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Upset by guilt trip from veterinarian


Pegasus
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My dog was a street rescue when he was a half-grown puppy. He was in bad shape, neglected and abused, covered in ticks. He is now 14 years old and showing the signs of being an old dog with health issues: heart murmur, arthritis, cloudy eyes, hard of hearing, and various lumps and bumps.  The vet is pushing for all sorts of tests to find underlying issues as well as surgery. Cancer is on the table as well as some rare disorder that I can't remember the name of.  I said no to the testing but she can't seem to let it go. She called again last night to discuss options.

The dog currently has, from all observations, a good quality of life. He does sleep a lot but shows clear signs of happiness when I come home, when he is fed, and when he gets to go for a walk (which is several times a day). I do not see any signs that he is currently suffering.  When that changes, I will have him euthanized.

Am I out of line?  I see no point in putting him through various testing, much less surgery, when I'm not interested in pursuing cancer treatments or other extensive treatments.  Am I heartless for simply letting him live the rest of the good times that he has left?

I need some feedback because, while DH is leaving the decision to me, I can tell that he isn't as on board with saying no to the testing/surgery.  He seems to think it is worthwhile knowing what is wrong even if we don't treat.

Thanks.

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No, you're not out of line at all IMO. I'm all about pain control (medication) in elderly dogs, and doing whatever else you can to maintain quality of life like warm, cushy sleeping spots and non-slip rugs and things like that. Expensive/invasive testing to maybe possibly gain just a bit more quantity of life--not so much. Don't let your vet bully you. Stand firm or maybe even consider finding another vet.

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I agree with you. It’s a hard decision to make, but you could spend thousands of dollars to extend your dog’s life by only a year or two. If he is comfortable, let him stay comfortable. 

I also agree about finding a new vet, one who has more similar beliefs. 

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The only time I'd do a bunch of testing is if I feared the dog was quietly suffering and I wanted to be sure.  I'm not sure how well dogs hide pain, but cats hide it well.  I had a cat who had bone cancer.  She hid the pain well and she lived with the cancer for a while.  But later, after she died, I found out that bone cancer is excruciating.  She lived for months in excruciating pain.

I can barely even think about it and I comfort myself with the fact that she's dead now and no longer in pain, because thinking of her lying in her little bed, hurting, is horrifying.  She would meow when we tried to move her, but we thought she was just being old and cranky because we didn't know better (I was only 20 at the time).  She was meowing because it hurt.

So...the only time I'd go for the testing, is if it would reveal a painful condition that the animal might be hiding.

If there doesn't seem to be a painful condition in the mix, or if it seems the animal has something with mild pain that can be controlled, and you are controlling it, then I wouldn't do the testing.  I do put my money where my mouth is (literally) and when I had a kitty 2 years ago who suffered from an expensive injury, I chose to have him put down because the treatment would have been triple the amount I can afford.. And the kitties before that who had things like kidney failure--we chose not to treat, but put them down instead.  Heart-wrenching decisions, but I learned from another cat whom w tried to treat, that treating complicated medical conditions in older animals makes their quality of life suffer, and only adds a few months to their lives anyway.

I love my animals dearly, and these things are hard to navigate.  Bottom line:  don't feel pressured to do the testing unless you want it for your own information--not for the vet to make money and treat the dog with expensive and painful treatments.

Edited by Garga
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3 minutes ago, Rachel said:

If your husband isn’t completely on the same page you could consider allowing testing and treatment for up to a certain dollar amount.  I would consider that only IF it would yield new information to help your dog continue to have a comfortable life. 

This.  I have a dollar amount I'm willing to go up to. And I stick to it.

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I’m so sorry you’re going through this ❤️ If you think he’s in pain, please find another vet that can help alleviate that pain so he can live out his days happy.  Otherwise, I think your vet is just a bit... overzealous, perhaps.  

We recently went to an emergency vet with a literally dying kitty in order to get her some palliative care and the vet tech was freaking out about all of these tests that we did not want just to figure out WHY she was dying.  The vet was much more understanding and willing to admit that kitty maybe had a day or two left and testing wouldn’t do anything.  

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I agree with you completely.  We recently lost a very sweet, beloved dog to brain cancer.  They deduced that it was brain cancer based on symptoms (and I saw two different vets for this to be more confident about the diagnosis).  They also offered an MRI to be certain of the diagnosis, and treatment options to extend life.  We decided instead to pass on both the MRI and the cancer treatment, and to put him on prednisone to reduce inflammation and make him as comfortable as possible for the time he had left.  I won't lie, finances were part of that decision.  His treatment was going to cost about what a year of my daughter's college expenses cost, and that was just unreasonable for us.  But it wasn't just that.  It was also a quality of life issue.  We did not want to put him through the trauma of treatment.  He got to spend his last few months at home with his family where he was happy, rather than frightened and uncomfortable in vets' offices.  He passed away peacefully in his sleep here at home.  We have no regrets about our decision.  And the vets who treated him were all supportive and understanding of that decision.  Different vets have different philosophies about this sort of thing, and that is of course understandable.  But your vet needs to respect your decision.  I hope that she will stop pressuring you, but if not, it might be time to look for a different vet.  And a second opinion might put your husband's mind at ease too.  Just a thought.

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I just had a late night visit with the cat last night.  (And I don't even like my cat. ? )  I was on board with a general blood test. I was pretty certain he was having kidney issues which, for us, means euthanizing. We tried comfort care for one cat about 15 years ago, but could tell that it wasn't really keeping her comfortable.  And our current cat's brother went to zero kidney function overnight.  So we don't mess with that anymore.

Wouldn't you know it, demon cat's kidneys are fine! He just needs about $20/mo in thyroid meds for the rest of his life.  (He's 12.)  I don't consider that an extreme measure, and his quality of life should be normal for quite a while.

So, while I wouldn't do thousands of dollars in testing and treatment, I'm clearly on board with a couple hundred bucks to make sure I'm not missing a simple issue.

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I think I'd do as you are trying to do.  That said, it might depend on how much the testing costs.  Even if you don't treat medically, it might be useful to know what to expect and possibly consider some reasonable pain management in the future.  But I have to admit I would not spend a lot to diagnose or treat an elderly dog for chronic / old-age issues.

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UnUnless there’s something very treatable  that could be figured out with a noninvasive test, I would not do them.

If he likely has arthritis as one problem I would try to use something for arthritis and Pain  which I think  could improve  life quality. 

We faced a similar thing  with an elderly dog a few years ago. And I am currently facing something similar in a 16-year-old cat, where I am making the decision to let her have good quality of life now, rather than surgery and invasive treatments. 

We had a dog some years back who died all alone at a vet hospital —and she had always hated vet hospitals so I am sure she was not happy— during an attempt at life prolonging treatment, which colors how I now deal with such situations. 

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He might change his mind about the worth of knowing even if you don’t treat when he sees the bill for testing and surgery. Because it’s expensive as all heck. And honestly, surgery is extremely difficult for a dog that old even without other health issues. Pain management can be handled as it comes up.

This is our plan with our dog and cat. The dog is nearly 13.  Poor thing is going blind and deaf, and has arthritis.  He has pain meds and when it ocassionally gets really bad, we give him an extra to ease things.  He is a happy dog who wants nothing more than to play ball and cuddle up next to anyone willing.  I see no reason to put him through painful testing and surgeries that will add recovery pain and down time for weeks or months while at best adding not much more time than what it took to have the procedures done.

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I am doing the same for my 18-yr-old cat, also a street rescue at about 2-yrs-old.

I'd actually consider some simple testing to rule out painful conditions, because as Garga said, cats do mask pain well. However, she now fights and tries to escape at the vet (usually successfully), so I can't imagine them getting much done. On her last visit for a respiratory infection, the vet was just like, yeah, I'mma take your word for it, here's a prescription, lol. 

While we do have to be gentle with her, she climbs onto my lap daily for lengthy petting sessions, so I'm pretty sure she's not in ongoing pain. 

I would give your doggo as much pleasure as possible each day, and leave it at that. If he's able to go on walks and is happy about it, I wouldn't be worrying about quality of life yet. 

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3 hours ago, Carrie12345 said:

Wouldn't you know it, demon cat's kidneys are fine! 

 

Ha!  I have a demon cat too...When talking to other people I differentiate "demon kitty" from "nice kitty".

And OP, I agree with you. 

Edited by goldberry
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I would probably get a new vet.  Unless the vet knows that there is likely a problem that has an easy treatment that will improve quality of life, then I can so no reason for her to be bothering you at home when you made your wishes clear.  Whenever we take our dog in for an illness, the vet always lays out the options ... what kinds of tests will yield what kind of information and how that would affect treatment.  And, he has always given us a conservative option to try first (unless it is an emergency).  And our dog is only 8 years old and very active.  He is very aware of the fact that cost and age are factors that come into play when it comes to treatment.  

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Honestly, in our family even a person at a comparable age would probably not pursue costly testing, but would rely on inexpensive treatment that focused on comfort measures.  

I have a 19 year old cat.  I've noticed a big difference in the vets that primarily treat vets (the Vets for Cats place) and the "farm vets," who also treat a lot of vets.  The first one seems to expect that cost will never be an consideration and that of course you want lots of testing.  

Our 19 year old cat has had kidney issues for years, but she still clearly is pleased by food and petting.  She walks around the house every couple of hours.  She jumps up on furniture.  She smacks the three year old cat around if he harries her.  She at least appears to have a good quality of life.  We took her into the vet fairly recently because she was vomiting a lot, and we consented to an xray and a blood test.  Turned out she was constipated, and that was a fairly easy treatment.  

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Why did the conversations happen with the vet in the first place? Did you take him in for an ordinary check-up or for a problem?

I know when we took one of our dogs in for illness/problem (which turned out to be the end of life issue) the vet presented so many options we couldn't decide. She called us later that night when she had more time to talk and we had time to process when she had presented.

I don't know how everything played out with you, and why your vet called you but maybe she felt like she hadn't done a thorough job during the appointment, with presenting the options and answering questions.

Edited by unsinkable
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that's great the vet cares about the dog, but how much difference would it make FOR THE DOG to spend that much money on tests?   I know it would make a difference to the vets bank balance. . . . (I've had a human dr who ordered tests for her bank balance, as opposed to my well-being. . . . )

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7 hours ago, Pawz4me said:

No, you're not out of line at all IMO. I'm all about pain control (medication) in elderly dogs, and doing whatever else you can to maintain quality of life like warm, cushy sleeping spots and non-slip rugs and things like that. Expensive/invasive testing to maybe possibly gain just a bit more quantity of life--not so much. Don't let your vet bully you. Stand firm or maybe even consider finding another vet.

Agree with Pawz. No vet I've worked for would have pushed for this. offered? Sure, they really HAVE to offer, or you could sue them for not giving you all the options. But push? No. 

I also agree that pain control is a BIG thing in dogs with arthritis, and what your vet SHOULD be pushing is pain medication. Not expensive testing.

I'd find a different vet, and seek out some pain meds for the arthritis. Dogs won't show you "pain" symptoms, they don't whine or whatever, because to show weakness like that will get you picked off by predators. They show pain by being slower to get up, limping, moving stiffly, etc. If you think he has arthritis, that's enough to say he is in pain and could probably use to have a script of anti inflammatory meds. Another vet will be happy to do that for you. 

Use the words "palliative care" and it might help them get on the same page. 

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Also, I think at some age/health any surgery will do more harm than good.  In the last year, I know of two elderly people who died prematurely because of surgeries.  And I don't know that many people.  One got an infection in the hospital, and the other just never really recovered from the surgery.   With our pets who can't really communicate their problems or know what is going in with a surgery, it has to be worse.  
 

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I used to have a friend that would drive around 10 hours for vet care at a premier vet school.   Drive started from a major metropolitan area with a great many excellent vets.  Her Siamese cat got a type of cancer that is both very painful and the treatment has an almost zero % chance of even prolonging life.  Nose, maybe?   Anyway, her vet gave her all sorts of grief and she was really torn up inside.  A beer or few and I were trying to patch her back together.  

 

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27 minutes ago, Ktgrok said:

Agree with Pawz. No vet I've worked for would have pushed for this. offered? Sure, they really HAVE to offer, or you could sue them for not giving you all the options. But push? No. 

I also agree that pain control is a BIG thing in dogs with arthritis, and what your vet SHOULD be pushing is pain medication. Not expensive testing.

I'd find a different vet, and seek out some pain meds for the arthritis. Dogs won't show you "pain" symptoms, they don't whine or whatever, because to show weakness like that will get you picked off by predators. They show pain by being slower to get up, limping, moving stiffly, etc. If you think he has arthritis, that's enough to say he is in pain and could probably use to have a script of anti inflammatory meds. Another vet will be happy to do that for you. 

Use the words "palliative care" and it might help them get on the same page. 

have to disagree here.  growing up, we have one whine frequently.  he'd caught something in his throat - it was painful, but didn't obstruct his breathing.  but you better believe he was whining!

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21 minutes ago, gardenmom5 said:

have to disagree here.  growing up, we have one whine frequently.  he'd caught something in his throat - it was painful, but didn't obstruct his breathing.  but you better believe he was whining!

It may have been more anxiety than pain that caused the whining, dogs DO whine with anxiety. But most do not whine over chronic pain issues like arthritis, or even with broken bones and such. In fact, they have done studies that show (using remote cameras) that many dogs will stop any signs of pain as soon as a human walks into the room. 

Panting, pacing, restlessness, stiffness, decreased activity are all more common signs of pain than whimpering/whining/crying out. 

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8 minutes ago, Ktgrok said:

It may have been more anxiety than pain that caused the whining, dogs DO whine with anxiety. But most do not whine over chronic pain issues like arthritis, or even with broken bones and such. In fact, they have done studies that show (using remote cameras) that many dogs will stop any signs of pain as soon as a human walks into the room. 

Panting, pacing, restlessness, stiffness, decreased activity are all more common signs of pain than whimpering/whining/crying out. 

That's so sad. I'd be heartbroken to find out my doggies were in pain and we didn't know. ?

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4 minutes ago, hippiemamato3 said:

That's so sad. I'd be heartbroken to find out my doggies were in pain and we didn't know. ?

That's why we (in the vet field) try to stress going to the vet if there are behavior changes, appetite changes, etc. A dog that no longer jumps up to greet you may be just sleepy, or going deaf and didn't hear you, or has arthritis and it hurts to get up and down. Or a dog that has been a bit grumpy may be in pain. heck, my own dog that got a bit less tolerant of dogs playing roughly with him turned out to have a GI problem caused by a food intolerance. We switched to a different protein and he's back to playing like a puppy. Another dog I had had settled down, and I though oh, she's finely maturing into a well behaved dog! turns out she was in pain from a broken tooth! It was way in the back so I couldn't see it, and she was still eating fine (probably chewing on the other side) so I had no idea. A routine check found it and after having it removed she went back to being an energetic pain in the butt, lol. She wasn't maturing, just hurting. And the ONLY sign was being less playful. 

And I can't tell you how many people ignore even obvious signs of pain. So many would bring their dog in because it was limping and then say it wasn't in any pain. Um, then why is it limping? That question would totally throw them. Short of a very rare muscle weakness or nerve issue, if you are limping, it's because it hurts to use that leg! And yet, 90 percent of owners of limping dogs would swear their dog wasn't in any pain, because it didn't cry or whine. 

 

Edited by Ktgrok
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For what it's worth, I am a licensed vet tech, (worked for 10 years and now I'm home with my child).  I also recently put down my 18 year old cat due to quality of life issues, and got a big guilt trip from a veterinarian about it. 

My personal standard for testing is this: Will the test change how you treat the condition?  If the results of the test will impact what you do, then you should do the test.  And if you run the test, can you afford the treatment that the test now indicates?  There's no point in running a test to diagnose a condition that you can't afford to treat.   

My question for your vet would be "What diseases are you screening for? What is the treatment plan for those diseases? What is the prognosis for a pet of this age with that disease? What kind of quality of life will they have? What is the prognosis if we *dont'* treat the disease?"  The vet would have to present a very, very strong case that surgery would benefit my pet for me to consider it at age 14.  Something like "The pet has a large mass that is causing limited range of movement.  If the mass is removed, they will be more comfortable and will be able to walk".  Something like that I would probably do, (or else consider euthanasia).  There are probably other reasons for surgery at that age, but I'd have to know more information about WHAT the doctor was looking for and WHY they want to do surgery.  Like...what's the end goal here? 

Honestly, for a 14 year old pet, I would tell the vet that you are interested in comfort care/palliative care only.  They may still want to run some bloodwork to make sure the kidneys and liver can tolerate the arthritis meds, and I think that is fair.  

   

 

 

Edited by MissLemon
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OP I believe you are doing exactly what you should be doing. We are animal lovers. Your dog has already lived a long life and hopefully can enjoy some additional months or years, with a good Quality of Life. If and when you believe that he is suffering, then the time has come to put him down.

I would probably be looking for another Vet.

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52 minutes ago, Ktgrok said:

That's why we (in the vet field) try to stress going to the vet if there are behavior changes, appetite changes, etc. A dog that no longer jumps up to greet you may be just sleepy, or going deaf and didn't hear you, or has arthritis and it hurts to get up and down. Or a dog that has been a bit grumpy may be in pain. heck, my own dog that got a bit less tolerant of dogs playing roughly with him turned out to have a GI problem caused by a food intolerance. We switched to a different protein and he's back to playing like a puppy. Another dog I had had settled down, and I though oh, she's finely maturing into a well behaved dog! turns out she was in pain from a broken tooth! It was way in the back so I couldn't see it, and she was still eating fine (probably chewing on the other side) so I had no idea. A routine check found it and after having it removed she went back to being an energetic pain in the butt, lol. She wasn't maturing, just hurting. And the ONLY sign was being less playful. 

And I can't tell you how many people ignore even obvious signs of pain. So many would bring their dog in because it was limping and then say it wasn't in any pain. Um, then why is it limping? That question would totally throw them. Short of a very rare muscle weakness or nerve issue, if you are limping, it's because it hurts to use that leg! And yet, 90 percent of owners of limping dogs would swear their dog wasn't in any pain, because it didn't cry or whine. 

 

 

We are at the vet all the time with 4 dogs, one of whom has a seizure disorder and neurological damage so his back legs don't work properly. I can't tell you the number of times we've taken the dogs in for behavior changes - it always means something! 

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57 minutes ago, hippiemamato3 said:

That's so sad. I'd be heartbroken to find out my doggies were in pain and we didn't know. ?

 

We have webcams to observe our pets when we are gone, they're really cheap these days. We didn't get them for this reason, but they would show if the animals are acting differently when humans aren't around. 

So far, all of our animals are their usual annoying, mischievous selves when observing them on camera, but that's good information to have. 

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Thank you, everyone. I really appreciate all the feedback.  I've never been thrilled with this particular vet but DH is usually the one who takes pets in for routine visits and he insists on one that is close and convenient.  I may very well take a day from work and take the dog to a different vet to discuss arthritis medication.  We've had him on joint support supplements for a few years now and he walks easily and still gets up and down from the one sofa he is allowed on.  He is laying on the floor beside me right now with his back legs splayed out directly behind him, just as he did when he was young.  So, I don't think the arthritis can be that bad.

This was a routine visit to the vet, mainly because we ran out of heartworm preventative.  I had a pet die from heartworms years ago so we are diligent to use the preventative year-round for the dog's lifetime.

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This is one of the reasons I'll never have another pet. The vet we had for my cat's whole life went from chill and helpful and supportive about stuff when the cat was young to shaming me for not putting down a ton of money the week we had to have the cat euthanized. I was like, look, you're telling me that the best possible outcome would be daily medication for this cat. This cat that throws up literally every pill you give him and has to be forcibly held down for an extended period to get him to swallow in the first place. And who is old. You're going to act like I'm a terrible person for not doing these tests?

I think the culture has just changed so much. If you don't spend every penny on a pet, you're a bad person. Finding a vet who gets that you're willing to do maintenance care and want your pet to be comfortable, but aren't going to drop thousands on an elderly pet is just getting really rare - at least around me.

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1 hour ago, Farrar said:

This is one of the reasons I'll never have another pet. The vet we had for my cat's whole life went from chill and helpful and supportive about stuff when the cat was young to shaming me for not putting down a ton of money the week we had to have the cat euthanized. I was like, look, you're telling me that the best possible outcome would be daily medication for this cat. This cat that throws up literally every pill you give him and has to be forcibly held down for an extended period to get him to swallow in the first place. And who is old. You're going to act like I'm a terrible person for not doing these tests?

I think the culture has just changed so much. If you don't spend every penny on a pet, you're a bad person. Finding a vet who gets that you're willing to do maintenance care and want your pet to be comfortable, but aren't going to drop thousands on an elderly pet is just getting really rare - at least around me.

What you are describing happens a LOT.  Veterinary medicine does a terrible job of explaining to owners what "end of life" care looks like for pets and owners.    

It's almost like the profession doesn't want to acknowledge the patients get old and die.  Some problems can't be fixed.  Sometimes the "fix" is worse than the cure.  I've worked with some doctors who privately admit to the support staff that they wish the owner would realize that euthanasia is probably the best option for the pet, but then skirt the issue in the exam room and say "This medication should help.  You should see improvement over time...".  (How much time? How much improvement? What's the goal of this treatment? What are we trying to accomplish here, doc?)  

Then those same owners would show up in tears in my ER, saying they'd spent tons of money, done all the treatments, and while Fluffy had improved fractionally, she was still suffering.  And the owners are confused and upset when we say "I'm sorry, but I don't think Fluffy has a good quality of life anymore.  We could do X,Y, or Z, but euthanasia is a valid consideration, as well".  

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1 hour ago, MissLemon said:

What you are describing happens a LOT.  Veterinary medicine does a terrible job of explaining to owners what "end of life" care looks like for pets and owners.    

It's almost like the profession doesn't want to acknowledge the patients get old and die.  Some problems can't be fixed.  Sometimes the "fix" is worse than the cure.  I've worked with some doctors who privately admit to the support staff that they wish the owner would realize that euthanasia is probably the best option for the pet, but then skirt the issue in the exam room and say "This medication should help.  You should see improvement over time...".  (How much time? How much improvement? What's the goal of this treatment? What are we trying to accomplish here, doc?)  

Then those same owners would show up in tears in my ER, saying they'd spent tons of money, done all the treatments, and while Fluffy had improved fractionally, she was still suffering.  And the owners are confused and upset when we say "I'm sorry, but I don't think Fluffy has a good quality of life anymore.  We could do X,Y, or Z, but euthanasia is a valid consideration, as well".  

 

I think that is true for people doctors/nurses too.   The truth comes in what they choose for themselves.  

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Our last dog had cancer.  It was in his leg.  The Vet in CA performed surgery but said he couldn't get it all.  It was embedded in his bone.  He said if it were his dog, when it came back, he would go ahead and put him down.  Between his age and going through surgeries, etc...it just wasn't fair to the dog.

We moved to NC.  It came back. The little Vet, young, just out of Vet school, took a look at me and said, "If you really care about your dog, you will have this leg amputated and let him live.  It will only be about $5,000."

The dog was 13 years old!  And the leg was a front leg.  His breed's typical lifespan was 14 (golden/corgi mix.)

We put him down.  It was hard and I was so upset about the Vet talking to me like that.  But I still don't think I made the wrong decision.

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