Monthly Archives: November 2013

Nov23

Euthanasia, Part 1: Why?

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Euthanasia, Part 1: Why?

Homeless puppaEuthanasia has been on my mind a lot lately. This year we have said goodbye to so many of our most beloved patients, it seems like the end of an era. I am at the point where I am saying goodbye to dogs I have known as puppies. One of the hardest things for all the members of our staff is seeing our clients try to ‘keep it together’ in our office while they undergo this most emotional of experiences. The phrase we most frequently hear in this moment is, “I was hoping she would just die a natural death.”

Many times, we hear this when the patient in front of us is laterally recumbent, panting, pale, and skeletal. Owners know that their pets look and probably feel awful. One thing I have told unknown numbers of clients over the years in this situation: we almost never see pets for an appointment like this too early. Here’s the deal, as I see it:

Our pet animals do not lead a natural life.

We have selectively bred dogs for a variety of unnatural qualities, like short, twisted tails, squat, compact bodies, muzzles that barely protrude from the skull, bulging eyes, flopping ears. We have bred dogs the size of teacups and dogs the size of small horses. Dogs turn out to have very plastic genes. Cats maybe not so much, but witness Persians, Scottish Folds, Devon Rex, Munchkins, Siamese—there is plenty of variation, if not as much in size.

We have domesticated them, and provide them with food and shelter not always available in the wild. We give them medical care to address common (and fatal) diseases, treat them when they are sick, brush their teeth (well, some of us do) or allow their veterinarian to perform dentistry procedures to remove excessive bacterial deposits in the mouth or abscessed teeth, we give them joint supplements and medicated shampoos. Some of us even provide acupuncture and therapeutic laser treatments. Consequently, our pets live far beyond an age that could be reasonably expected in the wild (I like to imagine packs of wild Shih Tzus when I say this).

One question this begs is: what do we mean when we talk about a natural death? Are we thinking of dying from the effects of disease, or starvation, or exposure, or being killed in a territorial fight with another animal? This is a common collection of natural deaths. No, in our minds, a natural death means curling up quietly on a pillow, drifting off to sleep, and never waking up. And once in a great while, this is what happens. Most of the time though, the story is quite different.

We diagnose many geriatric pets with diseases, in some cases metabolic diseases, such as diabetes, Cushing’s disease, hypo- or hyperthyroidism, and in other cases, cancerous or benign tumors. If you live long enough, chances are, you’ll have one or more of these types of diagnoses yourself. Few people die peacefully in their sleep at home of ‘old age.’ Why do we assume it will be different for our companion animals?

In my experience, many people are blissfully ignorant of the realities of the final stages of terminal disease processes. I consider this a perk of living as we do in a first-world country, where we have access to wonderful health care and where disease and dying are largely hidden from us. Unless you have watched a family member suffer through a terminal disease, or have had a previous pet with the same issue, you are unlikely to truly understand what those last days are going to look like.

For many animals, the end stages of several types of organ failure and cancers look very similar. It isn’t pretty. The pet is not eating, mentally foggy, and possibly in pain. Muscle wasting takes place, and moving around becomes difficult, even if it is not actively painful (although many older pets have arthritis as well). These pets can be nauseated, an unpleasant way to live. Congestive heart failure causes pets to be drowning in the fluid that builds up in the lungs, or unable to take a breath due to fluid in the chest.

At this point, many of our clients are hoping that their pets will ‘let go’ and pass quietly in their sleep at night. But the actual process of dying can take a long time. At some point, it becomes too hard to watch, or the pet simply stops getting up, or becomes agitated. We receive a number of faxes every week from the emergency clinics around town, letting us know that such-and-such patient presented at 3 a.m. laterally recumbent, taking agonal (dying) breaths, and was euthanized.

This is why we consider it a loving act to be able to spare our animal companions suffering. Death is a natural part of life, but that doesn’t mean that the natural way of death is in any way preferable to humane euthanasia. I personally hope that by the time I am diagnosed with some terminal disease, I will have the option to be euthanized at the time of my choosing!

I have made this pact with my own kitty, who at this time is pushing 16 years old, and starting down the well-trodden path toward renal failure. I have looked into her eyes and told her that I will not let her suffer. I will not let her become a cat skeleton covered in fur who can’t move and is too nauseated to eat, and has to receive so many mLs of fluids a day just to hang onto that tenuous thread of life. I know she doesn’t understand my words, but she knows I love her, and that I will take care of her.

This brings up the other objection many people have to the idea of euthanasia. We hear a lot about how the client isn’t comfortable “playing God” by deciding when Fluffy or Shadow will die. The truth that’s missed here is that you have effectively played God for the entire rest of your pet’s life, by feeding, sheltering, immunizing, and treating for illnesses. Why get right to the point of true suffering, and then stand back and say, it’s in God’s hands now?

For my part, I can’t imagine a God so narrow-minded that he would object to your selfless act of mercy on behalf of your faithful companion. If you want to be biblical about it, we as humans have been granted “dominion over the beasts of the field,” and regardless of how you interpret the ancient Hebrew ‘dominion,’ the responsibility for your pet’s well-being is yours.

‘Natural’ is a loaded word. I think that in this context, we have to take a hard look at what is truly natural, and what isn’t. Truly natural is not always better, despite how we have been conditioned.

Nov23

Euthanasia, Part 2: When?

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Euthanasia, Part 2: When?

Savannah's CakeA frequent question surrounding the issue of euthanasia is, how will I know when it’s time? How can I tell if my pet is suffering?

The short answer is, you won’t. That is, you may never be completely sure, and your pet may hide signs of suffering from you. Unless you wait until the point where your pet is actively dying, you will have doubts. And that’s okay. It means you have a conscience, and that you are concerned about doing the right thing for your pet.

Despite thousands of years of domestication, most animals still retain their instinct to hide injury, illness or suffering. In the wild, animals that are weak, injured or ill will starve or be killed. So there is a very powerful evolutionary drive to mask  any outward signs of problems.

Another contributing factor here is that unlike you, your pet isn’t worrying about tomorrow. Your animal buddy lives exclusively in the moment, whatever that moment may be like. Your pets will continue to try to go about their canine or feline business, until they simply can’t, anymore.

So my advice is this: you know your pet best. You will be the best judge of when his or her quality of life has decreased to the point that you should be thinking about euthanasia.

Quality of life can be assessed in a couple of ways. You can start a journal, and log good days and bad days. When the bad days far outnumber the good, it’s time to start thinking about your pet’s quality of life. This is a tough method for some people, because one good day in a month of bad days can give false hope.

Or, you can take a mental inventory of the things your dog has always loved to do. Does she love long walks? Playing with a favorite toy? Investigating every bush in the back yard? Following you around to see what you’re up to? Whatever the list, be aware when favorite pastimes drop off the daily schedule. Older animals do sleep more, but when your dog spends all but one hour a day sleeping, you have to wonder about his quality of life.

You have to be realistic. Your 17-year-old Labrador who can barely walk with arthritis is not going to miraculously get a lot better next month. How much can you take? Your lab will keep going until she gives out. Do you wait until she’s down and can’t get up? Many people do, because that’s what it takes to see that she is suffering.

One thing I find a lot of people have a very difficult time assessing is their pet’s daily level of pain. There is an anthropomorphic assumption many people make that their pet would cry or whine if he or she were in pain. Sure, we would, but human beings are wimpy, particularly compared to dogs and cats. If it takes your dog a minute and a half to reach a standing position from lying or sitting down, he’s painful. If your cat can’t jump up on the couch, she’s painful. If movement is restricted to to and from the food dish, or in and out to pee or poop, he’s painful. Unless you startle a dog or cat with a painful stimulus, you probably aren’t going to get the crying you expect from pain. I have seen dogs and cats with broken bones, who only vocalize when the break is palpated.

There are more subtle indicators also. A dog that breathes heavily and pants when he hasn’t been exercising or hot, is probably a painful dog. A cat that sleeps 23 out of 24 hours in a day is probably painful. You simply can’t assume that because he never complains, pain is not a constant presence in your pet’s life.

I wish that I never saw patients whose quality of life had so deteriorated that they were essentially already gone. I wish everyone was on the same page as far as preventing suffering and that no animal would have to suffer before the decision could be made to humanely euthanize. But the reality is that everyone is different. Everyone brings their own emotions and experiences to this decision. And many times, suffering has to occur before a person can feel like euthanasia is the right thing to do.

It’s about love. It’s about loving your pet enough to let go, and make the transition from life to death smoother and more comfortable for your faithful animal companion. What we do when we euthanize is to create the death everyone wants for their pet, snuggled in the owner’s arms, falling asleep. If you have ever been anesthetized, you know what it’s like. You are there, and then you are not there. It’s as peaceful as we can possibly make it. I believe that it’s our responsibility as pet guardians to provide this act of love if it’s needed.

Nov16

Unpopular Opinions, Part 2: Breeders

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Unpopular Opinions, Part 2: Breeders

puppiesThere is a huge range of breeders out there, from the truly great to the truly abysmal. A great breeder will breed only for the betterment of the breed, and love of the breed. They will be well-versed in the kinds of issues their breed could suffer from, and will work to eliminate or minimize that problem in their animals. Great breeders feed great foods, and vaccinate and deworm. Great breeders will carefully screen you to be sure you will be a good home for their puppy. Hint: anyone who has three pens in the dirt in their backyard, filled with different breeds of puppies, is not a breeder, not even a substandard one. But they will call themselves breeders exactly the same way people with a row of ribbons on their wall and champion lineages will. So beware.

It is no secret that there is a certain tension between breeders and veterinarians. There are lots of reasons for this, but from the veterinary side of the fence, here’s the scoop. Breeders are not veterinarians. Veterinarians are doctors. They go to school for about 8 years and at a typical cost of about $100,000 to become doctors. There’s a lot of medical knowledge you must master before you can graduate. It bears noting also that it is far more difficult to get into Vet School than Med School. You must be absolutely stellar, because at (for instance) University of Florida, there are about 4000 applicants for only 80 spots per year.

However, there are many breeders out there who consider themselves more of an expert in their dogs’ health than a mere veterinarian. We have gotten to look at lots of packets that breeders send home with new owners, stipulating what foods they must feed, what drugs the pet must never ingest, etc. I have even seen one recently that stated that Labrador Retrievers must never be bathed as it will make them more prone to skin allergies. Hoo, boy. This is the reading material that makes for some slightly awkward conversations with new owners. We don’t want to bash your breeder. But we have a duty to educate you on what information in that packet is real, and what is imaginary.

Here’s the deal: breeders (and here I am talking about Real Breeders, Real Breeders are focused on one breed only, have champion animals, and would far rather keep that puppy rather than sell it to the wrong home), are experts in their breed. They will know what kinds of issues their dogs may have. But a breeder should not dictate your puppy’s future diet or veterinary care (or forbid bathing). Great breeders want you to feed a high-quality food, but they should not really care which one you eventually choose.

There actually are a few breeds that have select drug sensitivities. But these are very few and far between, and—surprise!—your veterinarian already knows about breed-specific sensitivities. Remember that your veterinarian has probably treated your breed before, once or twice or twenty thousand times. No matter how much your breeder insists that your puppy will curl up and die if fed anything other than Purina ONE, this is simply not the case. And Purina ONE is crap.*

Some breeders, of course, think that 8 years of school and however many years of practice is worthless in comparison to their vast accumulations of knowledge. But please, take their stipulations with a grain of salt. No matter what you signed, they cannot come to your house and force you to feed their chosen food. That is actually not legal. If your veterinarian suggests that there are higher-quality foods out there that might be better for your puppy, listen.

If this seems a bit rant-y and mean-spirited, try for a second to put yourself in our shoes. Every day, we strive to provide the best possible advice on your pet’s care and nutrition. We want your pet to live long and prosper! We want you to be happy with the care we provide. We love to see happy, healthy cats and dogs. So every day, when we find ourselves up against something misleading or just plain wrong that your breeder, groomer, local PetSmart cashier, or best friend swore to you is the gospel, it can be wearing. Anything crazy that begins, “My breeder told me…” does create some negative connotations.

So let me balance this with an example of a phenomenal breeder. We have a couple who are wonderful clients, and who recently lost their older dog to cancer. After a brief period of mourning, they started scouting for breeders who specialized in their favorite breed. They turned up a breeder, who had puppies almost ready for sale, and started a conversation with him. The breeder ended up shipping them a puppy, once the puppy was of age. And then the trouble started.

The puppy was very smart—but willful. They easily trained him to sit, and stay (remember, this puppy was only about 8 weeks old!). They hired trainers, tried behaviorists. They did everything right. But their puppy was an unpredictable biter. He actually hurt his owners, and they never saw the attacks coming. Finally, after a lot of soul-searching and emotional distress, they contacted the breeder, to get his ideas. He immediately suggested that he take back the puppy, as it was not a good fit for the couple, and find another puppy with a more suitable personality. The original puppy will not be re-homed, but will live out his days on the property of the breeder. He will not be bred.

As sad as this story is for everyone concerned, it highlights what makes a wonderful breeder, in addition to careful attention to his dogs’ genetic makeup. He wants what’s best for his adoptive families and for his dogs. He acknowledges that some dogs are born with emotional and developmental disturbances, just as humans are. And he has a plan for when adoptions fail, one that doesn’t involve laying blame.

The happy ending is: the couple is now waiting for their next puppy to be ready for adoption. The rest of the happy ending is hypothetical, but no less important: the puppy is back living happily at the breeder’s farm. He is being well cared for and will not go the sad route he could have taken in life. Dogs with intractable behavioral problems are dogs that get abused, neglected, shuttled between shelters, and eventually euthanized.

So next time you are in the market for a breeder for that special puppy, please bear in mind that all breeders are not created equal. Look for breeders who produce only a couple of litters per year, and can talk knowledgeably about WHY they bred that specific male and female, what characteristics they were looking for. A great breeder will interview you as though you were applying to a very selective college. A great breeder will recommend that your puppy visit the veterinarian right away, not scare you away from visiting. Yes, you will spend a little more on a puppy through a great breeder. But you will also have a lifetime ally, who should be able to help you make good decisions for your puppy’s care.

*Quick nutritional guideline: read pet food labels. When you get to corn, put it back on the shelf. Corn is just a cheap filler.

Nov16

Unpopular Opinions, Part 1: How to Choose a Dog Breed

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Unpopular Opinions, Part 1: How to Choose a Dog Breed

IMG_1078If I could make a Global Veterinary Service Announcement (I have just patented that phrase in my mind, and also assigned it the awesome acronym GVSA), my very first one would be: Don’t choose a breed of dog to have as a pet just because you think it’s cute, or looks tough, or is enormous/tiny. Actually, I would have to shorten that up so it could be a snappy sound byte, but since this is a blog and I’m wordy, I think I’ll let it stand for now.

This is the single piece of advice that I think would save the most heartache (and pocketbook stress). Every time I see a college-age kid walk in proudly trailing her new pet English Bulldog, my heart sinks. Folks, some breeds are going to cost you a fortune, and the English Bulldog is only outdone by the Shar Pei in terms of how many expensive ailments your pet could potentially suffer during its lifetime (in my experience). For some reason though, people are almost uniformly surprised to hear that a Maltese the size of a hamster or a Bulldog that has been bred to share about zero morphology with its wolf ancestor is super duper likely to have a host of physical problems you will battle throughout its lifetime.

Now, I know I will catch some flak for this post; people will accuse me of ‘breedism.’ Or they will flock to tell me about how their aunt had Bulldogs her whole life and they never suffered so much as the sniffles. Let me say then to begin, I love all breeds of dogs. They are all wonderful, special creatures, and will give you so much love that these characteristics should be irrelevant. But the key word in that sentence is ‘should.’ The reality is, some breeds really are prone to more problems than others. And unless you are independently wealthy, this can become a strain on you, your pet, and your relationship with your veterinary staff.

Think about it. Many breeds of dog have been selectively bred for a variety of unnatural qualities. Let’s take the Pug. I love me a Pug. But if you think of all the genetic mutations that have been selected for to produce a canid half the size of a wolf (which should be your mental ‘ideal dog’ model), with a short, twisted tail, squat, compact body, muzzle that barely protrudes from its skull, bulging eyes, flopping ears—it should make your mind boggle.

So what’s wrong with that? Along with the ‘desirable’ mutations, you get some undesirable ones. Look back at that Pug. See those bulging eyes? Do you have any idea how many of the Pugs that come to see us have scratched or poked or otherwise injured those eyes, requiring exams and stains and drops? I would venture to guess the percentage is about 90%. See those tiny little nostrils? Hear that wheezy, snorty breathing? Many Pugs suffer from stenotic nares (tiny little nostrils), elongated soft palates (the source of a lot of that snoring, snorting, wheezing), and other problems that have arisen from genetically modifying a normal wolf-like muzzle down to something that in some cases is flush with the rest of the skull. Some brachycephalic dogs (the classification of dogs whose muzzles are severely foreshortened) actually require surgery to open the nostrils wider, or to shorten the soft palate so the animal can breathe. Then there’s the fact that about half of the dog’s teeth are in the mouth sideways (due to the fact that they can’t come in correctly since there isn’t any room), which can lead to an early accumulation of plaque and predispose the dog to periodontal disease. And all that is just in the dog’s head.

I could go on and on about breeds and issues: Boxers and heart disease, Schnauzers and bladder stones, Cockers and ear infections. But the point I am trying to make is not to avoid certain breeds on the grounds that they have a higher likelihood of specific problems. Mixed-breed dogs do benefit from hybrid vigor, but it doesn’t prevent them from developing allergies, or having other conditions. My point is simply to do some research on the breed you choose, so you know what to expect, and can be prepared for the potential issues you may have to face over your dog’s life. It’s ideal to go through this process BEFORE you bring home an adorable puppy.

When I say research, I do not mean visit a breeder’s website. The breeder is going to tell you that their dogs have never ailed a thing in their lives and never will. The breeder, you should remember, is trying to sell you a puppy. What I mean is, find a forum dedicated to your chosen breed. These exist, for any breed you can think of, and a lot you probably can’t. Then just scroll around and read. Once you are on page 10 of the forum, you’re probably done. Common problems occur commonly, and you will likely have identified several of the top contenders. Then, ask yourself if you have the time and resources to handle these problems if they arise. If you think cleaning ears is gross, do not adopt a baby Cocker Spaniel. If you think brushing a dog for a half hour each day is too time-consuming, do not even look at a German Shepherd puppy.

Choose a breed that fits well with your interests and lifestyle. If I had a nickel for every miserable Husky I see that lives in a Florida apartment with an owner who is gone 9 hours a day, I’d be rich. Think about what your breed was bred to do. Huskies were bred to haul heavy loads tirelessly through frozen terrain. Translation: they have LOTS of energy. Cooping this type of dog up in a house all day with nothing to do means you will come home to destruction. But if you live in Wisconsin and go for a daily run even in the winter, hey, here’s your new best friend!

In short, do your homework. Find out more about the breed you are interested in. If that breed doesn’t seem to be a good match for your personality or lifestyle (or pocketbook!), keep looking. I guarantee there’s a breed out there (or a mixed breed!) that will be perfect for you. And as a wise person once said, choose for personality, not looks. Because that great personality will transform even the homeliest mutt into a ravishing beauty in your eyes.