Saturday, March 10, 2012

This showed up in my inbox the day after Scruffy died.

The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

Letting Your Dog or Cat Die at Home

March 07, 2012 / (21) comments

For the past two weeks, we’ve talked about signs that require a mandatory emergency veterinary visit. The reason why I’m harping on this is because I’ve seen or heard about a lot of pet pain and suffering as of late. This week, we’re going to discuss whether or not it’s appropriate to let your dog or cat die at home. The short answer? No.

I have a lot of friends and family who think it’s okay to let their pet die at home versus having to bring them to a veterinarian for humane euthanasia. You may think you’re sparing your pet the "stress of a veterinary visit," but in fact, your intentions (while well intended) are, to put it bluntly, wrong.

Let me be bold — for the sake of your pet’s quality of life — by stating that allowing your pet die at home often results in the double "S": Slowly Suffering.

If you surveyed veterinarians, I’m willing to bet that the majority wouldn’t let their cat or dog die electively on their own at home (unless it was for religious purposes, but that’s a whole different ball of wax). Our oath as veterinarians is to prevent suffering and, in my opinion, it is a gift that we are able to relieve suffering via a pain-free injection.

By letting your pet die at home, you may eliminate that hard "decision" of having to end your pet’s life … but it’s not always for the best. Making the decision to euthanize is a horrible, stressful, painful process, and I had to make it with my own dog back in July 2011, so trust me, I know how hard it is.

In human medicine, hospice care often involves a lot of analgesia — pain medication — that relieves any symptoms. This is traditionally in the form of intravenous, constant rate infusions (a.k.a. "CRIs") of morphine. The benefit of a constant flow of pain medicine into a vein? No pain. Unfortunately, the tradeoff for that CRI of pain medication is that your loved one is unconscious, sedated, can’t relate or respond to you, and has poor cognitive response because they are heavily sedated. That said, they are pain free, which is good.

In veterinary medicine, hospice care is just starting to take off (I’ll elaborate on this another time). When pet owners take their pets home knowing that their beloved pet has been diagnosed with end-stage disease, they don’t always have that option of intravenous morphine being constantly dripped into their pets’ veins. In fact, it’s important that a veterinarian counsel the pet owner on when the "right" time to humanely euthanize is appropriate. For me, it’s when their quality of life is affected: when they can’t get up, when they don’t want to eat, when they are hiding, when they cry out in pain or act really clingy, or when they stop acting like a joyful puppy or kitten.

The key thing to keep in mind is that you, as a pet owner, may not be able to pick up on the body’s sympathetic response to stress; in other words, how the body (your pet’s body) will always try to save itself. The body doesn’t want to die and will attempt to trigger key homeostatic mechanisms designed to try to keep itself alive. The body’s goal: to maintain its heart rate, blood flow, and blood pressure. When you let your pet die at home, it may seem "peaceful," but it’s not — with the exception of severe, acute hemorrhage (where the body bleeds out quickly and the patient loses consciousness).

When you have a pet with chronic anemia, chronic kidney failure, cancer, or other metabolic problems, they are typically very dehydrated and "in shock." Their heart rate is typically racing to try to maintain their blood pressure and oxygen delivery. It’s the equivalent of feeling light-headed, dizzy, oxygen starved, and too weak to get up, while having heart palpitations for the 1-2 days before you actually succumb to death. Not a fun way to go.

If you can imagine feeling really, really hung over, that’s you just being dehydrated after 12 hours of drinking. Imagine the headache, nausea, and light-headedness that your pet actually is succumbing to from days of not eating. Because they may not show signs of suffering (as their goal is to please you, right?), you may not pick up on these subtle hints of the "double S."

Any easier way to check? Check their pupil size. Depending on the lighting in the room, pupils are typically very dilated in the presence of shock and body stress.

I know this isn’t a topic people like to talk about, but I don’t like seeing pets dying at home. It’s painful. It’s slow. And, contrary to what you think, it really is a gift to be able to prevent your dog or cat from reaching that point of shock and dehydration before humanely putting them to sleep.

When in doubt, talk to your veterinarian. A lot of veterinarians will now go to homes to minimize transportation stress. I'm a firm advocate of this, as it’s much more peaceful for all involved.

Justine Lee

from the PetMDNewsletter

Did it make me feel any better?

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