Do You Have To Choose Euthanasia

I’ve been a veterinarian for 50 years. Most of that time was spent in brick and motor small animal practices, but in the last 10 years, I’ve morphed into mobile practice. The first few years with that new paradigm, I did wellness and general medical calls along with in-home euthanasia. Presently, and for the last 3-4 years, I have stopped doing general calls and have concentrated on geriatric, elderly and end of life situations.

I have found that veterinarians are not well versed in how to deal with the elderly cat or dog. I certainly wasn’t when I was in general practice. What I have discovered is that the elderly animal presents a unique challenge, both for the pet owner and the veterinarian. Medications that are fairly well tolerated in the younger animal, are often detrimental to the elderly. Steroids are a good example. The elderly pet, as with the elderly human, has a compromised immune system related to age. Adding a steroid to the mix, can be devastating both from immune compromise and muscle wasting. This is especially true when the typical high doses are used. Certainly, there are instances where steroids are necessary, but they should never be used for speculative treatment (“Let’s just see if this helps.”) in the elderly pet.

It’s also a truism that the general consensus on the internet is that it’s “not humane” to allow a pet to die naturally, and that you must choose euthanasia. This is frustrating to me because it’s based on incorrect information. Dying is a process of ending life and that is true for all living beings. There are many built-in protective mechanisms that stop any realization of what is going on and there is no pain, regardless of what is found on the internet and what is verbalized by veterinarians: “You must euthanize your pet or it will be a horrible death.” I have heard this too many times to count. In fact, the actual end of life is a peaceful process for the animal or human. What is classified as “horrible” is the visualization of what occurs after “death.” This is what people see and they think their pet is in extreme pain and distress. No! We are electrical beings and when the brain succumbs, there are far reaching effects that occur within the body post mortem. The body can turn rigid, almost seizure-like and there can be a reflex vocalization or moan or cry. Along with this can be a machine-like breathing called Cheyne-Stokes respiration. It is not the normal respiratory cycle. Breathing can speed up, then slow down and stop and then start again. This can carry on for either a short period of time or it can be prolonged. It usually indicates that death is imminent or has already occurred. The limbs can move as if controlled and the muscles beneath the skin can twitch and then, just when the body is quiet, there can be a final release of air. All of these signs are both visually upsetting as well as emotionally upsetting. People that have experienced this with a pet and do not understand that death has already occurred, state emphatically that they would never let that happen to another pet. However, if the pet mom or dad has been forewarned of what to expect, the actual process is quite understandable and not frightening at all. I know this because I’ve coached numerous clients how to let their pet pass naturally. In most of those instances, the end was quite peaceful. However, getting there can be a arduous journey that requires extreme emotional fortitude. You will watch your pet diminish moment by moment and you will second guess your decision again and again. For these reasons, most people elect euthanasia and it’s certainly understandable, but not a requirement. You can take that path, but you don’t have to. However, if an animal is in distress, having a difficult time breathing, or in extreme discomfort, then I would recommend euthanasia.  I have heard the comment in one way or another: “He/she looks so sad and is ready to go.” No, the person stating that is “so sad” and is ready to let their pet go. Our animals are not emotional and live completely “in the moment.” They adapt to what is going on, we humans, don’t. It’s true, the animal may not feel well, but they are often able to deal with it as long as we can keep them comfortable. In many cases, they are not in significant pain, but mild discomfort, and sometimes, not in discomfort at all. Many of these elderly pets have a certain degree of cognitive dysfunction or dementia and they will moan and cry, especially at night as they often have a reversal of the sleep/wake cycle. People think vocalization is a sign of pain and many, if not most, veterinarians feel that way, too. It’s not true as it’s cognitively related and can be also due to anxiety. Another trigger for people to call me is when their pet stops eating, and the call is made even if the pet misses just one meal. Of course, these pets have some terminal affliction to begin with and the not eating is, in people’s minds, a sign of impending death or that their pet is telling them “it’s time.” It may be, but not as often as is thought. We know that humans who are in an end of life state will often stop taking food and water, and it’s important to know they do not feel bad when they don’t eat and take in fluids. Hospice nurses know that when this happens, death ensues within 5-7 days. That may be true in pets, also, but rarely are they allowed that much time before being euthanized. Cats with a relatively good body condition are of concern when they don’t eat, because the feline liver is not very good at dealing with fat break down. When normal weighted or obese cats stop eating, they can develop a fatty liver (hepatic lipidosis) within 3-4 days of inappetance, but this is not a problem for thin and elderly cats that stop eating. Cats are very good at living and when the time comes, they are very good at dying. Dogs are not as instinctive about end of life as cats. However, they also will stop eating when nearing death. People truly believe not eating is horrible and painful as do veterinarians. Of course, this explains why people call so quickly when their pet stops eating and they will try almost anything to get the pet to eat. When this fails, and it often does, even with appetite stimulants, pet caretakers believe it’s time for euthanasia. I certainly understand this and do help many pets to transition. However, if I can discuss the process of end of life and that it’s not as people believe and have been told, it can often relieve some of the anxiety that people have that their pet is in a very bad place. Death is a part of life as much as we don’t want it to be. It’s especially difficult when it’s a beloved pet that we can’t discuss it with. Please don’t hesitate to call me if you have questions and concerns. Below is an excellent article on how people die and what they go through. As an aside, there are many documented cases of near death experiences in humans. For those that have been brought back to life, their comments are always positive and there is no mention of pain or anxiety, just peace.

Follow this link to understand the dying process in humans. It’s quite informative and worthwhile to read.

https://www.abc.net.au/news/health/2017-05-26/what-to-expect-when-someone-is-dying/8550490