WHEN THE TIME IS RIGHT: MAKING END-OF-LIFE DECISIONS FOR PET FERRETS

Transcription

1 1 WHEN THE TIME IS RIGHT: MAKING END-OF-LIFE DECISIONS FOR PET FERRETS Lauren Pwers DVM, Diplmate ABVP(Avian) Carlina Veterinary Specialists, Huntersville and Charltte, NC LIFE IS BEAUTIFUL Enjying yur time tgether with yur pet ferret means nt wrrying abut the end We all understand ur pets will n lnger be with us ne day Death and euthanasia are nt tpics we want t be frced t address ALL THINGS MUST PASS In an ideal wrld, ur pets wuld knw when it s time, and pass away peacefully in their sleep Often, this is nt the case and we are frced t make life-ending decisins fr ur pets Animals cannt make these decisins fr themselves Ultimately, we are respnsible fr care and welfare f ur pets, and this includes end-f-life decisins DIFFICULT CHOICES - Events that may Frce Cnsideratin f Euthanasia Acute Events Severe, life-threatening r life-changing trauma Severe, life-threatening illness Sepsis, DIM, pisnings Severe, Chrnic Illnesses Chrnic renal failure Cngestive heart failure Inflammatry bwel disease (IBD) Neplasia (cancer) Insulinma Lymphma Adrenal tumrs Other frms f cancer INSULINOMA Neplasia (cancer) f the insulin secreting cells f the pancreas Hypglycemia (lw bld sugar) Lethargy Seizures Peripheral neurpathy Hindlimb weakness LYMPHOMA Cmmn frm f cancer in ferrets Can be life-threatening and affect quality f life Weight lss Massive lymph nde enlargement Intestinal perfratins, peritnitis (intestinal frm) Kidney failure (renal frm)

2 2 LYMPHOMA CHEMOTHERAPY Tzannes et al, J Feline Med Surg 10: 73-81, % f feline clients were happy they treated their cat and 87% wuld treat anther cat 10% felt regretful that they pted fr chemtherapy Regretful wners reprted mre adverse effects ADRENAL TUMORS Benign r malignant tumrs f the sex hrmne prducing prtin f the adrenal gland Mst ften NOT a life-threatening disease Clinical signs Alpecia (hair lss) Swllen vulva Pruritus (itchiness) Sexual aggressin Can becme life-threatening and/r impact quality f life Mass effect Prstatic abscesses and cysts (males) Urinary bstructin (usually seen in males) COGNITION Human vs animal cgnitin Humans can understand the cncepts f life and death Humans can usually make decisins fr themselves Humans can weigh the future benefits f a treatment ptin against the present pain and suffering it may cause Animals live in the mment It is unlikely that animals can understand the cncepts f life and death Quality f life is f far greater imprtance than quantity QUANTITY VS. QUALITY Oyama MA, Rush JE, O Sullivan ML, et al. JAVMA 233(1), 2008: Perceptins and pririties f wners f dgs with heart disease regarding quality versus quantity f life fr their pets (Chart) QUALITY OF LIFE In peple, QOL is determined by the nature f experiences and their meaning and value and pririty In animals, the term is brad and cmplex Animals nt likely t scre meaning, value and pririty t life s experiences Terms like well-being and welfare and happiness are frequently used Well-being Implies that the individual s physilgic, security, and behaviral needs are fulfilled Needs Must be met fr an animal t have an acceptable QOL Life-sustaining, health-sustaining, cmfrt-sustaining needs Desires Things that an individual prefers but are nt necessary Fulfillment f a desire increases emtinal pleasantness (happiness), imprving QOL DISCOMFORT Discmfrt negatively affects well-being Physical discmfrt

3 3 Thirst, hunger, disease, nausea, temperature extremes, pain, itchiness Emtinal discmfrt Fear, anxiety, lneliness, grief, frustratin, bredm PAIN AND SUFFERING Nciceptin Respnse f neurlgic receptrs t a painful stimulus Heat, pressure, chemical stimuli Pain Perceptin f unpleasant experience Subjective, cnceptual Suffering Discmfrt r pain f extreme r prlnged intensity SIGNS OF PAIN IN FERRETS Decreased activity Decreased interactin Decreased appetite Weight lss Restlessness Prlnged r repeated trembling Defensive biting Tth grinding unrelated t eating WHY TREAT PAIN? Pain causes suffering Animals live in the mment and cannt find cmfrt in knwing the pain may subside in a few hurs r days Untreated pain can result in weight lss, muscle breakdwn, impaired respiratry functin, increased bld pressure, prlnged cnvalescence TREATMENT OF PAIN Anesthesia Injectable narctics Inhalant anesthetics Lcal anesthetics Shrt-term management Opiids NSAIDs Lng-term management NSAIDs Tramadl Adjunctive therapies Narctic analgesics Hydrmrphne, buprenrphine Tramadl Has effect at piid receptrs Nt yet a cntrlled drug NSAIDs Melxicam (Metacam) Lcal anesthetics

4 4 Lidcaine, bupivicaine Adjunctive therapies Acupuncture, massage, heat therapy BASIC NEEDS: HYDRATION Adequate hydratin is essential t life Cnvalescence and disease can lead t dehydratin Oral hydratin Water bttles and bwls Liquid fd (gravy, Critical Care) Parenteral administratin Subcutaneus fluid administratin Intravenus r intrasseus fluids (hspital setting) BASIC NEEDS: NUTRITION Many illnesses lead t decreased appetite r inability t self-feed Sme illnesses increase nutritinal needs Maintaining adequate and balanced calric intake and intake f adequate essential nutrients is critical Assisted r supplemental feeding Hmemade diets Oxbw Carnivre Care Diet Surgical Feeding tube WELL-BEING AND HAPPINESS Can ferret be happy? What makes a ferret happy? Hw des a ferret tell yu it s happy? Playing with tys Engaging in nrmal activities Scializing with ther ferrets Interacting with humans QUANTIFYING THE QOL Dr. Alice Villalbs - Pawspice: End f Life Care Clinic, Nrwalk, CA Quality f Life Scale questinnaire fr pet caregivers Scale f 1 t 5 (5 is best) fr 7 categries. Ttal scre f >35 acceptable fr cntinued hspice care Hurt Adequate pain cntrl, including breathing ability, is first and fremst n the scale. Is the pet s pain successfully managed? Is xygen neccesary? Hunger Hydratin Hygiene Happiness Is the pet eating enugh? Des hand feeding help? Des the patient require a feeding tube? Is the patient hydrated? Fr patients nt drinking enugh, use subcutaneus fluids nce r twice daily t supplement fluid intake. The patient shuld be kept brushed and cleaned, particularly after eliminatin. Avid pressure sres and keep all wunds clean.

5 5 Mbility Mre Gd Days than Bad ADJUST IF NECESSARY Des the pet express jy and interest? Is he respnsive t things arund him (family, tys, etc.)? Is the pet depressed, lnely, anxius, bred r afraid? Can the pet's bed be clse t the family activities and nt be islated? Can the patient get up withut assistance? Des the pet need human r mechanical help (e.g. a cart)? Des he feel like ging fr a walk? Is he having seizures r stumbling? (Sme caregivers feel euthanasia is preferable t amputatin, but an animal wh has limited mbility but is still alert and respnsive can have a gd quality f life as lng as his caregivers are cmmitted t helping him.) When bad days utnumber gd days, quality f life might be t cmprmised. When a healthy human-animal bnd is n lnger pssible, the caregiver must be made aware that the end is near. The decisin needs t be made if the pet is suffering. If death cmes peacefully and painlessly, that is OK. HOSPICE Hspice is the supprtive care f terminally ill patients when euthanasia is nt an ptin Cnsidered when further tests and aggressive interventin nt likely t change utcme The client accepts withdrawal f all treatment and test except fr care and cmfrt measures Pet hspice can be prvided fr at hme r at sme centers Hspice services address nutritin, hydratin, hygiene, mbility, and pain cntrl MAKING THE ULTIMATE DECISION When the quality f life f the pet is pr and is unlikely t significantly imprve If the emtinal csts are abve capacity If the financial csts f cntinued therapy exceed the financial means If spiritual beliefs allw ne t accept that humane euthanasia is the best chice fr a pet PERSONAL COSTS TO THE CAREGIVER Emtinal tll f nursing a severely ill ferret Lack f sleep, lack f attentin t ther chres Emtinal tll f struggling with an end-f-life decisins Depressin, md swings Time away frm wrk, reduced jb perfrmance Effect n family including children Psychlgical effects n ferret cnspecifics FINANCIAL COSTS Veterinary care is usually an ut-f-pcket expense Illness r injury are ften unexpected Cst f veterinary care can be high Many diseases in ferrets require surgical interventin r chemtherapy, which can be very expensive Cst is ften a cnstraint t achieving effective relief f discmfrt t a pet RELIGIOUS BELIEFS Humane animal euthanasia is acceptable accrding t Christianity, Judaism, Islam, and Buddhism Althugh man has dminin ver the animals accrding t the Bible, the Bible als says that animals shuld nt be allwed t suffer Accrding t Christianity, animals lack spiritual suls and therefre d nt g t heaven Accrding t Buddhism, animal suls can be reincarnated

6 6 RAINBOW BRIDGE Just this side f Heaven is a place called Rainbw Bridge. When an animal dies that has been especially clse t smene here, that pet ges t Rainbw Bridge. There are meadws and hills fr all f ur special friends s they can run and play tgether. There is plenty f fd, water and sunshine, and ur friends are warm and cmfrtable. All the animals wh had been ill and ld are restred t health and vigr. Thse wh were hurt r maimed are made whle and strng again, just as we remember them in ur dreams f days and times gne by. The animals are happy and cntent, except fr ne small thing; they each miss smene very special t them, wh had t be left behind. They all run and play tgether, but the day cmes when ne suddenly stps and lks int the distance. His bright eyes are intent. His eager bdy quivers. Suddenly he begins t run frm the grup, flying ver the green grass, his legs carrying him faster and faster. Yu have been sptted, and when yu and yur special friend finally meet, yu cling tgether in jyus reunin, never t be parted again. The happy kisses rain upn yur face; yur hands again caress the belved head, and yu lk nce mre int the trusting eyes f yur pet, s lng gne frm yur life but never absent frm yur heart. Then yu crss Rainbw Bridge tgether... EUTHANASIA Derived frm Greek eu meaning gd and thanats meaning death As a medical prcedure, it means the purpseful act f terminating a life Euthanasia is a humane way t ending pain and suffering AVMA Brchure n Pet Euthanasia AVMA Brchure n Understanding Pet Lss PREPARE YOURSELF Timeline If pssible, schedule when yu have few distractins Take time fr yurself Prepare and gather yur supprt netwrk Speak with yur veterinarian Speak with yur family Disregard negative criticism EUTHANASIA Meant t be quick and painless Tranquilizer ften administered first Dexdmitr Aceprmazine Prpfl Barbituric acid derivatives are the preferred methd f animal euthanasia Sdium pentbarbital Cntrlled drug (Schedule-II) IT S OKAY TO GRIEVE In ne survey, 70% f clients were affected emtinally by the death f their pet 30% f clients experienced severe grief in anticipatin f r after the death f their pet 50% f clients experienced feelings f guilt abut their decisin t euthanize their pet STAGES OF GRIEF Denial

7 7 The mre sudden the decisin, the mre difficult the lss is t accept Anger and Guilt May be directed at family, vet, yurself Depressin Tears, difficulty perfrming day-t-day tasks Reslve and Acceptance Cming t terms with feelings f lss Over time, negative feelings becme less intense CHILDREN AND PET LOSS It is imprtant that the thughts and feelings f children are cnsidered Children appreciate hnest, truthful and simple answers If prepared, children are usually able t eventually accept the lss f a pet Avid euphemisms like put t sleep, and went away PUBLICATIONS D Pets G T Heaven? Nw There is Evidence Yu Can Believe In. Dennis Callen, Int the Light. Gail Ppe, I 'm Hme Again. Pet Reincarnatin: A Dg's Stry. B Brent Atwater, I See Yu! Nicle Hartz, Nikki Hspice Fundatin fr Pets. Mary and Herb Mntgmery bks. inf@pethspice.rg A Final Act f Caring: Ending the Life f an Animal Friend, 1993 Gd-bye, My Friend: Grieving the Lss f a Pet, 1999 Frever in My Heart: Remembering My Pet s Life (A fill-in bk fr Adults), 2000 I Remember: A Bk abut My Special Pet (A fill-in bk fr Children), 2000 PET LOSS SUPPORT HOTLINES r Staffed by University f Califrnia Davis veterinary students Staffed by Chicag VMA Staffed by Crnell University veterinary students (CARE) r (CARE) - Staffed by University f Illinis veterinary students 888-ISU-PLSH ( ) - Staffed by Iwa State University veterinary students and vlunteers Staffed by Michigan State University veterinary students ; , petlss@su.edu -Staffed by The Ohi State University veterinary students Staffed by Tufts University veterinary students Staffed by Virginia-Maryland Reginal Cllege f Veterinary Medicine Staffed by Washingtn State University veterinary students