Thou Shall Not Judge … Your Client

If a client refuses to medicate a pet a certain way, try to find out why.

We’ve probably all been there, standing across an exam table from a client who doesn’t seem too enthused about sticking a pill, squirting a liquid, or cramming a capsule down the mouth of their pet. So, being good veterinary professionals, we pull out all the advice and tricks of the trade … pill pushers, pill pockets, restraint tips, confidence coaching, you name it. If we still end up with a client that “refuses” to medicate their animal, it is easy to judge them at that point as inadequate pet parents, or worse. It affects our respect for that client, and ultimately, the way we treat them in our practice. Think you can fake it, and not let your inner feelings show? Think again. In fact, let’s think of this in a whole different way.

Shannon Fujimoto Nakaya, DVM, wrote a wonderful book called “Kindred Spirit, Kindred Care.” In this book, she encourages pet owners to look at their options and decisions regarding their pets in several different lights. She speaks of how to choose a veterinarian, how to assess the patient, advice on understanding the diagnosis and options, the sometimes limited financial commitments, and making decisions while managing the needs of the pet and the expectations of the pet owner.

Hers was the first book where I came to understand that “assessing the patient” meant not only knowing the medical facts of that animal and its condition, but also understanding the tolerance level of that creature for the treatment that may be indicated. When considering and comparing the options, she challenges the reader to ask the question: Will your pet be excessively stressed by or intolerant of the treatment and thus undermine the benefits of this option?

As veterinary professionals and pet owners, we come at this from two different, and sometimes opposing, viewpoints. That brings us to Rosy, my Somali whose kidney values were troubling last week; but we now suspect something more dastardly is hiding under the radar.

I took Rosy in to see the criticalist who assesses patients for our regional home pet hospice organization. She informed me that the kidney values just didn’t seem to equate with the loss of weight, vomiting and soft stools we were seeing with Rosy (2.9 Creat, 49 BUN, for those of you who like numbers).

She suspects a primary GI issue, likely, lymphoma. She didn’t feel a mass, but explained how kitty lymphoma often is in the lining of the GI tract, rather than creating solid masses you can feel. She mentioned we could do ultrasound…at first I leaped at the idea! Yes, I need to know! But wait, would it change anything I plan to do? Would I treat differently if I knew, then I will treat while controlling her comfort level? No, likely not, so Rosy has entered hospice.

We’ll talk more about hospice later, but the point I want to make it that Rosy hates medications! Yes, I am one of those clients who stands there and says, “But I can’t get a pill down her,” and you roll your eyes and think, geez, how hard can it be?

Yes, I can get a pill down Rosy, with a lot of struggling, scruffing, puffing and growling. By the time the second dose is due, she hates me and won’t come near me. And this is a kitty who truly lives to be loved on by her people.

So, we come back to that patient tolerance question again. Against my technician upbringing, I have made the decision to forego liquid Metoclopramide for now, and will go with injectables if needed in the future; the orange flavored liquid is just too much. When Rosy was diagnosed with asthma years ago, the pills and inhaler were too much as well. Ironically, she did great with the SQ fluids we gave last week, because she gets hugged and petted the whole time! So what if there’s cool liquid making shoulder pads? She drools with happiness until the last drop is administered!

Rosy has taught me that we must respect our pet owners and their choices regarding their pets. To live longer but be miserable? Or to live happier for a limited time…tough choice to make. But it is their choice.

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