Alternative thoughts

Re: Alternative thoughts

Kate Richardson — Thu, 09 Jun 2011 09:07:49 GMT

[quote user="Julie Innes"]

Having said that, I also once did an ex-lap on a cat belonging to one of our, erm more challenging clients, and found a liver riddled with nasty looking masses. She point blank refused to consider euthanasia while the cat was still under GA, so we reluctantly put the cat onto steroids to try to make it more comfortable. The bloody thing then went on to live for another 4 years, as she delighted in pointing out to us every time she came in. I swear she must have done some voodoo or something on him! I would have been doubting that I had ever seen the masses, but a colleague saw them too, thank goodness. One of those situations where you have to smile through gritted teeth and be glad to be proved wrong.

[/quote]

Shame you didn't/weren't allowed to biopsy. I had a similar case once where I was certain the liver was neoplastic. I knew the cat had liver disease and the plan was to biopsy it (this was before ultrasound was widely available) and on ex lap the the liver looked far worse than we were expecting, but the owner was keen to biopsy to confirm, so reluctantly I biopsied- it came back as severe inflammatory liver disease. Also had a bitch recently with what looked like nasty mammary tumours- again excised and histo- benign severe hyperplasia. So am always careful not to definitively diagnose neoplasia with my eyes alone now.

Re: Alternative thoughts

Andrew Kent — Sun, 05 Jun 2011 11:26:28 GMT

[quote user="claire godfrey"]

She refused to pay as she did not like the advice she had been given, the cat died by morning and we are still pursuing her for the money.

6 months later and still makes me wonder if I could have done anything differently.

[/quote]

Made her pay something up front before initiating treatment? I think that is entirely acceptable when seeing clients that you have no history with (and some that you do!)

Re: Alternative thoughts

Claire Godfrey — Sat, 04 Jun 2011 19:51:23 GMT

I had a lady ring me OOH, refusing to go to her own OOh provider and wanting me to see her cat.

When she arrived, well crashed through reception screaming as she thought cat had died, it was 12.30am saturday morning.

The cat was recumbent and non responsive, it was 19 years old, diabetic. Kidneys tiny, cat only just breathing. The lady refused to PTS, whenever the cat called out, in distress in my opinion, but in hers it was wanting to cling to life.

Her friend who had given her a lift to the surgery was of the opinion that she should PTS but ended up getting his head bitten off.

She refused to pay as she did not like the advice she had been given, the cat died by morning and we are still pursuing her for the money.

6 months later and still makes me wonder if I could have done anything differently.

Re: Alternative thoughts

Julie Innes — Sat, 04 Jun 2011 16:44:51 GMT

Horrible situation. I guess the fact that the cat died fairly quickly after that meant that it didn't suffer for too long

I was in a similar situation once, with a lovely elderly man who refused to get his enormous fat off-its-legs-and-urinary-and-faecally-incontinent german shepherd PTS. He couldn't life the dog, or help it outside, so it was lying in its own excrement, but he was horrified at the thought of getting it euthanased, I suspect probably because it was his only companion . I asked the local SSPCA inspector, who I knew quite well at the time, to pop in and have a gentle chat with him, and together they brought the dog in for me to PTS. I think I would possibly do similar again.

Re: Alternative thoughts

mariette asselbergs — Fri, 03 Jun 2011 20:58:07 GMT

Ha, we can actually do that since we grow purple potatoes (I think they are called "purple fuzzies!") in buckets (like Nelson Mandela........).

She also likes raw aubergines, I mean,she steals them if she can. This is an English Bull Terrier, they are a bit weird anyway,but very sweet.

Mariette

Re: Alternative thoughts

Evelyn Barbour-Hill — Fri, 03 Jun 2011 13:38:45 GMT

[quote user="J G Wray"]Oh dear, this isn't about you you know. No need to feel "hated".[/quote]

Are... are you s-sure? (Sob)

Re: Alternative thoughts

Bob Russell — Fri, 03 Jun 2011 11:35:07 GMT

Ultimately the decision is the owners and our job is to explain the situation and guide. This may have to be done firmly on occasions but over my whole career to date and thousands of patients I can only think of two occasions where I have felt strongly enough to 'bully' owners into making a decision. On each occasion there have been other factors involved.

On each occasion I have suggested getting a second opinion so the owner has had the opportunity for other options to be considered.

Re: Alternative thoughts

Martin Atkinson — Fri, 03 Jun 2011 11:17:54 GMT

The owner has a choice and apart from reporting them to the RSPCA for neglect/cruelty if we truly believe that choice to be wrong and will cause the patient suffering, we have to acqueisce. There are 2 sides to all these situations and as nutty as this client's belief seem to us they were plainly sensible to her. I am currently treating a fitting cat with CKD which came as a second opinion from a practice which had told theowner it should be euthanased to the point they were telling them it must be done or the cat would die a horrible death imminently (and probably they would subsequently spend their lives in purgatory). In all honesty its biochem wasn't that bad (BUN 38, Crea 647, Phos 2.47, USG 1.012 {they hadn't done UP/C ratio}, HCT 18%) - I've seen them a lot worse than that hanging on but more importantly it was bright and was eating a little. So apart from all the usual treatment for azotaemia/seizures in a CKD cat, I have implanted a skin button so the owner can easily give s/c fluids at home and addressed its concurrent anaemia with regular injections of EPO. 4 weeks on its BUN is 31, Crea 385, Phos 1.98 and UP/C ratio 0.5, & HCT 28%. He is very happy, does not resist the large volumes of fluid the owner is giving (>200ml daily), his weight is stable and his appetite acceptable. Whilst I wouldn't question Jon and his colleagues diagnosis/prognosis in his case, I have no doubt my case's ongoing survival is due is some part at least to the treatment I'm giving which the other vet hadn't considered but more than this, it goes to show that sometimes the owner's decision however irrational it may seem to us isn't always wrong.

Re: Alternative thoughts

Bob Russell — Fri, 03 Jun 2011 09:50:59 GMT

I was in this situation a number of years ago. That particular pet was in my opinion suffering and I told the owner in no uncertain terms my views. They were refusing treatment (euthanasia) but were in a very emotionally fragile state because of serious problems with a sick child. I gave them two options (a) take the cat to a vet of their choice for a second opinion (I would make the appointment on their behalf and check attendance) or (b) I would contact the RSPCA. After giving them some thinking time they allowed euthanasia.

They did come back a bit later and apologised for their behaviour! It was at this stage they explained (the child died).

I am glad they did not push me to the limit on this one!

Re: Alternative thoughts

J G Wray — Fri, 03 Jun 2011 07:31:35 GMT

[quote user="Evelyn Barbour-Hill"]What is wrong with respecting the owner's views, however lunatic?[/quote]

Hmmmm, there's a problem here if you can't see the problem with what you've written. [quote user="Evelyn Barbour-Hill"]

ere we go again, I've been led into trying to conduct a philosophical discussion which the shorter-sighted members of this forum are going to assume is my arguing an opinion that I do not hold. Well, you all hate me anyway, so here goes.

Cripes, even "pain" is hard enough to define. Define "suffering", without resort to anthropomorphism. Then say why you think your right to end suffering by killing the sufferer is absolutely indisputable.

[/quote]

Oh dear, this isn't about you you know. No need to feel "hated".

I chose malnourishment, loss of sensibility and mobility as additional qualifiers of suffering. All of these can be measured against normal levels of nutrition, sensibility and mobility -you do it every day in practice.

[quote user="Evelyn Barbour-Hill"]And of course if the other party happened to be a different nationality or skin colour to me, or Muslim, and I happened to touch on that fact then I would be in deep............... trouble.[/quote]

The persuasive argument to euthanase one of our patients should relate exclusively to the patient's condition, not the owners beliefs or circumstances. In this case I had the ink of their signature drying on the euthanasia consent form. I thought the argument had been made understood and manifestly agreed. But, out of the blue there was a change. That's weird. Arguing with the weird is not sensible and merely an exercise in repetition of previous failed argument if you stick to the brief for obtaining consent for euthanasia. If you digress into opinion about their behaviour, particularly without a big stick up your sleeve to support such a diatribe, you're in the brown sticky stuff. It might make you feel better, but what chance you get a reversal of a reversed decision having given the owner a mouthful?

JGW

Re: Alternative thoughts

Evelyn Barbour-Hill — Thu, 02 Jun 2011 23:50:13 GMT

[quote user="J G Wray"]

[quote user="Evelyn Barbour-Hill"]What is wrong with respecting the owner's views, however lunatic[/quote]

They're not objective and are prejudiced by a minority belief system

[/quote]

I said, "however lunatic".

What is wrong with respecting the owner's views, however lunatic?

[quote user="J G Wray"]

[quote user="Evelyn Barbour-Hill"]as long as the cat is not in severe pain? [/quote]

Suffering is not just pain, but a more sophisticated state, including malnoourishment, loss of sensibility and mobility.

[/quote]

Here we go again, I've been led into trying to conduct a philosophical discussion which the shorter-sighted members of this forum are going to assume is my arguing an opinion that I do not hold. Well, you all hate me anyway, so here goes.

[quote user="J G Wray"]

[quote user="Evelyn Barbour-Hill"]Express your own views of course, as forcefully as you wish.[/quote]

And you will end up having to justify your words and actions in a Court somewhere. Do you trust the RCVS court to support you?

[/quote]

Well, if I had resorted to foul language I might have to apologise. And of course if the other party happened to be a different nationality or skin colour to me, or Muslim, and I happened to touch on that fact then I would be in deep............... trouble.

Otherwise, I'm not sure I see a bigger problem than usual.

Re: Alternative thoughts

Michael Woodhouse — Thu, 02 Jun 2011 23:06:48 GMT

I have been in vaguely similar situations before but often with downer cows. Scenario usually pans out with a cow that has been down a number of days (sometimes more than a week) when they finally decide to get the cow examined. Frequently they have broken bones. Farmer would prefer knackerman to shoot cow as they don't charge any more for that part of the collection, whereas we charge for the euthanasia. If cow has a broken leg I will not leave her until the next day or even over the weekend with a fractured leg. Farmer sometimes think this is a perfectly reasonable request as she has been down for a few days/week already.

I have told a couple of people they could be charged with causing unnecessary suffering by not letting me put the cow down. A couple of times I will have pissed people off but either they get their gun and shoot it or I put it down. If they say they will shoot it they do it in front of me. They had no option.

I have never left yet, not sure what I'd do if they blatantly wouldn't let me. Morally I would like to ring trading standards, but wouldn't like to be in court with an (ex) client!

Re: Alternative thoughts

J G Wray — Thu, 02 Jun 2011 22:38:51 GMT

[quote user="Evelyn Barbour-Hill"]What is wrong with respecting the owner's views, however lunatic[/quote]

They're not objective and are prejudiced by a minority belief system

[quote user="Evelyn Barbour-Hill"]as long as the cat is not in severe pain? [/quote]

Suffering is not just pain, but a more sophisticated state, including malnoourishment, loss of sensibility and mobility.

[quote user="Evelyn Barbour-Hill"]Express your own views of course, as forcefully as you wish.[/quote]

And you will end up having to justify your words and actions in a Court somewhere. Do you trust the RCVS court to support you?

JGW

Re: Alternative thoughts

Evelyn Barbour-Hill — Thu, 02 Jun 2011 20:15:06 GMT

[quote user="Julian Earl"]

I was always under the impression that at a RTA you could euthanase an animal without the owner's consent if it was your professional judgement to do so. Assuming that I am correct in this, would the same right not apply to euthanasing any other animal with intractable welfare issues such as this?

[/quote]

Er, no.

What are you going to do, snatch it out of the owner's arms and stab it with pentobarbitone? Maybe get your biggest nurse to hold the owner back?

At an RTA you can euthanase a cat or dog (bit more complicated with livestock) without the owner's consent if it is your professional judgment that this has to be done, if the owner is not available to be asked. Completely different.

What is wrong with respecting the owner's views, however lunatic, as long as the cat is not in severe pain? Express your own views of course, as forcefully as you wish.

Re: Alternative thoughts

Julian Earl — Thu, 02 Jun 2011 19:09:54 GMT

Re: Alternative thoughts

Andrew Kent — Thu, 02 Jun 2011 19:06:51 GMT

I think these are very difficult situations to deal with especially when people are suffering with the delusion of alternative medicine.

In these situations I first ask a colleague for their opinion on a case so that I can put the opinion of 2 veterinary surgeons to a client and I can make sure that my own view is appropriate,

If people are adamant I have on occasion threatened people with their legal obligations under animal welfare law and pointed out that their views on treatment are against the accepted level.

BUT, I am not sure that in this situation I could have brought myself to enforce euthanasia - I might have had a damn good go at convincing them though!

Andy

Re: Alternative thoughts

Kate Richardson — Thu, 02 Jun 2011 18:52:45 GMT

[quote user="J G Wray"]

[quote user="Kate Richardson"]Just a suggestion, is it worth getting one of your nurses to have a chat to them? Sometimes clients relate to them better then us vets? Worth a try.[/quote]

Thank you all for your contributions on how to resolve this dilemma from 2008. For your interest the cat died overnight .

It was the post-script that carried the message.

[/quote]

I did appreciate that. It was just an suggestion for Simon to try.

Regarding your scenario, these are the situations when as a vet, I believe there should be something in the PGC to allow euthanasia to be performed against the owners wishes when it is clearly and absolutely the only rational option. Our oath is about animal welfare yet we are unable to perform euthanasia without owners consent. Obviously this could be open to exploitation and anyone caught doing so should be disciplined severely.

I'm afraid only brutal and frank discussions with the owner are the only option. It is a moral dilemma because if you alienate the client, she may not seek veterinary attention at all, in which case future suffering may occur. So which is more important, the immediate problem or the bigger picture.

One other thought is how about a letter after the event, outling your thoughts and asking her for an explanation as to why the Scenar or whatever did not work? Get her to question her own beliefs?

Re: Alternative thoughts

Niall Taylor — Thu, 02 Jun 2011 17:45:37 GMT

Good grief Mariette, a dog eating vegetables, hasn't this dog heard of the Raw Meaty Bones diet? What would Tom Lonsdale say?!

You could of course do a clinical trial - I would suggest a purple painted potato placebo controlled trial.

Niall

Re: Alternative thoughts

mariette asselbergs — Thu, 02 Jun 2011 17:29:12 GMT

PPS This owner may be in to alternative therapies but has found
nothing better in her or nearly-Peacock's armamentorium than 6 week
courses of cephalosporin for her Bull Terrier's recurrent pyoderma....."

Now I will be at risk of being seen as another "Alternative treatments" vet, (which I am defintely NOT, I am a Goldacre fan) BUT having inherited a bull terrier with unstoppable chronic pyoderma in 2005, which has been on malaseb baths and almost unstoppable cephalosporin / nisamox treatment for 4 years untilDecember 2009, I would like to share an astonishing result which I cannot explain but is genuine. In December this dog managed to get into our vegetable box and devoured all beetroots, green peppers, parsnips and raw potatoes. Three days later her raw, red oozing smelling lesions all over body had dried up. Since then we fed her various of these veggies, and settled very soon for beetroots. She has never been back on antibiotics, or malaseb, and stayed lesion- and inflammation free up to today. She has just past her 15th birthday. She gets a beetroot, boiled or roasted (when we use our oven) about twice a week. Whenever she seems a bit reddish anywhere, we give her an extra beetroot. I have tried to find what might be the mechanism but cannot find anything special in beetroots, no special zinc or something.

If anybody has a heart sink patient like this,please try, I would be so curious to know if it would work for others?

Mariette Asselbergs

Re: Alternative thoughts

Niall Taylor — Thu, 02 Jun 2011 17:00:33 GMT

[quote user="J G Wray"]It was the post-script that carried the message.[/quote]

If there is one thing which characterises charlatans and mountebanks generally it is their propensity for righteous indignation coupled with legal proceedings.

Niall

Re: Alternative thoughts

J G Wray — Thu, 02 Jun 2011 16:39:43 GMT

[quote user="Kate Richardson"]Just a suggestion, is it worth getting one of your nurses to have a chat to them? Sometimes clients relate to them better then us vets? Worth a try.[/quote]

Thank you all for your contributions on how to resolve this dilemma from 2008. For your interest the cat died overnight .

It was the post-script that carried the message.

JGW

Re: Alternative thoughts

Kate Richardson — Thu, 02 Jun 2011 15:55:38 GMT

Just a suggestion, is it worth getting one of your nurses to have a chat to them? Sometimes clients relate to them better then us vets? Worth a try.

Re: Alternative thoughts

Simon Neuhoff — Thu, 02 Jun 2011 15:50:49 GMT

One of my colleagues is currently struggling with a vaguely similar case - a cat in advanced renal failure that has been getting regular s/c fluids for months now. The cat is now extremely weak and hasn't eaten much of anything for 6-8 weeks yet the owners will not consider pts. A difficult one because they are "treating" the cat by bringing it in for sc fluids but in my opinion they are actually causing the cat undue suffering. The last time I saw the cat I advised them that the cat should be euthanased so now they won't see me.

Re: Alternative thoughts

Niall Taylor — Thu, 02 Jun 2011 15:45:55 GMT

I don't think there is anyway that you would have been able to persuade this owner that her cat needed pts. She is using her own belief system to confirm her own prejudices and it would have been impossible to persuade her otherwise without directly challenging that belief system. Yet she sounds like the sort of person who would have been outraged if she had seen an identical cat treated the same way by someone else - cognitive dissonance is a wonderful thing.

I'm interested that you felt she was manipulative and devious - can you clarify. Why not just "deluded and gullible"?

What was the final outcome?

Niall

Re: Alternative thoughts

Richard Carter — Thu, 02 Jun 2011 15:19:43 GMT

Probably would have done the same in returning the cat - a rehydrated purring cat may have some discomfort but is unlikely to be in actual pain, anaemia due to bleeding is not a painful condition and shock (and resultant demise) as a result of cardiovascular failure is also not painful or distressing, the body releasing all sorts of endorphines. Not your cat so not your decision.