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Euthanasia General    Cute as a Button   The Challenge of Euthanasia & Hospice 

 Pain Assessment Scale   Hotline Numbers to Call

EUTHANASIA GENERAL 

  by Alan Cunningham

Stedman's Twenty Second Edition Medical Dictionary defines euthanasia as a quiet, painless death. Euthanasia is the intentional putting to death by artificial means of persons or animals with incurable or painful disease.

The only places that legally authorize assisted suicide for human patients are Oregon, Switzerland, Belgium, and Holland. The relief from incurable or painful disease, however, is a universal privilege for animals.

Pet owners typically have many questions about euthanasia such as: May I be present when the procedure is performed, is it painful, how long does it take, and what happens to my animal afterwards?

Owners are encouraged to be with their pet when it is euthanized. The final act of companionship tends to provide a closing bond of comfort. Owners may hold or touch their animal friend during the procedure.

When the animal is severely painful or anxious the veterinarian will administer a sedative or tranquilizer to help calm it before the euthanasia is performed.

Some owners prefer to have their animal companion euthanized at home in familiar and comfortable surroundings with family members present. Or occasionally the animal will be too big and incapacitated to move it to the veterinarian clinic. In this case some veterinarians may accommodate or suggest a traveling veterinarian that may provide these services.

The drug used for euthanasia is sodium pentobarbital (beuthanasia). When administered intravenously, at high concentrations, pentobarbital causes instantaneous, painless death by severely depressing the respiratory center. Death may be slower or the injection painful if the substance is given perivascularly or outside the vein. Therefore an intravenous catheter is sometimes placed to assure a painless and effective administration.

Sometimes an animal may be so sick and dehydrated that it is difficult to locate an adequate vein to administer the euthanasia solution. Then the drug is given intracardiac or intra-abdominal. If it is given intra-abdominally, into the liver for example, the death will come more slowly, about ten minutes, but the event is still peaceful.

Several options are available after the animal is euthanized. Depending upon the living situations of the owner and the city ordinances, the animal may be taken home and buried or interned in a pet cemetery.

Other options include leaving the body at the veterinary clinic. The clinic has arrangements for weekly retrieval by a disposal company. The body is then cremated privately if the owner requests return of the ashes, or it is cremated with a group of others.

When a private cremation is requested the ashes are placed in a personalized urn or container. Some services also return a paw print of the pet. Some people may take a lock of hair or the animal’s collar.

During and after the euthanasia it is okay for the owner to cry. Grief is perfectly normal, and essential. Sometimes the veterinarian also becomes emotionally involved; it's hard not to. The owner should feel comfortable to spend time afterwards to say goodbye to their beloved animal companion.

As a veterinarian I recognize the difficulty of euthanizing an animal companion. The procedure is often accompanied with grief, guilt, and a feeling that we are letting a loved one down. But when a beloved companion is incurable, and chronically painful, the blessed relief from suffering is welcome. And in a sense we grant our animal angel "wings to fly."

The veterinary clinic should be able to provide animal loss support hot lines to help with pet loss and the healing process. And my book lists such numbers.

You can provide a photo of you and your animal companion, or just the animal companion, and have a beautiful drawing done that can be framed and hung in a special place in your home. You can contact our publisher for this service.

Alan B. Cunningham DVM

CUTE AS A BUTTON

  by Mike Motschenbacher DVM

Thank you for your first book Sleeping With Angels. It was a good read. My grandparents always had Boston Terriers, and when my dad retired he also got one.

Chloe. Click drawing for full image.

A Boston also changed my clinic policy on euthanizing animals. A client brought a rescued Boston into the clinic for euthanization. She wanted us to keep the dog over the weekend so she could try and find a home for it. If she couldn't, she wanted the dog put to sleep.

He was as cute as a button. He carried a chew toy with him wherever he went, and was as friendly as they come. I stewed all weekend, and decided I would not put him to sleep, and that from that time on I would only put sick or mean animals to sleep.

Come Monday, the owner came into the clinic and had found a new home for him. I still think of that dog.

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THE CHALLENGE OF EUTHANASIA
The Hospice Approach to the Dying Pet
Cheryl Scott RN, MS, DVM

  INTRODUCTION

Dr. Cheryl Scott Performing At Home Care.
Click drawing for full image.

It has been stated that American society worships youth and denies death. In the past few decades we have seen an emerging acknowledgement and concern in human medicine for the aged and dying patient. Gerontology and hospice care are now well established in our medical communities, as an increasing percentage of our human population is growing older.

Veterinary medicine is increasingly being presented with similar issues concerning our aged and terminally ill pets. We are now victims of our own success; with rapidly improved medical technologies, animal companions are now living longer. The oldest dog has been reported to be 29, and the oldest cat 34. With an expanding population of elderly pets and the increasing appreciation of the human-animal bond, veterinary medicine now has an obligation to address the situations encircling the aged and dying pet.

EMERGING CHOICES

In my previous career as a nurse, I witnessed the appearance and disappearance of many diseases and cures, the creation of amazing medical advancements and the reality of longer life. Through all of this, 1 spent much of my time dealing with death and dying, the one entity that has no cure. Death, in fact, may be the one issue that most of us will admit is difficult to accept gracefully or ever reconcile.

As a vet student, I don't believe I even considered geriatrics as a "real" area of specialty and the term "hospice for pets" didn't once cross my mind. I was way too busy learning enzymes, doses, schedules and treatments to fret over the stages of grief (other than my own).

Once I entered the real world of veterinary medicine, I quickly discovered a recurrent and disturbing inadequacy in the way we dealt with the terminally ill animal companion. Not that there wasn't enough compassion or empathy associated with the dying pet, we all had plenty. But the fact remained, there simply were not enough options given to the owner of the dying pet. Once the diagnosis was delivered, the next jump was to consider euthanasia. Of course, euthanasia is sometimes the only viable, humane option. But I kept coming back to the void between the diagnosis and the death.

  I concluded that we, as veterinarians, had a moral obligation to at least not ignore, and perhaps even give insightful thought to the power of the human-animal bond and the needs, passions and desires that may arise from this dynamic relationship. We cannot ignore the grief and bereavement that may be occurring, for some, at the loss of a pet. Once I began to take a more pro-active approach to this issue, the concept of Home Vet Hospice evolved.

Reggie. Click drawing for full image.

THE HOSPICE CONCEPT

The first contemporary human American Hospice was founded in 1973. A few years ago a New Hampshire veterinarian, Dr. Eric Clough and his wife Jane, an RN, began actively and successfully promoting and delivering hospice care for terminally ill animal companions. They have extrapolated information from the human hospice movement, and applied this knowledge to pets. Their premise is that hospice care may not be an alternative to euthanasia, but instead a kind, safe, pain free, end-of-life care that precedes death.

Many of the general hospice postulates apply to veterinary medicine: the illness is terminal, there is no longer a pursuit for a cure, and palliation becomes the primary focus. The goal is no longer to prolong life, but to progress to a gentle, graceful and dignified death. The quality of life is now more eminent than the quantity of life. In order to embrace the hospice concept for pets, veterinarians first may need to confront feelings about death and dying and then begin to cross the line from "cure" to "comfort."

But veterinarians have an additional challenge. Our concern is not only for the animal patient, but also for the human client. The expertise that we use in dealing with the terminally ill animal companion has to extend to the human companion as well. We cannot leave the human out of the hospice equation. For this reason, hospice care is not easy to define; it is unique, it is multifaceted, and it has to be applied to each case individually and separately. Keep in mind; hospice is not going to be for everyone, and everyone may not be right for hospice.
    Read more in the book. . .

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PAIN ASSESSMENT AND MANAGEMENT SCALE
Karol A. Matthews, DVM, DVSc, Dip ACVECC

  As a veterinary staff who has provided hospice care for a pet and its owner, you have the opportunity to complete the circle of care, and to be there when the owner is ready to begin again.

Aspen. Click drawing for full image.

0 No Pain
1 Probably No Pain
2 Mild Discomfort: Limping, Use analgesia to assess
3 Mild Pain or discomfort
    Abdominal guarding, depressed appearance, trembling, picky appetite
    Needs analgesia, e.g., Butorphanol, NSAIA
4 Mild to Moderate pain
    Resists handling, remains recumbent, not moving, RR & HR >>, cats lie still.
    Needs analgesia: Butorphanol, Morphine.
5 Moderate Pain
    Depressed, inappetent, may bite, abdominal splinting, ears back
    Analgesia: Oxymorphone, Morphine, use/add NSALA
6 Moderate Pain with vocalization
    Analgesia: Morphine increases
7 Moderate to severe Pain
    Increasing depression, will urinate or defecate when moved
    Analgesia: Morphine increase/add Fentanyl, Oxymorphone, NSAIA
8 Severe Pain
    Increased vocalization, recumbent and oblivious to surroundings
    Analgesia: High dose Oxymorphone, Morphine, NSAIA
9 Severe to Excruciating Pain
    Hyper-sensitive, nerve pain, inflammatory pain, enough to cause death
    Analgesia(by CRI) high dose Morphine, Oxymorphone, Fentanyl, NSAIA
10 Severe to Excruciating with Screaming or Unconsciousness
     Hyper-sensitive, hyper-painful, whole body trembling
      Analgesia: Opioids and NSAIA as above, anesthesia, local blocks

SELECTED MEDICATIONS
    Read about this in the book. . .

Hotline Numbers to Call

  Hotlines for Grieving Animal Companion Owners

Iowa State University 1-888-478-7574

UC Davis 1-800-565-1526

Colorado State University 1-970-491-1242

www.argusinstitute.colostate.edu

www.petloss.com