Dr. Phil Zeltzman’s Blog

Nobody likes to talk about it. Once we realize that our pets are, after all, not immortal, we may hope that they will just “go” in their sleep. Well, that almost never happens. Most of the time, we have to help them. Euthanasia is a very personal, heart-breaking, grueling decision. Let’s go over 16 common concerns and questions.

1. What is euthanasia?

According to the American Heritage Science Dictionary, euthanasia is “the act of painlessly ending the life of an animal who has a terminal illness or incurable condition, as by giving a lethal drug”.

I would say that euthanasia, or “putting a pet to sleep”, is the humane way to end a pet’s life with dignity when their quality of life is no longer acceptable. Euthanasia should not be a convenience when a pet becomes, well, an inconvenience.

2. When is euthanasia appropriate?

It’s all about quality-of-life. A quality-of-life scale helps you assess various criteria such as pain level, appetite, hygiene, happiness, mobility etc.

You can Google “quality of life scale HHHHHMM” to find a great example.

Basically, are there more good days or bad days? The challenge is that you need to try to look at the situation from your pet’s standpoint – not yours.

This is often difficult, because it is a very emotional situation that tends to make you lose your objectivity. In other words, if the same situation happened to your best friend’s pet, you probably would know exactly what to do. But because you are dealing with your own pet and your own emotions, you cannot see the situation as objectively. Sometimes, denial makes things even worse…

3. When will I know it’s time?

Some people say “You’ll know in your heart when it’s time.”

I’m not so sure it that’s easy. Sometimes, you just don’t know. Again, you are so emotionally close to the situation, that you often can’t reason with a clear mind. Therefore, some pet lovers just don’t know when it’s time.

It is a vet’s job and ethical responsibility to make the owner aware of the situation. It is however not a vet’s job to make the decision for a pet’s owner. So asking “What would you do if it were your pet” is usually not a fair question: it’s a very personal decision.

The vet’s job is to explain the facts, describe the medical situation, and present options. Only you can (and should) make the final decision.

4. How is euthanasia performed?

Each vet has his or her own protocol, so the description below is only one way to do things. Let’s try to forget emotions for a minute, and let’s try to focus on the scientific or medical aspect of euthanasia, so that you know what to expect.

An IV catheter is placed. Most veterinarians will give a sedative or tranquilizer IV first, to relax the patient, or even make them sleepy. Then, the euthanasia drug – an overdose of barbiturates – is given IV. This is a pain free, almost instant procedure. The heart and lungs stop. And it’s over. I think most pet owners are surprised how quickly euthanasia happens. It’s over in less than a second…

You may then want to spend some time alone with your pet to say goodbye.

Although not exactly glamorous, it is important to mention a few things that may or may not happen during euthanasia. For example, your pet may or may not have one last deep breath (called an agonal breath). Eyes typically don’t close. This is not Hollywood.

There may be noises or vocalizations, or muscle spasms, or urination, or defecation, as the body relaxes. These are just possible, physiological, medical things that can happen and may be traumatizing if you are not prepared or warned.

Regardless, euthanasia is a quick, smooth & painless process.

5. What do I do at the animal hospital?

An experienced team will guide you through the different steps. Here are two important suggestions:

. Ask if you can take care of all the paperwork and financial stuff BEFORE proceeding with the euthanasia. The last thing you want to do is stand at the front desk after the euthanasia, in tears, in the middle of a full waiting room. A good receptionist should spontaneously suggest this option.

. Have a friend or family member drive for you if you think you will have difficulty driving safely after it’s all over. Now is not the time to get teary-eyed and get into an accident!

6. Should I be present?

This is one of the most difficult questions to answer. There is no right or wrong answer. There are several options.

You can say goodbye, leave the room, and let the doctor proceed. You may or may not want to visit afterwards. Or you can be present, start to finish.

Here is a testimonial from a friend and former client in Cincinnati, OH:

“My daughter and son-in-law had to euthanize Banshee, their Bernese mountain dog. They had had his leg amputated, but the cancer progressed. In the end, they had to put him to sleep. It is always sad to lose a pet. He was one of the sweetest dogs I’ve ever known, and even in his illness, he kept his sweet disposition.

My son-in-law and daughter were both with him at the end. That is something I would encourage pet owners to do. It is a comfort to see how peacefully your pet can go, and for me their loyalty demands your presence. I recognize that some people may not be able to do it.”

7. A very special situation

In our surgical practice, there is another situation. We are occasionally faced with an incurable condition during a surgery. I will then call the owner on the phone during the surgery, discuss the situation, and if we both agree, humanely euthanize the patient “on the table.” In this situation, the patient goes from anesthesia to euthanasia with no awareness and no pain whatsoever.

Here is a testimonial from a client who had to make such a decision. Their cat Jackie needed surgery to remove a fibrosarcoma – a cancerous tumor – from the skin of her belly. It turned out that the tumor invaded multiple structures, including half of her diaphragm (the muscle that separates the chest and the belly). The cancer was inoperable.

The owner writes: “I was faced with a very difficult decision.

My kitty Jackie was on the operating table when I received a call from Dr. Zeltzman, telling me that the tumor she had was so extensive that he did not feel he could remove it all. Compassionately, he gave me my options:

#1 – He could wake her up from surgery and let her live out what would be the rest of her life. The tumor however would eventually cause her significant pain.

#2 – Put her to sleep now while she was still under anesthesia. He told me I could think about it for a bit and call him back with my decision.
I tried my husband at work, but was unable to reach him. I kept thinking about Jackie and that she was so young, only 7 years old. I thought about how she came to be my kitty. (…) She was my side-kick.
With Jackie still on the table, I called Dr. Zeltzman back. He talked me through my options, not making the decision for me, but helping me make the right decision. After my conversation with him, I decided to have Jackie put to sleep then, while still under anesthesia. My deciding thought: I did not want Jackie to suffer.
It has been two months since that day. I miss her so very much! The hardest part for me was that I did not get to say goodbye to her. But in my heart, I know I made the painful but right decision for Jackie. I take great comfort in that.”

8. What happens with the remains?

There are several options. Some people elect to bury their pet. This may be illegal where you live, so it is important to check. It you can’t, there are memorial gardens and cemeteries for pets throughout the country.

Most owners elect cremation. You then have 2 options: you may get ashes back, or not. Some people save the ashes.

Here is what a pet owner wrote after receiving her pet’s ashes. Cookie, a 1 year old female Boston terrier, had abdominal surgery that revealed a terrible condition called intestinal volvulus: 90% of her small intestine had twisted onto itself, which is deadly.

The owners were called during the surgery, and reluctantly elected the only reasonable choice: euthanasia. Later, they write:

“Cookie’s ashes now sit on our mantle in the beautiful box with her name on it. (…) Cookie has come home in style.”

Other pet owners sprinkle the ashes somewhere, such as the pet’s favorite place in the back yard. Again, this is a very personal decision.

9. What happens during the grieving process?

For most clients, losing a pet is like losing a family member, so the grieving process should not be taken lightly.

Typically, people who do not own pets don’t understand how sad a grieving pet owner may feel. This may be a good time to avoid such people, for example at work…

10. Where can you get support?

Support is crucial to get over a pet’s loss. It can require finding a friendly ear: a friend, a family member, a receptionist or a nurse you developed a good relationship with, or your family vet.

If you have other pets, they can also provide a support system, as you will need to redirect your attention to their needs. Actually, your other pet(s) will “feel” that their buddy is missing, and they will feel your sorrow. Now is the time to provide some extra TLC. They may become lethargic or have a poor appetite.

Your other pets may actually help you grieve, so you can actually help each other.

There are also some websites where you can share your feelings.

If you are completely overwhelmed, or you feel that you are grieving for an unusually long time, you may need counseling. This is now available through several vet schools and of course through a private counselor.

11. What can I do to get through this?

Here are a few things you can do to help you heal.

. Allow yourself to cry. It’s okay – really.

. Put your pet’s belongings (water bowl, food bowl, bed, leash and collar or harness, toys etc.) in a big box and store it away for the time being.

. Talk about it.

. Write in a journal. Nobody has to know.

. Depending on your artistic talents, you could draw a picture of your pet, write a poem, create a scrapbook with memorabilia and pictures…

. Create a memorial in your garden or on your balcony.

12. How else can I get closure?

Another vastly personal topic. Although it is difficult to believe it at the time of euthanasia, time heals all wounds. Eventually, you will get over your sorrow.

Getting closure requires going through the flow of the various stages of grieving.

You can write a letter, like the one above about Jackie the kitty. After writing it, she said: “I still miss her, but I think writing this text has helped.”

Getting your pet’s ashes and “taking care of them” may also help with closure, as this typically happens after a week or so.

13. When should I get a new pet?

Most people recommend waiting until you achieve complete closure before getting a new pet. Adopting a new pet too soon may lead to bad decisions that you might regret, which is not fair to the new pet (or you and your family).

14. What do I tell my kids?

This is another very complicated topic. I would rather direct you to web sites (mentioned below) that explain things very well depending on the age of the child. You just don’t explain things to a 3 year old the same way as you would a 13 year old. There a re many things to be aware of. For example, it may be inappropriate to say that your pet “went to sleep” or was “put to sleep” and will never come back, as this may traumatize a child at bed time for years. After all, their buddy is never going to wake up…

16. How can I help my grieving elderly parents?

Again, a touchy topic… Sometimes, a pet is the last link an elderly person has to the world. If a grandma or grandpa cannot walk Fluffy in the neighborhood, a whole part of their social interactions may vanish all of a sudden.

I hope this helps you understand the process of euthanasia. In a sense, euthanasia is an act of love. You will rarely see it that way the day you lose your pet. But after your grieving period, I hope you will understand that you made the right decision.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

www.DrPhilZeltzman.com

I frequently have difficult conversations with pet owners that revolve around quality of life.

Most recent examples include:

. Is it ethical to perform ACL surgery in a pet with cancer?

. Is it reasonable to perform surgery in a 13 year old dog with laryngeal paralysis (ie who suffocates around the clock)?

. Is it fair to amputate a pet who has non-operable cancer on a leg?

It certainly depends on the situation, but overall the answer is YES – for the right pet and the right pet owner.

Pets don’t need a vacation home, stock options or designer clothes.

What they do need is being able to eat, drink, breathe, walk, urinate, defecate, groom and sleep – all in a pain free manner. And hopefully, you can expect a little tail wag here and there from a dog and a happy meow from a cat.

This list is certainly debatable, I admit it. One could add that a pet should be free of loneliness, fear and boredom. But I think the short list is a good starting point when you consider medical conditions.

If any of these basic bodily functions doesn’t take place, or if it occurs with difficulty, discomfort or pain, then your pet has a decreased quality of life.

What can you do then? You need to start by having a serious conversation with your family veterinarian. Or a board-certified surgeon.

Questions that need to be answered are:

. Is my pet suffering?

. Why is my pet painful?

. How can we decrease the pain?

. Can medications help?

. Can surgery help?

Of course, you may not hear the real story, the truthful story, because some people may not be bold or upfront enough to tell you what you need to hear.

I regularly talk to clients whose cat has been beyond constipated for YEARS before they got help (surgery is the only realistic solution).

I regularly talk to clients whose dog has been struggling to breathe for months or even years before they sought help (surgery is the only realistic solution).

I regularly talk to clients who had been told that a skin mass is not a big deal, or that a mass cannot be removed… when it truly is a big deal, and it absolutely can and should be removed.

Of course, surgery is not always the only option, I’m much more objective than that!

If your dog limps, pain medications, surgery, joint supplements, weight-loss or a “joint food” might help.

If your pet has a hormone imbalance, medications may solve the problem. The list goes on…

How can you tell if your pet’s quality of life is changing?

One subjective but simple way is to use a scale from 1 to 10, 1 being the poorest quality of life and 10 being the best. If you rate your pet as a 9 in January and a 2 in May, then it is time to face the evidence. It’s time to have a heart-to-heart discussion with your family and your veterinarian about what can realistically be done.

If you are starting to wonder about your pet’s quality of life, here is my suggestion: print a few copies of the “HHHHHMM” Quality of Life scale. Then fill in one table regularly – monthly, weekly or even daily depending on the situation.

This will help you see a trend more objectively: is your pet’s status the same, better, or worse than last time you assessed the situation?

Remember this very important concept: “age is not a disease.” Just because a pet is 12 or 14 or 16 years old does not mean you should give up easily. That said, if neither pain management nor medical and surgical treatments can help, then maybe it is time to consider euthanasia.

As emotionally and ethically difficult as it is for a pet owner, the whole family, and the veterinarian and his/her staff, euthanasia is sometimes the only reasonable, humane solution. It may be the only way your pet finds relief.

Quality of life includes your pet’s right to stop suffering with dignity once all reasonable options have been exhausted.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified