Need I say more?

Ok, this has nothing to do with work.

 

How cute are these two??

 

 

  Mike

 

 

 

 

 

 

 

I've been blogging for a year today!  I guess I never expected that I could keep it up this long. 

 

I would like to thank everyone for reading and for your comments.  And thanks for listening - I have found that blogging allows me to decompress about some of the stresses I feel at times.  I did not expect that when I started this.

 

And although I certainly appreciate all the comments thanking me for being a kind person, etc., I really don't want anyone to think I am any more kind or compassionate or a better vet than anyone else (perhaps the way I write makes me sound that way).  Everyone I work with feels the same as I do, cares as much, works as hard or harder.  And I certainly have my bad days (just ask my staff!).

 

Thanks for reading!

This post on euthanasia will probably be the hardest to read.  It talks about some of the struggles I personally have at times with this topic – the tough ones.  Fair warning – these are not happy stories.

 

Sometimes, people bring in animals that are injured, but have injuries that could be treated.  Sometimes people don’t have money for treatment – we deal with this a lot, and I would say the great majority of times, minor injuries are dealt with, patched up, pain medicated and kept stable so the owners can try to work out financing and care. 

 

Sometimes, a more severely injured patient presents, and the owner has budgetary constraints.  Most often, on initial exam, the animal may not be very stable, and without basic diagnostics, we can only guess at the extent of potential internal injuries.  Sometimes, it is too expensive to figure out if the pet’s internal injuries are going to be life-threatening or not, or require expensive surgery or not, and the owners make the decision to euthanize.  This is difficult, but often in these cases the injuries are significant, and the animal’s survival is in question even with aggressive care.  The last case like this I had was puppy hit by a car.  I knew based on my exam that the pup had significant pulmonary contusions (bruising in the lungs), and she potentially could survive with aggressive care, but she might not.  The owner could not afford the aggressive care, and I euthanized the pup.  It was sad, but I actually suspected that pup had very life-threatening injuries, and her prognosis was poor even had the owner been a millionaire.

 

Sometimes there are cases that haunt me for a long time.  One example is an older cat who had been hit by a car.  She had a fractured jaw and some head trauma, but I believed she could be treated with a good chance of success.  Unfortunately, her owner did not even want to try.  It wasn’t the money - he just clearly did not want the cat.  She was matted and thin and dirty and declawed – I suspect (but to be fair I don’t know for sure) that he kept her outdoors because he really didn’t want her, and when she got hit, it was an excuse to ‘get rid of her’.  I tried to talk him into pain meds and to get her to his regular veterinarian, or to have us fix her (she needed surgery to wire her jaw), anything.  He refused all options except euthanasia.  That poor cat broke my heart.  But I didn’t have a home for her, and there are so many healthy cats that need homes, and without treatment she really was suffering and painful.  So I very reluctantly euthanized her.  And I cried while I did it, because I felt that she lived a life without love, without anyone really caring for her.  So I stroked her and talked to her, and I made sure that she didn’t feel more pain.  I will never forget her, and (anthropomorphizing again), I hope she forgives me.

 

Now, you might ask why I just didn’t fix her myself and take her home.  A very good question, one that I struggle with myself.  But there is a limit to how many times you can do this.  I would have too many animals to count if I didn’t make this very difficult decision at times.  The other thing is we have a ‘no surrender’ policy in our hospital.  The reason for this is when we have tried to take a surrender (where we have the owner surrender the animal to us for us to fix and adopt out), unfortunately a couple of people have decided they made a mistake and harassed us endlessly, threatening lawsuits and the like.  Also, my state’s Veterinary Medical Licensing Board does not look kindly on surrender situations.  So to protect us from liability, our hospital board set this policy.  It is hard, but it also makes us fair to everyone who walks in the door.

 

As all other veterinary hospitals I know of, we euthanize injured strays when the injuries appear significant (we always try to locate owners if possible beforehand).  All the strays get the same gentle stroking and talking to if possible.  If they are feral (and therefore terrified), we cannot make this a process that is comfortable for them, but I sedate them heavily as quickly as I can to try to minimize their fear.  In this case, I don’t talk to them until they are asleep, because I feel like human voices and touches increase their fear.  

 

One thing I don’t do is what I call ‘convenience euthanasia’.  In other words, if someone shows up at my door with a pet they just don’t want any more, they are directed to see their regular veterinarian for counseling before they make this irreversible decision.  One example of this is someone who brought their happy, tail-wagging, middle-aged dog in because he had diarrhea.  The owner had recently gotten a new puppy, and actually told us they didn’t want the older dog any more and didn’t want to spend any money on him.  The diarrhea had not been treated at all, the dog had not seen his regular veterinarian for it.  I refused to euthanize that dog, but I did recommend treating the diarrhea with medication (at least try something) – if the diarrhea persisted despite medication, then we could talk.  The owner became quite angry, and left with the dog, saying he would just take him to the shelter and dump him there.  Then I was left to wonder – did I do this dog a service, sending him out the door with someone who didn’t love him any more?   And if he dumped the dog at the shelter, I certainly did not do the beleaguered shelter employees a favor.  Perhaps it would have been better for me to give the dog a gentle, compassionate end.  These are unrewarding no matter what I do, and I resent the people who put me in this no-win situation.

 

I’m not sure I’m completely done with ‘the euthanasia series’, but I’m close!  I’ll try to lighten it up some in the next entries.  I’ll also try to answer some of the questions posed in some recent comments as well.

Several people have asked in comments on various posts how to make ‘the decision’ – the decision to euthanize a beloved pet.

 

As many of you know, it is very hard and it is also very personal.  I am asked this question frequently.  I’ll try to describe some of my thoughts on this, but these are just my opinions.  This is such an emotional and personal thing, you really have to put your own values on it.  As I have seen on the comments to my previous posts, many of you have given this much thought.  There is never right or wrong in this – you must follow what you feel.  And here’s another thing – try not to second guess any decision you make – remember that you are doing what you think is best for your beloved companion.  I like to think that they know that – that the decision we make is out of love.  Of course, this is anthropomorphizing, but what’s a little anthropomorphizing between friends?

 

There are some cases where the actual decision to euthanize is not really hard.  That’s not to say the loss isn’t hard – it is.  But if an animal has severe metastatic cancer to his lungs, and he can’t breathe, there probably isn’t much to be done.  So the decision is not that hard, but the act and the loss still are.

 

But many other times, the decision is very hard.  Every single case is different.  I try to look at this nebulous thing “quality of life”.  What does that mean?  It means something different to every person.  But I am often asked what is meant and when do we know the quality of life of a pet has deteriorated to the point that we should consider euthanasia?

 

There are many ways to look at this.  I particularly like the following ‘quality of life scale’ in these articles written by a veterinary oncologist, Dr. Alice Villalobos:

 

http://aah-abv.org/20060319_aaha_quality.pdf

 

http://aah-abv.org/20060319_aaha_quality_scale.pdf

 

Although I don’t follow it to a tee, I use the factors she talks about in my discussions with owners, and also in my own considerations regarding my own pets.

When I made the decision for Ivan last fall, it was really hard.  Because he still had a great appetite, he was still a happy little guy.  But he kept fainting from lack of oxygen due to his tracheal collapse, and the night I actually euthanized him, he fainted repeatedly.  He used to love to run around the parking lot (with me chasing him), he loved to eat, and he loved to be with me.  But he got so excited to eat, that he kept fainting when I put food down for him.  If he tried to run or bark, he just couldn’t do it.  When he woke up from a faint episode, he struggled to breathe and looked panicked.  As you read in Dr. Villalobos article, the struggle to breathe is considered a 10 out of 10 on the pain scale.  And that was what did it for me – I couldn’t let the little guy be panicked any more.  I still miss that little character (I have tears in my eyes as I write this).

 

I also have euthanized happy animals wagging their tails.  Two cases in particular stand out for me – both were dogs that had cancer in their nasal cavity.  The cancer was deforming their noses and actually pushing on an eye and deforming it.  Those dogs were still happy, but had to have some pain, and the owners both wanted them to be happy until the last minute.  This was very hard for them, but you know, those dogs were happy until their last second.  Those owners made very selfless decisions for the best interest of the dogs. 

 

A very common thing I hear from owners is “I just wish he would go to sleep and not wake up.”  I wish this too.  It’s the way I want to go.  But unfortunately it rarely happens.  And I will tell you this – I did have the experience to come home to my 10 year old cat, Trouble, who had died while I worked an overnight shift.  He had been fine when I left for work, and when he didn’t greet me at the door, I knew something was terribly wrong.  His death haunts me to this day – I wasn’t there with him, I don’t know if he suffered, and I didn’t get to say goodbye.  So to those of you who have lost a pet this way, you have my sympathy and empathy.  I know the path you walk.

 

So these are some random thoughts on ‘the decision’.  I don’t think anyone has any easy answers for the obvious reason that there are none.

A classic emergency:

 

 

This is Buddy.  We sedated him and pulled the bone off.  The trick is to pull the skin taut away from the tip of his chin, and then you can angle the bone off.  This usually works - if not, we saw the bone off.

 

 

I've got writer's block again!  Well, maybe that should be blogger's block.  We've been busy, but it seems like it's a rerun of things I've already written about (many dogs attacked by other dogs, foreign bodies in dogs, the usual vomiting and diarrhea, GDV's, etc.)

 

Also, I've been working some extra shifts because one of our ER docs is out of work with a bad cat bite - that leaves less time for blogging.   

 

And of course, we've had the same tough cases, sad cases and euthanasias.  So in my next entry, I am going to continue the series I was writing on the euthanasia process. 

 

Thanks for sticking with me, those of you who are still reading!

 

Susan