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I have this really difficult client. I truly believe he loves his dog, yet I cannot (ever!) get him to agree to do anything on her behalf beyond basic care. Luckily –– this being the operative word –– his strategy has worked for them so far. Coco has always come out on top, despite her owner’s reluctance to treat her conditions as I've recommended.
But no longer. Now that she’s 11 and feeling the distinct twinge of cruciate ligament-related arthritis (an example of fundamental care her owner has pointedly neglected to address), she’s going downhill fast! And to make matters worse, he’s started talking smack about the pain-relieving anti-inflammatory drugs I’ve prescribed.
To be honest, my goal was to motivate this owner to slim his
dog down and get surgery for her knees –– not to medicate her orthopedic discomfort 24/7. But when that wasn’t forthcoming, I latched onto the next best thing: drugs.
“Sure, she walks better with them, Doc, but how fair is it to drug her for the rest of her life just so she can move around better? It’s not as if she’s in pain. She never even so much as whimpers. By the way, I read that brochure you gave me. Those side effects are terrible! Are you trying to poison my dog? Why would you ever prescribe these drugs?”
He’s a doubting Thomas, a curmudgeonly contrarian, a want-it-all-my-way kind of a person. Which is fine. That is, as long as he’s rational about it. Which he’s not. No, here’s a client who’s wallowing deep in denial. I mean, he’s too well-educated to be just plain ignorant.
In case you’re wondering, this guy makes a big show of his veterinary reluctance having nothing whatever to do with money. He claims to keep a second vehicle (a luxury SUV) just for his dog’s comfort. He’s that kind of a person. Which –– between you and me –– isn’t much of a sales pitch for pet owner of the year. Not when he’s holding his dog’s health hostage on the basis of his narrow-minded view of what veterinary medicine should be doing for his dog.
OK, so everyone’s entitled to his opinions. This I will allow. But when a dog’s pain is at stake, you’ll have to forgive me for speaking my mind. Which, by the way, I do in his presence. Here’s what I told him last week when he refused to continue the course of pain-relieving NSAIDs I’d prescribed:
Most dogs over the age of 10 have some degree of "creakiness" as a result of the degenerative joint disease we call osteoarthritis. But when a specific orthopedic disease or excess poundage is a factor, (as they both are in Coco’s case), you can expect that the stiffness and discomfort will have typically progressed so that symptoms are present on a daily –– even constant –– basis.
Older dogs with this ultra-common condition may limp, walk stiffly, lose muscle mass (especially over the large muscles of the hind limbs and along the spine), have trouble rising and may even slip on slick floors. Most will appear to "warm into" their gait, starting off stiffly and progressing to a more fluid gait once they get going.
The daily grind of arthritis in most older, large-breed dogs, is considered a major quality-of-life issue. Yet many dog owners fail to accept that older dogs experiencing these symptoms are actually in significant pain, saying, "He does not cry, whine or howl, so he must not be feeling that badly."
Now, just because we humans vocalize our discomfort doesn’t mean dogs who don’t (and most won’t, unless the pain is acute and severe) aren’t feeling it. We humans need only consider how we would feel if we were limping, hobbling and struggling to move.
So to answer your question: Why do I prescribe these drugs? The short answer is, "because they save lives." Over the last decade, since these drugs have become available, the average lifespan of arthritis-prone dogs has skyrocketed. No longer is orthopedic euthanasia ('Doc, he can’t get up anymore') the primary cause of death for these dogs. They’re living longer, more comfortable lives. This, despite all those "horrible side effects."
Not to minimize the side effects. In fact, that’s why I always send home a fact sheet detailing the pros and cons of any drug intended for long-term use. But in this case, I’m starting to wonder whether I shouldn't have worked so hard to detail all of the side effects. That might not have been ethical, but it probably would have made me feel better right about now. And if Coco had a choice, I bet she’d agree with me.
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