Tuesday, May 27, 2008

Pet Loss and Tough Decisions

I haven't posted during the past ten days because I've been absolutely numb from the loss of our Basset Hound, Molly. (Her picture is the one to the right of the blog, with her nose sticking through a cat hole.) Even when we know the time is right and the decision is a loving decision that will prevent terrible suffering, it isn't any easier to make the decision or to lose a member of our family. Molly was at least 14 years old. It's possible she was older. Our vet said she may have been the oldest Basset he's ever seen. So this week seems like the right time to talk about tough decisions.

The word euthanasia (youth-an-asia) means gentle death. If you aren't familiar with the term, it's often referred to as putting an animal to sleep or putting an animal down. I don't like either term because those words are frightening to children, who may begin to worry that they will also die when they go to sleep. See the connection? The pet "goes to sleep" and never wakes up. Worse yet, if you can't bury the pet at a family service, the body disappears to be cremated and is never seen again or is returned as ashes--which is the norm. Most cities have laws against backyard burial of animals, and many cities don't have pet cemeteries. It's very hard for children to deal with death and loss. The permanence of death is beyond understanding for very young children. They will ask when their pet will come back for a long time. Patience and gentle explanations are essential, and it can be hard to be patient when you are also grieving.

Some of you may not believe in euthanasia for any reason. Others may be unsure when and how to make a decision that will end the life of an animal you love. Most veterinarians counsel pet owners to base the decision on the pet's quality of life. That's good advice, but what does it really mean? A simple explanation is that the pet has more good days than bad. There are more days that they eat well, sleep and play appropriately for their age, and are comfortable and happy than that they have pain or suffer.

When I consult with clients who have pets that are elderly, chronically ill, or terminally ill, I use a checklist of items to evaluate on a regular basis. There are ten common items that constitute a basic quality of life assessment guide for almost any species. The items on this list are things such as pain, hydration, elimination, eating, sleeping, playing, fear, anxiety, and other things that affect an animal's quality of life. Of course, it varies a bit by species and the type of illness or disease. It also varies with the breed and the person's experience. Animals hide pain and illness as a survival trait. Some are more stoic than others. Some pet owners are also more observant and connected to their pet than others. And sometimes, I have to guide them through a few initial assessments to develop their confidence and guidelines that fit their situation.

This type of consult is best done in person, but I also do them by phone and email because I've found many vets don't have time to discuss these situations as thoroughly as their clients need to to really understand and feel comfortable with their decisions. For first-time pet owners or caregivers forced to make this decision for the first time, it's very important to truly feel comfortable making such a huge decision. There's enough grief and pain without adding self-doubt or second guessing your decision. I have no doubt we did the right thing for Molly, but I still have a huge hole in my heart and my life.

We made the decision to choose euthanasia because we knew Molly's age and health limited further treatment. She had a spleen mass that was growing and made her chronically slightly anemic, lypomas that were too numerous and huge for further surgical intervention, pressure on her heart from fat accumulating in her chest, and a tumor in the urinary tract canal that was 99.9% sure to be cancer. The urinary tract tumor would have blocked her elimination causing tremendous pain and kidney failure within a short time. She had an ultrasound six weeks ago and that tumor was not visible, which gave us an idea how fast it was growing. In addition, her appetite was inconsistent (for a basset hound this is serious indeed). Plus, she'd collapsed and been taken to the vet on a stretcher a week the previous week.

This is not a decision we take lightly. After her collapse and our emergency trip to the vet, we immediately ordered another ultrasound and spent a total of almost four hours with two vets over the course of the final week, before making a decision. Her behavior during that week clearly told us she had discomfort most of the time now. Molly was arthritic, anemic, and had many allergies. She was also on pain medication and steroids already. In addition, the spleen mass had grown more during the past six weeks than during the past year. Everything seemed to become critical at one time.

We could have added more pain meds. But due to her already weakened kidneys, that may only have hastened the kidney failure and the subsequent decision. We also considered the fact that she was not a dog that expressed her discomfort. So we knew her pain was probably more severe than it seemed.

My husband said it well. He said, "This was our warning that it's time." I agreed that we were lucky to find out that things had taken a turn for the worst before it was a crisis. Most veterinary emergency clinics are wonderful, and they do great work. However, it's not my idea of a happy ending to be in a busy crisis clinic, with a strange vet, at midnight some night, with Molly in terrible pain and scared further by an unfamilar situation. Sometimes there is no choice. When there is a choice, a peaceful ending with the family present and the attention of a caring doctor and staff is truly better.

We prefer to do euthanasia at home with the other animals around. It is our experience that this helps them adjust much better than just having one of their own disappear. However, that's not always an option--as in this situation. Because of her health problems our vet suggested that it would be safer to do it at the clinic. We have a very good relationship with our vet and respect his opinion. So we went to the clinic.

The title above links to the Association for Pet Loss & Bereavement. They have excellent resources for anyone who is grieving. They also offer an Anticipatory Bereavement Chat Room for those who know their pet is terminally ill or who are sharing their final days with their pet. I highly recommend this resource. If you want more resources or a list of books, check my website under resources.

Later this week, I'll talk about the choices and options for aftercare and grieving. I'll also be teaching a class on helping children deal with pet loss. It will be held on July 27 in Austin, Texas. Let me know if you want more information or want me to put your name on the list to contact you about my classes.

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