WHEN THE TIME IS RIGHT LIFE IS BEAUTIFUL MAKING END-OF …ferretcongress.org/sym2008/PittsPDF/euth.pdf · 2009-04-23 · ©2008 Lauren Powers, DVM; Commercial use prohibited 11 MEMENTOS

IFC 2008 Symposium, Pittsburgh, PA

© 2008 Lauren Powers, DVM; Commercial use

prohibited 1

Lauren Powers DVM,Diplomate ABVP(Avian)

Carolina Veterinary SpecialistsHuntersville and Charlotte, NC

WHEN THE TIME IS RIGHT:

MAKING END-OF-LIFE

DECISIONS FOR PET FERRETS

LIFE IS BEAUTIFUL

! Enjoying your time together

with your pet ferret meansnot worrying about the end

! We all understand our petswill no longer be with us

one day

! Death and euthanasia are

not topics we want to beforced to address

Photo by Beth Reburn

ALL THINGS MUST PASS

! In an ideal world, our pets wouldknow when “it’s time,” and passaway peacefully in their sleep

! Often, this is not the case andwe are forced to make life-ending decisions for our pets

! Animals cannot make thesedecisions for themselves

! Ultimately, we are responsiblefor care and welfare of our pets,and this includes end-of-lifedecisions

Photo used with kindpermission from Dr. Cathy

Johnson-Delaney

DIFFICULT CHOICES

Events that may Force

Consideration of Euthanasia

! Acute Events

! Severe, life-threatening or

life-changing trauma

! Hemorrhage, traumaticbrain injury

! Severe, life-threatening

illness

! Sepsis, DIM, poisonings



prohibited 2

DIFFICULT CHOICES



! Ferret life span 7-9 years(some individuals may livemuch longer)

! Severe, Chronic Illnesses

! Chronic renal failure

! Congestive heart failure

! Severe inflammatorybowel disease (IBD)

DIFFICULT CHOICES



! Neoplasia (cancer)

! Insulinoma

! Lymphoma

! Adrenal tumors

! Other forms of cancer

INSULINOMA

! Neoplasia (cancer) of theinsulin secreting cells of thepancreas

! Hypoglycemia (low bloodsugar)! Lethargy

! Seizures

! Peripheral neuropathy! Hindlimb weakness

LYMPHOMA

! Common form of cancer in

ferrets

! Can be life-threatening and

affect quality of life

! Weight loss

! Massive lymph nodeenlargement

! Intestinal perforations,peritonitis (intestinal form)

! Kidney failure (renal form)



prohibited 3

LYMPHOMA CHEMOTHERAPY

! Tzannes et al, J Feline Med Surg10: 73-81, 2008

! 83% of feline clients werehappy they treated their catand 87% would treatanother cat

! 10% felt regretful that theyopted for chemotherapy! Regretful owners reported

more adverse effects

ADRENAL TUMORS

! Benign or malignant tumorsof the sex hormoneproducing portion of theadrenal gland

! Most often NOT a life-threatening disease

! Clinical signs

! Alopecia (hair loss)

! Swollen vulva

! Pruritus (itchiness)

! Sexual aggression

ADRENAL TUMORS

! Can become life-threatening and/or

impact quality of life

! Mass effect

! Prostatic abscesses and

cysts (males)

! Urinary obstruction

(usually seen in males)

COGNITION

! Human vs animal cognition

! Humans can understand the concepts of life and death

! Humans can usually make decisions for themselves

! Humans can weigh the future benefits of a treatmentoption against the present pain and suffering it may

cause

! Animals live in the moment

! It is unlikely that animals can understand the concepts oflife and death

! Quality of life is of far greater importance than quantity



prohibited 4

QUANTITY VS. QUALITY

Oyama MA, Rush JE,O’Sullivan ML, et al.

JAVMA 233(1), 2008: 104-108

Perceptions andpriorities of ownersof dogs with heartdisease regardingquality versusquantity of life fortheir pets

QUALITY OF LIFE

! In people, QOL is determined by thenature of experiences and theirmeaning and value and priority

! In animals, the term is broad andcomplex,

! Animals not likely to scoremeaning, value and priority tolife’s experiences

! Terms like “well-being” and“welfare” and “happiness” arefrequently used


! Well-being

! Implies that the individual’s physiologic,security, and behavioral needs are fulfilled

! Needs

! Must be met for an animal to have anacceptable QOL

! Life-sustaining, health-sustaining,

comfort-sustaining needs

! Desires

! Things that an individual prefers

but are not necessary

! Fulfillment of a desire increases

emotional pleasantness (happiness),improving QOL Photo by Beth Reburn

DISCOMFORT

! Discomfort negatively affectswell-being

! Physical discomfort! Thirst, hunger, disease, nausea,

temperature extremes, pain,itchiness

! Emotional discomfort! Fear, anxiety, loneliness, grief,

frustration, boredom



prohibited 5

PAIN AND SUFFERING

! Nociception

! Response of neurologic receptorsto a painful stimulus

! Heat, pressure, chemical stimuli

! Pain

! Perception of unpleasantexperience

! Subjective, conceptual

! Suffering

! Discomfort or pain of extreme orprolonged intensity

SIGNS OF PAIN IN FERRETS

! Decreased activity

! Decreased interaction

! Decreased appetite

! Weight loss

! Restlessness

! Prolonged or repeated trembling

! Defensive biting

! Tooth grinding unrelated toeating

WHY TREAT PAIN?

! Pain causes suffering

! Animals live in the moment and cannot findcomfort in knowing the pain may subside in afew hours or days

! Untreated pain can result in weight loss, musclebreakdown, impaired respiratory function,increased blood pressure, prolonged

convalescence

TREATMENT OF PAIN

! Anesthesia

! Injectable narcotics

! Inhalant anesthetics

! Local anesthetics

! Short-term management

! Opioids

! NSAIDs

! Long-term management

! NSAIDs

! Tramadol

! Adjunctive therapies



prohibited 6

TREATMENT OF PAIN

! Narcotic analgesics

! Hydromorphone, buprenorphine

! Tramadol

! Has effect at opioid receptors

! Not yet a controlled drug

! NSAIDs

! Meloxicam (Metacam)

! Local anesthetics

! Lidocaine, bupivicaine

! Adjunctive therapies

! Acupuncture, massage, heat therapy

BASIC NEEDS: HYDRATION

! Adequate hydration is essential to life

! Convalescence and disease can lead todehydration

! Oral hydration

! Water bottles and bowls

! Liquid food (gravy, Critical Care)

! Parenteral administration

! Subcutaneous fluid administration

! Intravenous or intraosseous fluids(hospital setting)

BASIC NEEDS: NUTRITION

! Many illnesses lead to decreased

appetite or inability to self-feed

! Some illnesses increase nutritionalneeds

! Maintaining adequate and balanced

caloric intake and intake of adequateessential nutrients is critical

! Assisted or supplemental feeding

! Homemade diets

! Oxbow Carnivore Care Diet

! Surgical Feeding tube

Fisher PG, Exotic DVM 6:23-25, 2001

Used with permission from author

WELL-BEING AND HAPPINESS

! Can ferret be happy?

! What makes a ferrethappy?

! How does a ferret tellyou it’s happy?

Photo courtesy of Dr. Cathy

Johnson-Delaney



prohibited 7

PLAYING WITH TOYS

Photos by Beth Reburn

ENGAGING IN NORMAL

ACTIVITIES


SOCIALIZING WITH OTHER

FERRETS


INTERACTING WITH HUMANS



©2008 Lauren Powers, DVM; Commercial useprohibited 8

Photos by Beth Reburn

ν Dr. Alice Villalobosν Pawspice: End of Life Care Clinic, Norwalk, CAν Quality of Life Scale questionnaire for pet caregiversν http://www.veterinarypracticenews.com/images/

pdfs/Quality_of_Life.pdf

QUANTIFYING THE QOL

http://www.veterinarypracticenews.com/vet-practice-news-columns/bond-beyond/quality-of-life-scale.aspx

ν Criteria: Hurt, hunger,hydration, hygiene,happiness, mobility,and more (good daysthan bad days)

ν Scale of 1 to 10, 10being the best

ν Scores above 5considered acceptablein maintaining an end-of-life program

ν Total score of >35 isacceptable for hospice

HOSPICE

ν Hospice is the supportive care of terminally ill patientswhen euthanasia is not an option

ν Considered when further tests and aggressiveintervention not likely to change outcome

ν The client accepts withdrawal of all treatment and testexcept for care and comfort measures

ν Pet hospice can be provided for at home or at somecenters

ν Hospice services address nutrition, hydration, hygiene,mobility, and pain control



HHHHHMM

ν Consider euthanasia when thequality of life of the pet is poorand is unlikely to significantly improve

ν If the emotional costs are abovecapacity

ν If the financial costs of continuedtherapy exceed the financial means

ν If spiritual beliefs allow one to accept thathumane euthanasia is the best choice for a pet

ν We need to put the pet’s QOL above our ownneeds and desires

Photo used with kindpermission from Dr. Cathy

Johnson-Delaney

PERSONAL COSTSTO THE CAREGIVER

ν Emotional toll of nursing a severely ill ferretν Lack of sleep, lack of attention to other chores

ν Emotional toll of struggling with an end-of-lifedecisionsν Depression, mood swings

ν Time away from work, reduced job performanceν Effect on family including childrenν Psychological effects on ferret conspecifics

FINANCIAL COSTSν Veterinary care is usually an out-of-

pocket expenseν Illness or injury are often

unexpectedν Cost of veterinary care can be highν Many diseases in ferrets require

surgical intervention orchemotherapy, which can be veryexpensive

ν Cost is often a constraint toachieving effective relief ofdiscomfort to a pet

$0.00

$20.00

$40.00

$60.00

$80.00

$100.00

$120.00

$140.00

Dogs Cats Birds Exotics

JAVMA 233(5): 727-728, 2007

RELIGIOUS BELIEFS

ν Humane animal euthanasia is acceptable according toChristianity, Judaism, Islam, and Buddhismν Although “man” has dominion over the animals

according to the Bible, the Bible also says thatanimals should not be allowed to suffer

ν According to Christianity, animals lack spiritual soulsand therefore do not go to heaven

ν According to Buddhism, animal souls can bereincarnated



EUTHANASIA

ν Derived from Greek eu meaning “good” andthanatos meaning “death”

ν As a medical procedure, it means thepurposeful act of terminating a life

ν Euthanasia is a humane way to ending painand suffering

ν A thoughtful decision – not just pet disposalν Often considered the “final act of love” for a

pet

PREPARE YOURSELFν Timeline

ν Timing may be guided by medical signs or throughhuman emotions

ν If possible, schedule when you have fewdistractions

ν Take time for yourself

ν Prepare and gather your support networkν Speak with your veterinarianν Speak with your familyν Disregard negative criticism

EUTHANASIA

ν Meant to be quick and painlessν Tranquilizer often administered

firstν Dexdomitorν Acepromazineν Propofol

ν Barbituric acid derivatives are thepreferred method of animaleuthanasiaν Sodium pentobarbitalν Controlled drug (Schedule-II)

EUTHANASIA DECISIONS

ν Locationν House callν In-clinic euthanasia

ν Family Presenceν To witness or notν Family members

ν Body Careν Home burialν Cremation




MEMENTOS

ν Polymer clay pawprintsν Ink and paper pawprintsν Hair clippingsν Photographsν Ash urnsν Planted treeν Engraved jewelry

www.goodshepherdpet.com

IT’S OKAY TO GRIEVE

ν In one survey, 70% of clients were affectedemotionally by the death of their pet

ν 30% of clients experienced severe grief inanticipation of or after the death of theirpet

ν 50% of clients experienced feelings of guiltabout their decision to euthanize their pet

STAGES OF GRIEFν Denial

ν The more sudden the decision, the more difficult theloss is to accept

ν Anger and Guiltν May be directed at family, vet, yourself

ν Depressionν Tears, difficulty performing day-to-day tasks

ν Resolve and Acceptanceν Coming to terms with feelings of lossν Over time, negative feelings become less intense

CHILDREN AND PETS

ν It is important that thethoughts and feelings ofchildren are considered

ν Children appreciate honest,truthful and simple answers

ν If prepared, children are usuallyable to eventually accept theloss of a pet

ν Avoid euphemisms like “put tosleep,” and “went away”




PUBLICATIONSν Do Pets Go To Heaven? Now There is Evidence You Can Believe In. Dennis

Callen, 2006. www.dopetsgotoheaven.comν Into the Light. Gail Pope, 2007. www.brighthaven.orgν I 'm Home Again. Pet Reincarnation: A Dog's Story. B Brent Atwater, 2008.

www.JustPlainLoveBooks.comν I See You! Nicole Hartz, 1997. www.soothinghartz.comν Nikki Hospice Foundation for Pets. Mary and Herb Montgomery

books. [email protected]ν A Final Act of Caring: Ending the Life of an Animal Friend, 1993ν Good-bye, My Friend: Grieving the Loss of a Pet , 1999ν Forever in My Heart: Remembering My Pet’s Life (A fill-in book for

Adults) , 2000ν I Remember: A Book about My Special Pet (A fill-in book for Children),

2000

PET LOSS SUPPORT HOTLINESν 530-752-4200 or 800-565-1526

ν Staffed by University of California Davis veterinary studentsν 630-325-1600

ν Staffed by Chicago VMAν 607-253-3932

ν Staffed by Cornell University veterinary studentsν 217-244-2273(CARE) or 877-394-2273(CARE)

ν Staffed by University of Illinois veterinary studentsν 888-ISU-PLSH (888-478-7574)

ν Staffed by Iowa State University veterinary students and volunteersν 517-432-2696

ν Staffed by Michigan State University veterinary studentsν 614-292-1823; e-mail, [email protected]

ν Staffed by The Ohio State University veterinary studentsν 508-839-7966

ν Staffed by Tufts University veterinary studentsν 540-231-8038

ν Staffed by Virginia-Maryland Regional College of Veterinary Medicineν 509-335-5704

ν Staffed by Washington State University veterinary students

NECROPSY

ν Necropsy - an examination and dissection of adead body to determine cause of death or thechanges produced by disease

ν Term “necropsy” commonly used in veterinarymedicine and the term “autopsy” most oftenreserved for use in human medicine

ν “Cosmetic necropsy” – once done, the ferretappears only as if it had surgery



NECROPSY

ν Samples of organs, masses, and fluids arecollectedν Formalin (formaldehyde) - histopathologyν Culture broth – bacterial, fungal, viral isolationν Fresh frozen – toxicology, viral testing

ν Photography

THE VALUE OF A NECROPSY

ν Diagnosing the cause of death (if noteuthanasia)

ν Diagnosing concurrent illnessesν Evaluating for infectious disease, particularly if

from a multiple ferret householdν Advancing information base in veterinary

medicine



We do not rememberdays, we remembermoments.

Cesare Pavese

Documents

WHEN THE TIME IS RIGHT LIFE IS BEAUTIFUL MAKING END-OF …ferretcongress.org/sym2008/PittsPDF/euth.pdf · 2009-04-23 · ©2008 Lauren Powers, DVM; Commercial use prohibited 11 MEMENTOS