At-home euthanasia eases discomfort for pets, families

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Adelman, and his dog, Maggie, next to his house-call veterinary service vehicle. (TREVOR HAGAN / WINNIPEG FREE PRESS) Photo Store

Quality of Life Scale

Dr, Alice Villalobos, a renowned veterinary oncologist, published a scoring system for life quality called the HHHHHMM Scale to help worried and/or confused pet owners make the best decision for their elderly or ill animals. Rate animals using a scale of 0 to 10 (10 being ideal). A total over 35 points represents acceptable life quality.

HURT Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet's pain successfully managed? Is oxygen supplementation necessary?
HUNGER Is the pet eating enough? Does hand-feeding help? Does the patient require a feeding tube?
HYDRATION Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
HYGIENE The patient should be brushed and cleaned, particularly after elimination. Avoid pressure sores and keep all wounds clean.
HAPPINESS Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be close to the family activities and not be isolated?
MOBILITY Can the patient get up without assistance? Does the pet need human or mechanical help (e.g., a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)
MORE GOOD DAYS THAN BAD When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is OK.
(Adapted by Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN, 09/2004, for Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, by Blackwell Publishing, Table 10.1, released 2006.)

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Dr. Larry Adelman

‘A FAVOURITE spot in front of the window is very common," says Winnipeg veterinarian Dr. Larry Adelman when asked where his clients most often carry out pet ownership’s most painful ritual.

Last December, after enjoying one last Christmas together as a family, Derek Foreman and his wife said goodbye to their beloved Buster on a blanket on the kitchen floor. Buster's best canine buddy, Nano, was also present and let out a single bark when his owner carried the blanketed bundle out to Adelman's car.

Forcing the arthritic 13-year-old border collie-Samoyed cross, who was in kidney and liver failure, to spend his final moments trembling on a steel examination table was not an option, Foreman says.

"The last couple of times we had taken him to the vet, it hadn't been a very good experience," he recalls. "They had to draw blood and couldn't find a vein anymore. He urinated in the vet's office.

"Also, getting Buster to climb up into the car and then driving him across town to a medical place just seemed cold and awful."

It was a surprisingly gentle death, Foreman says, given how Buster had spent most of that day grinding his teeth and shaking from the pain, despite being heavily medicated.

"Once the first injection took place, we knew he wasn't hurting anymore."

That first syringe put Buster into a state of deep sedation so he wouldn't feel the second one: a fatal dose of sodium pentobarbital.

"Quietly, their heart stops and then their breathing slows down and then stops so they go right to sleep," Adelman explains. "It's a beautiful thing."

Adelman makes a similar house call nearly every weekday, usually in the evenings.

At-home pet euthanasia has become a growth industry in North America, largely due to an aging population -- both the two-legged and four-legged kind.

"Pets are living healthier longer, just like people, because we have better care for them. We can do more and clients are willing to do more," says Adelman, who recently limited his Dr. A Housecall Vet practice to end-of-life procedures. He also owns Seven Oaks Veterinary Hospital.

When he graduated from veterinary school in 1981, there was nothing to give cats to safely ameliorate their pain, he says. Now, there's a medication that can be rubbed on the gums and lasts for up to 10 hours.

An estimated 38 per cent of households have a pet, according to the Canadian Veterinary Medical Association. And given how, over recent decades, people have been treating their animals more like furry family members than property, it's not surprising that our high standards for their comfort and care would extend to that final vet visit.

Pet owners pay a premium for an end-of-life house call -- around $200, which includes pre-sedation and euthanasia, plus a $50 transport fee. (Clinic fees start at around $120, depending on size of the animal). Cremation costs extra, starting at about $100 for a communal cremation. A private cremation, where the ashes are returned to the owner in an urn, can cost up to $200.

And it's not just dogs and cats. Dr. Lisa Sawka, who has been making house calls full-time since 2007, has also euthanized rabbits and birds. "Any animal is part of the family," says the owner of Animal Ark Veterinarian Services, who did 10 end-of-life house calls in January alone.

Winter is peak season for that kind of house call, says Dr. Pat Murtagh, owner of Mobile Veterinary Service since 1984. "When the cold first comes, all sorts of conditions and diseases get worse, not just arthritis," he says.

Sawka says older pet owners, in particular, may have a hard time transporting their animal, especially a large dog, to a vet clinic when the time comes. Or an animal might be so ill that moving it only heightens the suffering.

Also, she recalls working out of a clinic and worrying about grief-stricken pet owners getting into their vehicles and driving home afterward. It's a heartbreaking experience to walk through a busy waiting room carrying only a pet's collar or leash.

A death in the family is always traumatic, but even moreso when the loss is sudden, as Jan Finch discovered when her 10-year-old golden retriever, Beau, was diagnosed with a hemangiosarcoma, an aggressive tumour that bursts when it reaches a certain size.

"We were told we had to say goodbye to him that day," Finch recalls. Back home, the family, including Zoe, another golden retriever, gathered around Beau one last time.

"My husband and our daughters and I spread blankets on the front lawn and we fed him steak and ice cream and petted him and we just had time as a family," she says. When Adelman arrived later that afternoon, they moved into the living room, where Beau had his bed.

"We were able to say goodbye to Beau in our own home and in our own time," Finch says. "The nicest thing about having someone come to the house is being able to have your pet calm and comfortable and to cradle their head in your arms or lap. And then to see how peacefully they slip away."

carolin.vesely@freepress.mb.ca

Republished from the Winnipeg Free Press print edition February 12, 2013 D1