Comprehensive  Ways To Delightful Healthy Pets
FINDING THE RIGHT TIME TO SAY GOODBYE
Have the courage of your convictions—only you can decide when it is “time” for your pet.
HELPING AN OWNER DECIDE IF IT IS FINALLY “TIME” FOR THEIR beloved pet is a blessing and a curse of my profession. Veterinarians are able to alleviate unremitting suffering, but choosing the right time to say goodbye can be agonizing. While there is no template that fits every situation, the main goal should be to treat each unique pet and owner with the compassion and dignity they deserve.
Even though death is a normal part of every life, it is never easy to face the death of someone you love. Euthanasia comes from the Greek, eu meaning good and thanatos meaning death. Fortunately, we are able to provide “a good death” for our pets. Extreme and unnecessary suffering is heartbreaking—especially when the suffering continues without hope of recovery. But determining if an animal is at that point can be unbearably difficult.
Euthanasia, the last component of wild health, while unalterably sad, must be looked at as another duty we have as stewards of our animals. This is an aspect in which we may have some control. In nature, their final days would be different than it is for them in our homes. Often we keep them alive long past what would have happened in a more natural environment—just by feeding, cleaning, and keeping them safe. While this is an advantage for pets in our care, it can become a liability when a pet is terminally ill. For that reason, we are responsible for their humane treatment at this last stage.
One of the saddest things I’ve done was to euthanize Boris, a sweet little pug who had squamous cell carcinoma on his jaw. I’d only had him as a patient for a couple of weeks. His mom and I had a serious conversation.
She was unsure of what to do, but she was unbearably sad and overwhelmed by her pet’s condition. We talked about that “sad and overwhelmed” feeling. How it is a sign that means your dog is incredibly sad and overwhelmed, too. That feeling is an expression of the intense bond between a loved dog and a loving owner.
We began with the question “How bad does he have to get before we can let him go?” and continued from there. We talked about what he must feel like, how his cheerful nature kept him from showing any pain, how the tumor had degraded his jaw in a horrific way, and how he was becoming anemic from constant bleeding.
Her husband was with us that last day and we all shared a box of Kleenex, including some for adorable Boris because of his bloody drool while he sat in her lap as we talked and cried. There was such a loving bond in this sweet little family.
In my integrative practice, I treat many geriatric pets. With this approach, many are able to enjoy a good quality of life without invasive surgeries or side effects from harsh medications. My clients tell me that our alternative approach made their course of action more apparent, and when the time came, they felt less guilt. My clients feel empowered by improving not just the quantity but the quality of their pet’s life. The final decision for their pet is therefore made with a clearer conscience.
How do the geese know when to fly to the sun? Who tells them the seasons? How do we humans know when it is time to move on? As with the migrant birds, so surely with us. There is a voice within, if only we would listen to it, that tells us so certainly when to go forth into the unknown. —ELISABETH KÜBLER-ROSS
When dealing with chronically ill, significantly geriatric, or disabled pets, owners can quickly become overwhelmed. They can become mired in information about diagnostic tests, prognosis, possible medications, diet changes, and alternative medical options. They try to make sense of it all. Contriving ways to give medications, new foods, or to assist in procedures changes the owner-pet relationship, and sadly, it’s not a change for the better. Financial and time constraints as well as the diminishment of their pet’s physical abilities can cause owners to lose sight of their own needs. As they struggle to keep their pet alive, they say, often in the same breath, the same three things.
“I am so overwhelmed by what has to be done for my pet every day.”
“I will not make the decision to end my pet’s life just because my life is falling apart.”
“I wish my pet would just go quietly in his sleep.”
These seemingly conflicting statements are understandable because in these situations emotions are complicated. The amount of care required to keep a chronically ill animal is intense. Stress has an accumulative effect on an owner’s ability to care for an animal that is near the end. The empathy between pet and owner is often so strong that feelings overlap. When an owner is feeling overwhelmed, it could be because the pet is feeling the same way. If it’s too hard for you, it may be too hard for your pet as well.
It is crucial for owners to be aware that if they are feeling overwhelmed, chances are their pet is feeling the same way.
People will judge you and offer their opinions. As a vet, I’ve certainly heard some preposterous comments from well-meaning people. Stand firm about your decision, have the courage of your conviction, and maintain your own integrity. Only you know when it is time. Everyone thinks their way is the best, but in life-and-death dilemmas, your decision is imminently personal.
The amount of care required to keep an animal going can frustrate an owner. It is common for them to feel resentment, followed by guilt. Guilt builds a small prison in our heart. We feel trapped and can’t see a way out. Normal emotions are subverted. We know it is not our pet’s fault—soiling things, requiring lots of time, needing constant physical help, keeping us up at night—but we still feel annoyed. Especially if there is no end in sight. Pretending you aren’t feeling these things makes matters even worse. It is okay to let these feelings have a part in our decision-making process.
A SAD, BUT GOOD, RULE OF THUMB
If you feel you are performing practically all the duties a life support system might do in an ICU in order to keep a pet alive, and there is little hope for recovery, it’s probably time to let your pet go.
If you really don’t know what to do, I advise owners to notice if the pet has more bad days than good ones. It helps to keep a simple daily diary—noting just one word on each day—“Good” or “Bad” as an overall grade for the day. Although “good” versus “bad” is a subjective matter, there are a few factors to monitor.
It is extremely important to be aware of any medications that could also cause any of these signs. For example, I often see geriatric animals that are having increasing trouble walking and have apparently lost their will to live. However, these signs can also be side effects of a medication called tramadol, an opiate derivative that changes the way the brain perceives pain. In geriatric pets, careful dosing is essential. Overmedicating can make them more uncoordinated, cause depression, and dull their motivating energy. When I stop or significantly decrease the tramadol, they regain their spark and mobility. The next step is pain management, using more natural methods like acupuncture or herbs or changing meds. Tramadol can work as a sleep aid in some animals.
CONSIDER THESE QUESTIONS
Is your pet in chronic pain?
Surprisingly, pets in chronic pain will not show it by crying or vocalizing. That would not be effective from an evolutionary standpoint. An animal would not want to announce pain to a predator. Short-term acute pain is a different matter—an inadvertent step on a paw causes your pet to yelp to get you off his foot.
Chronic pain can best be determined by assessing subtle signs and behavioral changes.
Signs of chronic pain: panting, pacing, stilted gait, short strides, head held low, lamenesses, falling over, inability to get up or lie down, inability to move about freely, decreased appetite, increased thirst (sometimes due to panting), behavior changes (usually either more ornery or hiding more, sometimes suddenly overly needy), touch sensitivity, increased heart rate, decreased interest in their surroundings caused by focusing inward on the pain.
Does your pet still enjoy the basic routines of the day?
Is she excited by a walk? Interested in your actions? Responding to stimuli? Or do you notice her pulling away from family activities? Hiding in unusual places, avoiding play and contact?
Do you recognize your pet’s personality?
Does he seem chronically depressed? Is there some evidence of cognitive dysfunction—standing, staring into space, walking into the hinge side of the door instead of the opening side? Does your pet stand with his head pressed against a wall or corner? Again, remember to consider the possibility of this being caused by overmedication—especially if your pet is taking pain meds.
Does your pet still eat regularly?
Refusal to eat can be a definitive indication that a pet has given up. But there’s a difference between skipping a meal here and there—particularly the morning meal, which I find many older pets like to skip—and losing interest in all food. Make sure you’ve offered plenty of different options. Is it just food, or treats as well? Sense of smell or appetite can be significantly decreased either because of age or because of certain medications. Try warming food by adding warm water or low sodium chicken broth. You can also mix in some meat baby food, a small amount of canned cat food, or some tripe to enhance the odor of the food. A pet that feels bad enough to stop eating even fun foods may be seriously ill. It may not mean it’s “time” but if you know the end is near, it can be a sign. (See the diet chapters for tips on getting your pet to eat when he doesn’t have an appetite.)
Has your pet lost the control of his bladder and bowels?
Normally fastidious animals that are unable to control urination and defecation can become stressed by this problem. This can also be a health hazard, causing urine scald or infections from repeated soiling. If the animal has lost control of these functions, it makes life extremely challenging for everyone. But check with your vet. Urinary tract infections are more common as animals age and can be treated. Food or treat increases or changes, excessive water drinking, medications, or GI parasites can also cause incontinence.
Do you think your pet is giving you “the Look”?
Many clients tell me that they knew it was time because of “the Look” their pet was giving them. Their eyes show that they have “left the building.” They may be looking inward and have lost their will to live. This can be a good clue that it’s time. However, again, look carefully into any medication that could be causing them to seem dazed out. If this is the case, reassess the need for that medication. Some pain medications will do this. Try decreasing pain meds like tramadol to half doses, only at night, or even stopping them, and see if the pain is manageable.
Are you changing your assessment about whether “it’s time” from moment to moment?
In a decision this grave, consider asking for a second veterinary opinion. While your regular veterinarian, who has known your pet for years, may be an excellent judge, a fresh set of eyes may clarify things. It’s even acceptable to ask your vet who they would recommend. Most vets don’t mind a consult when there’s a difficult decision to be made.
If you notice many of the above signs, you might want to discuss the options with your vet.
With an integrative approach to chronic care, many injured, sickly, or geriatric pets can become rejuvenated. Because animals have bounced back, even several times, often with just a minor tweaking of supplements or treatments, owners may cling to the hope that this time, they will bounce back again. It can be hard to determine the difference between a setback and the end. In some cases, animals can regain a good quality of life before their last days. Many owners have told me that they felt greatly relieved about the decision to euthanize—when the time did finally come—because their pet had so enjoyed life with them before becoming incapacitated.
Even one good day before death can be a cause for joy.
SUE THE ELEPHANT’S LAST DAY ON EARTH
SUE, AN AGING INDIAN elephant, had been kept for years in deplorable conditions by a private owner who rented her out to circuses. The U.S. Department of Agriculture finally enforced elephant management laws and cited violations for this owner. An agreement was reached that she would go to a shelter in Tennessee.
Sue had been down for several days after collapsing when her regular vet had tried to sedate her for a blood sample. A “down elephant” is considered an emergency situation, as they usually can’t survive more than a couple of days. The weight of their own organs crushes other organs. The rescue team asked me to come and provide acupuncture for Sue, in a last-ditch effort to get her back on her feet. It was close to Christmas, snowing and cold, but I drove the two hours there to see what I could do.
When I came to the property, Sue was chained up in the foul-smelling barn. The barn staff, their vet, as well as the staff and vet from the sanctuary that called me had all been working together, night and day, to keep her going. There were an assortment of tractor tires for support, a forklift, huge canvas straps, pulleys and chains and ropes, all over the barn floor. Medical equipment, boxes of topical and injectable medications, IV bags, and medical instruments were strewn everywhere like a makeshift hospital.
A homemade canvas sling/vest contraption was rigged under her belly and she was suspended with the pulleys and the forklift to shift her weight regularly every few hours. Pressure sores on her hips, shoulders, and face were tended, and she was being given fluids and hand-feedings all day. It was an exhausting, dangerous task. At any time she could toss a person into a wall if she felt like it. We worked in a radius around her, just out of reach of her trunk, whenever possible.
Because of all the intense effort, with each day Sue had shown some signs of recovery. Every morning brought new hope—her blood work improved, she behaved in a more animated way, took more food, and ate more readily. We offered her anything she would eat. There were piles of options in boxes all around—from peanut butter and jelly sandwiches to the typical fruits and vegetables, to hay. Just the fact that she was still eating was encouraging. Everyone was hoping for an unlikely holiday miracle.
I treated her with acupuncture and she also let me treat her ulcerated eye. At one point she grabbed my arm with her trunk. I wondered if she was going to splatter me against the wall. But she just calmly looked at me, apparently decided I was there to help her, and gently let go.
I wished we could do more for her and I mentioned how ideal it would be if we could build a pool to float her in. Sue hadn’t been in water for decades and it would be a great present for her. The rescue team quickly mobilized and procured a huge Dumpster that could be made into Sue’s pool—if only she would survive until it was made.
Sue did live long enough to be lifted by crane into the makeshift watering hole. Warm water was poured over her. As soon as she was partially submerged, she started to splash about happily and began to play, filling her trunk with water and spraying and trumpeting playfully. No one could believe the transformation.
And then—after an hour of sheer joy—she died.
Years of mistreatment and poor nutrition had debilitated her to the point of no return. It was a small but potent consolation to us that we had brought her some relief before she left this planet. After such suffering, she still had the urge to play, and in the end, the water allowed her a final moment of happiness.
WHERE DO YOU GO, NOW THAT THE DECISION IS MADE?
ONCE YOU HAVE DETERMINED that it is time, you may have the option to choose where to euthanize—at home or in a veterinary hospital. Another option is choosing a veterinarian who will do a home euthanasia. Owners can decide what is right for them. For some people, just the thought of “the room where it was done” is too painful and is reason enough to not have it done in your own home. Also, animals may urinate or defecate at the end, which may be a trial for some owners.
I recommend that owners not watch the handling of the body, after the actual euthanasia is finished. It’s not horrible, but it is an image you don’t need to remember. If these don’t seem like worries for you, an in-home euthanasia can be a lovely sendoff. However, a clinic can offer a neutral environment.
WHO IS TO BE present for the procedure is a personal matter and can only be decided by the owner. Not everyone is able to deal with being there. It is not advisable to have very young children (under five) present, but, again, this is the owner’s call. Be careful using the term “put to sleep” around young children who may be confused by this. Using honest, clear language with children is best. They will probably understand more easily than you think.
It is advisable to bring the other pets so that they know what happened and do not search for the missing pet.
EUTHANASIA: THE CLINICAL VERSION OF WHAT HAPPENS
SOMETIMES KNOWING WHAT TO expect can help ease the stress of an already overwhelming situation. The vet team will place an IV catheter to use as a port to be ready for the injection. The veterinarian injects an overdose of an anesthetic agent or a mixture of anesthetic compounds directly into the vein. These usually cause cardiac function to cease. Typically all the owner sees is a peaceful release, with in seconds or minutes, after the injection.
Things that might happen:
The agent itself can cause a slight stinging sensation, especially in older veins, as it is injected, somewhat like lidocaine, but the sensation quickly disappears. This is less likely if there is an IV catheter in place.
Dogs and cats don’t generally close their eyes in death.
They will sometimes release the contents of their bladder and colon.
There can be a reflex, a gasp-like muscle spasm or vocalization as they move through planes of anesthesia.
They may have muscle twitching after the heart has stopped.
More than one injection may be needed to complete the euthanasia.
Chemotherapy or multiple IV injections, blood draws, or catheters in leg veins may hamper efforts to find a suitable vein and alternative methods may be required.
Disposition of the body is up to the owner. Most people use the cremation service recommended by their veterinarian, unless they have a permanent place to bury their pet. Many cities do not allow burials within city limits unless it is in a cemetery. If you do plan to bury a pet, remember that you must dig down to six feet to prevent scavenger wildlife from interfering with the body.
DECIDE IF YOU CAN in advance if you’d like to have the ashes back after cremation, or other remembrances like a clay mold of the pawprint, or some of the fur. There are companies that will take some of the ashes and make a piece of jewelry from it. If you are getting ashes back, it’s good to know if you plan to retain them permanently in an urn or scatter them somewhere. Cremation companies offer several urns to choose from. Some urns once sealed cannot be opened easily. You can also have the ashes placed in an urn that can later be transferred into a container you purchase yourself.
It is imperative to ask your vet if she is confident that the cremation service is reputable and the ashes are reliably returned.
BEFORE THE ACTUAL EUTHANASIA, make sure to have a designated friend or relative call you to check up on you afterward and to inform your loved ones that your pet has passed. It can be hard to call people and tell them the news, but it’s nice to hear from friends who already know.
Grieving over an animal is one of the hardest things to get over, especially if it is the sole pet. The echoes of the empty house are haunting. I try to remind owners to be extra nice to themselves for the days following the loss of a pet. Many people won’t understand why losing a pet can be so devastating, but it certainly can be.
Untended grief in any form can be debilitating. Our dogs and cats, with their compact life span, seem born to teach us about love and loss. When we lose a pet, it is important not only to grieve, but also to temper the destructive side of sadness with happy memories of our pet’s life with us.
AS DIFFICULT AS THIS final decision is, we make it with love. All of us grieve in different ways. Grief does not ever go away—it’s a permanent resident in your heart. But it does make your heart bigger. It is okay to feel relief at the unburdening because your pet is now also unburdened. You have made a difficult, heartbreaking decision—but it was the right one.
With time, the acute pain of loss may diminish and we can find joy in our memories, and, perhaps, in a new pet.