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That must be the worst part of your job ……

… is something I hear all the time. People are, of course, talking about euthanasia. They imagine it must be really hard putting pets to sleep. Well, it isn’t. I see it as a kindness, a gift, the final act of love for our pets.

Only very occasionally is euthanasia hard for me and that is usually when I am forced to put an otherwise healthy animal (almost exclusively dogs) down because of behavioural problems.

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Old cat, young cat: a bittersweet episode in the life of a companion animal vet

Mrs Kennedy was an elderly widow, whose only companion was a small seventeen year old cat called Puss. Mrs Kennedy had phoned me because she thought that Puss had broken her leg after chasing another cat.

I wasn’t expecting anything too serious. Cats commonly hurt themselves while fighting with each other. An owner may think that the leg is broken, but in most cases the problem is a simple cat bite abscess, which can be easily treated. However, this time it was different. The owner was right.

Mrs Kennedy explained how a neighbouring cat had sneaked into the kitchen, and Puss had leapt up to chase it away. Immediately afterwards, she’d started limping, and since then she had barely moved from her bed.

When I touched Puss’s shoulder I could feel heat and swelling, and when I gently probed deeper, I could feel the rough ends of broken bone. I asked a few more questions, and it turned out that Puss had been drinking more than normal for a few months, and she had begun to be fussy about her food. She had also started to vomit occasionally. The pieces of the jigsaw began to fit together, and I explained it to Mrs Kennedy.

Puss is very elderly and at this stage in her life, her body is gradually failing her. Her main problem is that her kidneys have stopped working properly, which is why she has developed an increased thirst and a poor appetite. As a result of her kidney failure, her bones have become very fragile. Unfortunately, advanced kidney failure in a seventeen year old cat is not easily treated. And worse again, a broken bone in a cat like Puss cannot be fixed. At this stage, all of her bones will be as weak as egg shells. If she carried on, Puss would continue to suffer from further broken bones during normal activities.”

Mrs Kennedy sadly shook her head. “ So it’s time to say goodbye.” She knelt down beside her cat, and gave her a last, long hug. I gave the painless injection, and Puss quietly passed away, as her owner whispered into her ear.

Mrs Kennedy told me how Puss had originally been a wild stray cat. She had finally been tamed after months of coaxing her into the kitchen with food. She had been Mrs Kennedy’s closest friend, but she would never have another cat. She was elderly and she could not bear to think about what might happen if she died herself. I tried to tell her that somebody would look after her cat, and that this could be arranged in advance, but she just shook her head again. I felt very sad as I left her house.

Two weeks later, I received a call from someone who had a half-tame feral kitten in their garden. They were moving house, and they didn’t know what to do with it. An idea occurred to me. I collected the kitten, and drove on to Mrs Kennedy’s house. When she answered the door, I smiled and I said that I had something that might interest her.

Mrs Kennedy could not take her eyes off the kitten in the basket beside me. “He is just like Puss used to be –the poor frightened creature. Bring him inside”. She went to her kitchen cupboard and took out a tin of cat food. I stood back, as she spooned the food onto a plate, and opened the cat basket. The kitten licked the food hesitantly, and then began to eat heartily. As he ate, Mrs Kennedy chucked his cheek gently. He looked up at her, and to my surprise, he purred. A new friendship had begun.

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Euthanasia – one vets opinion.

People often tell me that they think putting pets to sleep must be the worst part of my job but in many ways, it is one of the easiest. Yes it is sad, letting a beloved animal go, but in the majority of cases we are doing it for very good reasons; releasing them from a life that has become more about pain and suffering than the joy it should be.

A couple of years ago it was time to put our family labrador to sleep.  Molly had reached the grand old age of 14 and had been struggling with arthritis for many years.  Although her mind was still willing, her body had let her down and no amount of drugs would help her to be able to walk again.

What was interesting was my mother’s attitude.  She is a GP and admitted that in her job death can be seen as a failure, rather than a release.  She agreed with my decision but it was a totally different mind set to the one she was used to.

When patients come towards the end of their lives, in many ways the decisions that doctors and vets take are very similar, it is just that vets have an extra option; euthanasia.

Obviously with animals we don’t, and shouldn’t, take things to the levels that human medicine can.  It often isn’t appropriate to put a pet through painful surgeries or medical treatments, especially if it will only result it a short period of extra life.  Also, although it can be tempting to think an immobile pet could be kept going with nursing care, it simply isn’t fair.  We can’t explain why their lives are so restricted, they find it distressing and complications including urine scaling and bed sores are common and very painful.

End of life care in people is very different and is an extremely sophisticated process, often involving several teams of people, and usually relies on attentive and intimate nursing care.  It allows us to give our dying a peaceful, pain free end, often at home, with their family with them.

However, there are many people who believe this can sometimes prolong the inevitable and increase suffering and that we should have the option for human euthanasia in the UK.  Certainly I have lost count of the number of clients who comment “I wish we could do this for people” when I put their pets to sleep.

The debate surrounding this issue is a passionate one with contentious opinions on both sides.  I can certainly understand why some people diagnosed with degenerative or terminal conditions wish to be able to have control over their death and the option to end their lives before their suffering becomes extreme.

At least in veterinary medicine we don’t have this issue.  Animals have no understanding of their illnesses or how they will progress.  It saves them from the mental distress of their decline or the fact they will die. These are the burdens their owners have to bear instead.

Despite this I feel extremely fortunate to have euthanasia as an option for my patients.  It is never a decision taken lightly, is always upsetting but I know it is a peaceful, pain free process which brings an end to suffering and distress.

However, if it did become available for my colleagues in the medical profession, I would not envy them. Not only would it be the polar opposite of everything they trained for but to take that decision for another human being, even if they were supportive of it, would be a responsibility that I would not wish on anyone.

Cat Henstridge BVSc MRCVS - Read more of her blogs at www.catthevet.com

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Ask a vet online –‘after the vet said she had gone she gave out a cry and her body jolted’

Question from Diane Stirk: I had to have my little blind girl put to sleep Friday, she was 13 and had all symptoms off dementia, but after the vet said she had gone she gave out a cry and her body jolted, y did she do this does it mean she wasn't gone, I'm heatbrocken over this, Answer from Shanika Winters: Hi Diane firstly I am very sorry that you recently lost your pet, having a much loved pet put to sleep is always a very difficult decision.  I will try and explain what happens when a pet is put to sleep and to explain what can happen afterwards.  I hope that this can help to ease your upset over what happened with your pet. The reason we call euthanasia of a pet putting them to sleep is because your pet is actually given a very high dose of anaesthetic (drugs which are normally used to bring us to sleep for an operation).  The dose of anaesthetic given will cause your pet’s heart to stop beating; they will also stop breathing which results in them passing away. The anaesthetic drug is usually given by an injection directly into your pet’s blood stream.  With cat and dogs the injection is usually given into a vein on one of the front legs.  A small area of fur is first clipped away, the skin is then cleaned, and your pet’s leg will be supported by an assistant to enable your vet to put the injection into your pet’s vein.   You are still able to hold or hug your pet while the injection is being given if you want to.  In the case of rabbits the injection is often given into a vein on the ear, some smaller pets are given anaesthetic gas first followed by an injection. In some cases if the blood stream cannot be accessed, as your pet may have a collapsed circulation then the injection may be given into the kidney or liver.  The anaesthetic will then be absorbed into the blood stream a little slower than when injected directly into a vein. If your pet is distressed or generally frightened at the vets then they can be given a sedative before the anaesthetic injection.  The sedative is to calm your pet and reduce anxiety, which should hopefully make the process of losing your pet less stressful for both pet and owner.  Use of a sedative does however mean that the process will take a bit longer as the sedative will take time to work.  The sedative can be given as a tablet or injection into the skin or muscle. Once the anaesthetic reaches the correct concentration in your pet’s blood stream, this will cause your pets heart to stop beating and them to stop breathing.  Your pet will no longer react to sounds or touch; your vet will listen to your pet’s heart, feel for its pulse and may check its reflex by gently touching the eye.  This is all to confirm that your pet has passed away. After a pet has passed away as the muscles relax the bladder and bowels may empty, some pets also give a gasp as the air leaves the lungs.  In some animals there are jerky movements after death, called agonal movements.  These movements do not mean that your pet is alive or suffering.  The agonal movements happen as chemicals leak out of the body cells and allow muscle to contract.  Normally when alive these chemicals are kept in place until the body needs to use its muscles. Understandably it can be very distressing for a pet owner to see or hear sounds coming from their pet after he/she has been put to sleep.  If you have any concerns either before or after losing a pet then make sure you contact your vet or veterinary nurse.  We will make time to discuss things with you and do our best to help put you at ease with this very difficult situation. I hope that this answer has helped a little to explain what happened after you lost your pet and that your worries have been eased. Shanika Winters MRCVS (Online vet)
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Ask a vet online- ‘my cat is now 18 yrs old, bit loathe to help him on his way’

Question from Susan Banfield: My cat is 18 yrs old, has lost most of his front teeth, bad breath, dribbles all the time, extremely skinny and has trouble keeping himself clean.  Bit loathe to help him on his way over the bridge as his coat still shines, bright eyes, eats well and still goes outside to toilet and explore.  Am I being fair? Thank you Answer from Shanika Winters: Hi Susan and thank you for asking one of the most delicate questions that a pet owner and vet will face ‘when is the right time to have my pet put to sleep?’ As our pets ages we are very aware that we do not want them to go on for too long and that our vet can put our pet to sleep so as to prevent unnecessary suffering.  This is however never a simple or easy decision to make and is very much specific to each individual pet, its condition and its owner.  I will go through the way in which we try to help an owner work out if that time has arrived.  Please remember that as your veterinary team we are here to help and support you any your pet through all situations even after you lose a pet we are here to talk to. From what you are describing it sounds like your cat has done very well to get to 18 years of age and still be going out, toileting correctly and eating.  Loss of teeth is to be expected as pets get older, often as vets we may have extracted teeth due to infection or damage.  You mentioned that your cat was struggling to keep clean, by this I assume that we are talking about grooming of his coat.  Cats and dogs use their front teeth to almost comb through and nibble at their coats, as you mentioned most of these are missing then it would necessary to groom your cat using a comb, brush or mitt.  If an elderly cat is skinny yet eating well this tends to make us wander if the cat may have an overactive thyroid gland, which can be diagnosed by blood test and then  can be treated using tablets or by surgery/radioactive iodine. Does my cat still have a good quality of life? There is not a simple answer as to whether a pet still has a good quality of life, we need to discuss how your pet was at its prime and take into consideration that even though it may not be able to do all those things now he can still be leading a happy, pain free life. The most basic functions are eating, drinking and being able to go to the toilet.  As cats age we may need to offer them softer foods/smaller meals more often in order for them to get enough food.  Some cats need encouragement to drink, making sure we refresh the water in their bowls regularly, have the bowl near where they rest and some cats prefer running water so a water fountain may help.  Toilet function for a cat involves getting into the correct posture which is not always easy if there is any arthritis/pain in the legs/spine and also accessing the litter box( use of lower sided litter boxes can make it easier to get in/out of them).  Minimising pain can be achieved by treating any underlying arthritis and or use of joint supplements. So even if your pet needs a few small changes to be able to perform its basic functions then it can still be having a good quality of life just with a little bit of extra help. As owners we ask ourselves whether our pets are still happy.  How happy and responsive your cat is also needs to be considered relative to how it was when younger taking into account normal changes expected with age.  Not all animals are very responsive so cannot all be measured on the same scale, also there are natural changes at different life stages e.g. juvenile cats are very playful and this will reduce as they become adult cats.  Also obesity can affect how interactive a cat is, so helping your cat to reach its optimum weight will reduce risk of diseases such as arthritis and diabetes as well as help him to be more interactive with you. Grooming is an activity which cats spend a lot of time doing, as they become older and potentially less flexible then this becomes harder for them, but as owners we can help.  If we did not brush our hair for days on end think how uncomfortable, itchy and sore we would feel. So this is a really simple area in which we can help our older cats to feel happier and more comfortable. But they may not appreciate that we are trying to help them at first so little, often and gently is the way forward. I hope that my answer has helped you to work out how you can help your cat and that the final decision is always yours as the pet owner but that your veterinary team are here to help you make such a hard decision.  We are more than happy to give you the time you need to discuss matters with us to make sure we all do the right thing for your much loved pet. Shanika Winters MRCVS (online vet) If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.
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