Tails of Seattle: A pets blog

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December 8, 2011 at 6:00 AM

Veterinary Q&A: Euthanasia and memories of our pets

Posted by Neena Pellegrini

hanna1.jpgVeterinarian Hanna Ekstrom, left, who owns At Home Vet, a house-call practice in Woodinville, answers this week's questions about euthanasia as part of our series on the health issues of senior dogs. We also are including photos and vignettes from Seattle Times staff members in memory of dogs that have come and gone in their lives.

Question: Under what circumstances do most of your cases take place?

Answer: Most of the pets I see for end-of-life care are geriatric pets who have lived a full life, have just reached the end of the trail in one way or another, seem ready to pass but are having trouble doing it on their own.

For example, many large-breed dogs suffer from hip dysplasia and arthritis. Near the end, they may not be able to rise on their own, and many of them are incontinent, which can result in urine scald and bed sores.

Despite the best care by both the pet's owner and veterinarian, sometimes controlling their pain is just not possible; patient management is a nightmare unless you are home all day, up much of the night and able to comfortably lift 100 pounds or so.

These pets could hang on for many months or even years, so many owners feel it is kindest to "set them free" from their pain.

I also see a fair number of younger pets that are in crisis for a medical issue, for example, a cat with fluid in the chest or a dog with a heart-based tumor. These pets are unlikely to have a distress-free natural death, so most people will elect humane euthanasia, either in a clinic or at their home.

I personally do not want any pet's last minutes on earth to be filled with suffering or fear: Better a day, a week or even a month too early than a day too late. Our pets are so lucky that we can help them pass peacefully when it is their time.

Question: Euthanizing a pet can be one of the most difficult decisions an owner faces. Do you have criteria for clients who ask whether they should euthanize their pet?

Answer: Most of the time, the criteria are similar, although no single "checklist" can be used.

petcaseyscreened.jpg The bottom line is that any pet whose pain and suffering cannot be controlled and who has a poor prognosis for long-term survival is a candidate for humane euthanasia.

Individual questions we consider are:

-- How much of the day is your pet "your pet"? Can he or she interact with the family, or is their physical or mental distress too great?

-- Are the treatments that are necessary to minimize pain negatively impacting quality of life?

For example, we may be able to extend the life of a cat with chronic kidney failure with subcutaneous fluids and oral medications. But the cat's overall quality of life may not be acceptable if she spends all her time hiding in the closet. Perhaps it would be kinder to euthanize.

-- Is your pet's pain manageable, and can the family effectively provide the care needed?

Lifting an English mastiff six times a day to go outside to potty isn't as easy as doing the same for a Chihuahua. If getting a medically necessary pill down a cat's throat is a major battle (and there is no other alternative), then treatment may be impossible.

-- What is the likelihood the pet could suffer a crisis and need an emergency euthanasia?

Pets in respiratory distress can suffer a sudden and very traumatic death -- they may feel like they are suffocating -- so I encourage owners to let go of these pets earlier than I would, say, a pet in renal failure.

Deaths that occur in crisis are much harder, both for the pet and the family.

I encourage owners to weigh all the factors when thinking about end-of-life choices: how stressful or painful will the medical intervention be? How many "extra" months of good life are likely if we proceed with medical intervention and can they, as a family, manage the demands of their pet's care?

Remember to consider all the aspects of life quality, and ask respected friends, family and your veterinarian what they think. Your decision will be an amalgam of all this information. It is my opinion that setting your pet free from his or her suffering is an act of kindness and courage; it is a gift you are giving your pet.

Question: Is lack of appetite a sign of knowing when an animal may have given up? How do we know?

Answer: Not unless the pet honestly seems hungry but can't eat, say, because of an oral tumor. Many pets near the end of life simply are not hungry, so not eating (anorexia), is not a hard and fast criterion for choosing euthanasia.

The statement "you will know when it is time" does little more than increase the stress and grief many owners feel. Except in very obvious cases, for example, a golden retriever that has broken its leg at the site of a bone cancer, no one can definitively say, "It is time." Pets don't always give us a clear sign; sometimes we just have to use our best judgment.

Question: What about a pet who is not critically ill or old, one that has become inconvenient for an owner, perhaps because the owner can no longer physically care or afford to care for the pet?

Answer: The economic issue is a particularly thorny question. No one wants to let go of a pet because the treatments are inconvenient or too expensive, but the reality of life is that if we can't manage their care practically and economically, we are not doing our pets any favors.

Some of the hardest cases for me are the ones where, for whatever reason, the owners can't effectively manage their pet's condition, but they are unable to find the strength or conviction to help their pet pass.

In these cases, I do whatever I can to provide a comprehensive pain-management plan that may include combinations of different types of pain medicine for maximal effect, acupuncture or laser therapy, massage and environmental modification (such as blockading the stairs so the dog doesn't fall down them or placing runner mats to avoid slippage.)

Sometimes, in truth, people may "wait too long" because they can't separate their guilt from their grief. I try to help people let go of their guilt; guilt does not help them or their pet.

On the other hand, if the pet is young or healthy and the owner just wants to euthanize for convenience, we work with the owner to try to find a new home for their pet.

I have the hard and fast principle for myself that I simply won't euthanize a pet if I am uncomfortable with that choice and I feel there are other options that might work for both the pet and owner.

That said, I wouldn't, for example, refuse to euthanize an older cat that was consistently marking in the house if options for medical management had been exhausted (i.e., it had had a medical workup, a behavioral workup, medical management had been attempted and options for re-homing had been investigated to no avail).

Question: Much of your attention must be spent dealing with grieving owners. What have you found to be the most comforting for them?

Answer: Grief is such an individual process that every situation is different. We try to listen and address owners' concerns honestly, validate their decision if it seems that the choice has been made thoughtfully and, if possible, help them reminisce and celebrate the pet's life and their shared history.

We want people to know that whatever they do -- however they grieve -- it is OK and it is normal.

I have seen it all: people who are silent, people who wail or keen, people who vomit or collapse. All those reactions are normal, just different expressions of severe grief, and nothing the family says or does is going to make me uncomfortable or judge them.

Questions: What about children? Do you handle these family members differently?

Answer: Whenever children are involved, we spend time talking with parents about how to talk with their kids about the death of their pet and about the feelings the children might experience themselves or see their parent's experiencing.

If the kids are to be present during the euthanasia, we typically direct our entire conversation to them, at their level.

First, we explain exactly how the euthanasia will happen and what they can expect to see. Then, we always take whatever time is needed to help the kids through this process. This might involve looking at pictures they drew of the pet, asking them to tell us a story of their favorite memory or letting them help make a paw print after the animal passes.

Sometimes, the way kids deal with death can be jarring for their parents. I have had kids take tons of photos during the process of euthanasia, or asking the same question over and over.

One little boy kept repeating, "Is he dead? Is he dead? Is he dead?" Another wanted me to help him "doodle" with his Game-Boy to draw funny faces on the photos he had taken of his deceased pet.

There is nothing strange or abnormal about these requests, and, in the end, children (and our other pets) provide a distraction from our grief and remind us that life is a cycle, filled not only with grief but with joy.

Another point that is important to remember is that as hard as it is to see our kids sad, saying goodbye to a pet helps teach our kids how to grieve, which is an invaluable lifetime skill.

Question: And then there are the family's other pets. Do owners typically include them in the grieving process?

Answer: Many pets left behind will grieve, which may show up as lethargy, a change in their desired daily routines or a loss of appetite.

Also, sometimes having one pet pass in a multi-pet family will change the dynamics between the remaining pets, which may positively or negatively affect household karma.

Many owners want their remaining pets to "say goodbye" to their deceased pet, and we always encourage them to do so if they want, but warn them that sometimes, surviving pets will be very tuned in and appropriate (in our eyes) in their behavior; other times they may be more interested in us, or in the owner, and that is fine.

We encourage families to provide lots of extra TLC to their surviving pets (and to themselves), in whatever form that might take.

Also, it is important to realize that if your pet is staying in a "funk," he or she may be experiencing an illness rather than grief; always take your remaining pet in for an exam to make sure that there is not a medical basis for their lethargy.

Question: Are there grief-support groups you recommend?

Yes, there are multiple options for grief-support, both in person, via telephone, and online.

Locally, we have:

-- The Humane Society and SPCA of Seattle/King County Pet Loss Support group meets every Saturday from 10 a.m.-noon in the Humane Society Library. Owners can call 425-641-0080 for more information.

-- Loss and the Animal/Human Connection, Linda Neahry, MA, LMHC. This North Seattle support group provides counseling for pet loss or serious-illness diagnosis and sometimes organizes group meetings. 206-782-6144.

Online, you may find:

-- The Delta Society, which is a group celebrating the human-animal health connection, has a wealth of information and resources about pet loss and bereavement, though be ready with your hankies when you read through the site.

-- Veterinary Wisdom:

Many people may find it helpful to talk directly with a counselor, either one with a special interest in pet loss or even a regular counselor. There are several people in the Seattle area who are very familiar with the grief that comes with losing a pet, and indeed, even when anticipating losing a pet.

This list is in no way complete, it is just a place for you to start. Remember also that finding a counselor that you "jive" with is very important; indeed, even more important than the specific degrees they may hold.

-- Diane Dyer, Farewell Friend, 206-437-2991

-- Marianne Ellis Psychotherapy, 206-227-8552

-- O'Donnell Day, psychotherapy, 425-802-3000

Question: How many pets do you euthanize at home vs. in the office? Are most of the pets you euthanize at home left at the homes for burials or do you provide that service as well?

Answer: We do most euthanasias at people's homes. Although it sounds strange, in the right circumstances and at the right time, death can be not only peaceful but beautiful.

That said, it can be more expensive to euthanize your pet at home because of the travel charge, so some owners choose to come to our office. In such cases, we do everything we can to make it gentle and peaceful. This might mean that the owner drives to us and I climb in their car to perform their euthanasia, or that we greet the pet at the office with loads of yummy treats.

Question: How much does your at-home service cost, and how often is it performed?

Answer: Our rates are based on a travel fee plus the cost for the humane euthanasia, which includes all the medications used and doctor's time, a clay paw print of the pet and all the phone support that is needed (we will sometimes talk with people five to 10 times over the course of several weeks as they try to make their decision).

There is an additional fee for private or nonprivate cremation, which we also provide, and that fee depends on the size of the pet.

As an example, if we were called out to euthanize a cat in Kirkland, the house call would be about $67, the humane euthanasia $135. Private cremation would cost $165 and nonprivate cremation, where your pet is cremated and the cremation company sets the ashes free in an apple orchard, costs $65.

Many people also elect to keep their pets for a home burial (where allowed), and of course, there is no cost for such an option.

The number of euthanasias we do varies greatly, but on average, we help about five to 10 families per week say goodbye to their pets.

Question: What is the hardest part for you?

Answer: Just knowing that people are going to grieve and hurt and that there is no way I can spare them that grief. There is no way around grief, only through it.

Sometimes other people -- non-pet owners -- do not understand the pain that people can experience when they lose a pet, and owners do not necessarily get the support they need from friends, or even family, and that makes me sad.

The hardest part, however, is when I know an animal is suffering and I am not able to help them.

Once, long ago, I had a patient who had developed cancer and had already had a leg amputated and had received two rounds of chemotherapy. Unfortunately, despite treatment, the cancer had metastasized to her backbone and lungs.

I was called in on emergency because that beautiful dog had fractured her spine (where the cancer had weakened the bone). The dog was so brave; she was silent and still, but groaned when she shifted position. The dog's whole being was focused on trying to control her pain; there was nothing left of her beyond the pain.

Her owner was a devoted, sweet woman who loved her pet more than almost anything or anyone in the world and was not ready to let go.

She said, tears in her eyes, "Mocha is looking at me with her big brown eyes and she is pleading with me, please don't kill me, please don't kill me."

I disagreed, saying, "Mocha is looking at you with her big, brown eyes, begging you to set her free. You can do this. You are strong enough."

I am not sure what I would have done if Mocha's owner had not found the strength to set her pet free from her suffering.

Sometimes people do not find this strength, and the pet suffers. When that happens, I do everything possible to minimize the pet's pain and distress, and I check back in with the owner on a daily basis as medical situations can change rapidly.

People ask me all the time how I can do what I do, or they apologize that I have to euthanize their pet, and I wish I could help them understand that I see my role setting their pet free as a gift to them and their pet; I couldn't do it if I felt otherwise.

Life is a cycle of birth and death, and I am honored and lucky that I can assist so that the end of the cycle can be as beautiful and even celebrated as the beginning.

Dr. Hanna Ekstrom

Ekstrom, owner of At Home Vet, has been practicing veterinary medicine since her graduation from Cornell College of Veterinary Medicine in 1992. She enjoys treating dogs and cats in the comfort of their home, or in her office in Woodinville. She and her family live with a dog, two cats, four gerbils and many fish. In addition to her veterinary work, she has founded a dental health outreach for children in Nicaragua:

sandyforholly.jpgTOMORROW: Seattle Times photographer Dean Rutz remembers his dog, Sandy.

Read more about the animals that inspire contributors to this blog: About our pets

•   •   •

Read our past Q&As:
Veterinary Q&A: Dementia and senior dogs
Veterinary Q&A: More health issues facing aging dogs
Veterinary Q&A: Eye problems in aging dogs
Veterinary Q&A: Halloween treats and pets
Veterinary Q&A: Health issues facing aging dogs
Veterinary Q&A: Why blood work is necessary
Veterinary Q&A: Are prong collars safe for your dog?
Veterinary Q&A: Birth control for pets
Veterinary Q&A: How to find a good vet
Veterinary Q&A: Neutering your dog Part 2
Veterinary Q&A: Neutering your dog Part 1
Veterinary Q&A: Hyperthyroidism in cats
Veterinary Q&A: Incontinence in dogs
Veterinary Q&A: Hanging tongue syndrome
Veterinary Q&A: Bad breath in dogs
Veterinary Q&A: How much is too much exercise for my dog? Part 2
Veterinary Q&A: How much exercise does my dog need? Part I
Veterinary Q&A: A killer called bloat
Veterinary Q&A: Initial care for new puppies
Veterinary Q&A: Knee problems in dogs
Veterinary Q&A: Flea-control treatment
Veterinary Q&A: Bearded dragon lizards
Veterinary Q&A: Vaccinations for indoor cats
Veterinary Q&A: Lumps and bumps
Veterinary Q&A: More on aging dogs and arthritis
Veterinary Q&A: Aging dogs and arthritis
Veterinary Q&A: Puppy and geriatric exams
Veterinary QA: What dogs can safely chew
Veterinary QA: Why does it cost so much to clean a dog's teeth?
Veterinary QA follow-up: More on cleaning a dog's teeth
Veterinary QA: When to spay or neuter

•   •   •

Do you have a question about pet health? Ask now! We'll pose some of your questions to a local vet in an upcoming post.

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