“No, I don’t want him to suffer either,” I said.
“And there is no hope, is there, doctor?”
No, there was no hope this time. Two years before, he had brought Prince in because he was very stiff and painful in the hind end. At that time he had also said that he didn’t want Prince to suffer and had asked whether it would be best to just let him go. I examined Prince and decided that he likely had arthritis in his hips. I explained to Mr. Zielinski that I made euthanasia recommendations based on the answers to two questions. The first question is, is the patient’s quality of life poor? In that case the answer was yes, Prince was in pain, and his quality of life was definitely poor. But the second question is, have we run out of realistic options that could provide reasonable hope for significantly improving that poor quality of life? That answer then was no. There was still reasonable hope as there were a number of realistic treatments for arthritis that we had not yet tried with Prince. Euthanasia is recommended when there is suffering with no hope. Two years ago, Prince had been suffering, so we alleviated the suffering with treatment. Now, however, he had a tumour on the surface of his heart that was bleeding into the space around his heart. He was suffering, and there was no reasonable hope of improvement. This time we would have to alleviate his suffering by letting him go. It was Mr. Zielinski’s duty and my duty to do so.
Prince’s case was reasonably black and white. Obviously an attempt should be made to treat arthritis in the hips before declaring the end of life, but an actively bleeding right atrial hemangiosarcoma is about as clear a signal that the time has come as one is ever going to get.
But what about the ones that are not as straightforward? These are unfortunately the majority, and it is a tremendous source of agony and indecision. So many pet owners have told me that the decision to put their pet down was the hardest decision they have ever had to make. In humans, it is out of our hands for the most part. Only with our pets do we have to routinely make a decision to end the life of a loved one. And it is routine. The average pet’s life is only about a sixth as long as a human life, and, as discussed before, euthanasia is far more common than dying of so-called natural causes at home.
So how do we make this decision? As I mentioned, we look at quality of life and we look at hope. The hope part is usually a pretty easy medical question that your veterinarian can walk you through. The quality of life part is trickier though, especially in dogs and cats going through a gradual decline. Where do you draw that line? Quality of life is of course very subjective, but as a general guideline I think of the two A’s: appetite and activity (or attitude, in pets that were not very active to begin with). I also look at a rough 48-hour rule. So, if for two consecutive days a pet who is known to be near the end of their life does not eat at all or hardly moves at all (or appears very depressed), it may be time. Also, as long as the hope question has been cleared up, trust your instincts — when you think it’s time, it’s probably time.
It is important that you be gentle with yourself. Do not agonize too much over picking the right day. There is often no such thing. As long we are in the ballpark, a few days, or even a few weeks, at the end of a pet’s life doesn’t matter to it. They have no sense of a tomorrow, or of how many tomorrows they want or should have. I have had many people comment later that, in retrospect, they think they waited too long. I have had nobody comment later that they think they did it too soon. Literally nobody. But our inability to let go is understandable, and it is human. Again, there is usually no perfect day. We all just do our best.
It’s not easy, and it’s never going to be easy. How could it possibly be? The best we can hope for is to not make it even more difficult than it already is. Fortunately once the decision is made, the actual act of euthanasia itself is almost always remarkably smooth and painless and swift. And so it was with Prince. Within minutes of making the decision, he was gone. Mr. Zielinski cried, telling me that he hadn’t cried when his father died. He was heartbroken, but he had no regrets. Both he and Prince were at peace in their own ways.
Do They Know It’s Christmas?
The short answer is no.
The longer answer also features the word no but has more shading and nuance. But before I get into that let me reassure you (or warn you?) that this is not a typical veterinary Christmas essay. I will not be discussing the health hazards of chocolate and tinsel as you are all smart people and know this stuff already. Nor will I be discussing the moral hazards of forcing your cat to wear a little Santa suit or strapping reindeer antlers to your dog’s head as I know I will not be able to dissuade you from doing so anyway. (It’s an uncontrollable urge made worse by the advent of social media. Laws are needed. Personal essays are powerless against this urge.)
No, instead I will explore the question in the title. “Do they know it’s Christmas?” No, they do not know it’s Christmas, but they do know that something is up. And it makes them nervous. Now, to be fair, some of that something can be exciting and fun. Social dogs will enjoy sniffing the unusual people coming over, and self-confident cats will enjoy secretly licking the turkey. These are the exceptions though. Most pets are merely confused, and confusion leads to stress. Moreover, the majority of adult dogs and cats are deeply conservative (in the “small c” sense). Bliss for them is every day unfolding precisely like every day before it did. Bliss for them is the glorious routine. Everything. The. Same. Every. Day. Everything! You know this already. God forbid you get up at 7:05 instead of 7:00.
Christmas has the potential to mess with every element of this glorious routine. Furniture is moved. A giant tree is placed in the house and covered with myriad temptations you are forbidden to touch. A freaking giant tree! Festooned with shiny toys, for Pete’s sake! Your walks are changed or — gasp — cancelled. Your mealtimes become more erratic. Random people come and go. Uncle Darryl keeps insisting that yes you do love to have your furry tummy rubbed, but you don’t, and you bite him and people call you crazy. And your humans stay up late and sleep late. And all kinds of stuff is left lying around that you get yelled at for checking out. The list goes on. Christmas is stressful enough for many people, so just imagine how bizarre and unsettling it is for your dog or cat since they do not even know it’s Christmas.
So what can you do? Cancel Christmas? Sure, go for it. Vet-approved. However, that’s going to be unrealistic for most of you, so instead my recommendation is that you simply keep an eye on the importance of routine. Feed the same foods at the same times in the same amounts. Go for the same walks at as close to the same times as you can manage. Keep scooping that litter box. Set reminder alarms on your phone if you are worried you will forget or get distracted by the Christmas chaos.
And if you are going to put reindeer antlers on your dog, don’t tell too many people, least of all your veterinarian.
Cat Goes Mad
While I was hiking in England earlier this year, a headline in a small-town paper caught my eye: “COW BRUTALLY ATTACKS OAP.” Yes, it was all caps. In fact, those four words were the only thing on the front page. (By the way, “OAP” means old age pensioner. I had to look it up.) In any case, it brought to mind a story Lorraine had told me about a similarly startling headline in the Winnipeg Sun when she was growing up. Apparently the front page screamed, “CAT GOES MAD,” accompanied by a picture of a suitably concerned-looking elderly woman sitting on a couch festooned with doilies. And this got me thinking about rabies in cats. That’s how that funky old train of thought sometimes goes. One minute you’re thinking about OAPs, and the next you’re thinking about feline rabies.
Rabid cats came so readily to mind because just prior to leaving for England, I’d had a telephone conversation with a client about the subject. As I outlined in a previous essay, I don’t always have a minute-by-minute overview of my telephone messages. In fact, an hour or more can easily go by before I see them. On this particular morning, I opened the message centre on my computer to find a series
of eye-catching messages from my receptionist:
Please call Mr. Stirling. Thinks Buttons has rabies.
Urgent: Very concerned about his rabid cat.
Called again!
Intrigued, I called Mr. Stirling back. “Hello. I understand you are worried that Buttons might have rabies?”
“Yes! She’s not acting like herself at all!”
“How so? Can you describe what she is doing please?”
“Usually I keep the bedroom door closed at night, but two nights ago I left it open, and she came into my room in the middle of the night.”
“Yes . . . ?”
“And then she jumped on me and sat there for a while. I woke up, but I didn’t move. Then she bit me!”
“Oh dear. Did she break the skin?”
“No. I guess it was more of a nibble than a bite.”
“Hmm. Anything else?”
“Yes! Then last night she did the same thing, except without the bite. That time she just purred loudly.”
This was beginning to shape up like another Monty Python sketch. I have a great deal of faith in the shrewdness of my readership, so I’m confident you can more or less reconstruct my response and the rest of the conversation. No, Buttons did not have rabies. Buttons was bored and lonely and wanted to play. Mr. Stirling was relieved. He called back the next day to apologize for overreacting. There was no need to apologize. I would much rather people took rabies too seriously than not seriously enough, because that side of the coin is all too prevalent.
I am sometimes asked how many cases of rabies I have seen in my patients. The answer is zero. Shallow thinkers will take this as evidence that vaccination is not necessary. This is of course the wrong conclusion. The right conclusion is that it is evidence for the effectiveness of the vaccination program. Otherwise it’s a bit like saying, “See, my house has never burnt down, so I can start letting the kids play with blowtorches.” Countries without comprehensive rabies vaccination programs have shockingly high rates of the disease. Twenty thousand people die of rabies every year in India. Twenty thousand people die. It is one of the ugliest deaths imaginable. And the number of animals dying of it must be an order of magnitude higher.
So please, if you are at all concerned that your cat or dog (or cow) has gone mad, please do not hesitate to call. We won’t laugh. (Unless you use a Michael Palin voice.)
When the Sky Goes Boom
Norman sat beside Mr. Parker and looked at me expectantly. Expectantly because I had already given him three of his favourite liver treats. “If three, why not four, or even 14?” he seemed to be thinking. Regardless, he did not look especially nervous or anxious today. However, two days prior, this 30-kilogram Lab/border collie cross had put a dog-shaped hole in the Parkers’ kitchen screen door. Then he’d run flat out for at least four kilometres, through the hammering rain and deepening mud. The Parkers found him several hours later, limping down a grid road, panting, bedraggled, exhausted. They brought him in to get him checked over because he still had a bit of a limp, and because they didn’t want this to happen again. Norman had a storm phobia, and it was the start of the summer storm season.
Many dogs have storm phobias and noise phobias. These are actually two different things, although there is considerable overlap. About 90% of dogs with storm phobia also have a noise phobia, triggered by sudden loud sounds such as fireworks and cars backfiring. Curiously, the reverse is only true 75% of the time (noise phobic dogs who also have a storm phobia). Many also have other anxieties such as separation anxiety, but certainly a large number, like Norman, do not. There is evidence that storm-phobic dogs may also be reacting to the change in atmospheric pressure and to the flashing light in addition to the noise of the thunder. It is well known that dogs can hear the thunder approaching long before we do. This is a key part of the problem as many anxieties are worse when there is a wind-up anticipatory phase.
I talked to Mr. Parker about three types of solutions: training, tricks and drugs. Most of the time you have to use at least two out of the three. Norman needed all three.
Training is the best long-term solution if you can get it to work. The chances of success are higher if you can consistently put the time needed into it. That said, I don’t judge people who are unable to. My own dog still chases cars, steals entire cakes and barks at the vacuum like it’s the Antichrist. There are a few training approaches, but the one I like best is counter-conditioning. For this, find a long thunderstorm sound clip. Start to play it very quietly and briefly while feeding your dog treats or his meal. Keep it below the level that sparks anxiety. Over time, gradually increase the volume and duration, but always back off immediately if he shows any sign of being worried. You are trying to create a deep association between a temporary bad thing — storms — and a permanent good thing — food. For most dogs, the goodness of food will overpower the badness of storms, just so long as you take an extremely careful and gradual approach. This is best done well before storm season.
The tricks are fun. Get out your credit card and start surfing:
There are Mutt Muffs, to block sound: www.SafeAndSoundPets.com.
There are ThunderHuts, also to block sound: www.Thunder-Hut.com.
There are Doggles, in case the lightning flashes are part of the problem: Shop.Doggles.com.
And there are ThunderShirts, to calm by creating a secure feeling “hug”: www.ThunderShirt.com.
Of these I have only seen the latter in action. My observation has been that the ThunderShirt seems to help many dogs, but that it’s unusual for it to be the sole answer. Looks cool, though. Especially when matched with Doggles and Mutt Muffs. A cheap DIY solution is to let the dog tell you what reduces the noise and flashes for him. This means leaving all your (inside!) doors open and letting him find a bed to crawl under or a closet to stuff himself into.
And then finally the drugs. Some clients glaze over as I discuss all of the above and radiate a strong “just give me the drugs” vibe. There are several of these, but none are perfect, and all require you to be very watchful of the weather forecast as they won’t work once the anxiety is already building up. It is good to have some medication on hand for when you know that a storm is predicted later in the day. Most drugs are given an hour or so before the expected onset of anxiety. In severe cases, it may even be worth having anti-anxiety meds prescribed to be given on a daily basis right through the storm season. Regardless, talk to your veterinarian as there is definitely no one-size-fits-all answer.
Ultimately, some counter-conditioning, a ThunderShirt and an alprazolam prescription were the ticket for Norman. He had a great summer — until they went camping in an aluminium trailer and were caught in a hailstorm . . .
Elwood Regrets Nothing
Although he looked dejected, and although he would clearly rather have been somewhere else, in his heart I am sure that Elwood was defiant. He had done it before, and he would do it again. If his people left a Terry’s Chocolate Orange lying in reach again, by George, he would snarf it down again before you could say, “Elwood! Drop it!” No question. Foil and all. It was so worth it for the three seconds the chocolatey goodness was in contact with his taste buds. Furthermore, it was his Christmas tradition, and tradition was clearly important to Elwood. Actually, I’m kidding — just access to anything remotely resembling food was important to Elwood. Forget tradition.
I showed the Sykes the chocolate toxicity calculator, which told us that 157 grams of milk chocolate in a ten-kilogram beagle translated into 35 milligrams of the active toxic ingredient per kilogram of beagle, which was in the “mildly toxic” range, likely to produce vomiting, diarrhea, shaking and an increased heart rate. Fortunately, we had only seen the first symptom, in part because the Sykes knew their Elwood and had rushed him in immediately after the futile “Elwood! Drop it!” so that we could induce vomiting and get as much out of him as possible. As an aside, I want you to kn
ow that although veterinary clinics can be awash in a potpourri of vile smelling substances, chocolate vomit holds a special place near the apex of the devil’s perfumery. I mention this only so you know that the veterinary staff also suffers when you allow your dog access to chocolate. But I digress.
So chocolate is poisonous to dogs; this much most of you know. But do you know why it is poisonous? The aforementioned active toxic ingredient is theobromine, which is in the same methylxanthine class of stimulants as caffeine. What makes dogs different is that they metabolize it much more slowly than humans. Cats do too, but they are almost never interested in eating enough chocolate for it to matter as they can’t appreciate the sweetness. Because it is a stimulant, at a high dose it can cause severe heart rhythm disturbances and potentially fatal seizures. At about 200 milligrams of theobromine per kilogram, 50% of untreated dogs will die. Theobromine content varies between types of chocolate, with milk chocolate having the least and baker’s dark chocolate having the most. As a general rule of thumb, 28 grams (one ounce) of milk chocolate contains approximately 60 milligrams of theobromine while the same amount of dark chocolate contains about 200 milligrams, and baker’s chocolate about 400 milligrams.
It may be of interest to note that a recent study of 230 vet clinics in England indicated that the risk of chocolate poisoning was four times higher at Christmas than any other time of year except Easter, when it was two times higher. Curiously, there was no increased risk on Valentine’s Day or Halloween (although, mind you, the latter is a much smaller chocolate event in the UK than over here, and the former usually involves more expensive, closely guarded chocolates).
The Accidental Veterinarian Page 11
