There are few things that make you feel better in the treatment area than helping a patient to comfortably breathe. Whether it be via oxygen flow by or intubation, an O2 chamber, a nebulization or inhaler treatment, removal of a tracheal obstruction (foreign body, mucous, mass, or polyp), soft palate surgery, or a lar par tieback. Sometimes the patient comes to us looking rather pot-bellied with positive fluid wave from a build up of fluid in the abdomen. There are many causes for fluid in the abdomen (ascites) such as cancer, right-sided heart failure, abdominal ble
There are few things that make you feel better in the treatment area than helping a patient to comfortably breathe. Whether it be via oxygen flow by or intubation, an O2 chamber, a nebulization or inhaler treatment, removal of a tracheal obstruction (foreign body, mucous, mass, or polyp), soft palate surgery, or a lar par tieback. Sometimes the patient comes to us looking rather pot-bellied with positive fluid wave from a build up of fluid in the abdomen. There are many causes for fluid in the abdomen (ascites) such as cancer, right-sided heart failure, abdominal bleeding, hypoproteinemia, etc.
- An 11-year-old MN DSH cat was presented for “not breathing well”.
- The cat has a history of recently resolved transient diabetes and had been doing well up until this day.
- Upon physical examination the patient was found to be panting uncomfortably, with a distended abdomen and a positive fluid wave.
- Owners declined any blood work. They did agree to a radiograph which showed what we knew already, that there was a great deal of fluid in the abdomen. A complete diagnostic work-up including an ultrasound was strongly recommended, but declined. A very poor prognosis was explained at length to the owner, especially since we really didn’t know what we were treating with the help of that magical ultrasound probe. Frustrating to say the least. I wanted to help my patient but I have no idea what to treat it for! 🙁
- We then proceeded to drain the abdominal cavity (over 400 mls of clear fluid was drawn out). The patient’s breathing improved greatly.
- In a few short days this cat presented again for drainage of the abdominal cavity. Greater than 500 mls were drawn out. The owners were again gently reminded that he was getting worse with the fluid building up so quickly in such a short time. They seemed unfazed by this conversation.
- Within 48 hours this little guy presented once more for an abdominocentesis, his breathing was extremely labored and he was very uncomfortable. We extracted 475 mls of clear fluid in a tag team of butterfly catheters and stop cocks, only this time his breathing barely improved. He was never cyanotic, just uncomfortable.
- The technicians conversations turn to “He is suffering..Why don’t they put him to sleep?…I wish the doctors would say something to them..I don’t think they realize how uncomfortable he really is.”
Well in fact the owners did. They were not trying to let their cat suffer or cause him undue harm. They just could not wrap their heads around the fact that he was not going to get better. This is one of those bite your tongue moments that you have to allow your client to work through. At the next visit the owners did decide on humane euthanasia. How does your hospital deal with cases such as this? Do you ever tell your clients that they need to let their pet go? What are the ramifications for the practice? Word of mouth can damage your practices reputation despite the good intentions you have to alleviate that patient’s discomfort. Is that a concern in the back of your head when entering into a highly emotional discussion with an already upset client?
Comments
I think it often is a careful
I think it often is a careful balancing act. You must be very gently honest with them, and try to read their response and their emotions. You are right, it is so easy to criticize and I have done it myself, like we know it all. People often need time, and we must learn to recognize the signs that the owner is just not ready to let go. And then all we can do is what we can for the patient to make them comfortable while the family is processing it all and reaching their own comfort point with the reality.
Sometimes we have seen owners in such agony of indecision, the point where they do know their pet is suffering or will suffer, but they just cannot take that final step. We must recognize that also. Then we do gently tell them the reality, that there pet is suffering and wants to be let go, and we can give them that freedom from the pain. The key is to bring out our empathy, we have all been there, and the family does see our honesty and genuine care. I have seen my doctors do this and have never thought “oh oh, this will come back to bite us” , maybe because it usually feels right at that point. Especially when you say ” if it was my pet, I would let him go” , and it is true.
Ramifications for the practice? Sure there are, but if you practice from the heart, most of the time our clients know it and the fallout is good. And we see it in all of the lovely thank you cards we get.
I think it often is a careful
I think it often is a careful balancing act. You must be very gently honest with them, and try to read their response and their emotions. You are right, it is so easy to criticize and I have done it myself, like we know it all. People often need time, and we must learn to recognize the signs that the owner is just not ready to let go. And then all we can do is what we can for the patient to make them comfortable while the family is processing it all and reaching their own comfort point with the reality.
Sometimes we have seen owners in such agony of indecision, the point where they do know their pet is suffering or will suffer, but they just cannot take that final step. We must recognize that also. Then we do gently tell them the reality, that there pet is suffering and wants to be let go, and we can give them that freedom from the pain. The key is to bring out our empathy, we have all been there, and the family does see our honesty and genuine care. I have seen my doctors do this and have never thought “oh oh, this will come back to bite us” , maybe because it usually feels right at that point. Especially when you say ” if it was my pet, I would let him go” , and it is true.
Ramifications for the practice? Sure there are, but if you practice from the heart, most of the time our clients know it and the fallout is good. And we see it in all of the lovely thank you cards we get.