The little red heeler had a bowel obstruction and had crawled off into a ditch to die. By the time her owners found her and took her to Robin Downing, DVM, they feared that the veterinarian could do little but put her down.
This was in the late ’80s, in rural Wyoming, a time and place where neither surgical specialists nor pain medication were much in vogue in veterinary medicine. At the time, “Anesthesia was considered mostly for the purpose of restraining animals, and pain management was not emphasized,” says Dr. Downing, CVA, CCRP, CPE, Dipl. AAPM.
“In fact, in veterinary school, we were taught to fear morphine, because we were taught that it could cause respiratory depression and death. We weren’t taught the nuances of using (morphine).”
But Downing knew she could save the dog, if she could control her pain. Even as a young vet, she says, she had observed a hard truth: “Unmedicated pain kills.”
She consulted a client who was a medical doctor and general surgeon. He coached her through performing anesthesia and bowel surgery, and then how to manage pain through recovery. Two weeks later, the heeler was back to work on the ranch where she lived, helping herd 25,000 sheep.
“If I had to pick a watershed moment, that was it,” says Downing, 53, who moved to Colorado in 1991 and bought the Windsor Veterinary Clinic in Windsor, where she still practices. “After that heeler, my eyes were opened, and I began to look for ways to do a better job with pain management.”
The revelation led her to seek specialization in such fields as canine rehabilitation. In 2005, she even became one of just a handful of veterinarians who have earned a diplomate from the American Academy of Pain Management, an interdisciplinary society of pain management professionals.
And it has motivated her to become a leader nationally. Downing was a founding member and early president of the International Veterinary Academy of Pain Management, and she is the current president of the American Association of Human-Animal Bond Veterinarians.
“My interest in pain and pain management comes directly from my commitment to the human-animal bond,” Downing says.
Downing says she saw the light very early. Her paternal grandfather had a beloved shepherd-collie, Danny. When Danny had a stroke, her grandfather taught the dog to walk again by leaning against walls for support. When Danny went deaf in old age, her grandfather had him fitted for a hearing aid. Even as a 5-year-old, the young Downing intuited how much animals could, and should, be an integral part of the family.
So, after graduating with a degree in English from Loyola University (a degree she chose partly because it gave her a career backup plan if she didn’t get into vet school), she earned her DVM from the University of Illinois College of Veterinary Medicine. Then she set out to build a practice that catered to the deep bond between humans and animals she had always witnessed.
“Over the last two decades, we’ve experienced a societal shift in our relationships with animals, so we’ve ended up with this migration of animals coming in from the backyard, from the kennel to the couch,” she says. “This integration of animals into our family lives has really been a dramatic shift and it has affected the way we run our practices.”
Downing, for instance, has always seen the value in building a clinic team where every member, from the receptionist to the vet tech, is attuned to the animal’s needs, and is trained to notice signs of pain so that it can be treated and, if possible, prevented.
And as she recognized the limitations of modern pharmacology, she began to seek training in additional modalities. She added acupuncture, chiropractic, medical massage, nutraceuticals and laser therapy to her toolbox, she says, as a way to alleviate pain for as many animals as possible.
Veterinarians have always felt compelled to help clients achieve a balance between the care they need and want to provide for their animals, and what is actually best for the animal. But achieving that balance has only gotten harder in the past few years, Downing says: Veterinary technology has grown rapidly more sophisticated, and thus expensive, at the exact time the weak economy has limited some clients’ ability to pay for care.
“We as veterinary care professionals now need to begin grappling with the same issues that our physician colleagues have been wrestling with for years,
such as allocation of resources, quality of life issues, costs, financing care and setting priorities,” Downing says.
Seeing bioethics as the next great frontier in clinical veterinary medicine, Downing plans to begin a master’s program in bioethics at Union Graduate College in New York, in a program affiliated with Mount Sinai Medical School.
Eventually, she hopes to earn a doctorate in bioethics, and to help chart the veterinary profession’s future in such issues as pain management, advanced therapies, hospice and palliative care.
Client Jacqueline Hansen says Downing is a natural at this.
When her golden retriever Rocky was about 9, Downing diagnosed a rare pancreatic insulinoma. The Hansens were unsure what to do; they wanted as much time with their dog as they could get, but they didn’t want her to suffer. With Downing’s guidance, they agreed to try surgery. Rocky flourished for an additional 18 months before developing a different fast-growing tumor. This time, Downing warned, there was little they could do.
“Dr. Robin has a very good sense of what’s right for the animals,” Hansen says. “We always felt secure that she would help us decide what was best for Rocky—if it meant getting her help or if it meant letting her go. … We still miss her very much, but know that we did the right thing for her every step of the way.”
And that’s exactly what Robin Downing hopes for—for every client, for every animal.
Practical experience has helped make Robin Downing, DVM, an important figure in the fields of both pain management and the human-animal bond, says Peter Hellyer, DVM, MS, Dipl. ACVA, associate dean at the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and a noted pain-management expert.
He met Dr. Downing more than a decade ago, when she participated in a Colorado-wide study on the use of anesthesia, and he was impressed with the anesthesia support and monitoring she was already using at a small clinic.
“She is a very effective, very passionate, very knowledgeable spokesperson on behalf of animals and clients,” Dr. Hellyer says. “At the core of who she is, she really believes that one of our roles and duties as vets is to advocate on behalf of animals because they can’t advocate for themselves.
“So she has really helped raise awareness of what we can do for animals and what the expectations should be of practicing veterinarians. … She’s able to connect with veterinarians on some of the difficult topics because she’s been there.”