The Doctor Informs & Advises. The Owner Makes the Call

Question:
Last week you advised an owner of a Great Pyrenees to get expensive tests for her dog’s breathing problems. At 10 years old, that gentle giant is OLD. At what point do advise simple stuff and keeping the dog comfortable? Limiting exercise, losing weight (which you did suggest), maybe symptomatic help like asthma meds or prednisone but just letting nature take its course for a dog who’s near the end of its typical lifespan anyway? The dog didn’t sound that uncomfortable to me. This has been going on without any dramatic change for six months.

Dr. Nichol:
During graduation from veterinary school we took an oath “to use my scientific knowledge and skills for…the prevention and relief of animal suffering.” But is doing everything possible really in this older dog’s best interests? Humans can share their feelings verbally but pets must rely on their people.

It was a simpler question back in the day, before medical research brought us advanced diagnostic and treatment methods.  This dog struggles so hard to breath he can hardly sleep. I’ve been practicing a long time. I’ve seen panic in the eyes of pets who weren’t sure they could grab that next breath. Chronic respiratory disease doesn’t stand still. This old timer is headed in the wrong direction.

Veterinarians see the full gamut of disease from minor to life-threatening, presented by people who might care only a little to those who regard the pet as their only real friend. Decisions on how much to spend belong with the owner. Despite my training and experience I have no business foisting my beliefs on someone else. I am obliged to offer people the very best care available for the cat or dog they love.

Sometimes we are asked to provide a lower cost alternative. In this case I would never prescribe prednisone without a diagnosis because it could do more harm than good. Treatment for asthma, which is quite rare in dogs, may also be a disservice. There are pet owners who only want a shot in the dark and we do our best for their pets, but it’s really important to know what we’re aiming for. The standard of care is to diagnose first and treat second.