Saturday, April 2, 2011

Uncomfortable euthanasia

Every veterinarian is faced with 1 or more euthanasias that are really, really questionable. In those situations, we all have to think long and hard about what our obligations are to the client AND the patient. I have refused to do a euthanasia before and incurred the wrath of a client. It was not pleasant, but I felt that I was doing the right thing. Recently, I had a euthanasia that was just...difficult and left me questioning whether I'd done the right thing.

An older lady came in with her elderly small breed dog (14 years old). The dog, Katie, was bright, alert, and affectionate. She was a bit fat with a potbelly, some dark pigmentation on her belly, and a history of increased drinking and urinating for the past several months. That day, her owner claimed she'd begun having seizures - 3 to be exact.

On physical exam, Katie appeared to be Cushingnoid - an endocrine disease in which the body produces too much steroids. She had a muffin top, but she was otherwise pretty normal. No other significant abnormalities. She was very affectionate, and she ate readily when we offered her food.

I went to talk to her owner, and things went downhill from there. As I stepped into the room, the owner told me that she bringing Katie in for euthanasia. "Her kidneys are failing," she informed me. "That's why she has so much edema." I stopped for a moment. "What?" I finally replied.

The owner went on to inform me that she was a nurse and had been for many years. Several months prior, Katie had become acutely lethargic. The owner - instead of taking her to the vet - elected to start injecting her at home with penicillin. She claimed that Katie improved. A few weeks later, she developed "edema." Since then, the owner was convinced that her dog was dying of kidney failure. And now, Katie had developed seizure activity. From the owners description, they were tonic-clonic ("grand mal") seizures.

I tried to gently explained that her dog was not edematous, but rather fat and possibly Cushingnoid or hypothyroid. She argued with me, telling me that she was a nurse. Uncharacteristically, I argued back - telling her that I was an ANIMAL doctor.

We talked about seizures, we talked about endocrine abnormalities, and we talked about diagnostic and treatment options. In the end, the owner told me that she was away from home too often to take care of Katie, that she had financial limitations and couldn't do endocrine testing or afford anti-epileptics (although I explained they were relatively cheap), and that she had come to terms with the euthanasia of her pet. She cried when she said it and assured me it was not a decision she had come to easily.

It was obvious she loved her dog very much. These were no crocodile tears. Katie was old, but she was still wagging her nub, and she was still eating. Still, she was suffering seizures at home. Her owner wouldn't be there to care for her, and I didn't want Katie to suffer. Still, as she wagged her nub at me, I felt terrible.

I talked with her owner extensively, and it was clear that she was not going to change her mind. In the end, I don't think it was a wrong decision, but I'm not sure it was right either. Part of my job is balancing what is right for the pet with what is right for the owner. Sometimes knowing the answer to that is very hard. It is rare that I have to make this assessment, because most of the cases I see are pretty obviously suffering. In this case, the owner knew that she could not care for her dog as she needed to, could not afford the necessary testing and treatment, and was away from home much of the time. On the other hand, staring at me was a nub-wagging, happy old dog.

Though this has been several weeks ago, I question whether I made the right decision even now.


The Nurse said...

Boy.....that sure is a hard one :(

Holly said...


several of your posts this past week have hit close to home. Last week I made a wrenching decision to euth a dog who has frequent urinary episodes. I cannot seem to pinpoint when he will be unable to hold his bladder and when he goes, it seems like gallons. However, he's eating well, bounces out of his crate, can sometimes go weeks w/o an accident.

The day before the scheduled appointment, I canceled. I hate to do that but I just couldn't go through with it for what began to feel more and more like a convenience. Then I felt guilty because I did that to my vet.

Anonymous said...

The very fact that you question the euthanasia (and others) suggests that your judgment is outstanding. Please come back to the business. :) I will miss your blog posts once you're on maternity leave!!

@Holly: I bet your vet understands. Don't be hard on yourself for what is a really tough decision to make.