This week: tough decisions Life is full of tough choices, but fortunately for most people they don't involve life and death. In the medical profession things are different; doctors are featured on television shows making life-and-death decisions all the time. Just watching such medical action can be hair-raising and adrenaline-inducing. Vets are featured less on TV here, but overseas the life of vets has proven a successful formula for myriad TV dramas and educational and reality shows. One book and TV series that inspired thousands of vets and wannabe vets around the world is All Creatures Great and Small by Dr Alf Wight, more commonly known as James Herriot. It is a great read and for me it is interesting to see what the profession was like just after the second world war. It's amazing how much has changed and how much has remained the same. I am often faced with life-and-death decisions. Some are easy, as we often have limited choices. Some will lead to death, euthanasia; from a medical professional's point of view, this may be the best possible decision for a hopeless situation, but from a pet owner's perspective it is a daunting decision. Just yesterday I was presented with a poodle called Henry that has been struggling with a tumour in the back of the mouth for six months. At first we cut out the mass, which was making swallowing food difficult, but the laboratory report came back with bad news - the mass was invasive malignant cancer. There was no way we could completely cut out the mass due to its location and even chemotherapy was not an option because it was ineffective on this sort of tumour. Three months after the initial discovery and surgery, we had to repeat the surgery and reduce the mass so Henry could eat. But after six months and two surgeries, the mass had come back with a vengeance and it had extended up Henry's nose. Since Henry wasn't able to breathe through his nostrils, every time the owner fed Henry liquids and he tried to breath through his open mouth, he would choke. It was clear we couldn't maintain Henry's quality of life any further. We had successfully extended his life for six months but his time had run out. It was a tough decision to say the least, but Henry's dedicated owners decided to end his life, which was slowly turning miserable. It was a tough, emotional decision for the loving owners but, from an objective professional view, it was a straightforward and necessary decision. It was an easy decision professionally. But not all professional decisions are easy for me. One such decision involved my Pomeranian YY, which I adopted when she was 10 years old. Since then her teeth, despite daily brushing, have slowly deteriorated. When I first saw YY at the adoption centre, my first thought was she was gorgeous and how could anyone in their right mind abandon her. She was one of a kind, with a deformed shortened left foreleg that made her walk with a funny limp. What made her adorable was her eternally happy smile and her incessantly wagging tail that seemed not to be under her control. It was when I picked her up from the cage on the floor that I realised she was abandoned because her mouth smelt of rotten eggs and her previous ignorant or uncaring owners had not wanted or known how to fix it. I gave her dental treatment under anaesthetic that day but it was too late for YY. Because of her extreme gingivitis, the bacteria from her gums had travelled to her heart and infected the heart valves. If damaged, these valves will cause the heart to enlarge slowly and fail. Six years later YY's teeth were giving her trouble again. Her already damaged gums had receded badly and her remaining teeth needed work and some needed extraction. The renewed gingivitis not only threatened to make her heart infection worse, but it also risked her kidneys, where blood-borne bacteria could cause infection. By this time she had developed congestive heart failure and a severe heart murmur. With an inefficient heart came fluid build-up in the lungs, which made YY cough a lot. Her teeth were clearly giving her trouble and pain. But an anaesthetic at her age and in her condition was risky. I was damned if I did and damned if I didn't. I decided that if it was me I would rather risk death then continue with a sore mouth every day. So I decided for YY to risk an anaesthetic. We placed her on intravenous fluids for a few hours before surgery to increase her blood pressure and lower the anaesthetic risk and performed the quickest dental work in history. She woke up to wag her tail another day. YY eventually succumbed to her heart failure two years later at the ripe old age of 18. I miss her very much. It was hard to be dispassionately clinical about a beloved, balancing ending her pain and the risk of dying. But the decision I made was the right one.