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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

 

Deciding When Enough is Enough

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October 02, 2012 / (13) comments


I have a terrible job — at least that’s what many of my clients say after I’ve arrived at their doors. When I’m not writing about all things veterinary, I make house calls as an in-home euthanasia and hospice care provider. I wouldn’t call the job "terrible." Emotional and at times draining, sure, but it has its own rewards. I feel honored to be helping people and animals when they are going through an exceptionally difficult time.

I’ve been called the grim-reaper and Dr. Death. More pleasantly, I’ve also been referred to as an Angel of Mercy and a midwife, helping spirits transition from one stage to another (I really liked that one).

 

My job is not especially demanding from a technical point of view, although I have gotten very good at placing intravenous catheters under less than ideal conditions — in the dark, in the snow, squeezed into a tiny dog house — you name it, I’ve probably done it. The challenges arise when I am called on to counsel owners whether and when to euthanize their beloved companions. These are by far the hardest conversations veterinarians ever have with clients.

My veterinary practice helped a dog owner in Lyons, CO a few years back. Her name is Jessica Pierce; her dog’s name was Ody. Jessica is a bioethicist, and she has written a wonderful opinion piece (and a book) on the subject of end of life decision making for pets. The article is entitled Deciding When a Pet Has Suffered Too Much. It appeared in the New York Times on September 23.

I agree with almost everything that Jessica has to say in her commentary. It is an illuminating look into a difficult subject from a devoted pet caretaker who is also an expert on morality as it applies to the biomedical sciences. My only point of contention surrounds this statement:

 

Euthanasia is typically thought of as a choice between suffering and death — and, indeed, it can offer relief from unyielding pain. But death is too often prescribed as a de facto treatment for suffering when much less aggressive possibilities exist. We can ease our animals into the valley of death, rather than abruptly shoving them off the cliff.

 

In my experience, doing nothing (or at least too little) is the most common response to an animal’s suffering, not leaping towards the option of euthanasia. Many owners have said to me that they think they waited too long to euthanize. I understand; I’ve been there with my own pets. But, after the heat of the moment has passed, I have never had a single owner tell me that they think they stepped in too soon. Not one.

I beg of you, if your pet is suffering, do something about it. As Jessica says, "Untreated or undertreated pain is epidemic among companion animals." And remember that suffering is not limited to pain. If your pet’s poor health is preventing him from living the life he wants to lead, he is suffering. Relief may come in the form of a medical and/or surgical cure, disease management, hospice care, and eventually euthanasia. There is an option out there that is right for the both of you.

 

 

Dr. Jennifer Coates

 

 

Image: mythja / via Shutterstock

 

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COMMENTS (13)
1
Timing
by TheOldBroad on 10/02/2012 07:31am

In my opinion, deciding on when to euthanize is a very personal decision.

I will do everything in my power to provide a quality of life for my critters which includes treatment and medications.

Sometimes it's a no-brainer. I can see it in their eyes that they've had enough.

Sometimes my vet's experience and expertise has been a wonderful resource. He has gently helped me make decisions with compassion, understanding and medical information.

I agree. I'd rather euthanize a week to soon than a day too late.

by Roger Jordan on 10/05/2012 05:03am

I agree with you it is a very personal matter and I have had to make that decison on numerous occasions and no matter how many times you have to make that decision it never gets any easier. I believe that when the quality of live is such that your pet is in pain and there is no hope for improvement contact your vet because they have the expertise to assist you in that live altering deccision.

Roger J.
www.lovingcaninecare.com

2
by Grevillia on 10/02/2012 09:11am

I've had to make this decision twice & each was a very different experience.

With my first dog, Molly, she had an inoperable brain tumor. We were warned that it would not be fatal - eventually we would have to make a decision as gradually her quality of life would deteriorate. We were warned to expect loss of balance, increasing confusion & difficulty eating. An added complication was that Molly had also very suddenly gone blind (SARDS), she had great difficulty adapting to her blindness. My husband & I really struggled to come to a joint decision & even now, 3 1/2 years on, he still accuses me of letting her wait too long. Meanwhile, I thought he was in too much of a rush because he found her blindness so difficult to accept. It was a very difficult & traumatic time for me.

Last year we were faced with making the same decision for our boy, Ghillie. This time the decision was easy, although no less painful. Ghillie had undergone a lifesaving pericardectommy, which initially was successful. However, 4 days post-op he contracted a drug resistant infection that his body was unable to fight. He tried his best & we gave him every opportunity but in the end he was literally dying before our eyes. We had no other choice but to help him take his final journey. Losing my boy was no less painful but I felt far more at peace with the decision as clearly Ghillie's story was never going to have a happy ending.

3
Timing of euthanasia
by Lynn Vance on 10/02/2012 09:17am

2yrs ago, my beloved Doberman of 6yrs started acting funny, couldn't poop..so I took him to the vet who took x-ray and found blockage. Told me to try an enima and if it didn't get better over the weekend get him to the animal hospital for further evaluation. Well he didn't and I took him. Had to leave overnight,before I got home a call came in that his stomach was full of cancer. I made the decision to bring him home and care for him myself..for 3 months I gave meds and took him for walks everyday, fed him anything I could get him to eat, vet checked twice a week. I finally put him down when I saw that his bowels were loose and he couldn't control it anymore, he had lost almost half his body weight to the diease...sometimes I felt selfish by keeping him that long, then I wondered if I did it too soon, could I have done more for him. I still wonder and miss him. It was the first time I ever had to do that and I don't ever want to go thru it again...I cried like a baby, holding him saying I loved him and he could sleep now without pain...and mom was letting him go, it was ok to go now. I still cry about it. It ripped my heart out to let him go, but at the moment I felt that I had to. I will do anything to take care of my furbabies. I lost my cat of 21yrs last yr to old age, died in my arms close to me and content to the end...miss him just as much if not more..long time to have a pet with ya..my kids didn't stay that long..so whats right to do?

4
Stay with Your Pet
by oh holland on 10/02/2012 10:14am

I would only add that I think it's the duty of every pet owner to stay with their pets -- touching them, whispering to them, comforting them -- through euthanasia. When choosing the timing, there is no excuse for excusing oneself from the process. We owe those final moments to our pets.

5
Euthanaisa
by OscarsMom on 10/02/2012 11:12am

I think deciding when is the hardest thing I have ever done. I too have had to do this twice. The first time was with my beloved Winston. Winston was a beautiful red golden retriever with the biggest loving heart ever. I still tear up after nearly 19 years without him. I thank my Vet. Rich Meinert everyday that he made a house call to help us at the time we have to finally let go. It was hard but holding Winney as he passed help him and us.

After Winston, Rich decided he couldn't make house calls like that for small animals but we were grateful he was there for our little Bullett, a mixed breed, goofy pound puppy. Baby girl, as we called her developed a severe case of dementia and kidney disease as well. After a terrible winter when she got lost in the snow in the backyard and we had to carry her in, we decided it was time to let her go. We took her to Rich and he again help her and us throught this terrible time.

My point is, you will know when it is time. You just need to not be selfish and hold on because you will miss your fur babies. Our Vets can help us make that decision. I thank God everyday for Rich.

6
Book is coming
by mharding01 on 10/02/2012 02:42pm

I think the article was excerpted from her book which comes out in a couple of weeks. I want to read it though I expect it will be hard (as in painful).

7
Euthanaisa
by ibjennyjenny on 10/02/2012 05:38pm

In all the years that I have been a tech there is one person who was able to sum it all up for me and give me the tools to know when and that person is Helen from
'Tanya's Comprehensive Guide to Chronic Renal Failure' http://www.felinecrf.org/
These are her words about her own cats Tanya and Thomas who suffered from CHRONIC KIDNEY DISEASE and how she made the decision.....

"When Tanya was ill, I felt that I would never be able to bear having her put to sleep. The only way I was able to do it when the time came was when I finally accepted that neither Tanya nor Thomas was ever going to get any better than they were at that moment; that we had tried everything in our arsenal but our weapons were no longer working; and that waiting any longer would therefore ultimately be for my sake, not for theirs. How much more could I ask of them? Ultimately you cannot avoid death; but often it is possible to avoid suffering. Once I began to look at it from the perspective of what was right for them and what would spare them pain, it was still by no means an easy decision, but I did at least feel it was inevitable, because I simply could not stand by and watch them suffer when it was within my power to prevent that. By not acting, I would not be prolonging their lives, I would be prolonging their deaths"

These words have echoed through my mind each time I have had to say good bye to a friend.

8
Hef
by Jordan DuBose on 10/03/2012 12:03am

My girlfriend adopted a wonderful puppy she named Hef. He was such a fun and well mannered dog. After about six months he started having seizures. Otherwise healthy, he would have them about once a month and, srangley, at night. Each time, she would take him to the emergency vet until after many many months she could not afford the several hundred dollars required each visit and would administer Valium at home when he would have a seizure. She would also administer his anti-seizure medicine, as prescribed, 5 times a day. Hef was so playful and fun 29 days a month she never entertained the thought of euthanasia. But she needed help. She reached out to Joe Raibley at the Boston Terrier Rescue of East Tennessee. After many months of medicine and seizures, Joe was still unable to find a home that could provide the around the clock care that Hef required. Then one terrible day Hef went into a seizure around lunchtime (his first during daylight hours) and was unresponsive to treatment. He was rushed to the vet and the veterinarians did everything they could but it was clear in their opinion that Hef was never going to wake up from this seizure. She was crushed.

Days later she thanked Joe for looking but notified him he could stop his search. He responded with an email. She was crushed that he included the picture of Hef that she had sent him so long ago. This is that email.


From: Boston Terrier Rescue of East TN [mailto:boston_rescuer@yahoo.com]
Sent: Monday, September 17, 2012 11:19 AM
To: *************
Subject: Hef

We had a foster arranged for him the day after you had him euth'd. Right here in Maryville, a vet tech who works for my personal clinic.

There are far, far worse things to contend with than seizures once or twice a month. Dealing with you and trying to convince you to save your dog's life has been one of them.

Don't get another animal. You don't deserve one.


Euthanasia is a terrible choice to have to make and most of us have had animals live a long time and we may have to make that choice. But Hef had just turned two and she had no choice. Shame on you Joe Raibley.

Thank you for reading this.

by wikith on 10/03/2012 09:01am

How awful for her. I hope she did not take his cruel words to heart, especially since Hef's seizures became intractable. Clearly he does not understand either medicine or human pain.

by ibjennyjenny on 10/04/2012 02:42pm

Joe Raibley sounds like a very ignorant person. Scares me that people like that work in rescue, all they do is make people not want to ask for help which defeats the whole purpose of working for a rescue organization to begin with.

9
Hef
by Darrah Bordeaux Dawson on 10/03/2012 11:08am

It was my baby he is talking about above :) I loved that little man. Unfotunately, that story is true (though he had the timing a bit mixed up - Hef was actually just at 2 years when the seizures began and had turned 3 the week before he passed). It had gotten to the point where I was searching for a caring soul with more time on their hands, rather than a 40 hour work week, to keep watch over him. He had to be given medication throughout the day at different times and it had gotten expensive and trying since nobody could give me any answers. He was the second dog I had to go through euthanasia with, and let me tell you - it was definitely painful enough having to let go of the first, Chico, my 11 year old Chihuahua, who was sick and dying from kidney failure...but walking in with your 3 year old puppy who was just playing with you that morning before work is much more difficult...then having your decision - well, not even your decision - thrown in your face by someone you had reached out to for assistance during a time of need..it doesnt get mcuh lower than that, unfortunately. Just a sad reminder that REAL good people are hard to find.

by Ruth Dandrea on 10/04/2012 09:27am

I don’t understand why he would say “trying to convince you to save your dog's life
“ when you came to him to do just that. I have always felt that no one should get a pet unless they understand that they are just like having a child. Pets are not disposable like a broken toy. You where doing everything you could do to help your pet. Most pet owners would have taken them back or have them euthanized right from the first seizure. When you could not do anymore you reached out to find someone who could take care of you pet. Any parent who has an ill child does the same. There are cases of children who have to go to foster care because the parents just cant care for them alone. I do not feel your situation could be viewed any differently. Do not beat yourself up because of one persons views.
We had to euthanize our girl (cat) do to kidney failure in July this year, she was 16. Our boy (dog) had surgery for cancer. He also had blot and we almost had to euthanize him because we didn’t have the money for surgery. We fought with the Vet telling him we would pay what ever the bill is but we just didn’t have the money right then and there. Then he told us about the Care Credit card. We are once again facing a hard decision with our boy. But what ever decisions we make for him has always been in his best interest. He will tell us when he has had enough. I think that day is coming soon and it hurts far more then what anyone could ever say to me.
Don’t let anyone take away the good times you had by filling your memories with doubts. You are their mother and you know that what you do is what is best for them. You feel it in your heart. I feel your pain and sorrow.

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About fully vetted

Jennifer Coates, DVM

Photo of Dr Coates

Image credit: Jim Piraino

...graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999. In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado. She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-Speak Deciphered for the Non-Veterinarian. Dr. Coates also writes short stories that focus on the strength and importance of the human-animal bond, and freelance articles relating to a variety of animal care and veterinary topics. Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and various species of pets.

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