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Vet Talk

When the Patient Is our Own
June 27, 2016 (published)

Izzy Charlotte Waack

Izzy enjoys the sun. Photo by Charlotte Waack, CVT, RVT
Veterinary technicians are blessed with pets that, like any other pet owners, may have major medical issues. Not only do we have healthy pets, but also we’re more likely than the general public to take home the three-legged dog the owners no longer wanted, to work with a cat’s diabetes or to, nurse a tiny orphaned kitten back to health. Maybe there is a higher power at work that thinks we are better equipped to deal with these issues because we have studied these conditions in school and know more about them than most pet owners. Maybe this higher power knows what soft hearts we have and are willing to take on pets that would have no other chance.

That’s the up side, and most people understand that. However, there’s a down side that people outside the profession usually don’t realize. When we encounter health issues with our own pets, what we face may be a bit different than the general public. Due to our education and clinical experience, we know all the latest and greatest of treatments, what we refer to in vet med as the gold standard. We also know what those treatments entail, the toll it takes on our pets, and what it looks like when the disease process comes to the end where the only thing we can do is keep the patient comfortable.

This brings me to the other downside that we see: the prolonging of life may not be in the pet's best interest. Your pet may be on this earth longer, but due to progression of the disease or side effects of the treatment, quality of life may not be good. I think this is where veterinary professionals like myself struggle. We have seen many patients and our own pets go from happy, attentive animals to a point where the disease process is so painful, it strips the light right out of their eyes.

We also know the cost of any treatment that has to be taken into consideration. Even though we may receive discounts on medications and services, the price tag of some of the treatment is still greater than what we can afford. Remember, we have those soft hearts and more than likely have more than one pet with great medical needs. Many times we feel judged by our peers when we choose not to do everything possible or every treatment available. Are we bad owners? No, but we too feel the guilt that our clients feel when we may have to limit what treatments we choose due to the cost or quality of life of our own pet.

A bit over a year ago, my dog was scheduled for a dental and lump removal. Izzy, my rescue Samoyed was almost eight years old and at that time was considered geriatric. I opted for pre-surgical bloodwork before her surgery. One abnormal kidney value on her bloodwork lead to more lab tests with abnormalities and my heart pounded with each result. She was ultimately diagnosed with a tick-borne illness from Ehrlichia. Ehrlichia is a type of bacteria that infects and lives within the white blood cells and is spread by ticks. Chronic ehrlichiosis can cause abnormal bleeding, inflammation of the eyes, neurologic effects and urinary protein loss, which is what Izzy had. Treatment consists of antibiotics.

My first thought was "Okay, this is treatable. I will need to give her doxycycline for six weeks and life goes back to normal." While there was initial improvement in her kidney values after treatment, within six months after initial diagnosis from the tick disease, her kidneys did not respond as we had hoped and she was diagnosed having protein losing nephropathy secondary to Ehrlichia exposure. So now the veterinary technician has become the owner of a dog with long-term kidney disease.

I had myself a nice little pity party, cried and raged death to all ticks. I held Izzy close to me, as much as she would allow me, as she tends to not be a lovey-dovey canine. She was showing absolutely no signs of being ill, but her labs looked terrible! I did research. I researched protein losing nephropathy. I went to the International Renal Society (IRIS) and staged her disease. I started looking for any treatments. Veterinary professionals are similar to our clients, we too want to learn more about a condition our pet may have been diagnosed with. We may have a better understanding of the physiological impact of diseases thanks to our education and experience, and we may have access to textbooks or papers to help in researching the condition. We may have access to specialists that can help point us in the right direction in our research, as our wonderful VIN consultants helped me with. We also have a special relationship with the veterinarians we assist on a day to day basis. I worked closely with Izzy’s veterinarian, Dr. Jeanie, when I was still in clinical practice. She has been a tremendous support through Izzy’s illness, allowing me to keep track of Izzy’s urine specific gravity at home, drawing blood for her lab work at home and bringing it into the clinic to help keep Izzy’s stress level down, and looking into all of the research I have found.

But this knowledge and access to information can be a two-edged sword. In my 20-plus years as a veterinary technician, I have nursed patients with the same condition and know the poor prognosis too well. I had a good idea what Izzy’s future looked like and what little time I have with her. It is definitely not easy, but we have to remember that each pet or patient is different; they may not follow the textbook or have the same issues as patients we have nursed. Our knowledge tells us one thing, but that does not necessarily mean that the disease will progress in the same way. As I review Izzy’s lab results, on paper it looks like she should be a very ill dog. The reality of it is she has slowed down a little, but otherwise shows very few usual symptoms of kidney disease. A very wise friend told me to treat for the symptoms, not the test results. It is difficult though, because in my 20-plus year career as a veterinary technician, I have seen what happens with patients that have similar lab results. But I take it day by day and celebrate each day Izzy is active and happy. I know that one day, most likely in the near future Izzy will stop eating, may not be able to hold her urine, develop anemia from her kidney issues, and I will need to make a decision on whether or not she should go forward living in pain from her disease. Even though I have made this decision with other pets, it still hurts every time I have to face it again. But when the day comes, I will be there with her, hold her until she takes her last breath, and hope she knows what a privilege it was to share her life. I will forever have her memory in my heart.

The next time your veterinary technician or veterinarian tells you, “I understand,” believe that we really DO understand. We have most likely have encountered the same issues and feelings that you are going through. We are not only here to guide you through the intricacies of medical issues your pet may encounter, but we are also here to support you. And when we are on the other side and our pet is the patient, the veterinary medical team is there to support us.

2 Comments

Shanna Compton, DVM
August 30, 2016

Yes, knowledge is indeed a two-edged sword.  My darling fluffball, Jareth, was eventually diagnosed with lymphosarcoma during a training exercise with an ultrasonographer.  He's going through chemotherapy and I know all the positive and negative aspects -- even the ongoing costs that can be quite prohibitive.  I have no illusion that he will live forever, but I do know that I can face the next client with a pet with lymphosarcoma and say, "Here is my experience with chemotherapy."  I hope it will help.


Ginny
July 1, 2016

Nice article. I'm sorry to hear the damn tick has permanently damaged your dog, Izzy, and I hope you can deal with the progression of her disease compassionately.  I clicked on this article because my own dog was diagnosed with a right CCL tear, 4 days after being released from exercise restriction following his surgical repair on the left one. Go figure.


 


 
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