My family and other animals

Numerous famous authors, including Charles Dickens, TS Eliott and of course James Herriot (also known as James Alfred Wight) have written about their pets or animal experiences in their books or poems. Even incredible rock stars such as Freddie Mercury (‘Delilah’) have sung about their animals, with Freddie stating he loved his cat and her kisses. So, while I am not suggesting that I am a legendary author or singer, I would like to utilize this column to immortalize my beloved dog, Bertie. My dog Bertie. Bertie is my first ever pet. I could not have animals when I was younger because my brother had severe asthma and seemed to be allergic to everything on the planet, including dogs. Thus, as a child I could never understand or empathize with my friends' love of their pets, particularly not the grief they felt when their pet died. There is a famous anonymous quote that says, ‘having a dog will bless you with many of the happiest days of your life, and one of the worst’. While I hope that day is still some time off for Bertie, he has certainly given us scares over recent years. Despite being only a middle-aged dog, his medical history thus far includes moderate mitral regurgitation (on treatment), allergies with recurrent skins infections (on treatment), renal stones leading to obstructive renal failure requiring a cystotomy and further surgery, with post-op sepsis and wound dehiscence. Luckily for me he survived that episode. Luckily for Bertie his ‘mother’ is the kind of person who was more than happy to clean and dress his wounds five times a day and who will pay for a biologic drug (IL-31 blocker), albeit who even knew that dogs were prescribed biologics! Bertie's never-ending catalogue of (expensive) illnesses has given me a whole new understanding of the world. Over the years, I have cared for many patients who have refused hospital admission for respiratory exacerbations because they lived alone and there was no-one to care for their pets. Similarly, patients who have struggled with severe debilitating breathlessness have refused to consider moving into residential aged care facilities because they could not take their beloved animals with them. Both cases clearly demonstrate the immense comfort, love and friendship animals provide to humans, particularly those who are socially isolated and lonely, as so many of our respiratory patients are. Among my own patients, two animal stories are particularly worth noting. I had been looking after a woman ‘Elsa’ (name changed) with end-stage chronic obstructive pulmonary disease (COPD) for many years. Elsa knew that she would probably not survive her next exacerbation, but her main concern was for her 3-year-old dog called Frosty. Elsa was terrified that there was no-one to care for Frosty after her death and that he would be put down, even though he was a young, fit animal. Elsa's story caused deep upset among the clinic staff, so much so, that many of us offered to rehome Frosty when required. In the end Elsa's neighbours also offered to and did rehome Frosty when the time came. The importance of that offer was profound and relieved immense existential distress in Elsa's final months. My other notable patient was a lovely woman named ‘Maria’ who had severe COPD for many years, which had largely been well controlled without exacerbations. Suddenly, Maria's COPD deteriorated requiring four admissions and seven emergency department presentations over 3 months. During these presentations the treating team diagnosed her as being anxious and referred to my severe lung disease clinic for breathlessness management. A careful history (including a veterinary history) identified that Maria's dog had died suddenly 3 months ago. Maria was not anxious, instead she was extremely sad, lonely and grieving. While we could not give her a new dog (nor did she want one), we actively listened, and we provided psychological support to help her, and she did not admit again for over 2 years. In medicine, we are taught to take social histories that focus on exposures (alcohol, tobacco, environment and occupation) and what supports (physical or human) our patients have in place or need at home. And while as respiratory clinicians, we may ask about animals as triggers for allergies or hypersensitivity pneumonitis, we do not routinely ask or think about pets as beloved family members or important social supports. Nevertheless, a recent Canadian study in which primary care health providers were provided education to ask about pets during history taking, identified that asking about pets in the family revealed clinically relevant information, improved communication, and strengthened therapeutic relationships (https://doi.org/10.1177/0046958017734030). Similarly, a recent study from the United States identified that 41% of health professionals working in geriatrics asked about pets and that when they did, prevalent issues included pets impeding care, patients refusing care due to pets, patients' concerns regarding their pets' health, care or need to be rehomed (https://doi.org/10.3389/fpsyg.2022.920559). Both studies, highlight not only the immense importance of considering and asking about pets, but also the need to provide psychosocial and holistic care to our patients with respiratory illness. So, I urge you all to embrace the veterinary history. And for the record, my beloved dog Bertie is undoubtedly the best animal in the world. None declared.

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