For any health care professional, part of the job is to provide guidance in regards to the advisability of a given treatment option. In both the human medical and the veterinary professions, there are times where factors like a poor prognosis, the patient’s age, treatment morbidity or expense may lead to a recommendation against a particular therapy.
Sometimes this means keeping patients comfortable until they die. In the veterinary world, the alternative to therapy is commonly euthanasia. In certain cases, euthanasia is truly a wonderful option. Bypassing hours, even months, of needless pain, euthanasia provides an immediate end to the physical suffering of the pet and to the psychological distress one feels when their beloved pet is suffering.
I have watched family members and friends languish in the terminal stages of illness while the hospital ceases all nutritional support and provides massive doses of opioids, as the family awaits, or prays, for a merciful end.
It always seems to me like a slower and less humane version of euthanasia. It has occurred to me that if I were to allow an animal to suffer similarly, I may be considered cruel.
But do we in the veterinary profession tend to turn to this terminal alternative too readily? Does the nearly universal moral acceptance of the animal euthanasia option facilitate its implementation to the exclusion of viable alternatives?
Take the case of an 8-week-old male pug named Oreo. The finest Disney animators could create nothing more adorable than a pug puppy. And on the pug puppy adorability scale, Oreo ranks among the top. But in spite of all the attributes that should have given him a leg up in securing a wonderful home, he was born with a defect, which would be deemed by three different veterinarians to render him unfit to live.
The defect in this case is a cleft palate. It involves the hard and soft palate, and can only be seen by opening the mouth. The cleft constitutes an opening between the nasal and oral cavities. The problem with this is that whatever is in the mouth can get into the nose. This is not only irritating, but this opening also makes it difficult to create enough suction to nurse effectively. Without support, most of these puppies cannot survive.
Cleft palates occur in many breeds but are most commonly seen in brachycephalic breeds. These are the short-nosed dogs such as bulldogs, Pekingese and, yes, pugs. Selectively breeding for broad-based skulls has likely created a predisposition to cleft formation in these breeds. So breeding for these attributes that we consider cute comes at a cost. In this case, it was being suggested that Oreo pay the ultimate price for it.
Luckily, Oreo’s owners were not willing to pass the buck. At each visit, the owners opened with, “Euthanasia is not an option. We want him fixed.” Yet three times they were advised that surgery for this is so complicated and painful and the prognosis so poor that the best thing for the puppy would be to euthanize him.
Not taking "no" for an answer, the first thing they did was acquire a special bottle, designed to feed human babies with cleft palates. These bottles have an elongated nipple, enabling the babies to develop enough suction to feed. As with most of these cases, once weaned, these puppies are generally able to eat more solid food. It can be messy, and even a struggle at times, but they can generally feed.
Oreo was just over 6 weeks old when I saw him, and was already beginning to eat solid food, despite a large cleft. He was sweet, playful as any puppy, and blissfully unaware of his “defect.”
Cleft palate surgery is actually highly successful in the right hands. The tissue can be delicate, and paying close attention to technique is essential to successfully closing clefts. The odds of success are also greater if the surgery can be delayed as long as possible to let the puppy grow. Having more mature tissue, and plenty to work with, can make a big difference. Another reason to wait is the possibility of negatively impacting the growth of the skull if surgery is done too early.
I tell every client that sometimes you don’t close the entire thing the first time. Sometimes small openings will need to be touched up once or twice, but so far there are none that I have not been able to close completely. The prognosis for these dogs is excellent, and they go on to lead completely normal lives.
I don’t know where the belief comes from that this is not a treatable condition or that managing these puppies is so difficult, but it's certainly not in the prevailing literature, which is what should be informing the advice that veterinarians provide to their clients. So, whether it’s a cleft palate or any other condition that you are being told is beyond treatment, if you have doubts, seek a second opinion. Nothing carries a worse prognosis than euthanasia.