did you wrong when I was like, “I’m interested in pragmatism. Let’s talk philosophy.” You were like, “I didn’t come here for that, Andy.”

Dr. Jen Chatfield:
I’m totally happy to wax philosophical as often as the next person, but I really appreciate data. And if I’m going to change something I’m doing, which is one reason that I feel so lucky that I accidentally became a veterinarian … Because if I’m going to change something I’m doing, then I want to either know that I’m changing it because I want to or because I have data that supports that change.
For me, that is where a little bit of my fascination personally with artificial intelligence, with the robots and the machines comes from is … I don’t know. Is it better? Is it worse? Is it the same? And then, from that point, if we answer that and we say, “It’s better.” Well, then there’s more questions. Well, what does better mean? How do you define better? For me, overall, that’s clinical outcome. Hands down.

Dr. Andy Roark:
Got you.

Dr. Jen Chatfield:
Clinical outcome. What we learned is the only reason to do a diagnostic test is if the outcome is going to change.

Dr. Andy Roark:
If you’re going to use the outcome. Right.

Dr. Jen Chatfield:
I should phrase that better.

Dr. Andy Roark:
No. No. I see what you’re saying. Exactly.

Dr. Jen Chatfield:
Not as a medical lookie-loo.

Dr. Andy Roark:
It’s always that question of, “What are we going to do with this information?”

Dr. Jen Chatfield:
Yes.

Dr. Andy Roark:
If the answer is, “Nothing,” then do we really need to run that test? Yes. I’m 100% onboard with that. Got you.

Dr. Jen Chatfield:
For me, that’s the same thing with, “Is whatever I’m doing, whether it be related to AI or not, going to change what I’m doing with this patient?”

Dr. Andy Roark:
Well, start to lay it down for me. What does that actually look like in practice? Again, there’s a lot of people who get really excited about AI. I’m not running into a whole lot of people who are like, “This is what I do in practice.” Talk to me about that.

Dr. Jen Chatfield:
There’s a lot of, like you say, hand waving. People losing their ever-loving minds talking about AI, “Are the machines going to take over?” And this and that. While I do not currently live in fear of the machine I’m talking into right now, I do live in fear of taking the human component out of any job that’s focused on care, because you just can’t convince me they can do it better.

Dr. Andy Roark:
Right.

Dr. Jen Chatfield:
I’m fascinated by that interface and how we use it. So in regular practice, in a very sneaky way, it’s already there. I go into an exam room, a dog is sick, vomiting and diarrhea. Dr. Jen the Vet loves to see vomiting and diarrhea. I say, “You know what, little fluffy white dog with strawberry jam stool? I’m concerned that we have …” It’s not called HGE anymore. What do they call it? Like ADS or AHD? It’s got a new thing.

Dr. Andy Roark:
I still call it HGE. I’m old school like that.

Dr. Jen Chatfield:
Thank you. Appreciate you. Appreciate you. So I say, “I want to roll that out. Let’s do some blood work.” So I get some blood work. I’m going to run a CBC and I’m going to run a chemistry. I put my CBC in the machine. I don’t do a manual CBC. I don’t do a manual differential. Do you?

Dr. Andy Roark:
No. I mean … No. No.

Dr. Jen Chatfield:
Hey. Neither does our doctor. We put it in the machine and the machine kicks that out. That’s AI. That is AI, because it’s scanning, looking for cells approximately this size, whatever other characteristics, and then it’s calling that a neutrophil and kicking out a differential. Or it’s calling that a red blood cell and kicking out PCV plus or minus reticulocytes.
That’s AI. You’re already using it, friends. You’re already using AI. And then, obviously, we have a chemistry going on. Another way I think it sneaks in is when we run urinalysis. All of these tests that we use benchtop in clinic screening tests that we use, that all rely on what I perceive as color. Urine dipstick, I’m looking at you. All these color changes.
As a friend who’s a hairstylist told me, “Everyone sees color differently.” We’re looking at this dipstick with a bajillion colors, and I don’t know about you, but I’m like, “I’m holding it right here.” I’m turning the canister as the seconds tick by, and I’m like, “Nope. Not that color. Maybe this color?” Hey, guess what? That is open for error with interpretation of the color changes. What do we do now?

Dr. Andy Roark:
Our dipstick reader.

Dr. Jen Chatfield:
We have a system. And that removes that subjective interpretation error. That’s AI.

Dr. Andy Roark:
Okay.

Dr. Jen Chatfield:
Another piece. This is my favorite piece, because I am the fluids doctor. I am not the blood work doctor. I am not the x-ray doctor. No one has ever accused me of being a surgeon. I love that we now have sophisticated AI available on the market that will support interpretation of diagnostic images. X-rays. Love it. Love it.
That’s probably the scariest one for people, because we’re accustomed to blood work. Just trust in that machine. But it’s reading a picture. “It’s reading a picture, Dr. Jen. What the heck?”

Dr. Andy Roark:
I think that stuff is super exciting. I think that stuff is really cool. I think it’s going to open up doors for us to do ultrasounds and things like that in the clinic. There will be a referral part of it, where you say, “Well, let’s get a second pair of eyes on this.”
It’s not something I would race to right away. I think there’s going to be a long learning curve, but I fully believe that we’re going to be feeding our radiographs and then our ultrasounds and things like that into AI and just getting our results right back.

Dr. Jen Chatfield:
Dr. Andy, I’m already feeding my radiographs to AI. Every radiograph.

Dr. Andy Roark:
Interesting.

Dr. Jen Chatfield:
Every radiograph. Now, the better question is ask me, “Why? How come?”

Dr. Andy Roark:
Okay. Tell me.

Dr. Jen Chatfield:
Because the first question I had naturally a skeptic. I’m Texan. I’m naturally a skeptic. The first thing, I was like, “I wonder how often it’s wrong?”

Dr. Andy Roark:
Of course.

Dr. Jen Chatfield:
I wonder how often I’m wrong? And so, I wanted data. Because if I’m going to start adding this component in, what does the data say? Oh my gosh. The data is amazing. It’s incredible. First of all, you have to accept that … Again, I’m not banging on radiologists at all. I would love to have a radiologist in my pocket. I would love it.
Again, I was not the x-ray doctor. I don’t like it. I like x-rays for counting puppies and kitties. So it turns out that is partly because I’m human. The diagnostic error rate for radiographic interpretation ranges anywhere from 30% to 65% or 70%.

Dr. Andy Roark:
Okay.

Dr. Jen Chatfield:
Let me give you a specific data. So it’s very different in human land, because radiologists read only one body cavity. That’s all they do. Or one body part. In vet med, we’ve got to read it all. We take catograms for heaven’s sakes. Or at least, I do. You can put your nose up in the air if you don’t, but I do.
So if I’m looking at this x-ray … There was a study that was published fairly recently. They had four veterinarians. They had two that were reported radiologists and they had two that were surgeons. I think that’s fair. Surgeons … They look at tons of x-rays.

Dr. Andy Roark:
Sure.

Dr. Jen Chatfield:
They analyzed how often they were accurate when they were looking at images to determine intervertebral disc disease. Whether it was extrusion, protrusion, viscosity, whatever. IVDD. That’s what they were looking at. They were accurate 30% of the time. Now, when they told them clinical context, then they bumped up their accuracy to … I think it was almost 60%. That’s fair.

Dr. Andy Roark:
I think it’s fair.

Dr. Jen Chatfield:
Okay. 30% with four people who were boarded specialists who spend a lot of time in the dark room.

Dr. Andy Roark:
That’s brutal.

Dr. Jen Chatfield:
Or used to be in the dark room, I guess. I’m dating myself by saying that, but I’m like, “Well, what chance does Dr. Jen the Vet have?” It’s tricky. And then, if you look at the perceptual bias and the cognitive bias that’s available for our human minds. They looked at human radiologists. Mammograms is where this was all pioneered, because it’s one of the most difficult tissues to image well and to a diagnostic standard.
They looked at this. They discovered that a conversation happening across the room while a human radiologist was looking at images, they’re not in the conversation. Consciously, they’re not listening. It can impact their diagnostic interpretation.

Dr. Andy Roark:
I believe that. That totally makes sense. Our minds are constantly picking up the things around us. Even if we don’t want to be influenced by them, we are. I could 100% see someone having a conversation about a different case and influencing what you see as you look at this radiograph.

Dr. Jen Chatfield:
Yep. I could nerd out with more. There’s more data, but it just scares you. It just tells you this is a crapshoot. So if you go to cut section imaging, this is one of my favorite things. I have a friend that’s a human surgeon. She’s like, “I need an MRI for a surgical plan. I need an MRI.”
I’m like, “Sure. No problem.” That’s basically a crapshoot with interpretation. When you look at the error rates on interpretation of cut section imaging like CT and MRI … On the human side, for radiologists, if it’s 3% to 5% on plain films, it goes up to 30% or 40% on cut section imaging. Again, when we get down to the practicality of it, you could flip a coin and you’re 50/50.
Anyway, I’m very excited for AI. Now, I don’t always agree with it. Because again, it’s the same thing as … And this is why you can’t replace the veterinarian friends. How often do you look at a patient and you get the blood work back and you say, “Yeah. No.”

Dr. Andy Roark:
Well, it’s another maxim from vet school was, “First, look at the patient.” It was the whole hammer on you that the most valuable diagnostic tool you have is your physical examination. Putting your hands on the pet is the most valuable thing that you can have. I think that there’s a lot of wisdom there.

Dr. Jen Chatfield:
Frequently, the technicians that work with me, they know I say this. I’ll be like, “Nope. Nope. I don’t want this blood work. Give me a different one.” Even though it’s for that same patient. I’m like, “No, no, no. This is not it.”
Because the white count will be 8,000 or 9,000 and I’m looking at a dog that, clearly, I was expecting septic. It was going to be either through the roof or it was going to be in the basement, but it wasn’t going to be right in the middle. And so, I proceed with what I think.
It’s the same thing when I get this newfangled thing, this radiographic interpretation from the robots, from the machine. I look at it and say, “I don’t think that’s true. No. No. I see this here.” That’s okay. And I tell clients that, because that’s the hardest thing too. How do you talk about that with the client? I’m disagreeing with artificial intelligence? Yep. Yep. I am.

Dr. Andy Roark:
Hey, guys. I just want to jump in here real quick with a nice little bit of CE love for you. That’s right. On September the 5th at 4:00 PM Eastern time, 1:00 PM Pacific, I’ve got a webinar that I am putting on. I am hosting it for my good friend, Dr. Andrea Eriksson.
She is a board certified veterinary cardiologist, and she’s doing a webinar called CARDALIS: When to Utilize RAAS Suppression and Why. Guys, this is all about the new drug CARDALIS, which is out. If it’s not in your practice yet, it will be. This is talking about what CARDALIS does, which patients should be considered for it, and why suppression of the RAAS system should be utilized in what cases.
Anyway, that’s it. It does have an hour of RACE CE attached to it. It is going to be free for you guys. I’ll put a link in the show notes, but come get some cardiology CE with me and my friend, Dr. Andrea Eriksson. Guys, let’s get back into this episode.
Do you think that the rate of improvement is going to be pretty high? Do you think that you’re going to continue to see … The number of times when we don’t match up. Is that going to go down and down? Or is this going to be a constant thing, do you think?

Dr. Jen Chatfield:
I don’t know. I don’t know. I only know my own experience thus far, which is, it’s not that often that I will disagree with the artificial intelligence interpretation of the image. What it does for me, it’s more sophisticated than that. It’s not a right or wrong. It’s the fact that the artificial intelligence looks at the entire image.
For me, when I have clinical context … Because it doesn’t care. It doesn’t care that you’re looking at a Frenchie. It doesn’t care. And that heart looks giant and you’re like, “No. I dismiss it.” One of the most common perceptual errors that we make in radiographic interpretation is wrong decision. We search and we find it … Or I’m sorry.
We search, we don’t find it. We search and we see it, but we don’t recognize it. And then, the final thing is we search, we recognize it, we actively decide it’s not abnormal. Or we make the wrong decision. 60% to 80% are perceptual errors like that. So if I’m looking at this and I look at a frenchie, I’m like, “God. That heart looks giant. It looks super globoid.” Alan Spear, if you’re listening, globoid is a real word. It looks super globoid, but it’s a Frenchie, so I’m sure it’s fine.
That’s wrong. My AI isn’t doing that. It doesn’t know it’s a Frenchie. It doesn’t care. It’s calculating vertebral heart score and going to tell me what it is. It doesn’t care. So it finds things like that, and it actually helps me. At least in my experience, it’ll help me with a more sophisticated interpretation in order to either more proactively encourage a visit today to the neurologist … Even though your dog is walking around.

Dr. Andy Roark:
We’re all so strongly affected by our own personal experiences. You have those cases and you say, “Oh my God. I did this.” Or, “One time, I missed this.” And then, you’re looking for it. If you’ve been a vet for any time, you have your own biases.
You’ve had medications that a pet had a side effect to. Now, you’re just like, “I hate that medicine.” The truth is, the data on that is great. The safety numbers are wonderful, but you had the one in a million side effect, and now you never want to do it again.

Dr. Jen Chatfield:
Please. One of my favorite pathogens is leptospirosis. I go all around the world talking about leptospirosis. The metadata says that leptospirosis as a component of your vaccination is not … It doesn’t say, “It could be.” It is not a risk factor for adverse reaction.
Millions and millions of doses and dogs. And I still run into lots of veterinarians who are like, “I’ve seen it once.” It’s hard to get over. I don’t blame them. It’s super scary.

Dr. Andy Roark:
It is. It’s the way that we’re made. When something scary happens to you, you hold onto it. It’s wired into your being that this is a thing that you’re going to remember. It’s really hard. But that is the benefit of having AI or outside data that comes in, when you can say, “I have my biases. There are not biases here.” Or they’re not the same biases as the one I have.

Dr. Jen Chatfield:
Right. Exactly. They’re different. They’re not better or worse. They’re different.

Dr. Andy Roark:
Jen, when you look into your crystal ball five years from now, how does it look different from today? Are we interacting with AI in a different way? Do you think it’s going to be about the same? What does practice look like? Five years is not a lot of time. This is right around the corner.

Dr. Jen Chatfield:
It’s not. It’s really not. My hope is that we are, because I feel like it’s rapidly becoming such a powerful tool. But the difference will be whether or not … When you grow up as a veterinarian, you grew up in vet school. Whatever you learn in vet school is the way we do it.
This is the way. That’s your Mandalorian experience, “This is the way.” I feel like if vet schools don’t begin to embrace some of these tools, then it’ll be a harder struggle for the industry. But I think that they’re so cost-effective. I do think they enhance our ability to provide care at a level that now our clients are expecting. I think if we’re going to see more and more AI, I don’t think in a rapid acceleration.
I don’t even think it’s going to even enter the realm of replacing a veterinarian. I can order a hamburger from a kiosk in a screen … My expectation of that hamburger is a little different, but I cannot hold my pet up to a camera and truly get that diagnosis in a sophisticated way. And I don’t think we’re going to be able to do that.

Dr. Andy Roark:
I love it. All right. Dr. Jen Chatfield. Dr. Jen the Vet, where can people find you online? Where can they learn more about you?

Dr. Jen Chatfield:
Well, thanks so much for asking, and again, thank you for having me on your show. It’s my first time on your show. It’s been wonderful. If you can’t find me on the internet, you’re just not trying. You can find me at chatfieldshow.com. You can find me at drjenthevet.com. You can find me on the YouTube. Almost anywhere. And if you want to find me IRL, I’m usually speaking at whatever conference you’re going to.

Dr. Andy Roark:
Awesome. Thanks for being here. Guys, thanks for tuning in today. Take care everybody. And that’s it. That’s what I’ve got for you guys. Thanks so much for being here. Thanks to Jen for coming in.
Guys, if you enjoyed the episode, let me know. Leave me an honest review wherever you get podcasts. That’s the nicest thing you can do for me. It’s how people find the show. That’s it. To anyone, just be well. Take care of yourself. I’ll talk to you later on. Bye.

Talking About Behavioral Euthanasia (HDYTT)

August 24, 2023 by Kelsey Carpenter

Dr. Lisa Radosta, Veterinary Behavior Specialist, is on the podcast to discuss the behavioral euthanasia, the guilt and shame that pet owners experience as they consider it, and how best to support and talk to your veterinary team.

Cone Of Shame Veterinary Podcast · COS – 219 – Talking About Behavioral Euthanasia (HDYTT)

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Florida Veterinary Behavior Service: https://flvetbehavior.com/

Dr. Lisa Radosta Homepage: https://drlisaradosta.com/

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Lisa Radosta graduated from the University of Florida College of Veterinary Medicine in 2000. She completed a residency in Behavioral Medicine at the University of Pennsylvania. During her residency, she was awarded the American College of Veterinary Behaviorists Resident research award two years in a row.

Dr. Radosta is the owner of Florida Veterinary Behavior Service, a specialty behavior practice in southeast Florida and co-owns Dog Nerds, an online educational resource for owners whose pets have behavior disorders.

She is a sought after speaker nationally and internationally. She is a coauthor of several books including: Behavior Problems of the Dog and Cat, 4th edition and From Fearful to Fear Free. She is a contributing author for Blackwell’s Five Minute Veterinary Consult, Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Canine and Feline Behavior, Decoding your Cat, Canine and Feline Behavior for Veterinary Technicians and Nurses and Feline and Small Animal Pediatrics. Her new textbook, Handbook of Behavior Problems of the Dog and Cat, 4th Edition is due out May, 2023.

She has published research articles in the Journal of Applied Animal Behavior Science, Journal of Veterinary Behavior and The Veterinary Journal and written review articles for Advances in Small Animal Medicine and Surgery, Compendium, NAVC, Veterinary Team Brief, Clinician’s Brief and AAHA Newstat. She has served on the Fear Free Executive Council and the AAHA Behavior Management Task Force.

She has been interviewed for many publications including Cat Fancy, Dog Fancy, Palm Beach Post, NAVC Clinician’s Brief, Sun Sentinel, WebMD, AAHA trends, Real Simple, Good News for Pets, Catster, DVM 360 and AAHA News Stat. She has appeared on Lifetime television, Laurie Live, local news in southeast Florida, Mitch Wilder’s Amazing Pet Discoveries, Nat Geo Wild, Animal Planet, Steve Dale’s Pet Talk and Dogs, CNBC and Cats and Scapegoats.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody, to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with a really interesting episode. It is bit of a heavy episode. But this is a lot of head candy. This is a lot to sort of chew on. It’s a lot to kind of put in your mind and roll around and process. I am here with veterinary behaviorist, Dr. Lisa Radosta. And we are talking about behavioral euthanasia. And the first thing she tells me is how she doesn’t like the term behavioral euthanasia and we should stop using it, and we just start from there.
And anyway, this is a great thought-provoking interview. I am so glad that she came on and just talked through this with me. But I love her perspective. I think she provides a lot of clarity in how to work with these cases, and also how to feel okay about these cases, and also how to help pet owners feel more okay when they’re going through a situation like this.
So anyway, really good episode. I hope you guys are going to really enjoy it. Dr. Radosta throws out a bunch of really good resources, and I link to them in the show notes so you can check those out as well. Guys, let’s get into this episode.

Kelsey Beth Carpenter:
(singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:
Welcome to the podcast, Dr. Lisa Radosta. How are you?

Dr. Lisa Radosta:
I’m doing great. How are you?

Dr. Andy Roark:
I’m great. I love having you here. You are one of my favorite people to talk to. I have already been picking your brain. As soon as you arrived I was like, “I have questions for you.” And I should have just hit record because you’re amazing. But, for people who don’t know, you are a fellow Florida Gator. You are a boarded veterinary behaviorist. You are the owner of Florida Veterinary Behavior Service. You have been a guest on the podcast a number of times in the past, and you are a generally wonderful person to talk to. And so I have a question for you. It’s not a fun question, but I think it’s really important. It’s something that I’ve been rolling around with a little bit recently. I’ve seen some of these cases.
I wanted to talk to you today a bit about behavioral euthanasia. The idea that we have behavioral problems that have come to a point where the owners say, “I cannot rehome this pet,” or, “I don’t feel comfortable rehoming this pet, and I think this pet should be put to sleep because it’s dangerous.” Something like that or… Yeah, let’s just go with that.
I think a lot of vet professionals really struggle with this idea. That I have heard of clinics that just say, “We don’t do behavioral euthanasia here.” And I don’t want to cast judgment, I want to understand. And so as I started to parse my own thoughts and sort of say, “Are there lines in the sand for me?” I think everybody’s got their own. But are there rules or a general perspective or even a philosophy to look at these cases? I wanted to talk to you about it and sort of get your insight as a behaviorist. Let’s just start really high up. Lisa, how do you think about these cases?

Dr. Lisa Radosta:
Yeah. So if I may turn things around and disrupt just a little bit.

Dr. Andy Roark:
Sure.

Dr. Lisa Radosta:
I want to lose behavioral euthanasia, and I want to just say euthanasia. Because the last time I checked we didn’t say kidney failure euthanasia, brain tumor euthanasia. No, we just say that patient was euthanized, right? So euthanasia is euthanasia. It’s a choice to end suffering. And I think by taking the tag of behavioral off, we can start to open our minds to the suffering of animals with behavioral problems, and we can begin to put it into the same bucket as all the other ways that animals suffer.

Dr. Andy Roark:
I like that a lot. You’re already framing this up really nicely. Let’s go ahead and start to unpack. When you start to look at cases that come to you and people say, “I have a Belgian Malinois and it scares me.” Or, “It scares my spouse. And we’ve had some incidents. It bit one of the neighbors.” How do you start to look at those? Because, obviously, as a behaviorist, you have tools in your tool belt where you can work with this pet. And oftentimes, I think that we immediately want to fix the problem. How do you start with that? So when you’re looking at the beginning of these cases and you know that euthanasia might be required if we can’t make headway here, how do you start to set those cases up? How do you set expectations, things like that?

Dr. Lisa Radosta:
Yeah. The first thing is I recognize that behavior is different, whether it’s at specialty practice, where I am, or in primary care. So when a pet parent comes to you and her older cat is urinating everywhere, she doesn’t come to you with all of the advice from all of her neighbors to euthanize her pet. The advice, “Then go to your vet.” “Well, my cat had hypothyroid.” “My cat had kidney…” “My cat.” Right? But when the dog bites someone, the advice starts coming in, “You need to euthanize.” “I would never live with that dog.” “That dog’s going to bite your kid.” So all that advice feels really different. It’s terminal advice.
And so she comes, he or she, they come to our office with a lot of emotions. And the first thing I do is let them talk. Then I express empathy and I normalize what they’re feeling. You know what? Because they say things like, “And I’m scared.” And I say things like, “And if you weren’t scared, I think you were really weird. You should be scared. Your dog’s 90 pounds.” And I saw this case about a month ago, and he had bitten through both ladies’ hands.

Dr. Andy Roark:
Oh gosh.

Dr. Lisa Radosta:
Bit both her hands. She’s a graphic designer, can’t use her hands. And I said, “You should be scared.” At that point, you can see stress starts to dissipate. They’re like, “You get it.” I’m like, “Of course I get it. Of course, yes, you’re normal. You’re afraid of your dog.” And then I also normalize, “But you still love him.” They’re like, “We do.” Normalize what they feel, because that doesn’t feel right. Why would someone that loves me hurt me? Right? Okay, but that’s not what they think when their dog has lymphoma. Right? They don’t take it personal. Okay So first we normalize, we express empathy.
Number two, now we get into the ethics of who are we as veterinary healthcare team professionals. So ever since I euthanized my first own pet, my first pet as an adult that I had to decide to euthanize, I knew in my heart that no one could make that decision for me. So I was in vet school, in my junior year of vet school. So from that, I’ve created this 23 years of veterinary practice. I refuse to tell someone when it’s time because I feel for me. No judgment of any other vet. For me, it feels disrespectful because that’s not my family member, yet I am making a final decision. So I don’t generally… Nothing’s a hundred percent. I don’t generally bring this up. Clients start to bring it up. They start to say, “My friend said that I should euthanize him. I’m going to be sued,” or, “I should put him to sleep,” or across the rainbow bridge, we’re going to call it.
Then that gives me a chance to say, “Okay, let’s talk about options. What do we have on the table?” So for this case that I saw, single lady, two dogs, one was aggressive, one is just a regular Joe. Aggressive dog is biting her, is biting visitors. You can’t make this up, is biting the other dog. It gets worse. She lives in a one bedroom apartment by herself. No significant other that even comes to stay with her. So I say, “Okay.” She’s opened up the door, “I don’t know what to do, she’s crying. I don’t know what to do, I’m sad. I’m bored, I need her.” I say, “Okay, well, let’s just talk. What can we do right now?”
So here’s what I know. So I’ve already done a physical. I already know this dog is also sick. That’s another checkbox, right? And I say, “Okay, well, here’s the thing. What I need you to do to be safe is you’re going to live for about the next four to six weeks in protected contact, like at the zoo. He’s going to be behind a baby gate, separated from your other dog and you.” She was able to leash and muzzle pretty reliably. He muzzled up and they will leash him. “You’re going to muzzle him, you’re going to leash him.” She doesn’t have a yard. “You’re going to walk him in the back, he’s going to go to the bathroom, he’s going to come inside. I’m going to prescribe medications that are going to relieve his stress and make this easier on you. I’m going to give you ways that you can get him in and out safely. We’re going to wait for our meds to work. We’re going to set you up in the trainer. And then we’re going to slowly add back in the skills he needs to live with you safely.”
He may never be able to meet visitors. I’m not even going there yet. That’s an option. Re-homing is not an option. This dog doesn’t have a breeder. There’s no place for this dog to go. I make it real clear, this dog can’t go to a shelter. Sanctuaries are unicorns and there’s a lot of ethical concerns around certain sanctuaries depending. Right? So I explain that to them. And then we talk about humane euthanasia. And I say, “Your dog’s suffering. There’s no doubt your dog’s suffering. Let’s just forget it’s a dog and look at what your dog does. And now it’s your best girlfriend. If I’m out with my best girlfriend and we’re drinking martinis as we do, and she tells me that she hits her partner, she hits her mom. Anytime a visitor comes in her house, she tries to stab him with a knife. She cries all the time because she’s upset. She’s suffering. She’s suffering.” So we talk about the suffering that occurs when you have emotional disease, and we try to kind of broach it in that way.

Dr. Andy Roark:
Yeah, I really love that.

Stephanie Goss:
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Dr. Andy Roark:
I was was going to ask you about managing guilt on the part of the pet owner, and I think you really kind of already answered that question in a lot of ways. Because it’s such an emotional decision for them. But I really love this idea of you can take the guilt away if you can get them to buy into the idea that their pet is suffering. I really like that.

Dr. Lisa Radosta:
Yeah. I tell people it’s normal. Feel guilty, it’s normal. But guilt doesn’t move us forward, it’s the opposite. The more we sit in guilt, the more we are stagnant. And I also tell them, and I did tell this to that particular client, I said, “Oncologists get all the credit.” I’m like, “You’ve given this dog two years he would never have with anyone else.” If an oncologist gets two years out of a job’s lymphoma, they get a big Christmas basket full of cookies and candy, right? Come on, this dog has a disorder he had from puppyhood. You gave him two years with a chronic disorder. Wow. Where’s the wow in that?
And I’m not saying all dogs should be euthanized, my God. Or all cats with behavior problems. That’s not what I’m saying. I’m saying that if we had this dog with a chronic kidney disease and the pet parent couldn’t, physically could not, forget money, could not do the treatment, who’s going to stand in judgment of her? Who’s going to do that? And if you are, then you better be prepared to adopt that dog into your home and do the treatment. So who’s willing to do the treatment on this 90 pound dog? I’m not taking him into my home, that’s for sure. You see what I’m saying?

Dr. Andy Roark:
Yeah. Oh, definitely. Do you think that vet professionals struggle with these cases more or in a different way than pet owners do?

Dr. Lisa Radosta:
I think they do. And I think my heart goes out to shelter workers because they really struggle. I recently had a shelter reach out to me, and I meet with their medical director once a month to consult. And she has a real hard time, because the morale goes down when one of these long-term cases that is good with a couple of people there, but no one else can walk the dog. And she wants to clear space to bring another animal in that she can’t adopt out. And yes, I think that we think of it differently, but it’s only because we’re not really thinking about behavior disorders as systemic disease, which is what they are. Right? We’re thinking about them as somehow in a separate bucket, and it’s just not true.

Dr. Andy Roark:
Yeah. That absolutely makes sense. What mistakes do you think… what do you see most commonly GPs making? Are there pitfalls that we fall into? I know everyone’s trying to do their best, but are there places that you see practitioners who are trying to support pet owners that fumble or they make their lives harder than they have to be as they navigate this already challenging time?

Dr. Lisa Radosta:
Yeah. I think that, first of all, we need to forgive ourselves. There are some days where I have bad days. Where I have days I’m not at my best, and by the end of the day, by the millionth appointment, I’m not as patient as I should be. Right? So we have to first forgive ourselves for whatever mistakes we make. If I back up from that and I say, well, how can we be better? Don’t judge. Clients hear you. You say all these wonderful things, then the client pushes you with that question I wish they would never ask, “What would you do if this was your dog?” And then you know shouldn’t answer, but you’re tired. You’re tired, and you say, “I would not live with this dog.” That’s all they remember.
Then they come to this specialist and they say, “My vet said I should euthanize my dog.” Again, I think your vet said more than that, but okay. Number one, let’s not put ourselves into someone else’s place, except to empathize. Right? And number two, let’s not judge. Because, I’ll give you an example, we’ve all done this in [inaudible]. One of my residents saw this patient. The patient has a dog living in a household with other dog. This dog was tearing the other dogs up. And so she gave the first recommendation, you always give separate dogs for safety while we get this plan in place. The client went home, came back to the next recheck, didn’t separate the dogs, there was another fight. And this happened for about three appointments.
So it was real easy for the vet, for my resident to go, “What’s wrong with this lady? What is wrong with her? She obviously doesn’t care about the dog. Maybe I should report her to animal control. This is animal abuse.” She’s mad, right? So by the fourth appointment, the lady says, “No, my husband has terminal cancer and my husband will not separate these dogs. And I just want you to know that.” Okay, well, God, if we had maybe asked differently or had some empathy in the beginning and said, “Explain to me why you don’t feel comfortable separating, because I know that you know it’s safest. So what is happening?” And then I usually say, “You don’t have to tell me if you don’t want to. But if you do, sometimes it can be helpful.” So it’s hard when you’re tired to find that space to do that. But let’s not judge and let’s not put ourselves in a space where we’re making a decision for someone.

Dr. Andy Roark:
I just had a case last week with this cat that came in. And it’s a four-year-old cat, and it’s gained two pounds in six months. It’s a 10 pound cat now. It’s eight pound cat, and now it’s 10 and change. And I saw this chart and I’m like, “What in the world are they doing with this poor cat?” And so I go in to kind of give them a hard time about the fact that they’re letting this cat gain weight and do these things. And very quickly, it is a wonderful lady, and she was like, “Oh no, this is my dad’s cat and he loves this cat and he has dementia. And whenever the cat yells, he gives her treats, and then he forgets that he’s given her treats.” And we kind of had a good-hearted chuckle at like, “Oh, she’s got him trained.”
But again, when you understand the context of what’s going on, it doesn’t change the fact that, and I don’t want this cat to continue to gain 25% of her body weight every time I see her, but I also understand where this person’s coming from and I can be kinder, I can be better. And so anyway, I love that. Dr. Radosta, you are amazing. I so appreciate your time and you being here. You do so many things, you have written so many books, you present all over the place. Where can people find you online? Where can they learn more?

Dr. Lisa Radosta:
So they can go to drlisaradosta.com. They can go to Instagram or Facebook at Dr. Lisa Radosta. As a veterinary healthcare professional, you might like what we put on LinkedIn. And then we have our website, which is flvetbehavior.com. And the reason I bring up our website, even if you live across the world, is that we have handouts and videos that are meant for pet parents. So if you don’t know what to say, that might be on our website. You can send the pet parent there or to our YouTube channel and you’ll get what you need.

Dr. Andy Roark:
That’s so awesome. I love the stuff that you put out for pet owners as well. It’s always great to have good resources to send people to. Because you know that they’re going to search online, and so you could just to be able to point them in a good, supportive way. That’s awesome. Thank you so much for being here. Guys, thanks for tuning in. Take care of yourselves, everybody.
And that is it, guys. That’s what we got for you. I hope you enjoyed it. I hope you got something out of the episode. Thanks so much to Dr. Lisa Radosta for being here. Thanks to you for being here and listening. Yeah, if you like the podcast, do me a favor, leave me an honest review wherever get your podcast. It means the world to me. Anyway, that’s all I got. Gang, take care of yourselves. Be well. I’ll talk to you soon. Bye.

When Pet Owners Don’t Believe in Euthanasia

April 6, 2023 by Andy Roark DVM MS

Dr. Mary Gardner joins the show to talk about when pet owners don’t believe in euthanasia. This can be an emotional experience full of hard conversations for veterinarians. Let’s get into it!

Cone Of Shame Veterinary Podcast · COS – 196 – When Pet Owners Don't Believe In Euthanasia

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Links to Amazon.com are affiliate links and help support the show. (They’re also much smaller than normal links and easier to copy when typing up show notes!)

Lap of Love Pet Hospice: https://www.lapoflove.com/

It’s Never Long Enough: A practical guide to caring for your geriatric dog: https://amzn.to/3TpvhNi

Nine Lives Are Not Enough: A Practical Guide to Caring for Your Geriatric Cat (Old Cat Care and Pet Loss): https://amzn.to/40aEviE

Dr. Mary Gardner Homepage: https://www.drmarygardner.com/

Dr. Mary Gardner YouTube: https://www.youtube.com/@DrMaryGardner

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

There is nothing better to Dr. Gardner than a dog with a grey muzzle or skinny old cat! Her professional goal is to increase awareness and medical care for the geriatric veterinary patient and to help make the final life stage to be as peaceful as possible, surrounded with dignity and support for all involved.

A University of Florida graduate (AND ANDY’S CLASSMATE!), she discovered her niche in end-of-life care and is the co-founder and CIO of Lap of Love which has over 300 veterinarians around the country dedicated to veterinary hospice and euthanasia in the home.

Dr. Gardner and Lap of Love have been featured in Entrepreneur Magazine, The New York Times, the Associated Press, The Doctors and numerous professional veterinary publications. She is co-author of the textbook “The Treatment and Care of the Veterinary Patient”, co-author of a children’s activity book focused on saying goodbye to a dog called “Forever Friend”, and the author of a book dedicated to pet owners “It’s Never Long Enough: A practical guide to caring for your geriatric dog”. Dr. Gardner also won VMX Small Animal Speaker of the year in 2020!

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone Of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I’m here with my friend, the one and only Dr. Mary Gardner. You are going to hear us talk. We’re going to reminisce about the old days, but we’ve got a great episode today.
Mary is amazing. I always learned so much when I talk to her. We are talking today about hospice care when pet owners don’t believe in euthanasia. And so it is a bit of a heavy topic. But also know that Mary and I, we’ve been friends for 20 years and we are pretty tight. And so you’ll hear us talk pretty candidly and we do joke around because that’s who we are.
And also everybody who’s been in vet medicine knows that sometimes you have to have a little levity when you talk about heavy subjects because it’s just how you go and how you cope. And so you’ll hear us joke around a little bit about maybe dark stuff on this episode. Know that it comes from a good place. Know that it’s a coping mechanism that we all have for having hard conversations of this type.
So anyway, I don’t want anybody to be bothered by that, but we do enjoy each other a lot and we do make light of our profession as best we can. So anyway, guys, that’s enough of that stuff. Let’s get into this episode.

Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy

Dr. Andy Roark:
Welcome to the podcast, Dr. Mary Gardner. Thanks for being here.

Dr. Mary Gardner:
Hi, Andy.

Dr. Andy Roark:
It’s so good to have you back. I love having you on the podcast. For those who don’t know you, you are a classmate of mine from the University of Florida. We have known each other for-

Dr. Mary Gardner:
19.

Dr. Andy Roark:
… Oh gosh, almost 20 years now.

Dr. Mary Gardner:
We need a 20-year anniversary.

Dr. Andy Roark:
Next year. Yeah.

Dr. Mary Gardner:
Next year.

Dr. Andy Roark:
Yeah, we do. There’s other people that we met who could also…

Dr. Mary Gardner:
I’m so [inaudible 00:02:12].

Dr. Andy Roark:
They were also in our class. But mostly just you and me, I think mostly just you and me. We should get together. You are also the co-founder of a Lap of Love Pet Hospice, which is almost certainly the largest veterinary hospice company in the world. And so I am so glad you’re here.
You and I have had many philosophical conversations over the years, and I always really love to hear your perspective on these things. And I saw was a social media post recently, and a young doctor was asking for guidance because she had a patient who, in her opinion, needed to be put to sleep.
And the owners, “Did not believe in euthanasia.” And she was really struggling with this belief that she was prolonging suffering by not performing euthanasia. But the owners, well just said no. And it wasn’t a question of necessarily them understanding, I don’t think, but they did not think that that was a thing that should be done.
And so it reminded me of a case that still bothers me that I had way back at the very beginning of my career when I had a dog with kidney failure and it had acute renal disease, and this dog’s kidneys were shutting down and it was sick and it had been vomiting as dehydrated, and the owners refused to put this dog to sleep. And I remember it went in uric at one point and you could just see it suffering and it still bothers me today.
And so you have so much experience with euthanasia and hospice, and you take hospice very seriously as far as ongoing care, not just euthanasia. And so you’ve worked with so many people and you’ve seen this across your whole organization, and I just wanted to start to get your perspective on what it’s like to work with pet owners who say, “I don’t believe in euthanasia,” or things like that? And so let me just start this at a high level and say, is this a thing that you see?

Dr. Mary Gardner:
So usually not so much at Lap of Love because if they’re calling a euthanasia company, they want it. However, with that being said, a lot of people assume hospice means I don’t want to euthanize, so I just want to hospice them. And that was a huge just misconception, I think when we started it over a decade ago is when people heard hospice, they said, “Well, you’re prolonging suffering.” And I’m like, “No, no, no. You don’t understand. Almost all of my hospice families want euthanasia. They just want to live well until that time.” And that’s what hospice really is. It’s not about how you die.
So there are some people that call us because they don’t understand that and we’ll get to it, but they think of human hospice because we do not have euthanasia in human medicine. So they kind of then think, “Oh, well that hospice is what I want.” So that would be the only time when people call us at Lap of Love that don’t want euthanasia. And then they’ll say, “I just want hospice.”
And I think that will be a point I’ll bring up. Let’s talk about hospice, palliative sedation, and things like that with the family if they don’t want to. Now you said this post was they were adamant that they didn’t believe in euthanasia?

Dr. Andy Roark:
Yeah. So again, that’s just what I took away from the post was that the pet owners said, “We do not believe in euthanasia. We want our pet to pass naturally.” And that’s where they came from. And so I have a number of questions of morally, philosophically, how do you look at this in a way that makes you feel okay? Is there a way to make you feel okay?
And then getting into some action steps or approaches of what do you do from a communication standpoint with the pet owners? What do you say to them? And then honestly, what do you do?

Dr. Mary Gardner:
Okay, so first-

Dr. Andy Roark:
I say, yeah, easy questions. Should be pretty easy.

Dr. Mary Gardner:
God, I hope I remember all of them. So first, ethically, morally, like that whole world, right? So our degree is to end suffering and prolong it from ever occurring. So we definitely want to end suffering. Do I believe in euthanasia? Of course I do, that’s part of the company. Do I understand or I don’t know if understand is… I respect some people who think differently than me.
So if they think differently than me and they don’t believe in it, so then what can we agree on? And we will always agree that we don’t want the pet to suffer. So I always get to that point, “Okay, I’m fine, but let’s talk about what is suffering.” But that’s the action items. So it not for everybody, there are some veterinarians that actually will not euthanize an animal. So yeah, there are some-

Dr. Andy Roark:
Really?

Dr. Mary Gardner:
They don’t believe in it just religiously, whatever it may be. So there’s that. And there are some religions that do not believe in killing animals. And there are vegans and things like that that are very anti it. So I think it’s important to not judge and just really have a good conversation. And so I think there are different levels of not believing in it.
There’s truly, I do not believe in killing animals. And on my non-sassy day is, or on my sassy days internally, I think, “So you’re a vegan because are you okay with your steak tonight or your chicken sandwich? But you’re not okay with Rusty?” But I don’t say that ever. This is just after a long week, Andy.

Dr. Andy Roark:
Yeah, no, I would not say that.

Dr. Mary Gardner:
I’m sure everybody on this call, you have that long week where you’re just want to shake them because they’re not making any sense and you’re being a hypocrite. But I will come off my judgment mountain for a second and just say, “All right, there are some people who do not honestly believe in euthanasia.” Then there’s others that are scared of euthanasia. And I think that’s actually more of what we see. And it just turns into, “I don’t believe in it,” because they’re petrified of it.
Hello. They love their animal and they never want to say goodbye. So they’re also on Denial Island, and they just don’t understand. This may be the first time. They’re confused. There’s a lot of crap going on that we don’t know about in their lives. And so I think it’s really important to have a non-judgmental conversation with them first, understand what are their concerns? What are their fears? Where are they coming from?

Dr. Andy Roark:
How do you do that? I think this is great. I think you’re exactly right. Just sort of try to dig into this and explore a little bit of, “When you say you don’t believe in euthanasia, what do you mean?” Do you have wording or a way that you try to set the conversation up? I like your idea of working around to, “We both agreed that suffering is unacceptable.” I like that a lot.

Dr. Mary Gardner:
My first thing I say, “Let me just try to understand on what your belief systems are.” So I will just simply ask, but you have to do it in a kind non-judgmental way. You have to say, “I just want to make sure I do the best for you and what your wishes are. You do not believe in euthanizing animals? I just want to understand.” Or “Do you have some concerns, questions, fears?” Whatever that may be. And if they’re rock solid on do not believe, then okay, I’m not going to do some of my other stuff.
But really any, and you’ll have some that are just like, “I don’t think it’s time to euthanize.” So there’s the difference between, “I will never euthanize,” and also, “I don’t think it’s the time,” that you’re staring at this potato chip of a cat that’s barely moving.
We’ve seen maggots coming out of their faces and the owners are still like, “I don’t think it’s time.” So that’s also part of this. So there’s a myriad of situations. And I really have seen maggots come out of a cat’s face before. So that’s why I bring this up.

Dr. Andy Roark:
Oh, I could have gone my whole life not knowing that.

Dr. Mary Gardner:
So bad. So you have to find out where they’re at and if they’re nervous or they just don’t want to say goodbye, and then there’s different avenues that we’ll go down. But let’s go with the, “I don’t believe in it.” So then I say, “Okay, could we agree that we don’t want Rusty to suffer though?” And no one’s ever going to say no. They’re all going to say, “Yes, that they don’t want him to suffer.” And then my next action item is, “What to you is suffering for Rusty?”
And if there’s multiple people, I actually want them to write it down and not talk out loud. I say, “I want you to take a piece of paper. I want you to write down what are qualities that make suffering be present? What are some of the things that are happening or would happen in the future?” And sometimes just doing that, they get like, “Oh, maybe he-“

Dr. Andy Roark:
Everything on the list they’ve seen happen. They’re like, “I’m writing down yesterday.”

Dr. Mary Gardner:
Correct.

Dr. Andy Roark:
Oh yeah, I can totally imagine that.

Dr. Mary Gardner:
The first thing is to establish they don’t want him to suffer. So I always, “Okay, I agree. I don’t want Rusty to suffer either. I agree.” Just keep saying it. So let’s talk about what are the things that we would consider him suffering? And then you write it down and let’s talk about it and share it. And this, by the way, is also very good for the owners that don’t agree. So the mom and dad or the spouses or whatever that don’t agree with each other.
So I say, “Let’s write it down together.” And then we have to say, “Okay, are any of these things happening right now?” Now there’s also Denial Island where like maggots coming out of the face. It’s not happening, or they just don’t think… I get so many. There’s this dog that walks around my neighborhood and I swear it’s as slow as a slot. One wind and it’s knocked over. And he’s like, “He’s just slowing down.” I know it’s time soon. And I’m like, “This dog needs to be on stuff for gosh sakes.” But he’s on Denial Islands. So got to be gentle.
So that’s my first step. And then let’s talk about those things. Are they suffering? So my next action item is doing quality of life scales together. Because whether we’re going to euthanize or do palliative care and I explain that palliative care is ensuring that their pain and anxieties is taken care of. So wouldn’t you agree that we at least need to manage his pain and anxiety?
So then I like to do quality of life scales together. And that’s where I say, if it’s the person who’s on the fence about euthanasia, these are fantastic to do because then you’re going to draw a line in the sand with them.
There’s so many quality life scores out there. Lap of Love, we have some. I have my own in my book separate, Ohio State has some, so you can just quality life of scale and see tons of them. But it allows you to draw a line in the sand with the families. If they don’t want to euthanize it allows you to manage how their pet is doing for pain relief and anxiety relief. Pain scores and things like that too are really good.
Now, the voodoo magic also is to talk about natural passing. And I usually flip them at this point. So I say, “All right, I want to,” and you have to sound like you want to support them, “I want to support your decision.” And you know what I do? If somebody’s so anti it, “Okay, but we’re going to make sure your pet’s not suffering.”
I lost my sister last summer, Andy, and we didn’t-

Dr. Andy Roark:
Oh, I’m so sorry.

Dr. Mary Gardner:
We don’t have euthanasia. Her last two days, we should have had her in hospice for weeks before, so don’t even get me on that path. So two days before, and she just had a lot of morphine and I was like, “Okay, because we don’t do euthanasia, so let’s make sure she’s not feeling pain.” And she is sedated a lot. And that is something that you can do is palliative sedation and talk to owners about what we do in human medicine.
So if an owner is anti it, “Okay, but it is my job to make sure that that pet is not suffering.” So I want to talk to the owner about what natural passing is going to look like for the disease or the ailment their pet has. So a natural passing for a dog with arthritis, well, we got years ahead on us. This is going to be a lot on the caregiver. This is going to be flipping the dog, making sure there’s not bed sores, [inaudible 00:14:26], there’s poop all over. You go through the list and I have to explain to them that Mother Nature usually does not take care of arthritis. That’s not a disease you die from typically unless you’re in such severe pain.
But okay, your dog has heart failure, your cat has kidney failure. Let’s talk about how they will die naturally from that disease and let’s avoid some of the horrible symptoms that they’re going to experience. And then I say, “And let me talk about the day and when they pass.” I have a little mini movie that I play in my talks and my lectures that’s a cat that’s dying of kidney failure. And it takes about three hours for this cat to die. And it’s just paddling and it’s head is back.

Dr. Andy Roark:
It’s a long lecture.

Dr. Mary Gardner:
I show a clip of it. And I don’t show that to families.

Dr. Andy Roark:
… lecture just right there.

Dr. Mary Gardner:
But what’s interesting, Andy, is that so many of us in veterinary medicine have never really watched a pet die slowly. We always intervene. So if we’ve got a pet dying, we intervene.

Dr. Andy Roark:
Sure, of course. Yeah.

Dr. Mary Gardner:
So we’ve never sat there and said, “Okay, this is the end stage of kidney failure, lymphoma,” or whatever it may be, “and let’s watch them slowly die.” We always intervene. So it was interesting to watch this video to see the cat pulling its head back, paddling, things like that. And so I’ll say to owners, “It may be extremely peaceful. It may be in the middle of the night and it might be totally fine, but I want to prepare you so that way you’re not startled or scared when you see some of the things that happen in natural passing.” And that usually they’re like, “Well, what’s that Dr. Mary?” So then I’m like, “Okay.” They don’t know.

Dr. Andy Roark:
They don’t know. I think you’re right. I think people have this beautiful idea of, “I’ll wake up one morning and they’ll be peacefully nestled in their bed.”

Dr. Mary Gardner:
Peaceful.

Dr. Andy Roark:
And that will be that.
Hey guys, I just want to hop in really quick and give a quick plug. The Uncharted Veterinary Conference is coming in April. Guys, I founded the Uncharted Veterinary Conference in 2017. It is a one-of-a-kind conference. It is all about business. It is about internal communications working effectively inside your practice. If you’re a leader, that means you can be a medical director. It means you can be an associate vet who really wants to work well with your technicians. It means you can be a head technician, a head CSR. You can be practice owner, practice manager, multi-site manager, multi-site medical director. We work with a lot of those people.
This is all about building systems, setting expectations to work effectively with your people. Guys, Uncharted is a pure mentorship conference. That means that we come together and there is a lot of discussion. We create a significant percentage of the schedule, the agenda, at the event, which means we are going to talk about the things that you are interested in. It is always, as I said, business communication focused, but lots of freedom inside that to make sure that you get to talk about what you want to talk about. We really prioritize people being able to have one-on-one conversations to pick people’s brains, to get advice from people who have wrestled with the problems that they are currently wrestled with. We make all that stuff happen.
If you want to come to a conference where you do not sit and get lectured at, but you work on your own practice, your own challenges, your own growth and development, that’s what Uncharted is. Take a chance, give us a look. Come and check it out. It is in April. I’ll put a link in the show notes for registration, ask anybody who’s been, it’s something special. All right, let’s get back into this episode.

Dr. Mary Gardner:
So I also share my own dog, Neo, who you might have met back in the day, my Doberman.

Dr. Andy Roark:
I remember. Remember when you invited me to your house and I went out to my car and I came back in and I found myself locked out so I went to the back door and I opened the back door and Neo came to meet me, the Doberman Pinscher. And I thought, “Oh no, this is how I’m going to die.”

Dr. Mary Gardner:
This is how you’re going to die. So he had Cushings, he add adrenal tumor which I had removed and then it wasn’t benign. So he was doing chemo. I go full bore on all my animals. They’re getting everything. Anyway, it was the day after Thanksgiving and at 2:00 in the afternoon I went to go help a cat say goodbye.
And I came home and Neo was dead in my house and he died without me. And it broke my heart because I wasn’t there to say, “I love you.” I wasn’t there to make sure it went well. I wasn’t there for so many reasons. And so I don’t share that so dramatically with families. But I say, “If you want to be present, if you want to say goodbye, if you want to ensure that it’s as peaceful as possible, the only way we can guarantee that is with euthanasia. So I just want you to know that you may not be present. You may come home and it’s not going to be in the…”
Neo was just stuck in the hallway. His legs were stiff. I couldn’t get him out of the hallway. It was horrible. So it may not be, “And I want to prepare you that you could go run to Publix and come back and Rusty’s gone. And also here are the symptoms that you may see.” And listen, if it’s heart failure, I’m going to say, “He will drown in his lung fluid and it’s not going to look good. So we need to avoid any of that.”
So that usually, actually, a lot of people get on the train then. They’re like, “I like what you’re talking about, about it being peaceful.”

Dr. Andy Roark:
Yeah, I would process it that way as well. Even if I had preconceived notions, I think I would hear that.

Dr. Mary Gardner:
Totally.

Dr. Andy Roark:
I might have to sleep on it. But I think I would get up and say, “You know what? This is not what I want.”

Dr. Mary Gardner:
A 100%. And then I’ll say, “And I want to talk about where the emergency clinics are.” And then they usually say, “Well, why would I want that?” And I just say, “Just in case Rusty is struggling with his departure.” And I always say, “Euthanasia is not ending life. Euthanasia is ending the dying process.”
So if at any time, and I want to give them that so they don’t think I’m judgy, I don’t want them thinking they can’t come into my clinic with their tail between their legs because they’re embarrassed. If at any time this becomes too much for you or the process is too difficult for you to watch, please come to us or here go to the emergency clinic. So they could change their mind last minute because it’s not good or Rusty with arthritis is not dying.

Dr. Andy Roark:
I love this approach. I think that most people have preconceived notions about what it would mean to have a natural death or to not have euthanasia and then just honest education about, “This is what you’re in for.” And I do think that clear is kind usually and just saying, “This is what I want you to be aware of.”
It’s kind of like when we do a euthanasia and we tell the person, “Your pet may gasp or things like that.” I know it’s not the most pleasant thing to tell someone, but it’s a whole lot better than them finding out unexpectedly on their own.

Dr. Mary Gardner:
You know what I do for that? Little sidetrack. So for me, I always explain that their eyelids will not close. So they’ll remain slightly open. They will relax their bladder. And then here’s my trick. I say if anything else happens, I’ll explain it at that time. And I say that very calm and clear to make sure they hear me sit so that way I don’t have to list, “He may have a agonal breath, he may have a seizure, he may vocalize, he may twitch, he may do the, but if it starts to happen, I’ll say, remember when I said if something else happens, I’ll explain it. Let me explain this now.”

Dr. Andy Roark:
Yeah, no, I’m writing that down. I’m putting that in my playbook. That’s good stuff.

Dr. Mary Gardner:
You don’t want to scare them.

Dr. Andy Roark:
That makes so much sense.

Dr. Mary Gardner:
But I do want to scare them, or at least be open and honest for natural passing, because again, it could be completely peaceful. And I know people who have said that it was perfect, but were they there when they actually died? How many times do we hear people rushing to the emergency room and the pet dies on the way there? It just happens. And then I want to talk to them about pain management and anxiety management.
So whatever the species are the best for that. If it’s morphine, if it’s ketamine, talk to them about giving these medications. If it’s a fentanyl patch, why not? What do we do in human medicine? We highly medicate. And now you’ve had the conversation earlier about suffering and say, “Okay, irretractable pain is suffering. How comfortable are you with seeing that? And if you don’t want to see that, then we must give medication. You have to give this medication or you will see that.”
I don’t want to ever say, “Fair, it’s not fair,” because that’s all judgy words. So, “”That’s not what the experience that you want for Rusty to be.”

Dr. Andy Roark:
Yeah. When people are on Denial Island, you go through your presentations or through your spiel and everything and then do you just give them some time or are there ways that you kind of circle back around every now and then? Are there things that you can do to … It seems to me like they kind of have to come to the realization in their own time?

Dr. Mary Gardner:
They do.

Dr. Andy Roark:
Do you agree with that?

Dr. Mary Gardner:
They do. I would agree with that. I think for those that are on Denial Island and actually a good friend, or it was a client of mine and she had her dog and it had liver failure and it was just horrible. And she called me, she’s like, “Mary, I’ve done your quality life scales and I’m on Denial Island and I need you to come help me.” She’s the one that told me that. And I’m like, “Okay.” And so I said, “Well, why don’t I do the quality of life scale for Darby from what I see and let’s compare notes?” And she literally gave Darby an excellent. And I was like, “Darby’s not excellent.”
And when I did the scale, it said euthanasia is appropriate. And so she just said, “Okay.” And she’s like, “Can I have an extra day though?” And I was like, “A 100%.” This was a Friday. I said, “I’ll come back on Sunday.” And that just helped her.
So sometimes they do need to sit back and process it, but so many clinics do not have quality of life scales on their website. That’s our number one page on our website is the quality of lifestyle. It should be on every clinic’s website, kittens and puppy stuff, the clinic you work at, you got that?

Dr. Andy Roark:
We’re going to say yes. Yeah, absolutely. Absolutely.

Dr. Mary Gardner:
But it’s helpful to have… I did a video that’s my number one watched video because it’s just me going through my quality of life lecture but to pet owners. And I just send that all day long to people and I’m like, “Watch this.” And they’re like, “Oh, that was so helpful.”
But to the point of they need to process it and start with gentle, kind conversation, and information and check back in with them and do not judge. I had this one guy that was going into his clinic every single day with this cat that was the [inaudible 00:25:05] cat. And we went to go euthanize him the cat, or we went to go do a hospice appointment and the woman was in her 50s, but she had early onset Alzheimers. And when my vet started to talk about euthanasia, “When it’s time…”
This woman just went bonkers. And she was just like, “How dare you talk about killing my cat?” It just sent her over the edge. So the wife went away and so the husband said, “I can’t euthanize my cat because this is what’s happening with my wife and it’s going to set her back mentally with her disease.” And so he’s like, “Can you guys sneak in the morning and just euthanize the cat so it could look like it was euthanized?”
So I called the clinic though just because I was like, “I want to talk to the doctor like normally.” And they said, “Thank you for telling us this because he comes in every day for subcu fluids and we didn’t know why he wasn’t euthanizing this cat.” They just assumed he just was on Denial Island or he didn’t believe in euthanasia and he just didn’t know. He was up to his eyeballs in life.

Dr. Andy Roark:
Oh, yeah.

Dr. Mary Gardner:
And he needed help. So we helped him. But it’s so important to just try to have open conversations and leave your judgment hat at the door because this is tough. And remember, it’s the worst decision anyone has to make. It’s the worst. So of course they’re going to have struggles. Of course, they’re not going to understand. Of course they’re want to say, “I want every last minute.” So I get it. As do I. But I want them to avoid what I had with Neo.

Dr. Andy Roark:
I think it’s probably good for us as veterinarians and vet professionals to have pets because it’s always a reminder when bad things happen to your pet. And I know I’m not the only one who’s suddenly an idiot when it’s my pet. My years of medical training go. I was like, “I think he’s fine. He’s fine.”

Dr. Mary Gardner:
I remember with Neo when I was talking to the oncologist that she’s like, “So his AFAS is really high.” I’m like, “What does that mean?” I could not tell you at all what AFAS meant. I’m like, “I don’t know. What do you want me to do about it? What? Milk thistle? What?

Dr. Andy Roark:
I don’t know if I don’t want to know what it means or if I forget what it means, but yeah. Boy, when you’re on the other side of the table, it reminds you of how hard it is. So anyway, Dr. Mary Garner, you are amazing.

Dr. Mary Gardner:
Oh, Dr. Andy Roark.

Dr. Andy Roark:
Last time you were here, you had your new book was out. It was called, Never Long Enough. It was about hospice and dogs. And you have your new book now. It just came out in January. It’s called, I think, Nine Lives Are Never Long Enough?

Dr. Mary Gardner:
The dog book is, It’s Never Long Enough. And the cat book is, Nine Lives Are Not Enough. And it’s not just about hospice, Andy. It’s all about aging and caring for your senior and geriatric pet. So it’s all practical tips in the home. And I cover the ailments. So vision issues or mobility issues, not necessarily arthritis or disc disease, but what to do with the dog that can’t walk very well or a cat that’s got vision issues and things like that. And then I do talk about hospice. I have a whole chapter in quality life assessment, caregiver goals. I do talk about natural passing actually in that book.
So I have a whole chapter on it because I want to address it because it is what some people, and I talk about the symptoms, they may see the agonal breath and things like that. And then I also talk about euthanasia. So that way it might be helpful to direct people to that, just for them to absorb it. It’s on Kindle too, so they could just watch it, look, read it whenever.

Dr. Andy Roark:
I love it. I’ll put links to both of those books in the show notes so people can find them.

Dr. Mary Gardner:
Thank you.

Dr. Andy Roark:
What are your favorite resources of, the quality of life scale, for example. Where else do you like to send people? What are the links that people should have access to?

Dr. Mary Gardner:
Oh, perfect. So lapoflove.com absolutely is the first one. So we’ve got a ton of things on there. And we are redoing a huge pet hospice journal that I developed back in 2012, and we’re revamping it. And it’s just a badass diary and quality of life assessment and things like that. So that’ll be out by the end of the year. And also drmarygardner.com, I’ve got a lot of good resources and my YouTube channel’s good too. So it’s Dr. Mary Gardner on YouTube, and that’s where I have my videos on quality of life assessment.
I even have me with my other dogs. I have one that’s like, “Even as a vet, it’s hard to say goodbye.” I think owners really love when we are honest about the struggles that we have, like you said. They know then we’re human also.

Dr. Andy Roark:
Yeah. Oh, man. I’ll put links to all that stuff in this show notes.

Dr. Mary Gardner:
Thank you.

Dr. Andy Roark:
Mary, thank you so much for being here. Guys, thanks for tuning in. I hope you enjoy this. I got new tools in my toolbox. That’s a win of a podcast for me. So anyway, thanks a lot everybody.

Dr. Mary Gardner:
Thank you.

Dr. Andy Roark:
And that’s our episode. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks again to Dr. Mary Gardner for being here. Check the show notes for links to her books. I put the quality of life scale links in there as well. Gang, take care of yourselves. Be well. Talk to you later. Bye.

The Ethics of Behavioral, Convenience and Economic Euthanasia

August 9, 2022 by Andy Roark DVM MS

Dr. Mary Gardner is on the podcast to discuss the ethics of behavioral and economic euthanasia. We talk about what makes some euthanasia cases more ethically difficult than others, and the 4 types of euthanasia generally seen in practice:

1) Imminent Euthanasia

2) Non-Imminent Euthanasia

3) Non-Medical Euthanasia

4) Convenience Euthanasia

Dr. Gardner walks us through a series of challenging decisions and tells stories that bring her points to life. This is an outstanding episode that you will not want to miss!

Cone Of Shame Veterinary Podcast · COS – 154 – The Ethics Of Behavioral, Convenience And Economic Euthanasia

LINKS

Lap of Love Pet Hospice: https://www.lapoflove.com/

GSD Shorthanded Virtual Conference: https://unchartedvet.com/gsd-shorthanded/

Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/store/

What’s on my Scrubs?! Card Game: https://drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

EPISODE TRANSCRIPT

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
Hey, guys. Before we get started, I just want to remind you that the Get Stuff Done Shorthanded virtual conference is coming October 6th through the 8th. I’m letting this now super early. This is an uncharted conference that is, it’s my baby. I love it. I’ve been very involved with it. I will be very involved with it going on. It is a very interactive conference. It is not sit and just have webinars on. This is small group, discussion group. We make a big chunk of the conference content on the first day of the conference, where we figure out what people want to do. And then we make that happen in the back part of the conference. It is very much for attendees by attendees. It is all about getting things done, when you’re shorthanded, when you’re feeling overwhelmed.

Dr. Andy Roark:
And I know that some of you guys are so anyway, I’m going to put a link down in the show notes, check it out below. I’d love to see you there. You just get signed up and then we’ll keep you posted and let you know when registration opens, but October 6th through the 8th, virtual conference. That’s all I got for you. I’m going to put a link in the show notes. Welcome everybody to, The Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I am here today with one of my best friends in the world, Dr. Mary Gardner. This is an interesting episode. It’s a long one for us. It’s about 40 minutes, Mary and I talk, but we talk about the morality and the ethics of euthanasia’s.

Dr. Andy Roark:
We talk about convenience euthanasia, and we talk about economic euthanasia, and we talk about behavioral euthanasia, like reactivity in pets or aggression, whatever people want to call it, or imagine it as. Things like that. But we talk a lot about the hard euthanasia cases. And guys, I took a lot away from this episode. I love Mary’s perspective. I think she’s so interesting. She’s an amazing storyteller, amazing lecturer, but she geeks me out. So you’re going to hear us talking over each other, probably. But you’re going to hear us tell a lot of stories, but man, this is a great episode. I’ll be listening back too, probably a couple of times. So anyway, guys, without further ado, let’s get into it.

Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:
Welcome to the podcast, Dr. Mary Gardner. Thanks for being here.

Dr. Mary Gardner:
Hi, Andy. Thanks for having me again.

Dr. Andy Roark:
I love having you on the podcast. People should know, you are one of my best friends-

Dr. Mary Gardner:
I know.

Dr. Andy Roark:
In the world, in real life. For those who do not know the one and only Dr. Mary Gardner, she is a co-founder of Lap of Love Pet Hospice, which is a behemoth of a company that… I’m looking at you in your office and you have your Entrepreneur Magazine that you were featured in up on the wall. It’s that level of success. You’re a veterinarian. You and I went to vet school together.

Dr. Mary Gardner:
Yes.

Dr. Andy Roark:
We graduated in the same class.

Dr. Mary Gardner:
Love it.

Dr. Andy Roark:
We sat together in the back of the room and yeah, we have been dear friends ever since you are one of the best lecturers in veterinary medicine in America. And I say that in all sincerity and you are genuinely a hilarious, funny person who I deeply enjoy talking to. So I’ll always love having you here. Thanks for being here.

Dr. Mary Gardner:
Same back. And I love it when I see you in my lectures, which is always fun.

Dr. Andy Roark:
Oh, yeah. I 100% come and sit in your… Honestly, let that be the high praise that it is. I go to conferences and I’m busy. I don’t sit in on a lot of lectures at big conferences, but I come and sit in on your lectures because you’re that good. And you should be really-

Dr. Mary Gardner:
I would sit in yours, but I can’t wait in the lines. Can I get a backstage… I want speaker assistant tag.

Dr. Andy Roark:
Oh, my face is red. That was well played. All right. Now that we’ve fluffed our pillows enough. Let’s let’s move on. Okay. So let me also, I bring up how much I love you and how we to joke together, because we’re doing a sensitive topic podcast, but it is in our nature too just to talk and to be honest, and sometimes you laugh because you don’t want to cry. And so people, what they should know going into this podcast is we’re going to talk about some heavy stuff, but you’ll probably hear us also be very matter-of-fact about it and go back and forth. If that’s upsetting, now is the time to delete this podcast and listen, instead to, I don’t know, whatever.

Dr. Mary Gardner:
Headspace. I don’t know.

Dr. Andy Roark:
Yeah.

Dr. Mary Gardner:
No, this is a very disclaimer, because I’ve gotten very nasty comments just on, oh, you smile while you’re talking about pet loss or you’re… And you laugh and things like that. So you just, you can’t make everyone happy. Right?

Dr. Andy Roark:
Well, I’ve gotten those too. They’re generally when pet owners are there. You know what I mean?

Dr. Mary Gardner:
Agreed.

Dr. Andy Roark:
If I do a YouTube video and it’s about anything that has to do with pain in pets. If I’m smiling about something, even if I take a side step and tell a funny story on the side, they’re like, how did you-

Dr. Mary Gardner:
How dare you.

Dr. Andy Roark:
How could you possibly tell a funny story while you’re talking about this? And again, I get it. I think anyone who’s been in vet medicine for some time has got some pretty good coping mechanisms.

Dr. Mary Gardner:
Yes.

Dr. Andy Roark:
And can compartmentalize pretty well.

Dr. Mary Gardner:
Pretty much.

Dr. Andy Roark:
I think that is a learned skill. So anyway, I thought of it early on. I was like, I better give that disclaimer, because I don’t plan to have a deep emotional conversation with Mary. And at the same time-

Dr. Mary Gardner:
We will.

Dr. Andy Roark:
I’m going to ask you some heavy stuff. All right. Okay, cool. So here’s what I’ve got for you. And this is not a specific case, but this is a general head space that I wrestle with a lot. Okay. So a couple of things that are happening here, and this may be too big to really get all the way into the way I want. I’m might have to get you back. So I’m looking at a couple of things here, right? So I’m looking at the rising cost of pet care, the inflation. So just take it off of that medicine, just be, man. Inflation is real. And salaries for vet professionals is going up, which is good. It needs to happen. But at some point there’s not a magic money tree, right? This is all coming around from somewhere. There’s private equity groups that are buying vet hospitals, and they’re not buying them out of the kindness of their heart.

Dr. Andy Roark:
These are investment properties and they’re expecting to make money off of them. And so I’m looking at a lot of things and saying, oh man, I’m seeing the cost of care going up and things that. And so I was thinking through, and I go, what does mean? Well, at some point, I think it might affect the behavior of pet owners. There may be people who don’t get pets if they can’t afford them. And I don’t like that. And I’m working with everybody else to try to figure out how to make that not happen. But one of the things we’ve seen in the past, and I also add into this, we very likely are heading into recession in this country. And what does a recession mean for pet care? Well, it means that some people can’t afford to do things they could have otherwise done. And so I always worry or wonder are these things going to come back around to things like economic euthanasia? And so that’s part of this.

Dr. Andy Roark:
The other part, so I think about that and go, well, what does that mean? And what is my role in this? When we talk about euthanasia and the other part is behavioral euthanasia. And these are sort of related and not related, but I had people come in and they say, “Well, I have this dog and he’s bitten three people in our house and never badly, but we can’t have this person or this pat that we can’t trust.” Or you have people who come in and they say, “This cat won’t stop peeing outside the litter box and we need to put them down.” And that’s the classic sort of behavioral euthanasia. Is a convenience, euthanasia sort of thing. And so, I put these things down and they’re different. I know that I’m giving you a lot of really different examples, which make this hard for you, but I’m someone who… I know. I want to make this real hard.

Dr. Mary Gardner:
I know.

Dr. Andy Roark:
You’re getting the master level interview here where I just ask you horribly terrible questions. So I put these things down because I am someone who thinks deeply on these sort of things. And in the practice, I like to have some sort of philosophical guidelines and they don’t have to be perfect, but where are the stepping stones where I put my feet? And I’ve struggled with these to even figure out what lens to sort of look through and say, are there different levels of euthanasia? Are there different kinds of euthanasia? Are there different morality, levels of euthanasia? Help me navigate that. And so I’m going to start with that big wide open question of, are there different kinds of euthanasia and are there different moralities in euthanasia? And how do you start to parse those things apart?

Dr. Mary Gardner:
Oh, okay. So yes, I do believe there’s different levels. And I think it’s hard for us to pillow our head at night for some of them. Then there’s some that we’re like, yep, we’re ready to do this. And then there’s also times where we want to do a euthanasia and an owner doesn’t want to do it yet. Right. They’re on denial island or just, they love their pet. They don’t want to say goodbye. So we break it down into four categories. The first type of euthanasia is the imminent-ish medical euthanasia. Right. So I say, ish. So you’ve got a dog that’s got endstage kidney failure, cognitive dysfunction, whatever. And you might be able to still continue, but he’s a jalopy. Right. So he’s got a lot of stuff going on and we’re okay with that. Now, still in that one, there’s still a period of subjectivity that I think a lot of vets struggle with. Well, is he that bad? Can we do more? Could we go further? And they may not know the struggles that are going on at home.

Dr. Andy Roark:
Right.

Dr. Mary Gardner:
Why were you late to this podcast, Andy? Because you had to deal with your-

Dr. Andy Roark:
My dog yarked. He yarked upstairs and I had to clean it up and I was late.

Dr. Mary Gardner:
Great.

Dr. Andy Roark:
To the podcast with Mary Gardner. Yep.

Dr. Mary Gardner:
But it’s a lot.

Dr. Andy Roark:
No one knows my struggles.

Dr. Mary Gardner:
No one knows the struggles that go on at home. And if you’ve got a dog that’s incontinent or a cat that’s throwing up all over and they come into the clinic and they look not so bad, we can put our judging hats on. But typically those are the ones that we can wrap our mind around and we’re okay euthanizing a dog or cat with a terminal illness or very old dog or cat with problems. The second type is the non-eminent medical euthanasia. And I think we start to struggle with these because their recently diagnosed, they’re owners are managing it, but they want to say goodbye. So the classic one is a diabetic cat or dog. And the owner doesn’t want to give the meds. They can’t afford the meds. And we know if it’s not managed, it will get bad.

Dr. Andy Roark:
Yeah. Right. I put Cushing’s disease into this a lot-

Dr. Mary Gardner:
100%.

Dr. Andy Roark:
Because it’s an expensive-

Dr. Mary Gardner:
Thank you. Yeah.

Dr. Andy Roark:
Treatment. And the pet’s panting and peeing everywhere. And if the owners are like, “Look, we can’t do this.” And I’m like, “I don’t see how this gets better.” That’s the non-imminent for me. I think I’ve made peace with those. And also, I think that’s a great way to look at it. That totally makes sense. I’m right here with you.

Dr. Mary Gardner:
Yeah. And I’ve had three dogs with Cushing’s. I wish I paid more attention to Dr. Share, because I learned so much just from my own animals and the struggles and the trials, the dosing and da, da, da, da, da. It was a lot and it’s okay to say goodbye to a dog that’s… Are they healthy? They’ve got Cushing’s, but sometimes we don’t see how they will get worse and what they’re going through right now. Right. So I’m also with you. I’m okay. Does it suck sometimes? Yeah. And Cushing’s is almost a little bit easier for us to manage, right?

Dr. Andy Roark:
Yeah.

Dr. Mary Gardner:
Let’s talk about the diabetic cat, right. It’s just a little wee needle. 50 bucks a month.

Dr. Andy Roark:
Well, but I’ve got another one for you. It’s the happy arthritic dog. That one is a dagger in my heart. I hate it so much when they eat, they bright eyed, but they can’t get up, they can’t keep themselves clean, the owner can’t get them down the stairs. And you see their mobility going down and like, oh, that’s the one that just, oh, it bleeds me. That was so hard-

Dr. Mary Gardner:
It breaks my heart too. It breaks my heart too. And those owners, you can’t just say, well, throw a yoga mat around and you’re fine. It’s so much more than that. Right?

Dr. Andy Roark:
Yeah. It’s so much more. And of course the owners are struggling with this so mildly. Anyway, I’m-

Dr. Mary Gardner:
So that’s for-

Dr. Andy Roark:
Knowing imminent-

Dr. Mary Gardner:
Those two, I think imminent and non-imminent. Non-imminent, can be a struggle for some teammates though. And they’re like Dr. Roark, but this cat though, it’s an orange tabby and he’s so cute. We could re-home him. Somebody will take care of a diabetic cat, right? Or a Cushing’s dog. I had a Cushing’s… That whole story.

Dr. Andy Roark:
Yep.

Dr. Mary Gardner:
Then there are two others and the other one is a non-medical euthanasia. So the behavioral issues. And then before we talk more about that, let me jump to the fourth one. Then there’s truly convenience, euthanasia, where I simply do not want this animal anymore and I’m moving. Whatever it may be. We all hear the story, if they don’t match the couch, and that’s going to happen, once, maybe in our lifetime. I doubt any of us are really going to hear those. But those are so rare, Andy, that someone comes to your office and says, “I don’t want this animal anymore.” If that’s their mentality, they’re dumping them off somewhere. They’re putting it at the shelter. I’ve had a lot of people that maybe older pets, maybe 10, let’s say, and they’re like, we’re moving. He’s like, “I can’t take the animal. And I know it’s better to euthanize him than live in a shelter.”

Dr. Mary Gardner:
Now is that convenience? Or everybody will say, “Well, you should only move to a place where you can take your animal.” Right. Well, what if you’re going through a divorce? You’re got no ability. The only apartment that you can find doesn’t take them, or it’s a breed that they don’t take. Whatever the story is, it’s not always easy to move with your animals. So yeah, those are tough, but those are so rare. And I don’t ever do a convenience euthanasia, but I will help. So if I’ve got a dog that is a 12 year old Rottweiler, and they want them euthanized, I’m going to find the Rottweiler rescue in my area or around, and hook them up. Because there are people that will, but you have to be careful when you say no. What the consequences are of saying no.

Dr. Andy Roark:
Well, it’s just, well, yeah. Again, I hate to even bring this up, but we’ve all heard the thing of, if you don’t do it, then I’ll shoot them or something, or it’s been a long time since I’ve heard that, but I’ve heard that more than once in my career. And you go and again, that’s anyway, we could go off on a big tangent on that and I don’t want to, but we’ve all heard those things. And it does make you think through like, well, what are my real options here and what are these outcomes? And that is challenging.

Dr. Mary Gardner:
It is. So now let’s go back to that third one. So behavior. And there’s different types of behavior issues. So there’s untrained animals. So dogs that are just crazy jumping up and a pain in the ass.

Dr. Andy Roark:
Sure. I have one upstairs that matches this description. Yes.

Dr. Mary Gardner:
Yeah. Then there are reactive dogs. So many of us say aggressive dogs. Biting, just lunging, maybe just to certain people, certain situations, another cat in the house, another dog in the house, things like that. I’m going to start this whole conversation with it sucks, but I will euthanize those.

Dr. Andy Roark:
Yeah?

Dr. Mary Gardner:
It has taken me though years to get there without being upset over it, because you go there and sometimes they’re sweet and they’re nice. And you’re like, well, this dog wouldn’t hurt a fly. Yet if that cat mosey out, they would kill him. It’s so interesting behavior, euthanasia. And typically owners, listen, 90% of owners are going to come to us because they’re desperate, they need help. Are there some of those butt head owners that are just like, yes. You can parse those out usually.

Dr. Andy Roark:
Yeah, totally.

Dr. Mary Gardner:
They’re frustrated. They’ve tried stuff. What happens though in our world is what is our immediate response to that? And these people have probably had this, pet for a year or more, and everyone says, “Well, you need to go see a behavioralist. You need to go see a trainer. Have you tried positive reinforcement? Have you tried separating the animals? Da, da, da, da, da, da. Have you tried drugs?” All these things. And that’s a lot. It’s a lot to put on some people. And it I’ve come to realize that behavior is a mental illness. Mental illness is an illness. They’ve got anxiety. They’ve got something that is triggering them. And what helped me with this even better is my current dog. So I’ve always had perfection dogs, all my Dobermans. They’re always awesome. My Samoyed’s great. So when my last Doberman died, I went and got this dog, Noran is his name.

Dr. Andy Roark:
I’m pausing here for a second, because you say you’ve always had awesome Dobermans. And I have to admit that you do have awesome Dobermans. And I know because one of them could have killed me one time when, I don’t know if you remember this, I just, as a side. You had me and Allison, my wife, and some other people over at dinner at your house in Gainesville, Florida. And I left to go do something. I left something in my car. I went away and I came back and I said, I’ll just let myself in because I know they were in there having dinner.

Dr. Andy Roark:
And I open the back door into the mud room and Neo, the Doberman Pinscher, just, he walks into this dark room with his ears sticking straight up. And he just looked at me and I saw the end of my life there and I was going, “Hey, Neo. It’s me, your buddy, Andy. I saw you earlier tonight.” and you overheard and came to save me. But he was an impressive animal. And I’ll never forget letting myself into the dark room and seeing the silhouette shadow, outline of Neo looking at me from the doorway. I was like, oh, I have made a terrible miscalculation, but he was wonderful. So I’m sorry. Go ahead.

Dr. Mary Gardner:
He was wonderful. And he would be protecting of me. So just like many Bichons would. You could just do damage. So I’ve always had very great dogs. So I adopted this dog Noran a couple of years ago and the moment I saw him, I knew he was trouble. He had one blue eye, like the blue eyes just tell you they’re crazy. He got a magic, crazy eye. Right. And I’m like-

Dr. Andy Roark:
I imagine them being different sizes. I know that’s not true. But just, when you said that, it reminds me of, yeah.

Dr. Mary Gardner:
It looks different. So Dennis thought he’d be perfect. And I’m like, that dog’s got issues. I can tell this is behavior, whatever. Luckily we introduced him to my dog, Sam, who was like, Eeyore. Nothing bothers her. She’s 13. Has cancer, dying. She’s no problem. Little did we know, he wanted to kill everything else and so we have a cat. He wanted to kill the cat. Going for walks, he was like a gator. He’s killed rabbits in the house. He’s got anxiety. When we left, he was scratching at the door. It was-

Dr. Andy Roark:
Oh, man.

Dr. Mary Gardner:
Full on behavior problems. And it was so stressful. Every day I’d leave. I’d have my cat in another side of the house. And I’m worried, can he get through the door? I’d have to barricade the door. The stress and anxiety that this dog brought to me was unmeasurable. It was insane. And we were the fourth home.

Dr. Andy Roark:
Oh, wow.

Dr. Mary Gardner:
So it’s not easy to find someone to deal with this. And he was great. Didn’t chew on things. Didn’t poop anywhere. He was a great time, but he had anxiety. So I was lucky enough to afford the cost and the time to go see a behavioralist. And when I say the time, because it’s not just the money, it is time and patience.

Dr. Andy Roark:
And commitment.

Dr. Mary Gardner:
And commitment.

Dr. Andy Roark:
To keep doing it. Yeah.

Dr. Mary Gardner:
It is hard. So we went and saw Lisa Radosta.

Dr. Andy Roark:
Oh, she’s great.

Dr. Mary Gardner:
She’s great.

Dr. Andy Roark:
She’s been on the podcast a couple of times. Yeah. She’s great.

Dr. Mary Gardner:
If she can’t help you, no one can. Right?

Dr. Andy Roark:
Yeah. You’re going to the best. Yeah.

Dr. Mary Gardner:
I’m going to the best. So she’s like, he needs to be on meds. And then of course, Dennis didn’t want him on meds, this whole big thing. And so, and she’s like, yeah. Do positive reinforcement. Leave it, leave it, all this stuff. It was a hell year. I was near euthanasia three times.

Dr. Andy Roark:
Wow.

Dr. Mary Gardner:
It was really bad. The drugs were so helpful, but it’s patience. And I ran out of it a lot of times and the anxiety that if I can’t handle it, no one can. And I know he’s anxious. And she’s like, “It’s reactive. It’s not aggression. It’s react.” So I learned so much, but not everybody can afford that to go see a Lisa Radosta, and us doctors aren’t the best at dealing with behavior. We’ll put them on reconcile, and fingers cross that’s enough. Right. But there’s a lot to this. And so she taught me tips and tricks. So we’re three years in. He’s still alive, but I got to be honest. I wish I could find a home for him that is just him alone, where he could be-

Dr. Andy Roark:
Yeah. Just him.

Dr. Mary Gardner:
Just him. Because my cat has been a prisoner for three years and I can’t get anybody else. Sam is long gone and I can’t get any other pets because of him. And I can’t bring him to the beach. I can’t bring him to a dog park. Walking is a pain. It’s hard. So understanding that now, as bad as it is, I would’ve euthanized him and I would have helped a family do that. But it sucks.

Dr. Andy Roark:
Yeah. That’s really interesting. I had not thought of reactivity as mental illness. And that’s interesting. And so that’s exactly this type of philosophic sort of framework I was looking for. I had not put that together, but yeah. Sort of following those steps is reactivity is often anxiety, fear, things like that, at a pathological level. So mental illness, we know that mental illness is an illness. And at that point I go, okay, well, I’m walking up to this point where we have this pet that’s ill that is not responding to treatment and is negatively impacting, especially to the point where people are getting injured or we’re afraid for the lives of other animals. That’s super helpful.

Dr. Mary Gardner:
And just think, if a family has a Cushing’s dog that doesn’t want to try Trilostane for whatever reason. Are we okay euthanizing them?

Dr. Andy Roark:
Yeah. That’s exactly what we were talking about before, is I’m like, yeah. We know where this is going and yeah. We’re okay with it.

Dr. Mary Gardner:
We’re okay with it. What about if a family doesn’t want to do reconcile and training and all, and behavior and things like that. I mean, it’s a commitment and they don’t have the time, energy, emotional capacity, finances to do it. Reconcile is not free. Right. So I’m okay doing it. It’s hard though. Now there are some true Cujo’s out there that are just aggressive.

Dr. Andy Roark:
Oh, yeah. There are some that you just go, they’re terrifying. And you say, oh, I-

Dr. Mary Gardner:
Correct.

Dr. Andy Roark:
I see this as a benefit to society. It’s good for the dog. Someone’s going to get badly hurt here.

Dr. Mary Gardner:
Yes. And I think we all know it. Right. So I think those are easier for us to do. It’s the Noran’s out there that have a history that, and he’s bitten a few people and so he’s on the list. And I can’t travel. Oh, guess what? Going anywhere, I got to find a boarding facility that could specially handle him and now I worry about him hurting other dogs. And it’s intense and it takes a lot. So if any listeners would a monogamous relationship with a pointer mix, female. DM me.

Dr. Andy Roark:
Yeah. If you live on a farm somewhere, you don’t want people to come visit you.

Dr. Mary Gardner:
He’s perfect.

Dr. Andy Roark:
We got you. Yeah. If you’re like, I’m done with people, we can help you make that a more permanent state.

Dr. Mary Gardner:
Right. But he is great. So these are tough. And we do about, I think it’s about 2% of the families that we help at Lap of Love. And we help over 100,000 a year. So it’s a lot, but 2% is behavior euthanasia.

Dr. Andy Roark:
Yeah. Wow.

Dr. Mary Gardner:
And it’s on the spectrum of Cujo’s to a Noran and a lot of our vets struggle with it. And our biggest key is you got to go talk to the family.

Dr. Andy Roark:
Yes.

Dr. Mary Gardner:
You can’t say no until you talk to that family and you sit in their house and you see their fear or you sit in the clinic and talk to them, feel their frustration and understand it. And if they are just those few percent that are flip it and silly, you don’t have to, but understand what no means.

Dr. Andy Roark:
Yeah. That’s really good advice. I really appreciate that. Hey guys, I just want to jump in here real fast and give a shout out to Banfield the pet hospital for making our transcripts available. That’s right. We have transcripts for, The Cone of Shame podcast and the Uncharted Veterinary podcast. You can find them at drandyroark.com and at unchartedvet.com. This is part of their effort to increase inclusivity and accessibility in vet medicine. We couldn’t do it without them. I got to say, thanks. Thanks for making the content that we put out more available to our colleagues. Guys, that’s all I got this time. Let’s get back into this. So let me jump back here a little bit and say we talked.

Dr. Andy Roark:
So I talked about that at the very top about economic euthanasia and talked about when we have someone who says, oh I can’t afford this service or things like that. And I know these are different waters, but I think that what we just talked about with behavioral and reactivity, I think that was really helpful for me. And you’ve clearly thought these sort of things through. Do you have thoughts on how economic euthanasias, the impact that they have on doctors or their mental checklist that you run through in that regard?

Dr. Mary Gardner:
It’s tough because you’ll hear people all the time say, if you can’t afford the animal, you shouldn’t get one. Right.

Dr. Andy Roark:
Oh, man. Yeah.

Dr. Mary Gardner:
Which I can’t stand that actually, because I think we would have a lot more people with animals in the shelter, if that was-

Dr. Andy Roark:
Okay. So hold on. This is really interesting. Okay. So I’ve been thinking a lot about this in the last couple of days and weeks, because I have seen a resurgence of this comment of if you don’t want animal, or if you can’t afford an animal, you shouldn’t have it. Okay. And people go, well, I can’t believe anyone would say that. And of course, I don’t believe in that. And I think that lacks empathy when we say it, and I understand why doctors say it. It’s because we’re frustrated and we want to not feel we’re the bad guys.

Dr. Andy Roark:
And so, we like to sort of shift the blame and say, how dare you get mad at me. You’re the one who has this responsibility that you’re struggling to pay with. Why do I feel terrible? I didn’t have anything to do with this. And it’s funny because there’s this balance, right? There’s the, if you can’t afford a pet, you shouldn’t have one. And I think most of us go, oh, that’s not good. But if I flip it around and say, do you believe that we have a responsibility to take care of pets that we take on? I think most of us would say, yes, we do have that.

Dr. Mary Gardner:
Yes. But where is that line though? Why-

Dr. Andy Roark:
And that’s the interesting part.

Dr. Mary Gardner:
Yes.

Dr. Andy Roark:
Yeah. So anyway, I’ve been thinking a lot about that.

Dr. Mary Gardner:
Okay, good. So it’s shelter, it’s love, it’s food and water, right? That’s the basics that we all have to be able to give or else you shouldn’t have that animal. Yeah. Do we have to, what if they can’t afford? I mean, and heartworm prevention, maybe vaccinate, some very basic care. But if they can’t afford the Trilostane or they can’t afford… $50 to some people is a lot. Right.

Dr. Andy Roark:
Yeah.

Dr. Mary Gardner:
So I think you probably sat in my lectures once when I would be like, who’s got 1,000 bucks that could just hang out with me for the weekend. Right?

Dr. Andy Roark:
Yeah. Just plop it down.

Dr. Mary Gardner:
Just plop it down. We could just go hang out. And like, nobody raised their hand. And I said, well, that’s what a sick animal, for figuring out what’s wrong with them, getting them to do x-ray’s or whatever, is 1,000 bucks. 51% of the population of America do not have over 1,000 dollars in savings. They don’t have it. And should we say Care Credit and credit cards and stuff like that? Well, that’s debt and now we’re adding more debt. Okay. So I think for us just to say, if you can’t afford more than the basics, you shouldn’t own an animal. That would be great if we had a lack of animals in the world. Right.

Dr. Andy Roark:
Right. Oh, yeah.

Dr. Mary Gardner:
So only if you can afford 500 a month then you should. We are overpopulated, they’re out there. They’re needed. So we need homes for them. What’s the line though.

Dr. Andy Roark:
Well, and that’s funny too. So hold on. Let me throw another story in here as well. So I got a chance to interview the gang who was at the main veterinary emergency center that had this terrible sort of cyber bullying thing not long ago. And so, yeah. So basically, they had a patient that came in and it was a young pet and it needed surgery in a bad way. It had eaten a skewer.

Dr. Mary Gardner:
Yes, that’s right.

Dr. Andy Roark:
A wooden skewer and the story was basically this thing had done horrific internal damage.

Dr. Mary Gardner:
Per the lungs.

Dr. Andy Roark:
Exactly right. Perf the stomach, skewered the liver into the-

Dr. Mary Gardner:
It was a skewer.

Dr. Andy Roark:
Yeah. It’s skewer. Yeah.

Dr. Mary Gardner:
It was skewered.

Dr. Andy Roark:
Yeah. It did what it was made to do, but and it’s got pyothorax, it’s sepsis from a leaky abdomen. It was a $10,000 surgery minimum to fix this pet going in and you might have $1,000 laying around, you might have $5,000 laying around. There’s not a lot of us that have $10,000. And so even to me, and as I think about where is this line, I’m going, and it’s just an interesting question. Do I feel differently about a pet that needs a $3,000 surgery, and a pet that needs a $10,000 surgery?

Dr. Mary Gardner:
What’s the like?

Dr. Andy Roark:
One of them seems farther from, we can just do this and make this happen then the other one does, is like, is there a difference in saying your pet needs a $500 procedure versus your pet needs a $5,000 procedure? And that changes how I feel about this? These are all questions-

Dr. Mary Gardner:
It’s deep. Right?

Dr. Andy Roark:
I’m asking myself. Yeah. It really is. But if we didn’t used to have $10,000 procedures, Mary. When you and I came out of vet school, that was unheard of.

Dr. Mary Gardner:
Unheard of.

Dr. Andy Roark:
I remember the first time I heard someone say, “These people spent $10,000 on this pet.” And I was like, oh my God.

Dr. Mary Gardner:
Right. What? And I actually have friends of mine in school… They had a Doberman that came to the clinic. It had 30% body burns. And of course, everyone knew I loved Dobermans. So Mary got the case and it was two months in the clinic. They spent $20,000, something crazy like that. And I remember asking them like, “It’s okay to say no, it’s okay.” And they were like, “We’ll make more money, but this is our dog.” And I’m like, okay. But its okay also if they said no, and where is that? Where is that line? And I can go deep on, like, I don’t even know what the answer is.

Dr. Andy Roark:
Totally.

Dr. Mary Gardner:
And I think that’s the point is there isn’t an answer. I think I get upset if someone pays money for their dog, they pay $2,000 for a freaking Yorkie or whatever, and then they can’t afford a $2,000 surgery. I think that’s where Mary’s like, that’s where my line is. If you adopted a dog for 150 bucks and you gave it a couple of years of great life and food and kibble, whatever, and now all of a sudden you can’t afford a $500 block. Oh, I’m okay. I get it. I’m okay.

Dr. Andy Roark:
Yeah. That dog got five years of life that a lot of other dogs in the shelter or that don’t make it in the shelter would not have gotten, and they go, okay. It’s funny. Yes. That dog didn’t get the life it would have if it was in a home where there were people who had a bajillion dollars laying around, but most of us are in that home. And I mean, and you sort of say, well, I don’t know. It’s just, it’s really interesting to sort of say, where is that line where you say, this is what I could do. And I took care of this dog in a health state. And the fact that this dog could theoretically live on if I had $12,000 to spend on surgery, that doesn’t matter because I don’t have $12,000 and I shouldn’t feel bad about it. And the people who do have $12,000, they shouldn’t feel bad about it either. But I don’t want to hold those… Those two people are different.

Dr. Mary Gardner:
Just because we can doesn’t mean we should. Right.

Dr. Andy Roark:
Yeah.

Dr. Mary Gardner:
You know what’s so interesting too is I’ve done so much for my animals. And so many veterinarians have said to me, like, “That seems excessive. You did radiation, chemo, and da, da, da, da, da, da, da.” So it’s interesting, because I’m like, well, what if I didn’t do it? Would you judge me then too?

Dr. Andy Roark:
Oh, yeah.

Dr. Mary Gardner:
Right. And you get a person in the family that’s like, I don’t want to put my cat through chemo with lymphoma. Well, they actually have a really good response rate to it. Well, I don’t want to put them through that. But then you do put a cat in chemo and people are judging you then too. Like, what are you doing to that cat? It’s just a cat. You can’t win.

Dr. Andy Roark:
Yeah. You can’t win. You can’t win. That’s true. Yeah. It’s true. It is true.

Dr. Mary Gardner:
It’s just crazy. Now, let me let talk about this peeing cat that you talked.

Dr. Andy Roark:
Okay. Yeah. Let’s talk.

Dr. Mary Gardner:
And who here wants to get that? This is all over their house. No one.

Dr. Andy Roark:
No.

Dr. Mary Gardner:
No one wants that. Right. That’s a huge issue. So I want to read something to you, but before I do, I remember you sat in my lecture and I think it was this lecture I do on like, what would you do? And I go over seven cases from the urinater to the untrained dog, to the reactive dog, to the arthritic, but still okay dog. So we just go through cases. I think I’m doing it again at BMX. And it’s just a good interactive. Anyway, so you came up after me afterwards and you were just like, we put so much pressure on our staff sometimes that we don’t realize that, okay. Mary loves Dobermans. So guess what?

Dr. Mary Gardner:
We’ve got the diabetic Doberman that came in, guess who’s getting a phone call to adopt this dog? And the guilt we place on each other, we have to careful on. Because we’ve got staff members that have got 12 cats at home because they can’t say no. And I think it is really good to have this open conversation with the team to say, where are our lines? And don’t judge somebody. If Mary’s okay euthanizing a reactive dog, don’t judge her. This is why she thinks this way. So I found this on a Facebook group. And it was a veterinarian talking about this pet. I don’t know if it’s dog or cat.

Dr. Mary Gardner:
I’ll see in a second, but she said, “She is peeing on things randomly. Pillows, on my bed, her bed, the carpet, et cetera. I’m at the end of my ropes. I didn’t want a dog when I adopted her, but I was guilted into taking her on by my coworkers at my old job. I’m so frustrated. She’s really a sweet dog, but she has something bad and it makes her hard to re home and I can’t really afford to just do every test there is with no guarantee that we’ll find out what’s wrong and treating it.” A cat or dog that’s peeing, especially a dog, there’s something wrong. It’s probably not just training. Right?

Dr. Andy Roark:
Yeah.

Dr. Mary Gardner:
That to me is a medical issue. And if we can’t figure it out, it’s like, I’m okay. Do I want to figure it out? Yes. But we can’t. And our good friend, Megan Brashirs, who I just adore her.

Dr. Andy Roark:
Yeah. She’s amazing.

Dr. Mary Gardner:
She’s said a quote once. Do not shoulder the responsibility of the health and safety of every animal in this world.

Dr. Andy Roark:
I know people who should have that tattooed on their body.

Dr. Mary Gardner:
Right. This should be in a clinic everywhere. Do not shoulder the responsibility, the health and safety of every animal in the world. We do what we can. And so when I’m lecturing on euthanasia, I say, I can’t always be in control of why, but I can be in control of how, and I will do a really good euthanasia. I will make sure that pet… And it sucks, because sometimes I want to take them all. I want to take all the Dobermans and the orange cats and the black cats and I can handle it, but I can’t also. I can’t do it. And I have to pillow my head at night and I just, I don’t take on the guilt that’s not mine.

Dr. Andy Roark:
Yeah. I agree with that. I think it’s funny. I’ve been thinking a lot more about, and I don’t know if we’re really going to go this way. I think I would say the future of vet medicine is fragmentation. And I look a lot at you and Mary and what you’ve done, or you and Danny and what you guys have done with Lap of Love as one of the key pieces of that early on in my career, that’s all. When I say that the future of vet medicine is fragmentation, what I mean is I think we’re all going to do different things before long. Meaning there will be pet hospice. Some of us will just do recovery and rehabilitation. There will be the mega boujee 24-7 places. And then there’ll be the concierge vets who don’t have an office.

Dr. Andy Roark:
They just go to people’s houses. I think there’s going to be some low cost, high volume places, and some low volume, high cost places. And that’s not bad, because then people can sort to where they want to be. And we can get support for people who need it and financially and things that. I think that’s all good. But it’s just, as I start to think about medicine, where we’re going, especially recession, things like that. I do wonder at some point, if we need to look more at almost shelter medicine and start to think, at what point do we start to think of ourselves doing herd health, almost where you say, I can’t fix all the pets and I need to own that I can’t fix all the pets.

Dr. Andy Roark:
I have a flock who are my clients, pets, who I try to take care of and I need to maintain myself so that I can keep going. But part of the herd health is to say, some of these pets, we’re not going to be able to save them all. And the goal is not to save them. All the goal is to look at all the good that I do and all the work that I do and achieve the optimal outcome, not the maximum outcomes in every case. And it’s an interesting philosophy, but you have to switch away from eye to eye contact with the pet owner in the room and switch it more to looking at everything that I do and my career, and how I’m going to have boundaries and sleep at night and not burn out.

Dr. Mary Gardner:
100%. That is so well said. And you know what? It’s okay to remember some things, right. I remember Deedee, the very aggressive Rottweiler that wanted to kill me, but and I just used that, but you know what was great about Deedee, it was peaceful. It was good. I still did it well. Could it have been different? Yeah. But you’re right. The net result of all that we do is so good that, do not let these lived stories in your mind that you can’t then escape from, and it’s tough. These are our very difficult decisions and we love animals. That’s why I became a vet. I love animals. I’ll say it. Right.

Dr. Andy Roark:
Yeah. Oh, yeah.

Dr. Mary Gardner:
And I love the families that love them too, but we can’t be everything.

Dr. Andy Roark:
We can’t, we can’t. I’ve got this idea. I tried to write it one time and I think it bombed, I don’t think it’s funny. Either no one read it or they read it and they were kind enough to not mention it to me, but I got this idea. I call it the paradox of the special pet is the idea. And so in order to be in vet medicine, right, you have to be able to hold these two conflicting views in your head at the same time, I think. So here it is. All right. So the paradox of the special pet, you have to be able to look at a pet and realize that, that pet is the center of the world for that person, right. They are a special pet. And then at the same time, in order to keep your brain and not burn out, you have to also be able to look at that pet and know that there are an endless number of other pets out there in the world that need care, that need homes, that would be wonderful for any of us to have.

Dr. Andy Roark:
And so that pet is not special, because there’s a million other pets. And also, pets don’t live very long. In the best case circumstances, they don’t live very long. And so we have to be able to look at two completely contradictory views. One being every pet is deeply special and every single pet is not deeply special because there is an unending stream of sick pets and well pets that need homes. And we are looking at one little drop of water in the ocean. And I think that if you can hold both of those things in your head at the same time, you can be happy in vet medicine. I think so. And if you can’t hold them both in your mind, I think that one way or another, you’re going to have pain that you’re going to have to figure how to manage.

Dr. Mary Gardner:
Yeah. No, I would’ve read that and said, “Bravo, my friend.”

Dr. Andy Roark:
Oh, well, thank you very much.

Dr. Mary Gardner:
Because I think it’s good. And look how we started talking about my dog, Noran, and I said, I can’t get any other animals. I would adopt five more animals right now. I can’t because of him. Right? I can’t and there are so many out there and I think we could do probably… I think it would be very helpful to talk to other industries like child services, right? Those people who work in child services, how horrible is their job to see children that they have to leave in a house that they’re abused and stuff. Their minds must be so bad too.

Dr. Andy Roark:
Oh, man. We’ve gone through this thing in the last couple of years and people were talking about vet medicine is horrible, and vet medicine is uniquely challenging. It is a hard profession and we both know it. And burnout is a real problem. And mental health and wellness is a real problem. I don’t believe that we own the market on unhappiness, on stress, on emotional burnout. Because I have two friends that are in DSS and I don’t know how you go and take kids away from their families, or how you go and not take kids away from their families, given some of the things that these people see. I don’t know how you do it. I have a friend who is a pediatric palliative care specialist. She manages pain in children with cancer and other illness. And I’m like, I’m sorry, buddy. I don’t know that I would ever have the emotional fortitude-

Dr. Mary Gardner:
Me too.

Dr. Andy Roark:
And I’m, yeah, exactly. To do what you do. And I do fairly well with this, but I’m like, I just, I don’t know how other people do it. So I think that there’s lots of other people.

Dr. Mary Gardner:
Yeah. Right. We don’t have the market on anxiety. There’s a lot out there and I think we could learn a lot from how people manage some of these stresses and emotional tug of wars in their hearts.

Dr. Andy Roark:
Yeah. Yeah. I agree. I think we’re going to keep learning. And I think that there will… I do. I think as a society, I think we’re going to keep learning. I think there’s a lot of focus on anxiety and stress just in general. And I’m optimistic about the future. I really am. I don’t want people to think that I’m down. This is a hard part of our job that’s never going away, but it can be less hard. And I really do think that remembering your, why, matters a lot. We’re doing this because we believe it’s the right thing to do and this is part of delivering a good death is part of a good life. It really is. And protecting from suffering I think is often one of the kindest things that you can possibly do. Dr. Mary Gardner, thank you so much for being here. Your book is out. We talked about it last time we were here. Run me down on the title of your book again.

Dr. Mary Gardner:
It’s called, It’s Never Long Enough: A Practical Guide to Caring for Your Geriatric Dog.

Dr. Andy Roark:
Yes. If you guys enjoyed this conversation, check out Mary’s book. We also have a podcast episode from when it came out. You can listen more about that and hear more of me talking with Dr. Mary Gardner. Mary, where can people learn more about, Lap of Love? Where can they find you online?

Dr. Mary Gardner:
Yeah. So Lap of Love is just lapoflove.com, which has got a lot of great resources also for veterinarians on our sedation protocols and things like that. And then, or just my website, which is D-R, Mary Gardner.

Dr. Andy Roark:
All right, gang. Take care, everybody.

Dr. Mary Gardner:
Bye.

Dr. Andy Roark:
And that’s our episode guys. That’s what I got for you. I hope you enjoyed it. I hope you got something out of it. As always, I love an honest review wherever you get your podcast. If you’re watching this on YouTube, hit that subscribe button and tune in more often. Gang, take care of yourselves. Be well. Talk to you later. Bye.

Essentials – Canine Euthanasia (HDYTT)

January 12, 2020 by Andy Roark DVM MS

Dr. Andy Roark and Dr. Amanda Doran review canine euthanasia. This is an excellent episode for anyone on the healthcare team and we hope it will be a great refresher and conversation starter for veterinary teams.

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.

ABOUT OUR GUEST:

Dr. Amanda Doran is a practicing certified hospice and palliative care veterinarian (CHPV) in Duluth, MN. She has worked in the veterinary field for nearly 20 years and held every position from kennel assistant to veterinarian. Dr. Doran’s articles have been featured on DrAndyRoark.com, and she has been a guest on Dr. Roark’s Cone of Shame podcast. Dr. Doran’s medical interests center on end of life care, animal welfare, effective client communication, personal resilience for veterinary professionals, and the human-animal bond. She shares her home with her partner in crime, 2 goofy husky shepherds and a crabby old peach tabby. She also slings tarot cards for fun.

Thanks for the Reminder to Feel

April 21, 2019 by Dr. Andy Roark Community

As vets, we have wins and losses. That’s the job. And amidst challenging clients, long work hours, insurmountable debt, huge caseloads and attempts at work/life balance, it is easy to lose track of why we entered this field. We advocate for the innocent, we heal those who are deeply loved (and in that process, those who love them), and when the time comes, we give them a death with dignity.

Often I don’t feel sad after a euthanasia. I normally feel the burden of responsibility, but not sadness. And that is a choice I actively make; we as veterinarians can’t emotionally survive if we don’t put up those barriers. But that is a dangerous path – barriers become walls, and walls become apathy.

BUT, once in a while, a critter comes along who dulls the sharp edges of those barriers, who reminds us why we choose this career in the first place. A sweet animal who makes us feel not only their loss but the loss of all the other animals we’ve helped to die.

In my case, that critter came in rather… unusual… form.

Andie was a hairless rat, with a kink in her tail. She was presumably found abandoned in a graveyard five months ago. When I carried her around in my scarf under the guise of “monitoring” her (her owner saw riiiiight through that), she surprised and delighted my colleagues. She was so imperfectly perfect. She melted my heart in a way far “cuter” critters have failed to do.

Yesterday, I was the one to give her her last breath. And I feel so, so deeply, painfully sad about that; yet I also feel honored that she arrived in my life just in time to give me such a beautiful kick-in-the-shins to remind me to, you know, FEEL once in a while.

Goodbye, sweet Andie, and thanks for the reminder.

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.

ABOUT THE AUTHOR

Carrie Daly is a 2009 graduate of the University of Minnesota and a transient ER veterinarian – having practiced in Hong Kong, Minnesota, Oregon, and soon Colorado. She is a mom to 4-year-old twins and a 3-year-old son, and thus considers herself to be both a manager and purveyor of chaos. She enjoys international travel, unsuccessful attempts at meditation, running trail ultramarathons, writing on her Facebook blog (The Five Mayhems), and above all else – napping.

Euthanasia

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