I love watching vets work.
The vet opened the examining room door, looked at Pepe kindly and with happy anticipation, and called him to her by name. Pepe ambled in and we followed. [Cool vet tricks: How well does Pepe see and hear? How is his gait? How does he respond to a new place? Is he confident or uncertain? Also: Communicate to Pepe’s bosses – yes, we both went – that Pepe is charming and loveable and worth this focussed attention. Establish trust.]
We told her we were there because Pepe’s seizures were getting worse but he couldn’t take the medication he had been offered. We wanted to try an alternative. The vet brought out his file to see what the notes were, commented that it was a thick file. We acknowledged that. We knew he was chronically ill and we weren’t expecting miracles. [Cool vet trick: set up the bosses for possible end-of-life conversation.]
We showed her the video Mark had shot of Pepe having a seizure. The vet had asked for this months ago, but it’s only now that he has them daily and on cue that we’ve been able to catch him at it. She watched once, carefully, asked questions about his apparent state of consciousness, then explained why she thought this wasn’t epilepsy but an epileptiform seizure. [Cool human trick: explain your reasoning so that your listeners know they’ve been heard and understood.]
Mark volunteered that epileptiform seizures were caused by tumours. The vet agreed that this was one cause, then proceeded to examine Pepe, explaining what she was doing at each step. His heart is fine, therefore his seizures are unlikely to be caused by lack of oxygen to the brain. She listened to his lungs and felt his lymph nodes for signs of metastasis but didn’t find anything obvious. [Cool human trick: explain your reasoning to get buy-in for your conclusions.]
She checked his vision. He has cataracts, but he responds normally to light shone in his eyes and can track a moving light on the wall. He reacts to a raised hand and tapping towards his right eye… but not his left. By this time we were anticipating the conclusion: his brain tumor was affecting the visual processing for his left eye. Aha! moment: so that’s why he let someone pet him while I was holding him the other day: he couldn’t see her approach. [Cool vet trick: she particularly wanted to check his vision because she’d noticed him hesitate as he walked into the room, as if he weren’t sure what was there.]
The next step, she explained, was an MRI. We protested: what would be gained? Well, she said, it was the only way to know for absolutely certain that he has brain cancer. We protested again: it doesn’t matter, because we won’t be treating the cancer anyway. She agreed, adding that a scan would be too expensive. [Cool human trick: Ensure the bosses own the decision.]
She proposed a cortisone prescription to reduce swelling. It might help temporarily. I said what I really wanted to know was how to decide when to bring him in for the final visit. Well, she said, daily seizures really are a lot. They’re physically hard for the animal. Plus, his head must hurt him terribly. [Cool vet trick: load up the bosses with information to make the ultimate decision easier.]
I was stricken by the notion of my poor little dog sleeping in dark rooms because he was laid low by headaches: I had assumed it was just general fatigue. I asked about pain medication. Well, she said, she didn’t want to give him morphine because it’s addictive, and he can’t take both NSAIDs and cortisone, but the cortisone is an antinflammatory and will treat the pain. If the cortisone works he’ll be happy and lively and his seizures will stop or be reduced. If it doesn’t work, or the tumour grows and the cortisone stops helping, we’ll know. But with the cortisone we might be able to buy him a couple more months. [Cool human trick: establish reasonable expectations and next steps.]
So far the cortisone seems to be working. He’s happy, has his appetite back, and is pissing like a fire hydrant. Two more months is just about right: he doesn’t like winter, so it’s good to know he won’t have to go through another one.