Visiting the veterinarian for a health concern with your pet can be a very difficult time due to the worry of what may happen, what the diagnosis may be. To make your visit as efficient and useful as possible, you’ll want to make sure you are prepared in advance, that you use the time effectively at the vet’s office and are prepared to take on the caregiver burden afterwards.
The better you as the caregiver are informed, intellectually and psychologically prepared about the whole process – from diagnosis, treatment, through to end-of-life care – the better you will cope with the caregiver burden and with the psychological stress of grief.
Detailed communication about diagnostic tests, treatments, therapies, medication, side effects, progress of the illness etc. is the key to successful care and cure!
Successful communication is at the heart of providing a high-quality diagnosis and medical care for your dog and is key to building trust and a strong relationship between the veterinarian and the caregiver.
However, a lot can go wrong here if you as the caregiver are not prepared. Bad communication between you and the veterinarian can cause misunderstandings, incorrect diagnoses, conflict and frustration – and ultimately, death.
Unfortunately, we had to learn this the hard way!
In order to help other caregivers of cancer patients to avoid the problems we encountered, I wish to present some guidelines to help you through the diagnosis, treatment and end-of-life stage and to make as sure as humanly possible that all is done for the best of your dog.
I am certain, however, that the unfortunate experiences we had with Alice are not at all typical – as a matter of fact, they are probably more the exceptions than the rule. In the majority of cases, the communication between caretakers and veterinarians functions perfectly well. But, since we don’t want to run the risk, we are well advised to take preventive measures:
Prevention is better than cure!
One basic communication skill is to describe and ask open-end questions instead of expressing your often non-expert assumptions.
Close-ended questions are “yes-or-no-questions”.. With such yes-or-no-answer questions you could cut the conversation short, leaving you with an incomplete evaluation. You need more than one-word answers from your veterinarian—which means you need to ask open-ended questions: When, where, how, why….?
Let’s imagine the following fictional situation:
You go to your family doctor with a health issue. You tell him that for a couple of days you suffer from a bad stomach ache because you have eaten too much chocolate. The doctor will acknowledge this information and give you a medication like Bioflorin to ease your troubled digestive system and stomach ache. He will most probably not put you through a series of diagnostic tests to find out why you suffer from stomach ache – because you gave him a ready-made diagnosis.
Had you just told your practitioner that you have been suffering from a bad stomach ache for 3 days, he would have started different screening tests to find out what lay behind your pain.
In one word, in this fictional case story, you never gave your doctor the chance to think about a list of reasons for your pain and start a series of diagnosis tests to find plausible causes and formulate one or several diagnoses. You came with a ready-made non-expert explanation and assumptions, instead of asking open-ended questions. This is not a good communication approach!
Therefore, when you go to a vet for the examination of symptoms you have noticed, it is imperative that you describe your dog’s condition and ask your vet open-ended questions: don’t start giving your personal explanations and non-expert diagnosis, which might cut short the vet’s thinking about other possible and plausible causes.
Don’t forget: Let your veterinarian do his work! It’s his job to listen to your description of the symptoms and the abnormalities you have noticed, to find out what might be the causes for these symptoms by using diagnostic and screening tests and then to pronounce a likely diagnosis, which will then be followed by an adapted treatment.
IT’S NOT YOUR JOB !
Moreover, let’s not forget that vets often have a strict time schedule to manage and are often eager not to keep clients waiting outside. So some vets might be tempted to listen to and accept your judgment. This can be dangerous.
Here are some points / guidelines you want to consider for making the collaboration with your veterinarian a success:
1. Note down your pet’s condition: Symptoms
If something is bothering you about your pet, it is really helpful to keep notes about the things that you have noticed, such as reduced appetite, loss of weight, biting one area of the body, pacing, making strange noises or vomiting. You should also be able to provide information about the duration of the problem, the precise symptoms, and any unusual reactions that you have noticed in your pet.
2. There are no dumb questions!
There is no such thing as dumb, awkward, disturbing questions. The slightest change in your pet’s condition can be a symptom of a bigger problem. Do not hesitate to ask your veterinarian about it and to insist on further medical examinations and/or a second opinion, if necessary using different detection methods than the first vet. You are your dog’s parent and know your dog best, so don’t easily be contented by fine words and quick explanations. Don’t be impressed by the “white coat” authority effect.
3. Don’t lose time!
Don’t wait too long to address an issue you have noticed with your pet. Some problems can turn into serious emergencies within 24 hours. For many conditions (like Alice’s white tongue and gum), fast action and immediate treatment can save your pet’s suffering. If your veterinary office is closed for the weekend or doesn’t have the capacity to see you, immediately contact another veterinarian or clinic. This might be moment to insist and react quickly.
4. Prepare questions for the consultation at the veterinarian’s
It can help to write down a list of questions, so you have all the needed information and don’t forget anything when talking to the veterinarian. It could be questions about treatments, therapies, diet recommendations, future development of the illness, tips on how to organize care at home, how to give a prescribed medication, etc.
5. Pay attention to the exam
This is not the time to check your smart phone! Watch carefully what the vet is doing, and pay attention if he tells you anything important about your pet’s condition. If you have any questions about what the vet is doing during the exam, make sure to ask.
6. Get as much information as possible on further diagnostic options
You as the caregiver want to be sure that all diagnostic possibilities have been exploited to find the correct diagnosis. Have him explain everything as many times as is necessary, to clear up any confusion and to prepare you as the caregiver for what you need to expect and how to react to it.
Ask your veterinarian about his exam findings and have him explain (in understandable language) what may be the causes for the symptoms. Ask him to make his recommendations. If your dog is not well, or if something abnormal was seen during the first exam, your vet should discuss the details of further possible follow-up diagnostic tests to get a reliable result. If further diagnostic testing is recommended, ask the vet to explain what tests he wants to do, what the procedure is, the possible side effects and reactions, what these tests will tell him – and what they will cost. You want to make sure that all possible medical options have been exploited in favour of your dog’s cure.
7. Get as much information as possible on treatment and therapy options
If treatments and therapy are recommended, ask your veterinarian to explain what the treatments involve, what the procedure is, what side effects they might have, how they will help your pet – and what they cost.
Pay attention to what is being communicated. Clarify anything you are unsure about. Insist on the veterinarian using a language you understand, not medical jargon or abbreviations. The vet should take all the necessary steps to make sure you understand him and ask if you have questions before leaving the room.
8. Ask for diagnostic tests and treatments by a specialist
If you want to see a veterinarian with more specialized training in your dog’s condition, ask for a referral to a specialist or a clinic.
9. Talk about your emotional, time and financial limitations
Tell your veterinarian about the level of care you expect for your dog (if possible complete cure, or only pain management, hospice etc.), as well as your emotional, time and financial limitations.
10. Call your vet if you have additional questions
Sometimes you won’t remember everything the vet told you, or something else will come to your attention after the visit. Feel free to call and talk to the vet in order to get those sorted out quickly. It is his job!
11. Written handouts
Request reference materials and handouts with information on the diagnosis, treatments, medications and therapies for you to read at home, in a more peaceful and relaxed moment.
12. Ask about finances
Taking care of a pet can be very expensive, especially if your dog needs some additional medical treatment. If the vet suggests something, be willing to discuss possible options. This can include whether animal insurance will cover the costs, whether there are cheaper procedures, or if there is the possibility of paying large bills in installments. Be honest about your ability to pay.
13. Ask for abundant information about your dog’s final stage of life
If treatments and therapy have failed and your dog has entered his final stage of life, and you have decided on hospice care at home until his death, then ask your veterinarian to explain every single expected stage of this last moment of your dog’s life: what exactly hospice care involves, how your dog’s health will evolve, what pain management to undertake, etc. This will help you to make your pet’s final days as peaceful and dignified as possible.
Anticipating what exactly will happen during this last stage of your dog’s life will also help you to cope with this emotionally difficult time and attenuate your grief..
14. Ask for a special diet plan for your terminally ill dog
For end-of-life care, you will need to adapt your dog’s diet plan. He now needs a high-energy but easy digestible whole-food diet (see chapter 12).
15. Ask for practical pieces of advice on how to organize the end-of-life care and what comes with it:
For example, if your dog has developed incontinence and needs help getting up to urinate or defecate, your vet might suggest that you use a sling or a large towel to wrap under your dog’s body and assist her. If your dog suffers loss of movement, pain, a rattle-noise during the dying stage, and if your pet dies in your home, what are the options to consider ?
16. Ask for detailed and realistic information on your dog’s last stage of life
The more realistic and practical information you can have, the better you can help your dog to pass his last days/hours in peace and dignity – and help yourself to cope with the last good bye.
You might want to know: Which are the typical stages during the last stage of life? How will this impede the quality of life? How will the dog’s last days / hours be? How do I know when my dog is ready to go? How can I help my dog in that moment? When is euthanasia necessary?
17. Pain management at your dog’s final stage of life
When your terminally ill dog has entered the end-of-life stage and you have decided to care for him/her at your home (hospice care), ask your veterinarian to give you a pain-management medication. The field of pain relief is well advanced, so make sure you ask your vet to give you a pain-killer in form of a patch – in most cases, a dog in his final stage of life will not be able to swallow medication.
18. Discuss and elaborate a personalized, written end-of-life action plan.
19. Confirm your understanding of the message from the vet and, if possible, summarize what you think you have understood in your own words.
Case-story no. 1
Alice was not yet 5 years old. We had trained a lot for competitions, and all of the sudden she started to limp. I spared her and let her rest, gave her Arnica. But nothing seemed to help. So, we went to the veterinarian for an examination and a piece of advice. He looked at her, made his examination by touching her body, back and legs. It was clear, he declared, that Alice had a dysphasia and had to be operated on immediately. I was shocked and worried for my darling and accepted immediately: her well-being was my first concern, although her sportive career would be over from then on. A date for the operation was fixed the same day.
It is only thanks to my husband that Alice hadn’t to undergo the operation: He insisted on seeing another more specialised veterinarian for a second opinion. This veterinarian took an x-ray and found…. nothing! Alice just happened to have a sprained join, was given antibiotic and Arnica. And after a couple of days she was herself again….
Case-study no. 2
Winter 2017, approx. 5 months before Alice’s cancer diagnosis, we noticed that she had developed large dark (dark brown, reddish) patches just under the skin in the area of her abdomen. We went to two different veterinaries, asking the vets whether they would confirm what we had read on the internet, that the patches were pigment changes due to age? And they both did confirm this, reassuring us that there was nothing to worry about. We were contented.
However, at hindsight it puzzled us, that after the emergency surgery in August the same year (after her cancer diagnosis), when Alice’s spleen was removed, and 1 litre of blood was drained out from her abdomen and the blood-soaked flesh, these pigment changes had miraculously completely disappeared. Had these pigment changes been the first symptom of an important internal bleeding which had even penetrated the skin around the area of the abdomen?
Case-study no. 3
Spring 2017, only a couple of months before Alice’s cancer diagnosis, we noticed that she had suddenly put on weight and had a very swollen abdomen. We went to the vet and showed him our findings, explaining that we suspected this was due to the fact that we had stopped daily competition trainings a couple of months before, without adapting Alice’s nutrition plan. The vet looked at the abdomen and confirmed our suspicion. We were contented.
At hindsight, had the swollen abdomen not been the 2nd symptom of her internal bleeding, her punctuated spleen?
Case-study no. 4
Early summer 2017, a couple of weeks before Alice’s cancer diagnosis, we noticed that Alice had some blood in the anus. We went to the vet and showed him our finding, explaining that we suspected that the anal sac was infected and had to be emptied – a typical clinical finding with bitches. The vet had a look at the anal sac, emptied it and confirmed our suspicion and we were contented.
At hindsight, had the blood coming from the anal sac not been the first sign of massive internal bleeding due to the cancer?
Case-study no. 5
In the beginning of August 2017, 2 days before Alice’s cancer diagnosis, I noticed that Alice’s tongue was white. I phoned the vet and described the phenomenon, asking the assistant whether that could be due to the very hot weather and what to do? She kindly confirmed my suspicion and told me just to leave Alice quietly in a cold corner of the garden. I was contented.
This had already been the alarm signal!! Internal haemorrhage due to a punctuated spleen. She was bleeding to death! She could have died that very night already!
Case-study no. 6
Communication timing and place going wrong
10 days after the chemo-therapy, Alice lost massively blood coming from the bladder – although still being apparently fit, eating as normal, not showing any sign of suffering. We knew however it was the end, but went nevertheless with a blood sample to the local veterinary. It was a very busy day at the practice, many patients were waiting for their turn. After that we had handed in the blood sample at the reception, the veterinary met us in the waiting room and asked us to immediately drive to the clinic with Alice. Here and then, in the waiting room, in front of the reception desk, the veterinarian told me that I would now have to consider euthanasia. Alice stood next to us, wagging her tail.
It came as a shock!
A veterinarian’s personal opinion:
Finally, after Alice’s death, I asked our veterinarian if it would be advisable to have my other dogs regularly ultrasound-screened to prevent (or lessen the chance of) the same medical issue – especially keeping in mind that they both belong to the same family line and might have the same genetic background. This is a serious question! The veterinarian told me that of course I could do this but that in his mind this had little effect, then even if a regular screening was done, another cancer type could develop in other parts of the body. He gave me the example of breast-cancer-screening in women where despite of breast-cancer-screening another type of cancer might not be detected and develop elsewhere. In other words, he considered it not very useful …