Read the article in the New York Times “Deciding when a pet has suffered enough”
This article is written by a non-veterinarian but brings up issues and questions we as veterinarians and pet care-takers must wrestle with on a daily basis. With the advancement of veterinary medicine in leaps and bounds over the past 2 decades we are able to provide more and more advanced care for our pets, sometimes rivaling the care provided for human beings. The question I always ponder is, “Should we?” As a veterinary neurosurgeon in Charleston, SC I am able to provide services including spinal and brain surgery for my patients. Before I perform these procedures I always discuss that, although these options are available, it does not always mean we should or must pursue them. My perspective regarding the services I can provide in veterinary medicine is that the quality of the pet’s life AND the care takers’ lives are of the utmost importance. I try to use this consideration in guiding the care that you and I decide to pursue. I always try to help guide the decision-making process based upon my experience and understanding of the patient, but ALSO based upon the dynamics and ongoing care needed at home. If I truly feel that one decision is absolutely more appropriate than the other, I do not hesitate to say so. Although it can be a very difficult decision to make, I honestly feel that sometimes euthanasia is the greatest act of love you can provide for your pet. Whichever decision you make regarding care for your pet there may always be regrets down the line and you may start to question your decision. In these cases I always remind pet owners that the decision they made was made with love and with their pet’s best interest in mind and that is all you can do. This is obviously a very emotional and difficult topic to discuss. If there are ever any questions never hesitate to discuss them with myself, another veterinarian at Veterinary Specialty Care, or with your regular veterinarian. There are also support groups and counselors available for people who need further help coping with the loss of their pet.
Peter J. Brofman, DVM, MS, ACVIM (Neurology & Internal Medicine)
This is a topic that we, as veterinarians, face daily. I am often asked how will I know when it is time, should I be present for euthanasia, and what do I tell my children? I don’t know that there are any definitive answers to these questions. They certainly vary from family to family and on a case by case basis. I can only tell you what I believe and offer some advice for coping with this difficult situation.
How will I know when it is time?
This question is tricky because it really depends on the underlying process causing your pet to be ill. Certainly there are some clinical signs of progression of disease that apply to all pets. I generally tell owners that it is time to seriously consider euthanasia when the good days are outnumbered by the bad. This can be obvious in cases where pets have uncontrollable pain and/or vomiting, but it can be a little more challenging in cases where they simply are a little more lethargic or refuse to eat. I had a cat named Shadow who was diagnosed with Lymphoma back in 2006. I had it set in my mind that it would be time to euthanize him when he quit eating. As it turned out, Shadow ate ravenously every day up until the day I had to euthanize him. What made me decide it was time? I was holding him one afternoon and he urinated on me, something that he had never done before. It made me take a step back and really look at him. What I saw was shocking. He had become gaunt and he did not appear to really be seeing me even though he was looking at me. This is what I always think of when clients tell me that the light has gone out of their pet’s eyes or that their eyes have changed. I know that look and will never forget it. How had I had not noticed? I had set a single parameter in my mind… I will know when he stops eating. In hindsight, I realize that I had waited too long. In some chronic illnesses, the change can happen so gradually that it is hard to remember what “normal” behavior was. In those situations, I tell owners to keep a daily journal of their pet’s attitude, activity, appetite, and interactions with the other pets. This way, you will have something solid to review. If you look back and see that your pet spent most of last week in a crouched position on the window sill and was the last of the cats to come to eat, it might be time to consider euthanasia. Especially if you know from your journal that your pet use to sleep 12 hours on your head every night and then roam outside for most of the day.
Should I be present for euthanasia?
This varies from person to person and family to family. I will tell you that I do not ever judge anyone based on their willingness to be present for what can be the hardest decision they have ever made. If you are unable to be present, please take comfort in knowing that most of us became veterinarians due to our love of animals. This means that we will treat your pet as if they were our own and show them the love and respect that you would. We hold them, talk to them, pet them, and very often we cry. Tears are not something to be ashamed of and no one will think less of you for crying, so please do not ever let this keep you from being present for a loved one. If you opt to be present, we try to make this as comfortable as possible for both you and your pet. We tend to sit on the floor with our pets so that you are able to touch or hold them. The process itself is very fast and painless. Tux was the name of my first cat. He came to me in middle school and we shared 15 great years before he was diagnosed with metastatic cancer and I made the decision to euthanize him. This happened the first year of my residency. I remember seeing him decline at home, but being scared to bring him into work because deep down, I knew that once I found out what was wrong with him, I would be forced to make a decision. I waited 3 days before I had the courage to bring him in. Once I found the cancer and saw how extensive it was, I knew that euthanasia would be blessing for him. Even though I knew that in my mind, I could not make the decision right away and I took him home from the hospital. I felt a huge pressure in my chest whenever I would look at him and I could not eat. I was so distressed about making a decision that I delayed it for 48 hours. When I finally made the decision and moved forward with it, it was as if a great burden was lifted from my heart. I think this was because I was dreading losing him so much. The reality of his peaceful passing and knowledge that he was no longer suffering gave me immediate peace. I often hear people comment on how they feel great comfort after euthanasia. Making the decision to euthanize a loved one is a great burden to bear. Sadness is expected, but you should never feel guilty about having to make the decision to euthanize your pet. Often, it is the last gift we can give them to demonstrate our love and return the loyalty that they gave us.
What do I tell my children?
I believe that honesty is always best and that you should avoid using the phrase “putting him to sleep”. Children who are already having a hard time with the situation might misunderstand the permanence of euthanasia and it has the potential to make them afraid of bed/nap time. While it is incredibly hard to discuss death with a child, it is a natural part of life and the passing of life can often be a blessing. Children are very perceptive and they often share a special bond with our pets that is very different from ours. If your pet is painful, it is helpful to let your children know that we are helping them by relieving their discomfort. Based on your religious beliefs, you might feel it appropriate to discuss after-life. There are several children’s books available that can help with discussing euthanasia and the feelings your child might have.
Finally, if you or your child is having a difficult time making a decision or coping with the loss, I would suggest that you speak to someone. This someone can be a friend, family member, or grief counselor. The important part of this is to open up to someone. I do not believe that words will erase the pain, but I do know that time and a good support system are the greatest healers.
Pancreatitis- What we do and don’t know
Holly Mims, DVM, Dip. ACVIM
I was at a lecture given by Dr. Davis this weekend and one of the attendees inquired about pancreatitis. His dog died acutely from pancreatitis despite aggressive medical care and he was wondering why this happened. Unfortunately, this is not an uncommon scenario and one that the internal medicine doctors face regularly. Pancreatitis is a frustrating disease. I routinely have patients who can be treated as outpatients and those whose disease is so severe that they have to be hospitalized and despite our best efforts succumb to this disease. When this happens we are all left with unanswered questions and a sense of loss. What causes the disease to be mild for one dog and life threatening for others? In some cases, we can identify a trigger and in others we never identify a cause. As such, I thought I would put together some information on what we do know.
What is pancreatitis? Pancreatitis is inflammation of the pancreas. The pancreas is a digestive organ that is important in releasing enzymes that help to break down food. Those same enzymes that break down food can be released locally within the pancreas itself and result in “autodigestion” of the pancreas creating inflammation.
Pancreatitis comes in two varieties: acute and chronic. The acute form means that there is a rapid onset of action and this form is often the most severe. Acute pancreatitis typically requires hospitalization and intensive supportive care. It can also result in tissue death (necrotizing) and this is a life threatening form that often requires surgery to stabilize the patient and to remove the significantly inflamed tissue. Hypovolemia (decreased intravascular fluid volume/dehydration) from vomiting, diarrhea, and anorexia may contribute to the progression of the disease and severity. The chronic form is typically less severe with waxing and waning clinical signs when the inflammation flares up. This form can require hospitalization and supportive care for several days, but often can be managed on an outpatient basis.
We are not sure of all of the underlying triggers for pancreatitis, but experimental evidence suggests that low-protein, high-fat diets can induce pancreatitis. Overweight dogs and cats are considered at greater risk. This could be related to their diet or the fact that increased adipose tissue (fat) is associated with a chronic inflammatory state in the body. Concurrent diseases such as Diabetes mellitus, Hypothyroidism, and Hyperadrenocorticism (Cushing’s disease) are also commonly reported in dogs with pancreatitis. We also know that some breeds such as the Miniature Schnauzer are genetically predisposed to developing pancreatitis.
How can you prevent pancreatitis? Maintaining a healthy weight and feeding a nutritionally balanced diet is a good start. Avoid table scraps, left overs, or higher fat treats. Yearly blood work (fasting) performed by your veterinarian will evaluate cholesterol and triglyceride levels, help screen for concurrent diseases, and can give us clues as to the potential risk of developing pancreatitis. If clinical signs of vomiting, diarrhea, or anorexia are present, seeking medical attention sooner rather than later can also be beneficial to prevent the progressive effects of dehydration.
If you have ever been in an emergency situation before you know that time can be the difference between life and death. At both of our 24 hour emergency locations we know this as well and as such we created an emergency pre-registration option called VECARES. It stands for Veterinary Emergency Care Acute Response Enrollment System. It is very simple to do. When you click on the link below you will be taken to our web site and the online form will be available. Fill out the form completely and be sure to read the instructions that will explain to you what items you should have handy in case of an emergency. When you are finished completing the form you simply click the submit button. We will receive the information and enter in in to our computer system. Then, in case of a pet emergency you can head directly to one of our 2, 24/hr emergency locations in either Mount Pleasant or North Charleston, bring along all the information that the VECARES form requested and that is it. Your pet’s information will be in our data base at both locations and this means time is saved from filling out new client paperwork. Remember both of our emergency locations are open 24/365!
If you have any questions please feel free to contact Donna Recupido at DRecupido@VeterinarySpecialtyCare.com
National Wildlife Day serves to bring awareness to the number of endangered animals nationally as well as globally, that need to be preserved and rescued from their demise each year, but also to acknowledge U.S. zoos and outstanding animal sanctuaries for everything they do to help preserve this planet’s animals and educate the public about conservation – especially to children….our animal’s future caretakers and conservationists.
National Wildlife Day will also encourage citizens to stand up and fight for animals that need a voice, visit their local zoo more often – and especially on National Wildlife Day and donate what they can to worthy organizations that make a difference in the lives of our beloved animal friends.
Look up your local zoo or animal sanctuary, sponsor a favorite animal, donate or volunteer to help in any way you can.