 Hi and welcome back to You and Your Health. My name is Jackie Weirach and we're here at Orchimedia Studios with this new show. I think we're on episode five or six or seven. I'm not counting. But we have a very special guest today because when we're talking about being proactive about our health care, we have generally been talking about the human form and now we're going to talk about a man's best friends with Dr. Erica Bruner. Hi Erica, thank you so much for joining us. Thanks for having me. You have a very special practice and it's hard of Vermont veterinary house calls, right? And we met you maybe five years ago, six years ago? I think it was actually longer than that at the practice that I was at before. Where were you before? At a new river animal hospital. And now you travel around central Vermont and trade animals. Yes, now I don't have an office just, you know, my office is my car essentially and I work at home with people with their animals. So what made you make the transition from Onion River to being out on the road by yourself? That's a big change being with people and having that support staff around you all the time to going solo. Yeah, it's very different. There's been kind of a learning curve for me. I'm glad that I had all the experience that I had in the clinic beforehand because I feel like the medicine part of it I have down, you know, but the way things work in house calls is very different. There's much more time and people are more relaxed at home. Animals are usually more relaxed at home. Some animals that I see, especially some dogs, really don't do well in the clinic, but they're just fine at home. Other times it's because they, you know, are big dogs that are creaky and old and people don't want to stress them by having them get in the car and, you know, the clinic environment can be kind of stressful. It was kind of stressful for me and I didn't even realize how stressful until I left. I am an introvert so I like being alone. I like quietness. I like driving. So the fact that I spend a good piece of my day driving and by myself doesn't bother me. Back in the early days in vet school we used to have to do the exams and even sometimes collect blood samples or whatever on our patients in the small animal hospital, essentially by ourselves every morning. So I was used to that. Also my first year in practice I worked in a mixed practice so that means I did farm animals and pets. And I did a lot of bovine work and I did a lot of driving around for that job. So I had that familiarity and I liked that. It's kind of a slower pace. In the clinic you're going from visit to visit, you have maybe 15 to 20 minutes, maybe half an hour if you really stretch it out and you've got to go from one to the next and there's lots of activity going on, there's phone calls and there's people doing things and there's people rushing around and some people really thrive on that environment. I love all that energy but for me it was actually training and I would end up every day just feeling like a truck had run over me. So there was a turning point for me. I went to a Vermont veterinary medical association continuing education meeting and I met one of my classmates who's a large animal vet and I asked him what he was doing and was he still working for that practice that he worked for last time I'd seen him and he said no I'm out you know I'm my own now and I only see the people I really want to see and I don't work too many hours a day and you know I have scheduled appointments every day from 8 to 12 and then in the afternoon I'll see urgent things that come up so I've really kind of dialed it back and he was so happy with that and I was like oh can I have that? You know and I remember back to the days of driving around and seeing people which I always liked and there is definitely a movement in veterinary medicine a lot of things are happening in veterinary medicine like there's increasing specialization you know what I started in mixed practice farm animals plus pets that is sort of a dying we think of like James Harriet and that model of like you know he sees every animal and he's this folksy friendly guy and we're still folksy and friendly but it's really hard now to have the level of knowledge to practice the kind of medicine that farmers need that pet owners need and there's more and more specialization and so it's harder and harder to do all those animals and then I also think it's harder to do everything even for one set of animals and I found that as time has passed in my career because at this point I've been out of vet school for let's see 16 years is that I am less and less interested in the science of the medicine and more and more interested in the art of the medicine and the kind of spiritual aspects and the human aspects and I always have thought of myself as kind of an intermediary between the world of medicine and what people want and what their animals are dealing with so I feel like my job is to try to interpret the signs that I see in their animal and what they tell me about what's going on with their animal and then what medical options there are and then try to present those to the person so that they can decide what's best for me and my patent going forward is that the art of the medicine yeah I think so I mean and there's there's also the art of kind of well what is needed in this situation and what is going on and because I now work at home I don't have access to snazzy diagnostic equipment for some people I think that would be a real hindrance or maybe they would just choose to do house calls with the equipment which some people do they've got a mobile clinic where they have an x-ray machine and a surgery suite and blood machines and everything that's in a clinic they bring around with them driving on our roads well it's part of why I didn't do that and the other reason why I didn't do that is like I said I'm really more drawn to the sort of human and spiritual aspects of it so that means that there might be less emphasis on diagnostics and more on just palliative care which sometimes we need some diagnostics for that but it works really well to be at home and it's often the place where people are with their older animals you know they often feel like well I I don't want surgery or I don't want to do a lot of diagnostics I just want to make them comfortable right so sometimes diagnostics are really helpful for us to know how to do that and other times it's much more about talking with people about okay so what did he do today what did he do yesterday what does he do on average how can we help him negotiate this part of his environment better like if there's stairs how can we deal with that so being at home is nice to see that and so I find myself doing a lot more of the counseling aspect because much of my many of my patients are older and I think for their people it's a pretty challenging time sometimes people have been through it before with another pet but maybe that pet didn't mean quite so much to them not in a bad way just that I think there are some animals just like some people that we really have a deep connection to and maybe we had a cat before and that was just kind of a like a roommate relationship but now we have a cat who is really more like our soulmate or maybe we went through some difficult period like people say to me well I went through chemo with that dog and he was with me all the time and there's a bond that they have with their animal that is different from the kind of bond that we have with people but can be just as important and so trying to negotiate what happens when all of a sudden this animal who lives maybe 12 to 17 or so years depending on what species they are all of a sudden they become old and how do we deal with that they went from being our child sort of to our buddy and now they're like our aging parent and caring for aging pets has a lot in common with caring for aging people being a caretaker for an older pet it gets more and more challenging but there isn't really the support system in veterinary medicine that we have in human medicine like a hospice type system where caregivers could come in and relieve people or help with some aspect of the pets care there is a growing movement in veterinary medicine for hospice care is there yeah because the model in veterinary medicine for end-of-life care basically just has always taken for granted that euthanasia is the end of life which definitely there's a lot of counseling and you know management of palliative care even if our endpoint is euthanasia but for some people that's actually really uncomfortable and veterinary medicine only recently has kind of acknowledged that and acknowledged that that's okay I feel like I was kind of trained with that assumption that well if somebody doesn't want to euthanize their animal you basically just have to convince them to do that really yeah and that does not fit with how I think we should be as veterinarians but it's only recently that my consciousness kind of has been raised about this issue I have a friend who's a Buddhist who was interested in working on a book with me and she wanted me to provide the kind of vignettes of end-of-life situations for animals and she would write about the Buddhist like rituals and practices at end-of-life for people and how we can also use those with animals and so of course the Buddhist take on it is that there's no euthanasia that's not okay so being confronted with this from my friend of like well what do you do if you're not euthanizing the pet and I was like and so what are our options well it's really challenging because like I said there isn't a framework like hospice so people have to do all the caregiving themselves within their own family and often it's one person within that family who's doing the majority of it and sometimes I think quite often people there are not many people that I've met that really feel like euthanasia is absolutely not an option for them but there are many people that I encounter and I'm much more sensitive to this now who feel like you know there's sort of a bell curve of like where do we make this decision some people are ready to make it pretty early some people more people are kind of in this middle phase and then there's folks out here who it's not that they don't want to euthanize at all it's just that they don't feel like now is the time right but as we get further and further kind of out in the process of pets becoming more and more challenged you know they may have dementia issues they may have mobility issues that often we have contents issues how do you determine dementia with an animal that does not speak well I think it's easier to tell with dogs than with cats probably because we have domesticated dogs many many thousands of years before we domesticated cats right so there are facial expressions they are more like us you know we have made them more like us like dogs are the way they are because we bred them to be that way so I think that we have an easier time reading their thoughts and feelings from their faces and actions so often with dogs early signs are things like they get lost somewhere like they're in the bedroom and you're in the living room and they're barking like they don't know where you are even though two years ago they knew to just come and find you in the living room so or like going outside and looking like they don't really know what they're out there to do and how to get back in like sometimes they can't manage the dog door anymore or one classic sign is going to the wrong side of the door when it's time to go out like going to the hinge side instead of the side that actually opens being more withdrawn socially like just seeming to not connect with you in the way that they had those are typical early signs and with cats it's often harder to tell I experienced this was my own cat who lived to be almost 22 before I chose to use a nicer wow yeah and she I at one point thought that maybe she was blind because our typical relationship you know one of our interactions would be she'd come into the room and I called to her she wasn't really a lap kitty but she loved attention and being petted so I called to her and I put my hand down and she'd come over to my hand and I pet her and now she was just walking right by my hand I was like does she not see the hand but then I experimented with you know little tests that we have for can you see like if I put something in your way that's not normally there do you hit it or do you walk around it if I toss a cotton ball next to you something that lands without making a sound do you see that it's there or do you ignore it because it didn't make a sound and I could tell that she could see but I realized that she didn't know what that hand was and she didn't seem to know who we were like she was there was just like kind of no there there yeah and so that of course led me to many thoughts and questions about what is the purpose of life why are we here like sometimes somebody declines gradually and then all of a sudden something dramatic happens like they get seriously much sicker and it's very obvious that something has to be done and at that point many people will make a euthanasia decision if they don't want to go into that realm of like definitive diagnosis treatment surgery and things like that other times though somebody's decline is just so gradual that and you get so used to the new normal that it's really hard to know well when you know this is a thing that people agonize about all the time when do we make a euthanasia decision because like we mentioned before when there's so little support for a true hospice end-of-life process in pets where you know all the cleaning and all the nursing and all the maintenance and everything has to be done by one or two people and people can't do that like they just have to go back to their lives you know and so when someone declines really gradually there is that question of like well okay I'm not against euthanasia per se but how do I know when to make that decision you know it's there's no simple algorithm because what's going on with the pet is different what's going on with the person is different everybody's got their own philosophies so that's a lot of what I do is just talk to people about where are they where are their pets what do they think about where they are what kind of progression are we going to see as time goes on and what might they decide to do as we get into those later stages so and here in Vermont is there a movement to create hospice care for animals where they would actually go and be in a hospice and have caretakers they're with them where the family would come in I think in the world there are one or two facilities like that I know there's one in Japan I can't imagine we're gonna have one in Vermont any time soon I mean we barely have an emergency clinic you're kidding yeah we have an emergency emergency clinic in Burlington right so if you think about what kind of economics are needed to support something like that yeah the actually having a physical hospice building to for pets to go to so going back to your friend the Buddhist and euthanasia is not an option what are her suggestions yeah well we'd have talked about that and I've also been there's a great resource online for veterinarians called Vin veterinary information network and it's enormously huge and has many different boards where you can have conversations with other veterinarians and they've got moderators on the boards who are board certified specialists in that field or in the case of hospice there's no board certification but there are people who that's all they do and so learning from them about how they essentially what we have it access to right now is not really necessarily hospice the same way it's done in people but a much more palliative orientation with a greater understanding that it's okay to take time to think about all this stuff and it's okay to not use an eyes your pet right away and that it is possible to relieve pain and other symptoms and that you know there is an understanding that people may not be very comfortable with euthanasia I've got some clients that just feel like they feel like they're murdering their pet and maybe it would never feel okay to them or maybe it doesn't feel okay right now but they don't know that maybe there's another option that they could do more palliation or in some cases they're just kind of running up against the hard realities of like it doesn't feel right to them morally but there isn't any other option for them like they can't pay someone to take care of this animal and they can't stay home all day to take care of this animal so you know in that situation their hand is kind of forced into euthanasia but I think if veterinarians you know are aware about this and understand about this and it's not some kind of like oh they just don't see why this animal needs to be euthanized it's more that we're really all different about where we think that line can or should be drawn so in the case of my friend her dog went through a fairly fast decline and she was able to be with him over the couple of weeks that he his like active dying process was going on and she had a house call hospice type veterinarian to help her and she had morphine to give him it was a pretty I think it kind of worked out in an ideal way for her it's just not always we don't always get that but we have to kind of be that's sort of what Buddhism is all about anyways like we don't always get what we want the way that we want it and we've still got to be okay with that so that's probably why she wants all the different vignettes because she knows that she kind of lucked out with her situation and that's not always going to be as easy so-called to go through that the way that she ended up having her process with her dog yeah I know Peter and I have felt very grateful to have you be there with us as we've watched snowball age like almost overnight and we really thought last October he would be we would be making that decision or he would be passing and you've given him such amazing wellness care that he has had such a turnaround and is really like the old snowball again he's not going hiking like he used to but he is jumping and playing and dare I say laughing just like he was as a puppy so we really appreciate you and and I hope that introducing you to our viewers is really helpful right now you're only taking clients new clients who are those animals are for end of life care correct actually probably for the rest of the summer I won't be able to take anybody new at all but in the fall things usually calm down some but yeah I mean my I started with no particular focus in house calls just seeing everybody that wanted to vet at home right and through the four years that I've been doing this really want to focus on older pets the palliative approach and this kind of counseling and you know sort of thoroughness at end of life so yeah that's where my heart is well you're an angel thank you so much for coming on this show and thank you viewers for watching our time has gone very quickly once again this show will be up on our website and Dr. Eric will be able to share it with her friends family and colleagues so others can find out more about the different resources that were mentioned here today we'll have that at the end of this show and thank you for joining us until next time namaste