It’s Never Easy

I still remember the first person I had to share this terrible news with. He was a nice, middle-aged man with two small children and an 8-year-old Rottweiler named Stone. Stone was a member of the family, and when he started to limp, his owner brought him straight in to be checked out. Stone was a wonderful dog at home, but he was not a fan of the veterinary clinic. My best dog treats did nothing to warm his heart, and when I manipulated his painful left shoulder, well… that ended our chances of being best friends.
Even though Stone was not an admirer of mine, I liked him, and I really liked his owner. That made it so much harder to discuss his diagnosis: osteosarcoma. Osteosarcoma is a painful bone tumor that responds poorly to treatment. In some cases, treatments involving limb amputation and/or radiation therapy can be beneficial. In Stone’s case, these options were not feasible.
Together, Stone’s owner and I decided to provide him with the best palliative care we could, and we promised each other that we would not let Stone suffer. When the time came, we would do the right – if tough – thing and put him to sleep rather than allow him to live in increasing pain.
Stone’s owner was the first person I ever had an end-of-life discussion with, and he was also the first person to ask me a question I have heard hundreds of times since: “How will I know when it’s time?”
The most recent person to ask me this question was my own mother. Her Miniature Schnauzer has battled long-term health problems and was recently diagnosed with diabetes. Unfortunately, she initially responded poorly to treatment. She lost her love of food, began soiling her bed and was generally acting pitiful.
How to Decide

Over the past few years, I’ve heard a lot of veterinarians give wonderful advice to people who are wondering when it is time to give their pets the gift of a peaceful passing. Here are four of the best pieces of advice I’ve heard, and they are the same ones I passed on to my own mother for her consideration.
Every pet, illness and situation is different. There is no single rule that can be followed for when it is time to help your best friend “cross the rainbow bridge.” Getting input from your veterinarian on the specific medical conditions that your loved one may face is vital for doing what is best for your pet. You may also benefit from having a caring friend who is not as emotionally involved in the situation as you are to help you gain perspective and really “see” what is happening with your pet.
Related: Euthanasia – Why Some Pet Owners Choose to Stay and Some Choose to Go

Remember that pets live in the moment. One of the most wonderful things about animals is how they embrace the present. Every time I walk into my house, my faithful Vizsla throws a one-dog ticker tape parade. The fact that I have entered the house thousands of times before, or that I will leave again in a few hours, means nothing. All that matters to him is the joy that he feels right now.
When our pets are suffering, they don’t reflect on all the great days they have had before, or ponder what the future will bring. All they know is how they feel today. By considering this perspective, we can see the world more clearly through their eyes. And their eyes are what matter.
Ask yourself important questions. Sometimes, articulating or writing down your thoughts can make the right path more apparent. Some questions that help pet owners struggling with this decision include:
Why do I think it might be time to euthanize?
What are my fears and concerns about euthanizing?
Whose interests, besides those of my pet, am I taking into account?
What are the concerns of the people around me?
Am I making this decision because it is best for my pet, or because it is best for me because I’m not ready to let go?
Measure their quality of life. This is no more than trying to determine how good or bad our pet’s life is at this moment. Trying to assess this can be difficult, but there are some ways you can try and evaluate it. Let’s take a look at a few of my favorites in the next section.
Is Life a Joy or a Drag?

Our pets may not be able to talk to us and tell us how they are doing, but if we pay close attention, there are many clues that can help us answer that question.
The Rule of “Five Good Things”: Pick the top five things that your pet loves to do. Write them down. When he or she can no longer do three or more of them, quality of life has been impacted to a level where many veterinarians would recommend euthanasia.
Good Days vs. Bad: When pets have “good days and bad days,” it can be difficult to see how their condition is progressing over time. Actually tracking the days when your pet is feeling good as well as the days when he or she is not feeling well can be helpful. A check mark for good days and an X for bad days on your calendar can help you determine when a loved one is having more bad days than good.
HHHHHMM: t is a well-known veterinary oncologist. Her “HHHHHMM” Quality of Life Scale is another useful tool. The five H’s and two M’s are: Hurt, Hunger, Hydration, Happiness, Hygiene (the ability to keep the pet clean from bodily waste), Mobility and More (as in, more good days than bad). Dr. Villalobos recommends grading each category on a scale of 1-10 (with 1 being poorest quality of life and 10 being best). If the majority of categories are ranked as 5 or above, continuing with supportive care is acceptable.
Pet Hospice Journal: Keeping a journal of your pet’s condition, behavior, appetite, etc., can be extremely valuable in evaluating quality of life over time.
A Tale of Two “Endings”

Thankfully, my mother’s Schnauzer, Zoe, eventually responded to her therapy. As a perpetual optimist, I like to think that she may be with us for some time to come. Still, the reality of having older pets is that we must be vigilant in their care and aware that every day is a gift.
In the case of my long-ago patient, Stone, with whom I first walked this path, I am glad to say that he did not suffer unnecessarily with osteosarcoma. His owner made a good decision, and Stone crossed the rainbow bridge while in the loving arms of his people. He was remembered by them as a strong, loving protector of the children in his family, and I will always remember his owner for having the strength and wisdom I hope we’ll all have when the time comes to say that final goodbye.

http://shine.yahoo.com/pets/know-time-euthanize-pet-162100593.html

Veterinarians treat multiple species of animals in a variety of settings. Unfortunately, the Controlled Substances Act (CSA) makes it illegal for veterinarians to take and use controlled substances outside of the locations where they are registered, often their clinics or homes.

This means that it is illegal for veterinarians to carry and use vital medications for pain management, anesthesia and euthanasia on farms, in house calls, in veterinary mobile clinics, or ambulatory response situations.

Veterinarians must be able to legally carry and use controlled substances for the health and welfare of the nation’s animals, to safeguard public safety and to protect the nation’s food supply.

We encourage you to contact your members of Congress and urge them to support the Veterinary Medicine Mobility Act of 2013 (H.R. 1528), which would amend the CSA that currently prohibits veterinarians from transporting controlled substances to treat their animal patients outside of their registered locations.

The Drug Enforcement Administration (DEA), which enforces the law, has informed organized veterinary medicine that without a statutory change, veterinarians are in violation of the CSA and cannot legally provide complete veterinary care. The DEA has already notified some veterinarians in California and Washington State that they are in violation of this law.

The practice of veterinary medicine requires veterinarians to be able to treat their animal patients in a variety of settings, such as in:

rural areas – for the care of large animals where it is often not feasible, practical or possible for owners to bring livestock (i.e., cows, pigs, horses, sheep, and goats) into a veterinary hospital or clinic;
“house call” services or mobile clinics – where veterinarians offer a variety of veterinary services for their patients or in the communities;
research and disease control activities – where it may be necessary to conduct research away from the veterinarian’s principal place of business;
emergency response situations – where injured animals must be cared for onsite; and
the removal or transfer of dangerous wildlife (e.g. bears, cougars) or to rescue trapped wildlife (e.g. deer trapped in a fence).
Tell Congress that veterinarians need to legally be able to transport controlled substances to the locations of the animal patients, not only for the health and welfare of the nation’s animals, but for public safety.

http://capwiz.com/avma/issues/alert/?alertid=62592206&queueid=9474225031

If you need small animal services, please contact
Hannah’s Mill Animal Hospital in Thomaston @ 706-647-4164
Barnesville Animal Clinic in Barnesville @ 770-358-3763
Griffin Animal Care in Griffin @ 770-228-4321
Animal Medical Clinic of Forsyth @ 478-994-4986
Crescent Veterinary Hospital of Newnan @ 770-304-8900

For exotic animal needs, please contact
All Creatures Animal Hospital of Dunwoody @ 770-393-3400
For Pet’s Sake of Atlanta @ 404-248-8977

For after hours small animal emergencies please contact
Southern Crescent Animal Emergency Clinic of Fayetteville @ 770-460-8166
Fur Buds Emergency Clinic of Opelika @ 334-737-6201

Thank you for your understanding and support during this time.
Regards,
Dr. Jennifer E. Gardner and Family

I, and many of my colleagues, practice a style of medicine that requires we put a piece of ourselves into every patient. We care so much that the only way we can practice good medicine is to love our patients, to give them a piece of us, a piece of our souls if you will. We pour ourselves into their care. We stay late, we get up in the middle of the night, we call to check on them in the middle of dinner because they pop into our heads, we go out on weekends, holidays and in all weather, for the sake of the patient. We take hours away from our family, our home life, and God bless our families, they forgive us and love us anyway. We bring them into our homes when we can’t stand the thought of our patient sitting in the hospital over night. We lay in bed reading research, hoping to learn more, to find the key to curing our patients. We advocate for our patients. We strive to provide them with the best medicine, the best of care, to be their voices when the cannot speak, even when it means we are advocating for them to their owners, pleading with owners to allow us to treat our patients. We are crushed and heartbroken every time our patient’s care is dictated by money. We do not care about the money. We care about the patient. But we have bills to pay too. If we were independently wealthy, we would give our knowledge away for free and gladly treat every patient by the gold standard. It hurts our hearts, our souls, our beings, to see an animal in pain, unhealthy, and to be powerless to fix it. We pour ourselves into our patients, and when we can no longer fix them, when we can no longer keep them comfortable, when we cannot find a cure, when they are ready, and worst, when money isn’t available for their care, we end their life. We take the life we’ve been trying to save. We take life. We end it. We do that which cannot be undone. For me, this action weighs heavily upon my heart every single time I do it. It is never easy. It doesn’t get easier. For us, a part of us dies with our patient. The part of us we gave to them is gone and we never get that back. We mourn the loss of our patients. We cry with the family. Sometimes, we cry more than the family when we get home. We are not only sad, but angry and frustrated and tired. We yell at ourselves, our family, at God, because we had to end that life and we have a hole in our soul. I don’t know if it ever heals, but it gets better with time. We pray that we have plenty of uplifting, positive, happy cases in between the sad ones to allow our souls time to recover. Many vets have dubbed themselves Dr. Death. On more than one occasion, we have a day where it feels everything is destined to die by our hand. Those are the days where I crawl into bed and hide under the covers at the end of the day. Those who have not walked in our shoes suggest we just need to distance ourselves from our work or put up boundaries, but we are not wired that way. Our loved ones say they are sorry for what we had to do and that they understand, but they do not. They want to, but they do not understand. They cannot. Only another who has it ingrained upon their souls to care for the voiceless, to heal, to cure, and to fix, and yet has had to kill, can truly understand what it is we feel. Yet, we do the best we can, every day. We get up every morning (some more slowly than others) and go back to it. We do it for the ones we can save. We do it for the ones we cannot save. For them, we would rather lose a piece of ourselves than allow that patient to die alone, hungry, unloved or in pain.

Subsidized Gelding Day
November 7th