Browsing tag: euthanasia

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)

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.

Is Paul O’Grady mad to spend so much money on his terminally ill dog?

Paul O’Grady, the comedian-turned-dog-advocate, hit the news this week when he talked about spending over £8000 in vets’ fees to treat his nine year old Cairn Terrier Olga for cancer of the kidney. The Daily Mail reports that Paul has ignored advice to have her put down, and instead he’s paying for intensive chemotherapy and surgery to keep her alive. The story has ignited a debate about veterinary fees and pet insurance: Judith Woods, a feature writer for the Daily Telegraph, has added her own tale of spending £3600 when her Manchester Terrier, Daisy, developed a rare form of kidney disease. She had her pet insured, so her feature extols the benefits of pet insurance for these unexpected occasions.
Paul and Judith are clear in their opinions, with no doubt that they have made the right decision for their own pets. It’s the online comments on the stories that are interesting, with members of the public sounding off with their own thoughts on expensive treatments for pets, and the pros and cons of pet insurance.

The Daily Mail readers’ comments to Paul’s story are mostly short and positive: “It’s lovely that he’s done this for his beloved dog”, “Good on you, Paul, you are a true dog lover” and “If I was as rich as him, I’d do the same”.
Telegraph readers have responded in a predictably more loquacious way to Judith’s feature.
First, of course, there are many “dog lovers” who are supportive of giving pets all reasonable treatment that can be afforded, accepting that high quality veterinary care can be costly, and agreeing that pet insurance can be a sensible way of budgeting for unexpected health crises. When completing a survey of attitudes to dogs on a recent trip to a slum in Delhi, I found that around 60% of the local population “liked dogs”, with 40% disliking them: I now find myself wondering if a similar proportion of attitudes exists in the UK population. For the 60% who care for their pet dogs, it’s hard to consider withholding treatment.

There are plenty of comments from the opposite side of the spectrum – perhaps the 40% who aren’t so fond of dogs. Some of these “anti-treatment” comments are worth discussing in more detail:
“All pet insurance does is persuade owners to consent to prolonged and possibly invasive treatment of their pet. Unless they own a valuable breeding animal they would be kinder and more sensible if they had a really sick pet put to sleep.”
While it’s true that it may make objective sense to have an ailing animal euthanased, when it’s your own pet, surely it’s wise to analyse the options available? Once a clear diagnosis has been made, vets are often able to give a reasonably accurate estimate of treatment, prognosis and life expectancy. If you are able to pay for the treatment (via insurance or otherwise), and if the vet can reassure you that your pet will not suffer during the process, many people conclude that the correct course of action is to give the animal extra life. Why should anyone else feel that they have the right to tell them otherwise?

“Look at the dog and think, ‘If that was me what would I want?’ Or, ‘Am I keeping the dog alive for the dog’s sake, for my sake or I do I lack the moral fibre to do the right thing?’”
I am sure that most owners look at their pet and ask these questions before making a treatment/euthanasia decision. And most vets take time to guide owners through this process. Most vets and owners would agree that if a pet has no hope of living a good quality life, euthanasia is the kindest option. And treatment for serious disease may not be as uncomfortable as people expect in pets. Treatment modalities like surgery, chemotherapy and radiation treatment are often deliberately used in lower doses in pets compared to humans, so side effects are usually less severe. Nobody want animals to suffer pain or discomfort for the sake of a few more weeks or months of life.

“These poor animals haven’t a clue what is happening to them in the vets’ surgeries, all the pain, trauma and strange smells….. people aren’t doing it in the interests of the animals they are most of the time doing it for themselves. Better IMO to let the animal have a peaceful end – a right denied to humans. And don’t get me started on animals with limb amputations.”
Anyone who has owned an amputee dog will know at once that the person who made this opinionated comment has not known any animals with limb amputations (they often have marvellous lives, with no discomfort or visible disability). I suspect he’s also had a similar lack of experience of vets’ surgeries and sick animals recovering from illness.

“I have come to the conclusion that Veterinary Surgeons generally, are individuals who parasitically feed off pet-owners emotions. The fees they charge can bear no resemblance to costs incurred. Have their charges ever been investigated? I suspect this is yet another bunch of rip-off artists. They know you will pay to save a soulmate… So they take you for an expensive ride.”

I’m sorry that this person has such a negative view of my profession: what else can I say?

“As for vets, I told my son to be either a vet or a lawyer. They make the fees up as they go along, nobody really questions the amounts and they get paid even if the client dies.”

This person should really do some proper research before making recommendations to his son. Vets’ salaries are not as high as people may expect. In the USA,  $80460 (£50824) is the median pay, with veterinary graduates struggling to pay off huge university debts. In the UK , according to this website, “the average starting salary is between £21,800 to £33,500 a year, depending on experience. Further training and experience can increase salary to £36,500 per annum. Senior vets can earn around £44,000 to £53,000+” .
So while vets may earn a substantial salary, it’s nothing special compared to doctors (Salaried GPs earn between £54,319 and £81,969). solicitors (between £25,000 and £75,000)  or dentists (between £50,000 and £110,000). And did he tell his son about the high suicide rate in vets – higher than any other profession, and around four times the national average? The job of a vet is not the easy, money-spinning dream career that some people seem to believe.

“I have heard that vets in England charge more if you have insurance, but it wasn’t made clear if this is because they run every test necessary when the insurers are paying but stick to the bare minimum for hard up punters.” 
This person probably is closer to the truth than they realise. The reason why vets “stick to the minimum for hard up punters” is that these clients are unable to afford anything else. Is there anything wrong with this?

Something else needs to be explained: this odd statement in Judith Wood’s feature. ” Vet fees have doubled in a decade, and are rising at an annual rate of 12 per cent.”
Vets’ fees per item have certainly not “doubled in a decade”, nor are they rising at 12% per year. But more advanced tests and treatments are now available to those who can pay for them, which is why the amount spent on pets may indeed have “doubled in a decade” and may be continuing to increase.
The key truth that seems to have been missed by everyone writing on the subject is this: diagnostic tests are amongst the most expensive items on the veterinary menu. The specialised machinery needed to carry out laboratory tests, ultrasound scans, x-rays, MRI scans and other work-ups can cost tens or hundreds of thousands of pounds. Yet these pricey investigations are often the only way to achieve an accurate diagnosis, which is the key fact that’s needed to decide on treatment and to predict the prognosis.

Do you want to be able to do the best for your pet if he or she falls ill? If you do, get your pet insured so that you can give your vet the go-ahead to carry out the tests needed to give you the best advice possible. And don’t listen to the “objective” scoffers who tell you that you would be better to have your pet euthanased: talk to your vet and make the decision for yourself, based on facts, not opinions.

 

 

Marius the giraffe – right or wrong? The great divide

“Danish zoo kills healthy giraffe and feeds it to the lions”
The headlines are appalling, and the international outcry has been almost as dramatic as if the Danish zoo authorities had fed a human to the lions. Do the protesters have a point, or is the zoo simply being honest about an unfortunate but necessary situation?
The answer to this question highlights a major divide in the broad community of animal lovers: those who are in favour of animal rights, and those who believe in animal welfare.

Animal rights people believe that animals have similar rights to humans. Animals are sentient, living individuals, often referred to as “non-human persons”. They have a right to exist and to be granted the Five Freedoms – freedom from pain and disease, freedom from hunger and thirst, freedom from discomfort, freedom to express natural behaviours and freedom from fear and distress. They also believe that animals have the right to life, and that humans do not have the right to take that life away. People who believe in animal rights really  ought to be vegans, since they do not believe in the right of humans to exploit animals for meat or milk. They believe that animals should not be viewed as property, or used for food, clothing, research, entertainment or as beasts of burden. They believe that animals deserve equal consideration to humans: if animals are not given equal rights, this is “speciesism” which is as bad as racism. They believe that in the future, we will look back on our time and see our attitude to animals in the same way as we currently view human slavery.

Animal welfare people believe that  non-human animals are sentient and that efforts should be ensure their well-being, especially when they are under the care of humans. However they do not believe that animals have the same rights as humans. They also believe that animals deserve the Five Freedoms, but they believe that humans have the right to decide what happens to animals, which includes taking the animal’s life in a humane manner in some circumstances. They believe that it’s acceptable to farm animals for meat and milk, as long as the animals have a life worth living while they are farmed, and as long as the animal’s death takes place in a way that is free of fear and pain. They believe that it’s acceptable to use animals for food, clothing, research, entertainment or as beasts of burden as long as the Five Freedoms are not impaired. Animal welfare people do not believe that animals have a right to life, justice or freedom. This is the most widely held view in the Western world today: that it is morally and ethically acceptable for humans to use non-human animals, provided that adverse effects on animal welfare are kept to a minimum.

So what about Marius the giraffe?

The protesters about the zoo in Denmark are seeing the situation from an animal rights perspective, whereas the zoo defends their stance from an animal welfare point of view.

The animal rights stance would say that Marius the giraffe was a “non-human person”, and that it’s outrageous that his life was taken. They also believe that the zoo compounded the unfairness by butchering Marius in public (even with children looking on) and then feeding him to the lions. This showed lack of respect to Marius, and an uncaring attitude to an adorable creature.

The animal welfare stance would understand the perspective of the zoo, which has stated that the giraffe was surplus to its own requirements,and there was no simple alternative. The options that were available included rehoming to non-accredited wildlife parks and private sanctuaries, and the zoo was concerned that they would lose control of the giraffe, and that he might end up in an inappropriate situation where he was suffering. The zoo believed that quick, pain-free death was a better alternative for the giraffe than to take that risk. The zoo would say that millions of cattle, pigs and sheep are killed in the same way every day and nobody complains about them, so what’s the difference?

The problem is this: onlookers see the zoo’s attitude as disingenuous. Zoos are quick to humanise their animals when it suits them, such as when they ask the public to sponsor individual creatures, or when they advertise to encourage visitors. They are happy to create an animal-rights type illusion of the animals being “furry people”, and the public are happy to accept this. Most of us are animal rights believers at some level, especially when considering animals (such as our pets) that are well-known to us. And when an animal has been given a name, and has featured in attractive photographs, we also like to take an animal rights view on behalf of that creature.

Yet the reality is that zoos take an animal welfare stance, and so do most of us when we do not know the individual animals. How many of us are vegans? Perhaps 1%? If we put our money where our mouths are, then 99% of us are animal welfarists, not animal rights believers, at least when it comes to farm animals.

But we don’t like it when our pockets of animal rights belief (like Marius) are blatantly treated with animal welfare rules. The zoo has clearly not understood this, and their “practical” approach of publicly butchering the animal and feeding him to the lions has compounded their error.

Whether they are right or wrong, the zoo has created an image of uncaring arrogance which does not serve animals or the zoo’s purpose well. It’s a PR disaster. The zoo has lost a sea of international supporters and the animal rights argument against the continuing existence of zoos has moved one step forwards

 

 

Part 3: Surgical Colic

As we saw in the previous part of this series, Medical colics are those which can be managed medically, usually on the yard. However, about 1 in 10 cases of colic require emergency referral to an equine hospital for surgery.

This is what most horse owners are terrified of. The general indicators that a horse has a surgical colic are:

1) Heart rate over 60 that isn’t relieved by injectable painkillers.
2) Dilated loops of small intestine on rectal exam.
3) Positive stomach reflux from the stomach tube.
4) A definite rectal diagnosis of a surgical problem.
5) “Toxic rings” – dark red or purple gums, that indicate that the horse is going into toxic shock.

Of course, it varies between horses, and the vet has to make a judgment call based on all the evidence available.

We also have to talk to the (by now usually frantic) owners about costs. Colic surgery usually costs between £4000 and £5000, but can easily be a lot more. Even if the horse is insured, it is important to check how much the insurance company will cover – there are a couple of companies out there who will only cover part of the costs of emergency surgery. If in doubt, always call your insurer’s helpline.

However, colic surgery is one of the most genuine emergency operations there is – and it can be truly life-saving.

So, what causes a surgical colic? Probably the most common are:

1) Twisted bowel. If a length of bowel twists around itself, it can cut off the circulation. At this point, the gut begins to die, and unless it can be removed by surgery, and quickly, the horse will go into toxic shock and die. This commonly happens in the small intestine or occasionally the colon, but there’s also a condition where the caecum gets turned partially inside out (an intussusception).

2) Small intestinal blockages. Horses rarely eat things that get stuck in the small intestine (although it can happen). More commonly, a really heavy worm burden can simply block up the bowel; with the bowel overfull, the blood supply starts to fail, and the gut, again, can die. I once had a patient who was a little foal with a severe colic; we removed two gallons of worms from her small intestine!

3) Strangulating Lipomas. These are really common in older horses and ponies. A small, benign, fatty tumour forms somewhere in the abdomen, causing no harm at all. However, it grows on a stalk, and eventually, the stalk gets wrapped around a length of gut, cutting off the blood supply… This results in the bowel dying, as if it had twisted. Fortunately, these are usually really simple surgical procedures; unfortunately, older horses and ponies are less likely to be insured for surgery.

There are also a number of medical conditions that can mimic those requiring surgery – particularly peritonitis and anterior (or proximal) enteritis. Horses with these conditions are often referred for possible surgery because it’s very hard for the vet in the field or on the yard to be 100% certain they’re not surgical. I think that most of us would say it makes a lot more sense to have the horse at the hospital, with a surgeon on call, to make the definitive diagnosis, rather than waste time in the stable, and risk having to then decide it needs surgery when it’s still an hour or more away in travelling time from the hospital!

So, what happens when the vet decides that a colic case isn’t suitable for medical management?

Firstly, they’ll talk to you about the options. If a horse isn’t insured, or there’s no money for treatment, it is a perfectly respectable and responsible decision to decide, sadly, to put the horse to sleep rather than prolong its suffering.

Hopefully, of course, that won’t be the case. Once you and the vet have decided that referral is the way forward, your vet will get in contact with a referral hospital. If you’re very lucky, it will be one run by your vet’s practice, but in most cases, it will be a specialist referral hospital. I must say here that not every centre with surgical facilities is able to cope with emergency colic surgery – they need not only to have the facilities (knock-down box, operating theatre, recovery box etc), but also the staff (not only a surgeon, but also enough vets and nurses to take care of your horse in the vital recovery period). Your vet will have a list of suitable referral hospitals – generally, its best to send the horse to the closest one with the shortest transport time, but your vet will be able to advise you.

Making an emergency referral is simple – but only your vet can do it. A referral hospital will not accept referrals from the horse’s owner! Once you’ve made the decision to refer, your vet will call them and speak to the veterinary team on call, who will be available 24/7/365 (when I was part of one such team, we ALWAYS seemed to get our referrals at about 10pm!). They’ll let him or her know what they want done during transport – generally, they’ll describe what painkillers they want given, and what samples they want taken (don’t be surprised if your vet gives you a couple of blood tubes to take up and give to the referral team). In addition, they’ll sometimes ask the vet to put in a stomach tube and tie it in for the journey – this is to prevent the stomach from getting over-full and bursting if there’s an obstruction in the small intestine. Don’t forget your horse’s passport – legally, they do need it even when being rushed to emergency surgery.

Your vet will generally give you directions and a contact number for the hospital, and send you on your way. Remember, they can’t normally go with you, because your horse’s colic, while devastating, is probably only one of several cases they’ll have to deal with.

If there’s a problem (e.g. your horse getting distressed) in transit, call your vet or the referral number you were given – but if at all possible don’t stop unless they tell you to! Remember, you’re on your way to the best equipped help available.

On arrival at the hospital, you can expect to be met by the veterinary and nursing team. Your horse will be rushed to an assessment area, and you’ll probably be given a lot of scary-looking paperwork to sign. Generally, this comes into 2 parts – firstly, you’re signing to give consent for whatever they need to do (and remember, a lot of drugs aren’t technically licensed for use in horses, because the manufacturers haven’t paid for an official license for that drug in horses. It doesn’t mean a drug is dangerous or experimental, it’s probably used on a daily basis by the hospital. You’ll have to sign consent to use unlicensed medication – it’s absolutely routine, and nothing to worry about). Most hospitals will also ask to see your passport – if you haven’t got it, or it isn’t signed to mark the horse as “not intended for human consumption”, legally the hospital can refuse treatment (although they rarely do).

The second set of paperwork you’ll sign is a bit more pedestrian – you’ll be signing to say that you will pay for any treatment!

While you’re contemplating the paperwork, your horse will be undergoing another examination by the veterinary team. This is to establish what’s going on, and what’s changed since your vet examined him back on the yard. They may well repeat some tests – most colic conditions are dynamic (i.e. constantly changing), and sometimes the change is more useful in working out what’s going on than a one-off test. Other tests they may wheel out include ultrasound – the powerful ultrasound systems available in a hospital environment can give the vets a lot more information about what’s going on. The vets will then make a decision about what to do – don’t be disappointed or worried if they don’t rush immediately to surgery! They may decide to try a course of medical treatment first (remember, they don’t have to rush as much as your vet does – if your horse’s situation deteriorates, they can operate at a moment’s notice).

In many cases, however, they will decide to take the horse straight to theatre. If so, you normally won’t be able to follow, so I’m going to describe what happens once you’ve been gently steered in the direction of a waiting room.

To begin with, the horse will have an intravenous catheter fitted, to allow easy access for fluids and drugs. A horse with colic is systemically weakened, so will almost invariably be given intravenous fluids during surgery. He’ll then be given a premed – this is a sedative, designed to make induction into anaesthesia gentler. It will usually contain the drug acepromazine, because the use of this before surgery has been demonstrated to reduce the risks of anaesthetics.

He’ll then be led into a knock-down box: this is a special padded room, designed to make induction of anaesthesia safer. Then he’ll be anaesthetised with an injection containing (usually) a mixture of 2 anaesthetic agents, ketamine (no, it’s not a tranquilizer, it’s an anaesthetic) and diazepam or a similar drug. Shortly after the injection, he’ll go wobbly, and then quickly lie down.

Once he’s asleep, the team will swing into action: a tube will be passed down his throat to help him breathe and he’ll be moved into the operating theatre. While this was going on, the surgeon(s) will have been scrubbing up, ready to start.

Once he’s in theatre and safely ensconced on a well cushioned table (to prevent pressure sores etc), he’ll be put onto anaesthetic gas to keep him asleep.

Colic3 - SurgeryThe surgery involves a long incision down the midline of the belly. The surgeons can then have a good look through all the intestines, to find the problem. This is the exciting, sexy bit, but it’s actually pretty simple in principle: “if in doubt, cut it out”. In other words, removing devitalized (dead) bowel, emptying out anything in the bowel that shouldn’t be there (e.g. a caecal impaction), replacing anything that’s got stuck in the wrong place (e.g. an entrapment) and untwisting anything that’s tied up. There are usually at least 2 surgeons, because one person is needed to hold loops of intestines (and they don’t stay still – sometimes they wriggle around in your arms)! Meanwhile, the anaesthetist will be carefully monitoring all sorts of parameters (heart rate, blood pressure, ECG, reflexes, breathing and blood gasses can all be monitored at many hospitals) and adjusting the anaesthetic and any other drugs to give the safest and most effective anaesthetic.

Once whatever the problem was has been found and (hopefully) sorted out, your horse will be returned to the recovery room. In many ways, this is the most dangerous part of the procedure. Horses are very prone to breaking things when they wake up, so everything is done to keep it as calm and quiet as possible. Sometimes, the veterinary team will help the horse to rise, using hoists and lifts; other times, it works out better to let him get up in his own time. In either case, he will be moved into a padded room, and left in dim light, as quietly as possible, so he wakes up slowly.

Once awake, and steady on his feet, he’ll be moved to an intensive care box; he’ll almost certainly be on a drip to keep him hydrated. At regular intervals through the next 24 hours (or longer) he’ll be checked by vets and nurses. In some cases, the guts don’t start working properly on their own, and medication may be needed to encourage motility (e.g. a lidocaine drip). Although everyone gets excited about the surgery, it is this recovery period that is in many ways the most important in getting a good long-term prognosis.

As time goes on, the vets and nurses will try and tempt the horse to eat – normally, we’ll try and get him eating fresh grass as soon as possible. As soon as he is stable enough and eating on his own, he’ll be sent home – most horses do better in their own home environment, so as soon as they no longer require advanced medical intervention, they can go home. Once home, it’s important that the discharge instructions from the hospital are followed – it can be tempting to try and speed things up, but don’t rush it! Major abdominal surgery takes time to recover from.

Colic is a worrying condition to have to deal with as an owner, especially as it often seems to come out of the blue. However, if you ever have to go through it, I hope that having read these blogs, you’ll have some idea of what’s being done, and why. Remember, our aim as vets is to help your horse and, if at all possible, send him home to you fit and well.

If you are worried your horse or pony may be suffering from colic, talk to your vet, or check the symptoms using our Interactive Equine Symptom Guide to help assess how urgent the problem may be.

The death of Ben Fogle’s dog: his honest grief is helpful to us all

Ben Fogle has written a moving piece in the Sunday Telegraph about the loss of his Black Labrador, Inca. At twelve years of age, she had lost the power in both hind legs. Ben made the right decision for Inca, but it was still terribly difficult to go through the process of euthanasia. His article is unusually frank, with Ben describing how he “burst into uncontrollable tears” on the telephone when talking to his veterinary surgeon father, Bruce, about the situation. Then later, Ben describes the actual act of euthanasia:

“I carried her from the car into the house, burying my face into her fur, and laid her on the kitchen floor. Mum, Dad and my sister were all there. “I lay on the floor, hugging Inca while Dad injected her. Her breathing became heavy. I could feel her heart pounding and the warm blood beneath her skin. I breathed the familiar scent of her fur as I nuzzled into her thick coat. I have never sobbed like that in my life. It was a primal, uncontrollable, guttural sob as I felt her heart stop beating.I lay there on the kitchen floor clutching my best friend, unable to move. Wishing, hoping it was a dream, I held her lifeless body.”

Many readers have commented on the online version of Ben’s article, with some describing how tears were streaming down their face as they read his words.

Ben’s account will come as no surprise to vets and nurses: we witness people going through the emotional trauma of losing a pet every day, or even several times in one day.  Perhaps the only surprising aspect is that the depth of grief isn’t discussed more commonly in public. It’s as if it’s only behind closed doors that it’s acceptable to express this level of grief for an animal.

The private nature of grief for pets can make it doubly difficult for some pet owners to cope with their emotional distress. They feel deeply upset, but they may feel that it’s somehow  ”not right” for them to be so distressed. To an owner, the loss is as deep – or sometimes even deeper – as if a human friend or relative has died. To society at large, the loss is still ranked as minor, with people making heartless comments like “It was only a dog”. When a human dies, a wide leeway of sympathy is given, with time off work, and sensitive understanding for many weeks. When a pet passes away, people are often expected to “get over” their loss almost immediately.

Behind the scenes, there’s wide recognition of the emotional distress caused by the loss of a pet. The Society of Companion Animal Studies runs a Pet Bereavement Support service, in conjunction with the Blue Cross. This offers support by trained counsellors for people who need someone to talk to after a pet has died, both on the phone and by email.

It’s also increasingly recognised that veterinary staff can be emotionally traumatised by the daily witnessing of deep grief: after all, there are not many jobs where, every day, you need to offer support to grown men (and woman and children) as they cry their hearts out. The suicide rate of vets is around seven times the national average, and the complex nature of pet euthanasia is thought to play a role in contributing to this. Vetlife is a website designed to provide resources to help vets and nurses cope with the stress of their daily job.

Ben’s account is sad to read, but it’s heartening that he expresses his emotions so openly. If more people like Ben spoke out so clearly and truthfully, it would make it easier for those many individuals out there who still feel that have to hide their deeply held emotions.

But can’t he just die in his sleep…..?

This week my Granny died, which was sad for us all but she was very old, had had a wonderful life and her family was with her at the end. She had been in a home for some time and was cared for very well. When she became sick and bedbound, the doctors and nurses worked together to keep her comfortable and pain free, until she slipped away in her sleep. I am lucky in that she was the first person I knew well who has died and this experience has made me understand why many people hope this is how their pets will go. However, to die in their sleep is rarely a pleasant or pain free experience for our animals.

Domino sleepingAlthough, just like people, our pets are living longer and healthier lives, inevitably there comes a time when their age catches up with them and illnesses develop. Advances in veterinary care mean we can do a lot for them but eventually we won’t be able to keep up with their problems. If they were people we would put them in wheelchairs or place them in a home where their needs could be catered for, for example being assisted to the toilet or spoon fed but this isn’t practical, or in most cases fair, to a pet who won’t understand what is happening (there are many people who would argue this is no kind of life for a person either but that is a whole other debate). For a pet, when they can no longer get up and out to do their toilet or feed themselves properly, or when their illnesses or pain can no longer be controlled with medication, this is the time as owners we should objectively assess their quality of life and decide whether it is fair to let them continue. Also, just as important is your quality of life, it is hard work caring for any pet, let alone an elderly one who may be incontinent or senile.

The vast majority of pets who reach the end of their natural lives are euthanased by their vet. This is inevitably a sad experience for their owners (and us) but is far preferable than allowing them to slip away on their own. Many people hope this will happen, having probably experienced death this way with people as I recently did myself, but it is very different for animals. Bodies are designed for living and will go on doing so regardless of how painful or unpleasant it becomes for the individual. When people die in their sleep they are usually heavily medicated and cared for to ensure they are not in any pain or dehydrated but this doesn’t happen for our pets. If an animal dies this way, they have usually suffered to a large extent; likely being dehydrated, malnourished and in pain. Although from the outside they might look peaceful, they are anything but; it is simply all their exhausted body can manage.

This is why when our pets become infirm and their quality of life declines to a point where living is a struggle and not the joy it should be, by far the kindest and most humane thing we can do as owners and vets is to euthanase them in a painless and peaceful way. I often say it is the one big advantages we have over human medicine; we can stop the suffering before it becomes too great. Although it may seem daunting your vet will talk you through the procedure and make sure you are happy with the process and your decision. You will be able to stay with your pet if you want to and most vets will come to your home if your request it. Euthanasia means ‘a peaceful death’ and as a pet owner it is the final act of kindness you can bestow upon your companion.

If you are worried that your pet may be ill, talk to your vet. Try our Interactive Symptom Guide to check any symptoms they are displaying and help decide how soon you’ll need to visit your vet.

Difficult decisions towards the end of life.

A few weeks ago I was asked by a close friend to put her dog to sleep at home. Timmy was a farm dog really, who slept in a stable, but just as much of a family member as any house-dog and much loved. I trusted Timmy’s owners’ judgement completely as to when the “right time” came to part with Timmy, and I was already familiar with his medical history.

I was glad to be able to carry out the euthanasia in the way in which his owners wanted. Timmy was in familiar surroundings, greeted me like an old friend and showed no distress at all. With his owners beside him, I clipped some hair from his front leg and injected a strong solution of anaesthetic into his vein. He went so peacefully that there were only a few tears, mixed with feelings of relief. Timmy was buried on the farm.

Amber curled upOne of the questions people commonly ask when they first know that you are a vet is “How can you bear to put animals to sleep?” The answer is that it is still one of the most difficult parts of veterinary practice, even after many years. You become used to the technicalities of carrying out the procedure in various different circumstances, because you have to. You never become immune to the feelings of owners at this time, and never should. If you are satisfied that what you are doing is in the animals best interests and you carry it out with as little distress as possible, then you feel that you have done a necessary service.

Not everyone is fortunate enough to be able to plan exactly when, where and how their pet’s life might end, but sometimes considering some of the options in advance can be a good idea.

We would all prefer it if our dog or cat would live a happy life and then die at home in bed at an old age. Unfortunately this does not always happen, and many owners are faced with the difficult decision whether to have their pet put to sleep (euthanased) in order to prevent suffering.

Deciding when the right time has come can be difficult. No-one wants to cause unnecessary suffering by leaving it too late, but equally it would be regretted later if a hasty decision was made. Vets can advise what the likely outcome of any illness is going to be and what treatments, if any, could help. If everything has been done that should be done, then it may come down to the small things in life: does your dog still enjoy a walk, recognise members of the family, enjoy their food; does your cat show an interest in surroundings and people?

Home visits for euthanasia are often requested, and if this is your wish it would be worth talking to your veterinary practice in advance. Sometimes, however, it is easier and safer to do this at the surgery because of the availability of experienced helpers, and the availability of other drugs, if for example sedation was needed in a scared animal. The other big factor could be the time of day. In a night-time emergency, it may not be possible for the vet and nurse on duty to travel far from the surgery because of other patients.

Labrador cropEuthanasia in most cases is quick and painless. An injection is usually given into the vein because this will work more quickly than if given by other routes. Sometimes a sedative may be needed first, if an animal is nervous or aggressive. The decision whether to be present or not is an entirely personal one for the owner. Some people will feel they want to be present and others will prefer to leave after signing the consent form. If you are not present, your pet will be handled by gentle, caring, experienced staff on your behalf. If present, it may be better for both the owner and the animal if the holding is done by the veterinary nurse, who can raise the vein for the injection at the same time. This leaves the owner free to be where the dog or cat can see and hear them.

Most practices will use the services of a pet crematorium who will offer various different types of cremation or burial, depending on individual wishes. For example, you may wish to have your pets ashes returned so that you can keep them or scatter them in a favourite place. If you have a suitable place you may choose to bury your pet at home.

There is no right or wrong way to grieve. The bonds that exist between people and their pets are strong and the loss of a pet can cause a similar sense of loss to any other bereavement. Many people like to remember their pet with photos, by planting a tree or placing a plaque in a special place. Some practices keep a book of remembrance or a wall of photos of past and present pets. Vets and nurses also like to remember their patients.

Some practices have staff who have been specially trained in supporting clients who are going through bereavement and if you would like this help, do ask at your surgery. If not directly available within the surgery, counselling services are available including support from the national charity the Blue Cross. It can be especially important to help children talk about their loss as it may be their first experience of death. Other pets may also grieve. Some people think it helps to allow other pets to see the body of the pet who has died, and I have certainly no reason to think this is harmful or distressing to them.

Euthanasia and death are subjects that all of us would prefer not to have to consider, but sometimes things can be made a little easier for everyone by thinking ahead, so that if the worst happens, we are as prepared as possible, and left with happy memories.

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