November 14, 2006
Dealing with Beau's end of life
This collage recalling some moments in Beau's life was e-mailed to many of our friends. I have about 70 replies in condolence. Lamont also printed a few for me, which I have mailed to friends who do not have e-mail.
A week ago today, our sheltie Beau (see "Thank you to FOB, Friends of Beau") was euthanized in our home by vet Dr. Lisa Tuzo.
Beau made it to 16 years, 10 months. Because he was battling kidney failure, which is an up-and-down disease, and because dogs stoically try to hide their pain out of a wild survival instinct, it was difficult to pick a time to let him go. I hope to return to this entry and flesh out some of the issues we faced for the benefits of other pet owners, who may not be aware of home care of canine kidney patients, hospice and home euthanasia options.
Some links I found helpful:
Evaluating pain in pets with kidney problems
Life Support Issues: Kidney Failure. Great question -- this is exactly the information I sought without success. Was Beau in a lot of pain from kidney failure, or just weak and sleepy? I do not find the answer provided by the hospice nurse adequate. I will try to get more details on this matter. When I asked my regular vet about palliative care for Beau in his final days, she said, "He's not going to get better." That was not helpful -- palliative care is by definition not curative, but aims at reducing symptoms or pain.
Dr. Tuzo is herself interviewing humans with kidney failure to try to determine their level of pain. This information should be invaluable in applying the facts to our pets who cannot speak for themselves.
One aspect of kidney failure is the odor of ammonia on a pet's breath, from toxins once cleaned by the kidneys and now circulating in the blood. Even if the pet doesn't suffer tremendous pain, one can only imagine this failure of an important body system, and their tremendous thirst as individual cells try to cleanse in place of the kidneys, places them in a difficult position. Beau suffered from uremia, tremendous weight loss (from 30 to 20 lbs.), dull coat and seemed feverish toward his last few days. Kidney failure seemed less menacing than say cancer but still places a tremendous challenge to the body.
Animal euthanasia. The final two paragraphs persuaded me that waiting for a natural death for Beau carried too great a risk of real suffering, especially since he wasn't going to get better:
A word on natural death. Although this may always seem the ideal end, pets do not always die easily in their sleep without help. They may suffer much distress in their final hours, vomiting repeatedly, struggling for breath, or experiencing convulsions. Sometimes, as the organs shut down, the animal may drift into coma, but you cannot count on this happening. If it has become obvious that your pet is no longer enjoying life or showing any enthusiasm for it, it is kinder to put it to sleep and end its suffering.Sometimes death can be sudden, as when caused by a stroke or heart failure. This can be particularly distressing to the owner, when the pet had seemed previously healthy, especially if the cause of death is not apparent. You can request the vet undertake a post mortem, but usually these kind of deaths are unpreventable.
This link also gives a list of a pet's basic needs:
... intended only as guidelines when used as a benchmark in deciding your pet's wellbeing. Euthanasia may not be appropriate even if some of these criteria are not met. Each case for euthanasia should be judged on its own merits and your vet should always be consulted beforehand. As the owner you also know your pet better than anyone.
- Freedom from uncontrollable pain, distress and discomfort.
- Ability to walk and balance.
- Ability to eat and drink without pain and vomiting.
- Freedom from painful, inoperable tumours.
- Ability to breathe freely and without difficulty.
- Ability to hold up head when at rest.
- Ability to urinate and defecate without difficulty or incontinence.
- Ability to see and hear.
- Ability to enjoy food.
- Pet responds to owner and family.
- Not suffering from repeated vomiting and/or convulsions.
End of life decision
How Do You Decide that Today is the Day to Put Your Best Friend to Sleep?
Euthanasia: Gentle Death, Painful Decision
When Should You Put Your Dog Down?: How to make a decision you never want to make. I found this article singularly useless, and am surprised Jon Katz didn't do a bit better job on this difficult topic. While he provides interesting anecdotes and interviews, Katz seems so determined to avoid sentimentalism towards dogs that he comes across as a bit cold. He describes some who euthanize their pets when they lose their "dogness," or lively interest in their surroundings, and others who keep hopelessly ill pets on ventilators. For Beau, faced with a heart and kidney patient, the right euthanasia point seemed somewhere in between. Ultimately, you gauge how much of a dog's withdrawal is fatigue and old age, not yet overwhelming the overwhelming urge of living things to cling to life, and try to sense the moment when your pet's withdrawal changes and becomes preparation for the end as disease overwhelms his organs.
In-home euthanasia
Euthanasia... What To Expect See the section on in-home euthanasia. Lots of details including the need for a plastic sheet. I got ready the following items: box of tissues, damp cloth (to wipe my own face), checkbook to pay the vet, brush to make Beau look nice. The main thing I forgot was a towel to shroud his body for the walk to the vet's car. Alternately, you could make a cardboard coffin for your pet.
Another Dog's Death by John Updike. I believe I read this poem in the Washington Post Book World section soon after its 1993 anthologization. It's quite an unforgettable poem that stays in the mind for decades. Updike's writing made me determined to avoid if at all possible the sad (for me) and uncomfortable (for Beau, who couldn't lay down easily in a moving vehicle) last drive to the vet. The poet makes it clear that as awful as the moment is, his dog enjoys calm and collected final moments. I include this poem here because it details better than a how-to link the advantages of in-home euthanasia.
Hospices for pets
Without realizing it, I had been providing hospice care for Beau for at least four months -- being certain he was let out whenever he stirred to his feet, pureeing foods and syringe feeding him when necessary, and switching to yoghurt and cool foods. I wish I had known about the growing movement toward pet hospice in this country, especially about place in Virginia listed in my first link. This could have made my bumbling efforts to feed Beau and keep him comfortable (for example, buying him his first bed ever, a fleece one, about a month ago.)
Veterinary Holistic and Rehabilitation Center (Vienna, Va.)
The Nikki Hospice Foundation for Pets: History and Philosophy
Hospice Care in Cats
Learn More About the Pet Hospice Program
Products
Hill's a/d Canine Feline (pet food). I had been pureeing a variety of dog foods for Beau in a food processor and syringe feeding him with a catheter syringe from the vet. Actually, I had four syringes that I would fill, refrigerate, warm in hot water, and feed him with. Our vet at Essex Dog and Cat provided some of this prescription food, which did not require pureeing! You may need to mix it with a little water, but then it pulls readily into the syringe, much easier than the pureed dog food, even thinned with water, ever did. Dr. Tuzo also suggests meat baby foods for feeding ill animals.
Quiet Time Pet Bed -- Beau got his first bed in the last month of his life. He still seemed to prefer the floor or carpet but he was so thin this fleece bed with rolled sides seemed best to protect his ribs. He seemed to appreciate being led to the bed and turned one turn to curl into it. Our cats, Olivia and Hanno, appropriated the bed whenever Beau wasn't in it and enjoy it now.
- posted by jbelliveau at 8:09 PM in The Neighborhood
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