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Canine Patient Advocacy

Speaking For SpotMaking Medical Decisions You Can Live With
By Nancy Kay, DVM, Dipl. ACVIM

As your Berner's medical advocate, your goal is to make well-informed choices that result not only in the best outcome for your dog but for your peace of mind as well. How to make choices that serve your dog's best interest was discussed previously at What Would My Berner Choose?". The current article addresses the second goal of the savvy medical advocate, namely making decisions for your dog that result in the greatest peace of mind for you. I'm not necessarily talking about short-term peace of mind. Rather, I'm referring to the kind you desire after having lived with your decision weeks, months, or even years down the road. Canceling a long-awaited Hawaiian holiday because your dog needs emergency surgery may feel disappointing at the time, but in the long run, it will likely be the decision that will best serve your long-term peace of mind.

Finding peace of mind is usually a natural consequence of determining what is in your Berner's best interest. This doesn't mean that you will invariably choose the most aggressive option; rather, your choices will be guided by what you ultimately believe are the right ones for your dog. Even if the end result isn't what you'd hoped for, you will be at ease knowing that your actions were always guided by your good intentions.

No matter how refined your medical advocacy skills are, some circumstances render it impossible to make decisions based solely on your dog's best interest. Here are some exercises to help you deal constructively with these challenges.

When Cost Gets In the Way

If you are in the throes of decision-making and it feels like money concerns are taking center stage, I encourage you to do the following:
Pretend that you are wealthy beyond compare on par with Oprah Winfrey or Bill Gates. Then have another look at the choices on the table. Once cost concerns are removed from the equation, it's often much easier to hone in on the decision that truly serves your dog's best interest. You might be pleasantly surprised to learn that the best option is not the most expensive option.

What happens when the obvious best choice is not affordable?

Know that rarely is there only one right way to do things. The key to making things work in this situation is examination of all of the medical alternatives and options for paying the bill. I strongly encourage you to lay your "financial cards" on the table. I know this can be hard to do. Talking "fleas" is one thing having a candid conversation with your veterinarian about your bank account is a whole 'nother ball game! For your Berner's sake, however, it is important to be completely honest about your financial constraints. Such conversations can open doors to other options that make better financial sense. In addition to discussing a creative payment plan, perhaps a less expensive test can be run, a less costly surgery performed, or a more economical antibiotic prescribed.

When No One Knows What's Truly Best for Your Berner

Sometimes medical circumstances are such that, no matter how much information you've gathered, neither you nor your veterinarian can predict which choice will result in the best outcome for your Berner. In such situations, I encourage you to do the following.

► First, play out every single option to both its best and worst possible conclusions.
► Step two is to focus on determining which set of outcomes would best serve your peace of mind.

Let's run through this "peace of mind exercise" using the following scenario:
imagine that your Berner is sick with vomiting and diminished appetite. An ultrasound examination has revealed that he has a large liver mass. A non-surgical biopsy was unable to differentiate whether the mass is benign or malignant. If the liver mass is benign, surgery (albeit involved and lengthy) has the potential to provide a cure. If malignant, even extensive surgery is unlikely to be curative and may, in fact, hasten your dog's demise. Besides aggressive surgery, the only other realistic option for treating your Berner is supportive medical care, consisting of diet changes and traditional or alternative/complementary measures to reduce nausea, decrease stomach acid production, and promote liver health. Neither you nor your vet knows what's truly best for your dog.

Now, let's proceed with the "peace of mind exercise."

    • ► Step one is to consider the best and worst possible scenarios for each option.
    • - - - Surgery.
      The best-case scenario would be that your Berner's disease would be cured and his normal, good quality of life completely restored.

      In the least favorable outcome, the tumor would be malignant and impossible to be surgically removed. Your dog's decline would be hastened (even death might occur) as a result of the surgery.

    • - - - Medical therapy.
      Even if the mass were benign, because of its large size, the best-case scenario would be gradual progression of his symptoms over the course of several weeks to several months.

      The worst imagined outcome would be rapid progression of symptoms resulting in a more immediate need for end-of-life decisionmaking.

    • ► Step two is to determine which set of outcomes would best serve your peace of mind; which is most likely going to allow you to sleep at night?

      - - - This second step often requires a great deal of thought, investigation, introspection, and yes, it requires "discussions" with your dear Berner.

Once you make your choice, will you know with certainty it was the right one?

Absolutely not! Might the ending to this story be an unhappy one? Yes indeed, but when all is said and done, what you will know is that you made a well-informed decision with nothing but the best of intentions for your wonderful dog. Now, that should be worth a great deal of peace of mind.

Speaking For Spot     About the Author

    Nancy Kay, DVM
    Diplomate, American College of Veterinary Internal Medicine
    Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
    Author of: Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life


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