Bringing them back from the edge

When I was on my small animal medicine rotation a few months ago, I had a patient with bad kidney disease. This little dog was sixteen years old — about a hundred years in human terms — and very frail and thin. I got into the habit of calling her “Grandmother,” because she seemed so venerable. None of us had very high hopes for her long term recovery, not even her owner; we were just trying to give her a shot at a few more weeks of life by rehydrating her with IV fluids.

Two of the residents disagreed about our goals for this dog. One of them wanted to send her home as soon as possible, arguing that she didn’t have much time left and shouldn’t spend it in the hospital. The other argued that we should give the dog a few more days to wean her off of her IV fluids properly before sending her home, to give her the best chance. The second resident ended up handling the case, and the dog stayed in the hospital for those few extra days for some extra care before going home.

This week I encountered the same dog (and the same resident) in the hospital for a recheck. I hardly recognized the dog, and not just because I had never expected to see her again. She had put on weight and looked filled out and healthy. She was moving around the hospital under her own steam (when she was my patient, I had had to carry her outside to pee) with a happy trot. She was bright-eyed and curious. Her owner reported that she was even playing sometimes.

“Look,” the resident said, “sometimes we really can bring them back from the edge.”

At age sixteen, this dog doesn’t have much time left no matter how you look at it, but that doesn’t mean it was time to give up on her. The lesson had personal meaning for me. My fifteen year old cat, Kai, is currently battling kidney disease, heart disease, and stomach cancer (gastric lymphoma). Each of these diseases is serious; each has almost killed him at one point. Each time I have to decide whether to continue with him, I ask myself whether I am being silly, whether it is time to give up. The treatments are not invasive, but is there any point to them when I may just have weeks left with him? Then I look at how good his quality of life is (he steals food off my plate, sneaks outside when I am not looking and eats things he shouldn’t in my back yard, and uses foul language to tell the dogs what he thinks of them) and remember the lesson of the little sixteen year old dog. Sometimes, even when things look bleak, animals can make a remarkable recovery for a little while. If the treatments are not invasive and the animal is not in pain, it can be worth trying.