My boss, Dr. Michael Rose, and I can rightfully be accused of sophomoric behavior. Call it a healthy survival tactic in a very difficult profession. We care deeply about our clients, their pets, and their problems, probably more than is good for our own mental health, and we work hard to serve them all. So, we balance this with some good old-fashioned immature behavior, wisecracks, and lots of laughter behind the scenes. Don’t worry, there will be no Matt Lauer stories coming from our hospital; this “therapeutic immaturity” is more inspired by our preteen boys. Fifteen years later, we’re still happily practicing together and (I think) doing a good job.
One of our less-than-professional questions we often ask each other is “Are we kickin’ or stickin’?”, referring to when the doctor and the client are faced with a difficult decision of whether to go forward with a procedure, or just “wait and see.”
“Are we kickin’ or stickin’” is a football reference. It’s fourth down, the stakes are high, and you’ve got the ball. Are you going to punt the ball? (kickin’), or are you going for it (stickin’). In the medical field, when faced with a difficult decision such as a risky surgical procedure, we can ask ourselves if we’re kickin’? (not doing the procedure, “wait and see” approach) or stickin’ (going forward with the procedure).
All joking aside, “are we kickin’ or stickin’” is one of the most common and most difficult discussion points we have with our clients as we decide what our care options are for elderly pets with problems. Most commonly, we are faced with geriatric pets who have either a tumor that needs to be removed, or a bad dental problem that we need to take care of. Both of these procedures require anesthesia and surgery and when you’re dealing with a 13-year-old dog, “are we kickin’ or are we stickin’” is not an easy question to answer.
I’ll reference two classic case examples that we see on a very regular basis.
Case 1: Jojo
“Jojo” is a 13-year-old Labrador Retriever with a large tumor on his leg. Jojo is full of tumors, mostly benign, all over his body, but there is one in particular on his front leg near his wrist that is quite large, hangs by a stalk, and looks like it’s going to rupture any day. He licks at it a lot, a sign that it probably bothers him. Jojo also has bad arthritis and a heart murmur, but he is otherwise still full of life and energy. So, are we kickin’ or stickin’?
Tumor removals on older animals are a common dilemma. On one hand, the vast majority of tumors I see, both benign and malignant, are surgically resectable. There is a problem and I can resolve it by cutting it out. On the other hand, there is always risk when putting an older patient through anesthesia and surgery, and then there is the emotional part that we don’t want to put the older pet through anything painful without a clear guarantee for a cure.
The good news is that anesthesia is very safe, even in older patients with lots of problems. Losing animals under anesthesia, when done properly, is very rare now! Yay! Additionally, dogs and cats both handle surgery very well. Perhaps an adaptation to dealing with fight wounds in the wild, their skin heals quickly from surgical wounds and I am always amazed at how quickly pets return to normal even after more major surgeries such as bowel resection or other abdominal procedures. Am I saying that surgery is not a big deal? No. However, many clients seem to have an overly negative view of just how difficult surgery will be on their pet.
As a surgeon, I don’t want to get involved with a procedure that I think is going to fail, so typically I won’t ever recommend something that doesn’t seem like a good idea for the patient. But in the end, I think that far too many older pets are left to deal with their tumors because of a somewhat unwarranted fear that surgery will “be too much for them.”
In Jojo’s case, leaving that tumor on his arm eventually would result in the owners coming home one day to a tumor that opened up and bled everywhere. Jojo seems in pain and his big tumor just ruptured open…this can often lead to discussions of euthanasia, or we are doing surgery when it will now be much more difficult.
If we had removed Jojo’s tumor in a timely fashion, he would be back to chasing squirrels in 2-3 days and the owners only complaint would be “how do I keep him quiet!?”
Case 2: Meeka.
Meeka is a 16-year-old cat with terrible teeth. We’ve all known for years that Meeka has had some heavy tartar buildup and gingivitis. However, she has never shown obvious signs of pain and she also had a lot of other old-cat diseases going on—kidney failure, hyperthyroidism, and a heart murmur. Last week Meeka started drooling profusely and is not eating well. When she does approach her bowl, she seems hungry and takes a bite, but seems stricken by sudden pain as she goes to chew. On exam, Meeka has several severely infected and even broken teeth. She needs to be put under anesthesia for a dental cleaning with some extractions. So, are we kickin’ or stickin’?
Dental disease is the number one chronic disease in older pets. Over 15 years of practice, I have extracted literally thousands of infected and broken teeth from dogs and cats. The vast majority of these pets were not telling their owners that they were in pain. But dental disease hurts! Every day!
Meeka’s owner would rightly be concerned about the safety of anesthesia, but again, even for an old cat with all of these problems, I still put her risk as low. And if we can get her under and take care of the bad teeth, she will immediately feel so much better, like a huge weight has been taken off her shoulders! On the other hand, if we punt and “just watch it,” we are condemning Meeka to a lot of oral pain and discomfort for the remainder of her life. Even if the anesthesia were risky, it would be a risk worth taking.
There is really never a right answer when making these decisions for our older pets. Every owner is different as far as what they find reasonable, and also we are balancing people’s personal finances when expensive procedures are needed. However, I always advocate to “go for it” because more often than not we convert on fourth down and give those senior pets the gift of no pain for their golden years. That is definitely a reward worth the (usually low) risk.