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September 29, 2014

The Euthanasia Conversation: Caring for a Sick Pet. ~ Ezat Luba Yomtovian

Hiding Pet Cat

How can we make the decision of whether or not to euthanize an animal?

Unlike humans, pets cannot always communicate when they are unwell, and depend on their caregivers to decide what is best for them.

Sometimes, what’s best could be euthanasia.

The Humane Society estimates nearly four in five households in the U.S. owns at least one cat or dog. This means, at some point, most of us will face the difficult decision of when to put our pet down. Yet as modern medical knowledge and technology progress, and the life spans of pets have the potential to be extended, recognizing the “right time” to euthanize a pet can become complicated.

Sadly, just like our human loved ones, our pets are also victims of disease and injury.

There are a number of ways pets may die, from accidents and emergencies to insidious illnesses and acute disease. When the phone call comes and the numbers are crunched, the discussion vets have with their clients is (well, should be) more about quality of life than cures and prolonging life. Sometimes, what is best could be ending the suffering.

It is always a difficult conversation to have.

Many veterinarians delay the euthanasia conversation for fear of upsetting their clients, a reluctance to admit defeat to a worsening disease or because their clients are willing to pay anything to try to save their pet.

As a result, sometimes when a pet is sick, too much focus is directed toward high-tech interventions similar to those used with humans (MRI and CT scans, surgery, chemo and radiation therapies, dialysis, etc).

When this happens, it can be easy to forget that there is a sentient being behind the images and numbers.

Multiple visits to the clinic, with lots of strange faces and hands, are stressful, especially for an unwell animal. Pets cannot comprehend how repeated injections and drugs that make them dysphoric and sick will actually (maybe) make them better.

Animals live in the present.

They become apprehensive of adverse experiences from the past. Most pets are reluctant to visit the vet for their annual exam because every year there is another injection, thermometer up the bum and abdominal palpation. Imagine the stress of an overnight stay, confinement in a cage with IV fluids or biweekly chemotherapy visits.

Putting a pet to sleep becomes an option when the quality of the animal’s life is significantly compromised.

Some owners seek to euthanize their pets because of a change in lifestyle. A new baby, restrictions on a lease, more demanding work hours, etc.

Inconvenience is not a reason to euthanize an animal.

I always decline putting healthy animals to sleep.

When clients cannot handle an unruly puppy, I suggest re-homing it. If a cat is incontinent but otherwise healthy, I suggest transitioning it to outside. When an owner complains about an aggressive dog, I often consider the home environment and offer behavioral advice and training. Animals that are obviously ill, however, require a deeper conversation with the owner.

The most important factors to consider when deciding whether or not to euthanize your beloved pet:

Is your pet eating?

It is not normal, healthy behavior for a pet to decline food.

Loss of appetite is a symptom of many underlying diseases. Some are easily treatable if addressed early and appropriately. Some are terminal. Sometimes a change in diet can help boost appetite and improve the pet’s condition. Ultimately the owner must consider whether the pet is getting the nutrition it needs to live a quality life.

Is your pet mobile?

Pain is difficult to detect in pets, so pet owners need to pay close attention to the signs, including decreased mobility.

Like a loss of appetite, declining mobility can signal a variety of diseases. It can be a symptom of something manageable like soft tissue damage from rough play or arthritis, or a manifestation of something more serious, like a pathological bone fracture from osteosarcoma, or neurological deficits.

Exercise intolerance and sudden collapse are symptoms of life threatening conditions, such as heart failure, a ruptured spleen or airway obstruction, and should be seen immediately.

If the pet has developed an acute reluctance to move, I advise emergency medical attention. Just like people, when an animal is in pain, it is reluctant to move. An owner who finds a pet cowering or hiding in a corner for hours or even a couple of days should suspect it is in pain.

The source of pain might be immediate, like a fracture, or referred, as in pancreatitis. Regardless of onset, if a pet cannot get around easily and comfortably, its quality of life is diminished. They become depressed, inappetant and the risk of infection is exponential if they cannot lift themselves out of their own toilets or groom properly.

What’s your financial situation?

Money is often the limiting factor when making decisions in the veterinary profession.

I encourage a conversation with your vet about the necessity of tests and how the treatment plan might change with more information, without losing sight of how the collection of more data might impact your pet’s quality of life.

The medical industry as a whole is lucky to have so many diagnostic tools at our disposal. But sometimes those tools do not actually improve the treatment plan. Rather, they are useful only for naming the problem and providing a definitive diagnosis.

I try to give my clients all of their options. I encourage them to ask questions. And I never leave a consultation room until I am satisfied that the pet owners understand why we (vet and owners together) have chosen the specified treatment plan.

Additionally, I encourage clients to pursue further testing only if they can afford it, if their pet is stable and if there are treatment options that are potentially available with more information. To clients who do not meet these criteria, I present a list of differential diagnostics and explain how we might approach each of them.

No matter the problem, the most important thing for every owner to keep in mind is the comfort of their pet and, ultimately, quality of life.

Medical tests can be expensive.

Blood work, for instance, can cost $50 to $200. X-rays may cost $200, and MRIs or CT scans can cost as much as $2,000.

But euthanasia is not free either. Depending on the size of the animal and the clinic’s protocol, putting an animal to sleep can cost $50 to $300. And disposing of the body is an additional cost. Some states allow for burial on private property. Private pet cremations are more expensive than the weekly mass pet cremations because the ashes are returned.

Emotionally numb and not distracted by grief, it is the veterinarian’s responsibility to present financial matters and euthanasia options in time to allow the owner to be present, and fully experience the last moments with their pet.

How is your pet’s quality of life?

The most obvious and crucial factor in determining when to put an animal to sleep is when it is experiencing unrelenting pain and/or distress.

Many people do not know what pain or distress looks like in an animal, especially given their mostly stoic nature and the insidious onset of some diseases. However, every good owner who spends time with their pet knows when their pet’s behavior is changing, and recognizes when they are beyond unwell.

Not eating, changes in posture, vocalizing, pale or yellow color, rapid weight loss, etc, are all signs of distress. If an animal is suffering and in pain, and pain relief is not available or is ineffective, euthanasia should be discussed seriously and immediately.

Final words on pet euthanasia and letting go…

Pet owners sometimes regret putting their pet to sleep too soon. Others regret holding on for too long.

Veterinarians stand apart from our human physician colleagues in that we sometimes hasten and sometimes postpone death.

I remind my clients that putting a pet to sleep is a forever decision. So long as their pet is eating and comfortable, I recommend they spend a couple days with the pet, and seek counsel from their loved ones before making a decision that cannot be reversed. If, however, their pet is in significant pain or obvious distress, I encourage a quick decision.

After spending months and years with our beloved pets, four in five of us will have (or have already had) to experience putting them down.

Knowing what to expect does not lessen our grief.

But it does enable us to feel confident that we were compassionate owners, and helps us focus on the good quality of life we were able to provide to our unconditionally loving and dependent companions.

 

 

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Apprentice Editor: Chrissy Tustison/Editor: Travis May

Photo: via Flickr/James Whitesmith

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