Your Pet's Best Friend

When is it "time" to euthanize?

Here's today's tough question [edited]:

I have a cat, Zoe, who is 15. She is diabetic.   Even when her diabetes is stabilized, she's so skinny! She has gone from a big 12 pound Maine Coon to a weeny 5 pound Maine Coon. She looks and feel bony. We know she has some arthritis (she gets chondroitin); the vet thinks she may have a tumor of some sort, possibly even/as well as a brain tumor. She definitely has dental problems.

Zoe's quality of life seems to me to be poor - she will accept petting but is not the affectionate lapcat she used to be; she has always lived in a multicat household but now HATES the other cats; and she's occasionally incontinent. Mealtimes get her excited but that's it; the rest of the time she spends asleep.

How do we know when it's time? We keep taking her back to the vet every 3 months for an assessment to see if she's in much pain and they never seem to think she is. I don't want to euthanize her just because she is no longer a charming little kitten or because she has health problems - she has definitely earned her retirement, but I also don't want her to suffer through a terrible existence because we haven't got the guts to make a decision.

My Answer:

Well... no pressure, huh?

The decision to provide euthanasia is often a difficult one.  In fact, it is almost always a difficult decision, even when the situation is pretty clear-cut (as in the dog caught in a combine harvester header who had all four of his legs cut off: the owner wanted me to "fix him". Holy cow!)

"Quality of life" and "quality of life issues" are the buzz-words.  They are more than just buzz-words, though.  If one is sure that a patient is in constant pain which is NOT going to get better, then the decision is pretty clear.  But what about the patient who just never feels good? 

You don't really see obvious signs of pain (screaming, moaning, writhing, restlessness, etc.), but you never see what you consider the normal activities.  No playing, no exploring, no interaction with other pets or people.  She still eats and is interested in food, but just sleeps the rest of the time.

With this pet, we know she won't have any energy -- she's wasting away, burning up her body fat and muscle tissue just to stay alive.  This means that she isn't getting much good out of her food.  Just breathing is taking all she's got.

Is she in pain?  This is a very hard question to answer, particularly with cats, as they are very stoic and famous for concealing signs of illness.  Even when you know your pet better than anyone else, this can be a hard call.  One of the few ways that I know to assess this is to give a trial therapy of pain medication, such as buprenorphine, and see if there is improvement.

Another criterion that I use is to think to myself, "If this were me, would I be in pain?"  This is less useful here, as I've never been 100 years old and wasting away (at least not this lifetime).  My great-aunt Clara lived to be 101.  She retained her mental faculties to the end.    You could tell pretty quickly how interesting your conversation was.  If you were boring her, she'd just go to sleep.  If not, the conversation would be lively for as long as you could stay with it.

Aunt Clara was rather feeble physically in the last ten years.  She didn't feel bad, but she had trouble getting up and walking, even around the house.  She slept a lot.  When asked how it felt to be 100, she would reply, "I'm just surprised every day when I wake up."

Contrast this with an experience I had with a relative dying with cancer in a hospice environment.  She begged me to smother her with a pillow.

Which brings me back to my opening statement: No pressure, huh?

Whenever a client uses the "S" word ("Do you think he's suffering?"), I know it's over.  In 31 years, nobody has ever used this word unless they were looking for the way out.

In your case, you are concerned about whether you are condemning the cat to slow death.  Ironically, you are afraid someone might think you were considering a "convenience euthanasia".  Since most cats don't live to be 15 in the first place, and many owners will not go to the trouble to treat diabetics (and it IS some trouble, I know), you could hardly be thought to have cut any corners in the cat's care.

Here's what the numbers say:
Your cat has lived to an above average lifespan of 15 years.
Your cat has lost sixty percent of its body weight.
Your cat never plays, explores, or interacts with others.
Your cat never "feels good".

Your question: is the cat in pain?   Answer: I don't know.
Your question: is it "time"?            Answer: Only you can decide.

I wish I could make it easy for you, but it never is.

Best wishes,
Everett Mobley, D.V.M.

How much is a teaspoon?

This is a question that I have long known to be a mystery to many people.  When I ask for a teaspoon of poop for a stool specimen, I receive anything from a smear on a kleenex to a coffee-can full.  I have a feeling that these people rely on food-products that don't require much measuring in the recipe.

Today I was presented with a little pup having some problems.  The owner told me that she had "wormed it" a few days ago.  When I asked what she had used, she was much better prepared than most folks, whose answer is "I got it at Wal-Mart". [I really must spend more time in the pet-care aisles of discount stores.]  This lady, however, had brought not only the bottle of stuff, but the medicine-dropper she had used to dose it.

 

"I dosed him for 10 pounds." [Sure, he only weighs 7 pounds, but that's safe enough.]  The bottle says 5ml  (one teaspoon) per 10 pounds of body weight.  "Here's the dropper I used."  "How many of those droppers did you give him?"  "Just one." Well, let's just see how close that was to 5 ml (or "one teaspoonful", and whose teaspoon do you use, anyway?)  Not too close.  It takes five of these droppers full to equal the 5ml teaspoon.

Interestingly enough, your basic cheap tableware, AC/DC, regular teaspoon holds the full 5ml.  It's a close fit, and it will spill over the edge with the slightest tilt, but it will hold it.  It's lousy for medicating the pet, but it does hold a teaspoonful. 

This medicine dosing thing: you need to follow directions, and you need to know how much your pet weighs, and you need to know how much is a teaspoon.

Fledgling birds

Here's our annual bird's nest in the kennel window, sheltered under the eaves.  We've seen the momma sitting, and flying back and forth.  It's empty now, which I wouldn't have noticed, as we try not to bother them, but a fledgling nearly landed on me when I got out of the truck this afternoon.  Soon the calls will be coming.

"I've just found this baby bird that's fallen out of the nest.  What should I do?"  Leave it alone.  This fledlging bird is too big to stay in the nest, fully feathered, an "adventurous teenager", not a helpless baby anymore.  So she hopped out and is learning to hop around and fly.  Mother is nearby and watching her, bringing food when necessary.  If you pick her up, she'll just hop out of the nest again. If you take her in the house, you have drastically reduced her chances for survival. You're not a very experienced at finishing her "raising", and teaching her to survive in the great outdoors.  She probably won't survive your good intentions.

"What if I cat or dog finds her?"  That will be bad, but we can't really police the law of the jungle.  When minding our own business increases the chance of survival, that's what we need to do.

If you find a little downy chick of a baby bird, it's okay to put them back in the nest.  The mother bird WILL NOT reject them because you have touched them.  If you can find the nest, do put them back in.  It is possible to hand rear the birds, but without seeking good information on how-to, and making a significant commitment, you will not succeed.

We all want to make a difference, but sometimes the best thing you can do is to mind your own business and let the birds mind theirs.

The worst pitfall in pet adoption.

Old Yeller Alert

In a previous post, I discussed many of the problems one might encounter in adopting a pet of uncertain origin.  In an attempt to be warm, fuzzy, and make the idea attractive, I pretty much glossed over the worst case scenario.

The problem is that these animals are not brought to the shelter or rescue agency because people have been loving and caring for them.  They are brought because people want to get rid of them.  "Give me your  tired, your poor..."  Sometimes they are already carrying a disease.  Sometimes they are so stressed that they don't have any resistance when they are exposed.  That same level of stress can also prevent them from responding to the vaccines given by the rescue folks.

This puppy looks really cute.  What you cannot see are the white gums, bloody stool, prolapsed rectum, subnormal body temperature (room temperature) and severe dehydration produced by her parvovirus infection.   Her new owners adopted her less than a week ago.  The Animal Rescue had given her first puppy vaccines and dewormed her for hookworms and roundworms less than 10 days ago.  If you showed me her paperwork, I would have asked you to bring her in for a quick check-up and a stool exam.  On paper, she ought to be okay, and last night she still looked okay.  She wasn't, though, and today she crashed.  She was exposed to the parvovirus before her body could respond to the vaccines.  It is as though somebody started machine-gunning you with live ammo while you were training on a paint-ball course -- you are not prepared to fight back.

SO, part of you says, "Don't get an animal like this; it's such a crap-shoot.  They could become seriously ill and die just about the time you get attached to them."  Then there's the part of you that says, "If we don't adopt these guys, they will ALL die."  You're between a rock and a hard place, with that "No good deed goes unpunished" feeling.  Somehow, a "money-back guarantee" just doesn't make you feel that much better. 

Does it happen that often?  Not really.  Very seldom, in fact.  That's just a pretty small consolation when it happens to you.  We keep doing it anyway, partly because we feel it's the right thing to do, and partly because we tell ourselves that nothing bad is going to happen to us.  Sort of the same way I justify getting on the motorcycle.  You pays your money and you takes your choice.

Blood vessels are slippery for a reason.

It's time for that yearly check-up again.  Have you ever been a little frustrated when the venipuncture technician had trouble "finding your vein"?  Did they ever have to poke you more than once? Don't you hate that?

This is my hand.  They don't have trouble finding my veins.  Sometimes I do have trouble finding the veins on my patients.  They can't roll up their sleeves -- for a routine yearly physical, most people are not crazy about you shaving their dog's leg.  Plus some patients have an extra layer of fat around the leg that makes it more difficult to visualize or to feel the vessel.   Sometimes, though, the problem is not finding the vein.  The doggone thing just keeps slipping away from the needle.  Those things are slippery for a reason.  I guarantee you that if I cut my little hand, I'm glad that big nasty vein is very likely to slip out of the way instead of turning into a gusher.

We had some bad storms last night, and some of this mare's barn blew off into the pasture.  We figure the metal siding is what sliced into her fetlock.  The vein did not slip out of the way.  This horse was streaming blood like a faucet running.  In this picture, we're all sewed up and bandaged.  If you look closely, you can see a lot of bloody gauze on the ground.

It's wounds like this that give me more patience when some vein is slipping around and doing its best to avoid my needle.  I wish that horse's vein had been just a little more slippery...  I would have wound up wearing a lot less blood.

Why we don't feed bones to dogs.

"Do dogs get hemorrhoids?"  That's how the phone call began late last night.  Actually they don't typically get the same problem in that area that people do. On the other hand, they can certainly have polyps in the rectum, or even rectal prolapse (turned inside out).  "Does it look like a red bump? How big is it?  Marble sized? Pea sized?" "It looks like a ribbon."  Well, she had me there.  Over-the-phone diagnosis is always tricky, but I couldn't figure the ribbon thing at all.  "He's panting and acting like he's in pain." Hey, let's go back to work tonight.

Do you remember those ads: "Here's your brain.  Here's your brain on drugs."?

Here's your butt.  Here's your butt with a jagged chunk of bone stuck in it.  Can you say, "Owie"?   Three days earlier, this dog had received a lovely bone for his Christmas Eve present.  It came from the grocery store, labelled "Pig Bone; not for human consumption".  If it's not for people, it must be for dogs.  He ate it really fast.  In a previous post, I talked about the pros and cons of chew bones.  These pictures will be added to that post. 

When the old boy ate the bone, his teeth broke it into fragments.  This one looks a lot like an arrowhead made by prehistoric man, doesn't it? One of those jagged ends was hung up in the back door.  That deal where he was acting like he was in pain?  I don't think you'd have to spend much on acting lessons for that one.  Fortunately, it wasn't hard to remove after he was sedated.  Oddly enough, he didn't want you to monkey with it while he was wide awake and feeling it.

If looking at that piece of bone doesn't make your bottom hurt, then you probably don't understand why we don't feed bones to dogs. I suspect that most of you do understand.

Second opinions via the Internet

I have posted on this once before, but I believe it bears re-visiting.  Lately I have had quite a few readers asking for advice on their personal pet's problem.   These are folks who have been doing an internet search about their pet's problem and accidentally arrived at my spot here.  I'm glad that they feel they have been helped enough by my information to ask for my opinion.  The thing is, I'm still limited to giving general advice and information; I still haven't perfected the psychic abilities that would allow me reach out and get in touch with the problem over the ether.

This is a particularly difficult situation when I am asked to second-guess the doctor who is actually seeing the pet.  Chances are, he has some information about the case that I don't have.  My goal would be to actually help the client and the pet's regular doctor by opening a common ground for communication about the situation.

If you're reading this, you know that when you search the internet, you can find that your search expression will yield an awful lot of results.  It's difficult to know which one to trust when they are in conflict.  What is it that makes a reliable site?  If I wanted to put up a site that says the Pope has three illegitimate children and won't pay alimony, I could do it.  It would be utter rubbish, but you could "find it on the internet".  I can tell you that there many doctors who dread nothing more than "...I've been researching this on the internet."  People who are perfectly reasonable and intelligent in other respects will bring in a print-out that just makes no sense whatever and wave it about like a talisman.

I'm happy to answer your questions as best that I can.  If I'm not as specific as you would like me to be, at least you'll have something that's a discussion point for you and your pet's doctor, and I don't think it will make him/her crazy.  That is a positive point.  So keep reading, and keep those emails coming.

Interesting Cases

Back when I was in veterinary school, Dr. Larry P. Thornburg was a lecturing pathology professor (as opposed to the hands-on pathologists who worked with us in the laboratories).  One of my favorite Thornburg-isms was "This is a very interesting disease -- we don't know a thing about it."

When we moved on to the clinical aspect of our training, one would occasionally hear the clinician (the instructor/doctor in charge of the case, as opposed to the lowly student in charge of all the work on the case) say, "This is a very interesting case."   It didn't take too many of those pronouncements to realize that interesting cases were living on borrowed time. 

The thing is, if you're an expert, and you know all about the regular stuff, seeing the routine, run of the mill disease or injury is just "ho-hum, seen it all before".  For things to get interesting, it has to be something really unusual, something that is hard to figure out, something that maybe nobody has ever seen before.  In other words, it may take a while to figure out what's going on (maybe such a long while that you're too late to help), and you may have to invent a new treatment, or there may not BE a treatment.  In a teaching institution, that translates to a very interesting case report, complete with post-mortem results and microscopic analysis of the deceased's diseased organs.

I'm telling you, you don't want to be an interesting case.  When the doctor starts calling in everybody to look at you because your disease is so cool and unusual, it's not a good thing.  You want to be Mister Dull, Mister Boring, Mister See-these-everyday.  It's like the old Chinese curse: "May you live in interesting times." [Read your history books -- "...and there was peace and prosperity for 100 years." versus plague, pestilence, war, famine and other interesting things.]

Don't get me wrong, now -- I love an interesting case as much as the next guy... just not at five o'clock (or six o'clock, or any o'clock when I've had a long, full day and would like to go home, for heaven's sake).  Of course, I love it a lot more when I figure it out in time and the patient gets well. I'm batting .500 this week.  Monday we had a really interesting case that has gone on to that great litterbox in the sky.  Tuesday we had a really interesting case that is a whole lot better today. Both days had me working till eight o'clock, and back here again until ten.  It's never dull around here, but today was a little less interesting.  I'm okay with that for a while.

Lock up your iodine.

I don't use a lot of strong tincture of iodine.  This bottle is so old, that I'm not sure just how old it is. Strong iodine is very caustic -- in fact, about the only thing I use it for would be some type of chemical cautery, like sealing the navel cord on a newborn foal.  When we want iodine activity in an antiseptic, we would use a tamed iodine.  Povidone iodine (Betadine being the most well-known trade name) has the iodine bound to another molecule that makes it less traumatic to tissue.    Even with the tamed iodine, we use very low concentrations.  0.5% (that's one half of one percent -- looks like weak tea) is plenty to kill germs.  Any stronger, and you begin to kill the tissue you're trying to protect.  All that stuff that burns when you pour it on is burning for a reason. It's not just hurting your feelings, it's hurting the tissue that you were trying to help.  If it burns like crazy, don't pour it in an open wound.

It's a good thing I don't use much of it, as it is being declared a "controlled substance"; I'll have to keep records on its purchase and use, just like a narcotic.  It seems that iodine crystals are used as a catalyst in methamphetamine manufacture.  So, just as cold-pills with pseudo-ephedrine got moved behind the counter, and you can only buy two lithium batteries at a time, the meth-heads (with help from federal regulators, of course) have now created a hassle for legitimate users of iodine. [ This is just for the strong stuff, strong tincture, crystals, and so forth. You can still buy the weak stuff without a problem.]

Of course, there are people who shouldn't have access to iodine, I suppose.  This past week a lady brought in her little Dachshund who had been vomiting a bit.  Her uncle had told her that the dog might have parvovirus (it didn't) and that she could kill the virus by putting a drop of iodine on the dog's tongue. This is not the dumbest thing I've ever heard, but it will make the semi-finals.  NOT a good idea.

Apparently her uncle thinks that the skull and crossbones refer to some sort of pirate-themed party.  "Poison" is only one letter off from "poisson", which is French for fish, and again you've got your nautical reference.  My client was made a little uneasy by this warning, but ... she trusted her uncle.  She compromised by touching the dog's tongue with a cotton-swab moistened in iodine.  It was a bit like our Presbyterian approach to baptism: sort of a promise of moisture, rather than immersion.

Probably didn't taste too good, but not enough to poison the dog, thank goodness.

Heat Stroke in Dogs

I sometimes wonder how the Dingos of Australia and the wild dogs of Africa get around the issue of heat exhaustion.  They are built on the same game plan as all other successful canines, but they live, run and hunt in a much less temperate climate.  Do they mostly hunt at night?  I should be a better naturalist, I guess.

Dogs in general have pretty poor mechanisms for getting rid of excess body heat.  People perspire for evaporative cooling. "Horses sweat, men perspire, and ladies feel the heat." Dogs only perspire on their nose and footpads, which is not nearly enough to cool them off.  Panting exchanges hot inside air for cool outside air.  When the outside air is 100 degrees Fahrenheit, that doesn't cool you off much.  You can lose heat by simple radiation, as in walking around in the cold with your coat off.  Again, that doesn't work so well when the heat index tops 100.  Also, the bigger the dog, the fewer square inches per pound.  Square inches radiate heat, and pounds generate and retain it.  This means the big dog seldom is bothered by the cold, but is miserable in the hot summer time.  Generally, this goes double for the weird-looking dog, especially the brachycephalic ("smashed face") breeds.

Conduction is another way to get rid of heat.  Lie down on or in something cool.  You might try a dip in the pool, and you'd have evaporative cooling when you got out.  Then there's the ever popular expedient of digging a big hole in the yard.  This exposes cool, moist earth which you can lie on and wick away some of that excess heat.  Of course, after a while the dirt dries out and gets as hot as the rest of the yard. "Hey, I need to dig another hole, here."  You might call this the mine-field crater method.

If you're a big dog, you generate a lot of heat just by being alive.  The chemical reactions that carry out your basic metabolism all generate a little waste heat.  If you get up and move around some, you generate more heat.  Since you can't "work up a sweat", you just get really hot.  Eat a big meal and you generate more waste heat in processing your fuel.  It's not uncommon for big dogs to lose weight during extremely hot weather; they just don't want to do much or eat much.  My own dog usually won't eat untl after ten PM, and then she only eats a big meal about every two days.  Think about your own point of view:  if you're working hard outside, would you rather have a cold sandwich or a big steaming bowl of hot chili?

If you generate too much heat, and can't get rid of it, bad things start to happen.   You can get anything from an irregular heartbeat to a profound state of shock, where your circulatory system collapses.  This can be followed by the sloughing of the gut lining, kidney failure, and even death.

With dogs, this most commonly happens when the animal is tied up and gets his tether tangled up.  He can't reach his water and shade, or he just panics because he's caught and begins to struggle violently. Choke collars (which should NEVER be left on an unattended dog -- they are strictly for training use) are worse, but even a broad, flat, well-fitted collar won't protect a struggling dog in high temperatures. My most recent patient was on a chain long enough to enable him to hop over the fence...but not quite long enough to make a landing on the other side.

Only once have I seen heat-stroke in a dog who wasn't tied.  He was running alongside while his owners rode their four-wheelers by the borrow pits (big holes full of water where he could swim, for you city folks).  You'd think that when he felt hot and tired he would have just stopped and taken a quick dip. He was a Labrador Retriever, a water dog, after all.  Of course, if you talk to people who have suffered heat exhaustion, they will tell you that one minute they're feeling okay, working like they have so many times before, and the next minute things are going south in a hurry.  I guess you couldn't expect the dog to be any smarter; he was having fun running with his people.  He had so much fun that he ran himself into a heat stroke and collapsed... and died.  His folks brought him directly to the clinic, but he was already pouring blood from his rectum and he did not respond to treatment.

Speaking of treatment, if you fear that your dog may have become overheated, start cooling him with cool (NOT ice-cold) water, and using the hose is fine.  Cool large areas, rather than concentrating on a spot.  Don't use ice, don't use alcohol, don't use extreme measures (like cold-water enemas -- you can push him too far the other way). DO get him to your veterinarian, as he needs support with intravenous fluids, antibiotics, and intestinal protectants.  Realize that he may appear to be responding rapidly to treatment and still take a nose-dive later.  A lot depends upon how bad he gets and how long he stays that way.  Getting those I.V. fluids going as soon as possible may save his kidneys (and he does need his kidneys).

You know that your dog needs shade and plenty of water, and a fan would be nice, too.  If it's over 80 degrees outside, be your dog's conscience.  Unlike the Dingo or the wild dog of Africa, your dog may not know when to quit.  Never tie a dog out with a choke chain, or leave a choke-collar on an unsupervised dog.  Avoid chaining the dog in the first place: aside from being dangerous, it makes them crazy -- they hate it.  If you MUST chain your dog, be double-sure there is nothing to get the chain wrapped and tangled around.    Just assume that the dog will do the goofiest thing possible and be sure he can't get into trouble.  Put that chain on your own neck and see if you can get into trouble. 

Stay cool.