Choices

I’ve been stuck at home for a few days, keeping an eye on a pup. A couple of days ago she gave a sharp yelp of pain when she came outside with me, but I wasn’t able to isolate the cause. We checked her limbs – feet, lets, joints, back, felt her gut (in case it was bloat), looked for any other possible causes – and she let us do all of that without twitching. Then, later, it happened again – and again – when she climbed onto the couch and when she lay down. A very distressing sound, a very unhappy dog and a very anxious me. So – vet time.

Dr Kelly has known MissM since she was a puppy and she could immediately see that she was off her usual enthusiastic crazy-pup form. She checked her out from top to toe and found her vitals all normal, weight perfect, gut fine, legs all okay — but the muscles in her neck were very stiff and MissM didn’t want to turn her head from side to side. Up and down was okay, but sideways no. And she didn’t shake her head at all either, as she often does after an examination.

Prognosis? Well, it could just be that she’s hurt her neck racing around, but Kelly reckons it could very possibly be wobbler syndrome – a narrowing of the bony canal that the spinal cord passes through, resulting in compression. This was a definite ‘no, wrong way, back out’ sort of moment. Delighted that it hadn’t turned out to be bloat, but wobbler?

For now, MM is on meloxicam (non-steroidal anti-inflammatory) and gabapentin (anticonvulsant & analgesic), with another appointment booked for Monday. If she’s not significantly better, then X-rays are the next step so that Kelly and/or a specialist can identify the precise locations of the spinal cord compression and recommend suitable treatment…

Meantime, she wants to be close – and by that I mean closer than usual (!), is anxious and a bit dopey because of the gabapentin. Except of course when there’s food in the offing, someone comes to the door or she moves her neck in a way that makes her yelp. This part is very stressful all round. If you’ve ever heard a dog cry in pain, you’ll know what I mean. She’s got to be kept quiet and indoors except for nature-stops – which is tricky. So I cancelled various things and have spent the last couple of days sitting/lying with an extra-close, anxiously dopey dobermann and a rather worried springer spaniel circling the edges.

Anyhow, between dog-things, I read Acacia House, by Vivien Stuart. Of all the topics in the world to be reading about at present, this book is about palliative care > what a funny old place the universe is! (For clarity, I’m talking humans now, not pups… just in case that wasn’t apparent!) Acacia House packages various views about end of life decisions, treatment and hospice funding – or the lack thereof. It’s thoughtful, sometimes funny, and very touching.

With my sad dog curled up next to me, I found myself wondering once again about why it is that so many humans avoid conversations about end-of-life issues, arrangements and preferences? I get it that no-one wants to lose a loved one, and I get it that most people would prefer to think about happier things. But surely it’s better to have these conversations before ill health or accidents alter the way final treatment decisions should or could be managed? Particularly for those of us who any sort of advanced chronic condition or life-limiting condition, or may perhaps be at risk of developing a dementia-related illness.

After all, who will speak for us if we’re no longer in a position to state our preferences? Will they understand what it is that we want – rather than what they think we want… or would prefer us to want? When it gets to that stage of the game, the emotions of people with vested interests of one sort or another can tend to cloud issues and complicate them, taking away the final choices people should be entitled to make for themselves.

Many people have told me that they’ve tried to have these sorts of conversations with their loved ones, only to be shut down. They get variations on a theme of “We don’t want to think about it!” or “You’re still able and fit, so there’s no need to go there.” Is this perhaps because talking about our mortality and decisions around that makes these people confront both the notion of loss and the notion of their own personal mortality? If so, surely this is very narrow-focus thinking? After all, talking about something doesn’t make it so – otherwise we’d ALL be lottery winners!

By the time I’d finished the book yesterday afternoon and contemplated how I felt about it, snuggly-sad dog by my side, I’d concluded that having these conversations with loved ones is an absolute must. If you get stonewalled, perhaps wait a while and try again. It may turn out to be a bit like a war of attrition, wearing them down – one conversational gambit at a time, but it’s worth it in the end, I reckon.

An advanced health directive is the next step. This can be amended at a later date if your preferences change. But in the interim, it provides medical professionals and your loved ones with a clear idea of what you would prefer if you’re no longer able to make or communicate decisions. I downloaded a copy of the pro forma this morning and plan to complete it and then lodge a certified copy with my GP – ‘cos you never know what happens next in life.