Euthanasia: When it’s Time to Say Goodbye

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The loss of a pet is hard. It is often made worse when we're faced with the decision to euthanize.

For me, one of the most challenging things about being a pet owner is the almost inevitable decision about when to euthanize the pet. We recently faced that very decision about one of our cats. She was a few short months shy of her 24th birthday; so, it was not a decision that took us by surprise. But, even as prepared as we thought we were, it was very difficult.

How will I know when it’s time?

This question haunts most pet owners. And, my best advice is to have a set of criteria for each pet species you have that reflects the minimum standards for an acceptable quality of life. For instance, you might expect your cat to be interested in eating, make it pretty consistently to the litter box, get around on its own, and seek out attention and purr when petted. In fact, those were our exact criteria for Chantal. For a horse, dog, or parrot, your criteria may be different. Each criterion should reflect some measurable aspect of welfare (comfort, adequate nourishment and hydration, acceptable hygiene, etc.).

Choose your criteria when your pet is young and healthy, so that you will not be tempted to ignore changes to “protect” an ailing pet.

Once you have set the criteria, any consistent drop below the standard in a given category will raise a red flag. For us, Chantal starting missing the litter box daily and began to be ataxic (stumbling) while walking around; both problems may have been due to worsening arthritis, a failing nervous system, systemic weakness, or some other process. In any event, we knew we had reached a decision point.

What will I do when it’s time?

When your pet reaches a quality of life you can no longer pretend is adequate, it is likely time to say goodbye. The most responsible plan of action is to schedule a “euthanasia consultation” with your vet; during this consult, your veterinarian will examine your pet, offer you any possible treatments for the problems you have noted, and, if nothing can (or should) be done, euthanize your pet. Relevant family members should attend this appointment in the event that it does, in fact, become an actual euthanasia. On the other hand, I have had a few clients book these appointments, braced for grief, only to leave with some antibiotics or fluid therapy for their very-much-alive pet.

What is euthanasia like and who should be there?

If you’ve never been present for the euthanasia of a pet and think you would like to be present for the next one, it’s a good idea to know what to expect.

When you arrive for the appointment, there will be a release form to sign and a discussion about what you would like done with your pet’s remains. Options generally include private cremation and group cremation; other options, like home burial, may be available in your municipality. You may take care of the payment in advance so that you will not be bothered with it after the pet is gone.

You and your pet will be taken into an exam room or a special room designated for euthanasia. A technician or the vet will get a weight and may do a brief exam. Following any discussion about whether continued treatments are possible or advisable, the staff may prepare for the euthanasia. Some clinics require a catheter to be placed in a leg vein to facilitate the process; others may not. Depending on how nervous your pet appears, staff may elect to give a sedative and give you a few minutes alone with your pet for the medication to take effect.

The actual euthanasia is performed using a strong sedative given in an amount that stops body functions. The veterinarian will have pre-measured the amount to be given based on your pet’s weight. He or she will give the drug slowly while you hold or pet the animal. During this process, your pet may make sudden movements, lose control of his bladder or bowels, or simply go limp. Even if unexpected movements do occur, the pet is not experiencing any discomfort. This is procedure is far more painful for the human participants than for the pet, who drifts gently away.

As for the question of who should be present: that depends on you, your family, and your support system. If your kids are old enough that they can understand what is happening and not be traumatized by the event, they may want to be there. If you have developed special relationships with clinic staff, you may wish to ask them to join you (in fact, if your pet has become a frequent patient, many of the staff may ask to be there with/for you). If you know you will be grieving extensively, you may wish to have a friend with you for the ride home.

What if I can’t bring myself to be present?

That’s fine. Your pet will pass just as smoothly without you. And, if you are someone who would be tortured by the memories of the event, he would rather not put you through that, anyway.

How will I react to my loss?

Depending on your personality, you may respond with anything from a little sadness to acute grief when your pet has gone. For pets that required extensive amounts of care, you may experience some relief at their passing; this is normal.

If you had a very intense attachment to the pet or are someone who naturally grieves deeply, the loss may be very difficult for you. There are pet loss support groups available to help you through your grief, if friends and family are not sufficient. The reality is that you may continue to experience and process your grief for months or even several years. If, at any time, you feel despondent, please seek professional help.

How we move on

As my husband likes to point out, “It all ends badly.” So how do you pick up the pieces and commit to yet another pet, knowing that this, too, will end badly? Again, we each approach it differently. Some people decide they’d rather not invest emotionally in another pet. Others are looking for a new furry friend right away. Then, there are those of us in the middle – knowing we’re a little worse for wear but also knowing that some other wonderful pet will find its way into our lives and hearts when the time is right.

Whatever type of person you are, one of the single most important things to keep in mind about euthanasia is that it is something we elect to do because we love our pets and want what’s best for them. Some people worry that they are rushing into an irreversible decision, when, in fact, our love for our pets and reluctance to lose them causes us to wait far longer than we should. One look at Chantal on her last day would have shown you what I mean.

Why is My Cat Not Using the Litter Box?

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Not all cats like all types of litter boxes (or litters, or locations), no matter how convenient they are for the owners.

I posted previously about one specific reason that indoor house cats might urinate on surfaces other than the litter box. But, I still get many questions about cats peeing where they shouldn’t. So, this is part 2, if you will. For background information and specifics on feline idiopathic cystitis, please read my previous post.

So, you’ve been finding pee outside the litter box. You’ve taking the kitty (or kitties) to the vet to rule out infection, cancer, etc. What now? First, you’ll need to determine:

Is He Urinating or Spraying?

Urinating outside the litter box and spray/urine marking are two distinctly different problems with different causes and different treatments. So, to treat him effectively, we need to know for sure whether the kitty is peeing or spraying.

If you see it happen, this is an easy one: is he backing his little rear up to a wall or other vertical surface, twitching his tail, and leaving urine running down that surface? If so, he’s almost certainly spraying. If he’s marching over to the corner of the rug (or onto a pile of clothes, or 6 inches from the litter box, etc.), squatting nicely, and leaving a large volume of urine behind, he’s likely peeing.

What if you never see it happen? You can still make an educated guess about whether it’s spraying or peeing.

Spraying is most often reserved for vertical surfaces and is usually in small amounts. It often happens near doorways, under windows, or by stairs; unfortunately, it can also be aimed at new household items, electrical appliances, and other items of interest to the cat. Spray marking is a message left by one cat for other cats; so those socially significant, high-traffic areas are the best places to broadcast the message.

In contrast, urination is aimed at emptying the bladder fully and, if the cat is not painful or arthritic, is performed in a squatting position. This leaves all of the urine on the floor/carpet/pile of clothes. Often, the location will be a low-traffic area and a soft substrate. The message here is not to other cats, but to you: He no longer wishes to use his litter box. Now, you must find out why.

What if He’s Spraying?

Urine marking is a normal activity in wild and domesticated felines. But, it is not desirable indoor behavior. Whether indoors or out, it’s done as a signal to other cats; and this cat’s relationship to those other cats is key to diagnosis and early treatment. It is important to note that, contrary to what many people believe, females and neutered males can participate in urine marking.

Treatment for Spraying:

First, clean up all urine with a GOOD enzymatic cleaner. My personal favorite for urine is Anti-Icky-Poo.

Next, determine whether your other cats or outdoor cats (strays, ferals, neighbors, etc.) are stressing the spraying cat. If outdoor cats are annoying him (he’s spraying mainly around exterior passage ways or sits in the window, growling), there are two good options. You can block his visual access to these other cats by using an opaque window film.  You can also keep these cats out of your yard by using a remote animal repellent device, like the Scarecrow by Contech or Spray Away by Havahart.

If your other cats are the big stressors, there are ways you can help everyone get along. First, create a “house of plenty,” in which each cat has free access to food and water dishes, litter boxes, perching spaces, hiding spots, and any other valuable resource. The goal is to prevent any bully cats from keeping other cats from the resources they need or desire.

What if “other cats” is not the problem? Determine what other things may have caused this stress: new pet, missing pet, new baby, new home, new roommates (or roommates leaving), new furniture, etc. can all cause stress in a sensitive cat. If you can determine the problem, talk to your vet about ways to address it.

If you make these changes and do not see any reduction in spraying frequency, you can discuss medications with your vet. There are a few medications that have showed improvement in spraying when combined with the plans presented above.

What if He’s Urinating?

There are several reasons a cat may vacate the litter box in search of another potty location: aversion to or preference for a specific location, substrate, or type of box; problems with litter box cleanliness; or extreme anxiety or physical pain causing problems getting to the existing boxes. To find out which cause (or causes) applies to your cat, you need to do some homework and be creative about solving the problem.

First, you must determine whether the cat is avoiding the box because he does not like its size, shape, location, litter, cleanliness, etc., or because he has developed a preference for a new location or the substrate he has begun using (carpet and clothes are the most common). Please remember that many litters and boxes are designed and marketed for the convenience of the owner, not because they are the most desirable for the cats that use them (or don’t).

Take a Good Look at Your Current Litter Box(es):

Start by taking a good look at his litter box choices:

  • Size: Most cats prefer large, uncovered boxes; if the box is too tiny or the cover prevents the cat from keeping tabs on those who might be stalking him, it is less desirable. You cat does not care that this designer box looks far better to you than the big, open box he craves.
  • Litter: Cats generally like boxes filled with a couple of inches of unscented clumping litter. Crystals or other hard substrates can be a problem for those with sensitive feet. Litters with perfumes or those that smell too much of their source materials when wet, can be less desirable, even if they mask the urine smell better than unscented.
  • Cleanliness: Cats like clean boxes; ideally, they should be scooped daily and cleaned completely with dish soap and water every week or two.
  • Location: Cats prefer someplace with good ventilation, on the quiet side, and convenient to your cat. He would probably prefer that you not put any of his litter boxes in a closet (where you will forget to clean it), beside the noisy washing machine, in the darkest corner of the basement (where you don’t even like to go), or in the kids’ bathroom (where the comings and goings are far too unpredictable). Your older, arthritic cat would like a box on each level of your home, and one especially close to the place she sleeps most of the time.

So, how do your litter boxes compare? To tell the truth, one of ours is in the kids’ bathroom; but all of our cats (even the 23 ½ year old arthritic one) would die before they would “go” outside the litter box.

Maybe Litter Isn’t What He Wants

If you check out on all of the above, maybe your cat has developed a “substrate preference,” meaning that he simply prefers peeing in the rug/fabric/potting soil he has started using. To find out, give him three identical litter boxes. Fill one with the litter you already use. Fill the second with unscented clumping litter (unless that would be the same as box one). Fill the remaining box(es) with pieces of the substrate he is currently using. Yes, I am suggesting you put a carpet remnant, your pajamas, or potting soil in those remaining boxes. Then see what he uses. You may want to confine him to a smaller space, like a bathroom or bedroom, to force him to select from among these choices. If he chooses something other than the litter, you can “convert” him to litter by putting that item on top of litter and gradually removing it.

If he chooses litter, reassess the locations and cleanliness of the boxes he usually has access to.

Maybe He Doesn’t Like Where You Put the Boxes

Really, the only way to know is to try other locations. Start by putting one where he is already urinating. I’m sure you’re thinking that the location he’s chosen would be a terrible place for a litter box. But I hate to break it to you: as far as your cat is concerned, you already have one there. So, you may as well make it official. If he starts using the box in the new location, you may choose to reassess your aversion to having a box in the formal dining room/entry way/master bedroom. Alternatively, you can try to convince him that a similar location that you find more pleasing should be just as nice for him.

The Treatment for Litter Box Avoidance.

Clean the soiled area very well. Again, an enzymatic cleaner works best. Also, try Febreeze Pet Odor Eliminator for the area around the carpet that may have absorbed the smell.

Make area less desirable by putting food, a cat bed, or plant in each place your cat has chosen to urinate. Cats do not like to eliminate when they eat, sleep, or play. Alternatively, as noted above, you can give in and put a litter box there.

If none of these things works, see your veterinarian for more suggestions and to look again for medical explanations for the problem.

There is a great resource for cat and dog owners: www.indoorpet.osu.edu. This site focuses on understanding the particular issues that arise from keeping bright, active, and interactive pets inside our homes for extended periods of time. The suggestions for environment and behavioral enrichment are wonderful. Enjoy!

Aural Hematomas in the Dog and Cat

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Aural hematomas are puffy pockets of blood

I always thought that aural hematomas (blood pockets in the ear flap) were the curse of floppy-eared dogs. Then I saw one in a German Shepherd Dog. Still, I was sure that these annoying complications were limited to dogs – until I saw one in a cat. So, what causes these big, puffy blood pockets that owners despise so much?

How hematomas form: Many people are familiar with the concept of a blood blister, like the kind you get when you pinch your finger in a door or pair of pliers (or am I the only clumsy one?). Aural hematomas are very similar to these blood blisters. They form when an ear vein is damaged and leaks blood under the skin of the ear flap. The pressure of the blood against the skin causes a pocket to form, which allows more blood to leak from the vein. This vicious cycle continues, sometimes until all available space has been used, leaving the ear very puffy and heavy. At this point, pressure or trauma may cause a small opening in the ear flap, allowing blood to ooze, pour, or otherwise escape into the environment. More typically, however, the owner is able to get the pet veterinary care while the blood is contained. More

Urolithiasis: Urinary Stones

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Most bladder stones can be seen on plain x-rays.

This week, we had several discussions around the clinic about bladder stones in cats and dogs. I thought this might be a good topic, as these often take owners totally by surprise.

Urinary stones can form from many different inorganic compounds and can make trouble anywhere along the urinary tract. Common types include struvite (magnesium-ammonium-phosphate, sometimes still referred to as “triple phosphate”), calcium oxalate (“CaOx,” which come in monohydrate or dihydrate varieties), urate, and cystine. Struvite and CaOx constitute by far the majority of stones seen in cats and dogs. Each type develops based on fairly specific conditions, such as urine pH, the presence of bacteria (struvite in dogs), or a primary disease process (urate with liver disease). In addition, breed-specific mutations may permit large amounts of the precursor compounds that lead to stone formation; this is true of cystine (Newfies, Dachshunds, and English Bulldogs) and urate (Dalmatians). More

PU/PD Series: Acute and Chronic Renal Insufficiency

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The nephron, the functional unit of the kidney, can be damaged in many ways to cause renal insufficiency.

Along with all the other organs that can cause PU/PD (increased urination and drinking known as polyuria/polydipsia), the kidneys themselves are sometimes to blame. While renal disease is complex, it is important to understand some acute and chronic kidney problems that lead to PU/PD.

With acute or chronic insults to the kidneys, the ability of the kidneys to concentrate urine is lost; in most cases, the renal tubules that are responsible for drawing water back out of the urine, are damaged. The pet urinates out a higher percentage of water, thus diluting the urine and leading to possible dehydration. The pet drinks more water to counter this loss, and is officially PU/PD. More

PU/PD Series: Feline Hyperthyroidism

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Methimazole (Tapazole) is a typical first-line treatment for feline hyperthyroidism

One of the strange realities of veterinary medicine is that cats become hyperthyroid, while dogs become hypothyroid. Even stranger: some treatments for hyperthyroid cats may leave them permanently hypothyroid, which does not appear to cause health problems the way it does in dogs.

What causes it? Hyperthyroidism is caused when the thyroid gland overproduces thyroid hormones, either because it has a benign or malignant growth, or because it has undergone “adenomatous hyperplasia.” The latter is by far the most common cause and is a fancy way of saying “it got bigger and is producing lots of hormones.” The thyroid is a bi-lobed structure that sits on either side of the trachea; and the increase in size can affect one or both sides. More

PU/PD Series: Diabetes Mellitus

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Nearly all diabetic dogs and over 50% of diabetic cats rely on insulin given by their owners.

Diabetes mellitus is a fairly common cause of polyuria/polydipsia in cats and dogs. In nearly all diabetic dogs and over 50% of diabetic are dependent on insulin given by owners. In the other 30-50% of cats, the disease can be treated with diet, exercise, and oral medications. Either way, it remains a difficult disease to manage.

What causes it? Diabetes Mellitus (DM) results from a drop in the insulin levels in the body (or, in some cases, the body’s perception that insulin levels have dropped). Insulin is produced by the pancreas and, among other things, acts on the liver, muscles, and fat deposits to cause them to take glucose out of the blood and store it as glycogen or fat. If the ß cells in the pancreas stop making insulin – or receptors in tissues stop recognizing it – the glucose stays at high levels in the blood, can spill into the urine, and can create a multitude of health concerns that we associate with DM, including cataracts, glaucoma, urinary tract infections, weakness in hind legs, and life-threatening ketoacidosis. More

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