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Euthanasia difficulties.

Species: Cat
Breed: Alley Cat
Age: 11-15 years
Well, Kiggy passed away May 21, 2012 after a vet recommended euthanasia. She was 14 and until 3 days before her euthanasia, she was seemingly normal. After a night of dehydration and blood tests and xrays, the vet called and said she had end stage renal failure, most likely CRF. She recommended euthanasia. As with others, this cat was very dear to my partner and myself. Moreso to me because my family is dead and my partner and our 2 cats is all I have. We were numb and hysterical. We hurried down because the vet said she would have a seizure or heart attack and die and the poisons were going into her brain. We had 10 mins. to say goodbye and she was dead. After this, I researched online in case this ever happens to Rugby, or surviving kitty. What I have read has made me panic. All we were told is that she had a creatinine level of 10 and a BUN of 300. Her temp had fallen overnight by 1.5 degrees. I have read where other vets have recommended at least trying treatments, or have tested levels more than once before recommending euthanasia. We were never consulted first or shown the data, explained what to expect, what any options would be, or even what would happen during the euthanasia process. Needless to say, we did not expect her tongue to jet out, or her eyes to stay open. This has haunted me for the last month, and has disturbed my sleep and is now causing me to zone out at work and start crying, every day. It has not gone unnoticed by my bosses. Also, she gave Kiggy 2 shots, but they were in rapid succession. First the pain killer, immediately followed by the lethal shot. Both shots took about 30 seconds. Were the shots given too soon? Was she unconscious? Could she have had other treatment options? My big thing is to have my pet home to pass, it's something I won't bend on unless I feel it's an immediate life or death thing, which we did. Needless to say, I did tell them I would file a complaint with the State Vet Board. I can't believe she would recommend euthanasia without properly informing us; we had no clue what to ask and were frantic. She has called me twice to try and assure me we did the right thing, but she has obviously not been convinced herself I am okay now, and I'm not. So on Monday afternoon she arranged for us to have a post mortem consultation with the senior doctor at the hospital for a different perspective. What should I ask? Should I ask whatever I need to? I'm no longer totally convinced she was asleep if her eyes were open, regardless, and I worry tremendously about this. I worry we weren't given the proper time or tests before a drastic step was recommended. As a life long supporter of euthanasia in theory for ill pets, I am no longer convinced myself and will probably waiver too long if I am ever faced with this decision again. I am angry and I cannot deny this, am I right to be concerned? I know she was ultimately terminal, my partner and I battled his end stage renal failure for 6 years at home with Kiggy by our side. Luckily for him, a transplant came just as they expected him to pass away. I wish I could have returned the favor to Kiggy. Oh, they are also giving me a copy of her file and xrays, etc. Since I am not sure what they will say Monday being the same hospital, should I bring the file to another vet? I can't go on without sleep and this horrible guilt and anger forever. Thanks for any advice.

Online vet, Dr. Marie

Dr. Marie replied:

I'm very sorry to hear of Kiggy's passing. It sounds like things happened very quickly and as such it must have been a very difficult situation for you. I'll see if I can help explain some of what may have been happening.

I have had cases like this where I have called owners to say they needed to come right away because their pet was passing away. Most likely, if your vet called you to come urgently, then they really did feel like death was imminent.

I hate situations like this because, from experience, I know that if I don't act quickly, we are likely to have an unpleasant situation on our hands. When an animal is dying from renal failure, often the animal will have seizures and will do something called agonal breathing where they are desperately struggling to breathe. Both of these happen just before death. Sometimes they can happen very quickly and then the animal passes, but I have had cases where the animal really struggles and the process of passing "naturally" from life to death is really horrible. So, when I see an animal that is showing signs of nearing death I really do want to euthanize the animal quickly before it shows these horrible signs of struggle.

The procedure of the two shots given is quite normal. Often there is more time between the two shots. But, if the animal was sedated enough after a short period of time following the first shot (which can often happen if an animal is in the process of dying), or if she was showing signs of distress, then it is quite reasonable to followup quickly with the second shot (which is the one which causes the heart to stop completely).

The medication that we give for this shot that stops the heart usually is something called pentobarbital. It is extremely humane. It immediately anesthetizes the brain so that the animal is completely unaware of anything. And then, it causes the heart to stop. It is the kindest way for an animal to pass away. One unfortunate thing though is that, because it affects the brain so quickly, the animal's eyes usually do not have time to close. I would say that 98% of the time when I do a euthanasia, the eyes remain open after death. I have had many animals that will have their tongue stick out after death as well. This is not a conscious reaction, but simply a muscular reaction of the body.

I'd like to address the issue of whether or not treatment should have been offered to you instead of euthanasia. There are different stages of renal failure. There is a staging methodology that vets use called Iris Kidney Staging. This method places cats in one of four stages of renal failure. (If you are looking at the link, please note that there are different units that can be used. The American units are the smaller number.) A cat in early, stage 1 renal disease will have a creatinine level less than 1.6. Stage 2 is 1.6-2.8. Cats in this stage of renal disease can usually be treated quite well for a period of time with medications and special foods.

Next, is stage 3 which has a creatinine level of 2.9-5. These cats usually are quite sick. But, we can sometimes get them feeling much better by administering intravenous fluids and giving medications. Then, if we can get the kidneys functioning properly again we can do some long term treatments with medications and special foods and sometimes subcutaneous fluids.

And then we have the stage 4 kitties. These cats have a creatinine level of greater than 5. This is a very poor sign. There are still some cats that will respond to intravenous fluids and medications like the stage 3 renal disease cats. But, most cats that are in stage 4 renal disease are close to death. The higher the number goes above 5, the worse the prognosis.

So, if we look at Kiggy's numbers, not only was she in stage 4, but her creatinine level was shockingly high at 10! Her chances of survival were very small. Also, a drop in temperature is a sign of impending death. What I don't know, as well, is how Kiggy was behaving. There are other symptoms that we can see that can indicate that death is near as well.

I'm a little uncertain, from reading your question, whether Kiggy was on intravenous fluids at the hospital. If so, this actually is the treatment that we use for chronic renal failure. We do several days of IV fluids to see if we can get the kidneys functioning again. However, if this were my case, and I had a cat with a creatinine level of 10 and a temperature drop of 1.5 degrees I would have advised greatly against trying further treatment. If Kiggy actually was on IV fluids and was continuing to have a temperature drop and was not doing well then there really was not anything else that could have been done.

I understand how difficult this type of situation is because I have been there many times. As a vet, I do the best I can to give my clients options. The most important factor in my decision, however, is that the animal doesn't suffer.

It sounds to me like your vet did everything that I would have done. And please know that I am not just saying this as some sort of a "vet brotherhood". I also know that the grief of losing a pet can sometimes be extremely overwhelming. It is very common for pet owners to second guess themselves or to express anger at their veterinarian when they are grieving. I know this because I have experienced it! In fact, just yesterday I had clients who were yelling at me because they felt I didn't give their dog enough sedation before administering the IV injection for euthanasia. We do the best we can, but I recognize that most people have difficult controlling their emotions in hard situations like these.

Please know that it is normal to have these difficult emotions, especially when the final decision making has to be done so quickly as it was in your case.

I would urge you to really really think this through thoroughly before reporting the veterinarian to the state board. In my opinion, the types of cases that should be reported to the board are ones where there was gross negligence. In this case, it's possible that communication could have happened better. (I think it was likely rushed so that the vet could euthanize Kiggy before she started to suffer). But, it really doesn't sound to me like there was negligence. A complaint is not likely to cause anything to change here, but will cause distress to the veterinarian.

I still think it is a good idea for you to have a meeting with the senior veterinarian. You can review the details of the case and get their opinion on how likely it was that further treatment could have been offered. If you feel that your original vet didn't communicate well with you, perhaps you could ask the senior vet to speak to the veterinarian about this. As vets we are constantly learning and adapting how we handle different situations.

I truly am so sorry for your grief. Please know that you did all you could for Kiggy.

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Hi Dr. Marie!

Thank you very much for giving me so much time and information. There were lots of things that we never got to cover with the vet, because all she told us was basically the cratinine and BUN level and that temp had dropped. I was concerned about the diagnosis as CRF in particular, only because my partner is a surviving kidney/pancreas transplant patient. The other day after Kiggy had passed, we noticed Rugby biting at something on the floor. It turned out he had a TYlenol in his mouth, which we luckily got away from him without him eating any of it. But my partner had suffered for 42 years with type 1 diabetes before we added end stage renal failure onto that for 6 years. He is not very clever with his hands, and has dropped pills such as Cellcept, Prednesone and Prograf. Some of them I discovered while vacuuming under his desk. Do you think the blood tests that would have been done would have shown these drugs in her system, or would they have had to be looking for them? I never realized there was CRF and ARF, and even with her numbers, I realize even with an ARF diagnosis that the damage was very bad. I honestly dont want to cause trouble for the vet, but I hope she will learn that in this, or any, type of critical diagnosis that people need to be informed and have a conference so they can make a sound and informed decision. I had to learn all this on my own, and that left the door open to lead me where I am now. You know, there were other odd things in her file, like she said we brought her in also because she had been drinking too much water; she had not been drinking any... the report says abdomen was palpable and on the next line it was not palpable. She was only in the hospital for 24 hrs and had less than 1 bag of fluid rehydration and that antibiotic that lasts for weeks. That's it. I wasn't too keep on the temperature drop, but that from reading I guess can be caused from many different things. In her 14 years of life, she had never been out of her home. THis was Kiggy's first venture into the world she had never seen, and her last. One thing I will always remember was how wide her eyes were when they were walking her through the halls, like everything was so overwhelming and new for her. Having come so close to losing a partner to renal failure, I know all to well how it can play out, luckily we never made it to the seizures or convulsions. But he had in home dialysis I had to administer myself. I had just hoped we could rehydrate her at home, I would have done this hands down, and medicated her so where she could spend some time with us before the inevitable. Just even for 1 day would have made a world of difference. Euthanasia at home would have been my preference too. I doubt I'll file a complaint, as long as they can reassure me she had limited time, and that they will promise me they will always sit people down first before recommending anything.

If you can answer these questions for me, I'd appreciate it. I don't want to keep bugging you. Oh one last thing, this is now the most important question I have, and I'm serious. Is the Rainbow Bridge a real place?

Thank you so much for your information. IT really did help alot.

Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome.

I can understand that this situation would be even more difficult for you given what your partner has been through! One thing, if it is any consolation, is that renal failure is probably the most common way for a cat to pass away.

This really doesn't sound like Tylenol toxicity. Tylenol is toxic to cats but causes liver and blood issues, not increased renal enzymes. What you have described is really not likely to be because of drugs at all. Plus, it is quite uncommon for cats to eat pills like a dog would.

Regarding "palpable" that depends on what they are describing. "Palpable" just means something can be felt. So, it's possible that they couldn't feel the kidneys but they could feel the bladder. They kidneys would be not palpable but the bladder would.

I don't know that anyone can answer your question about the Rainbow Bridge. Here is my thought. I am someone who deeply believes in God. The bible talks in several places about animals being in heaven. There is a place in Genesis where it says that every animal will need to give an account to God. So, yes, I believe that our animals go to heaven and I really do believe that we will see them again one day.

Dr. Marie.

Customer reply:

Ok. I did have just one more thought, I'll prob. get this answered later today if we make it to the meeting (My car almost blew up last night, radiator fail!). If she had been drinking water normally, would her levels have been lower? Does drinking water affect the creatinine level as well as BUN? She did not drink and would only eat certain foods. Oddly, cold cuts wuld snap her out of her lack of wanting to eat and she'd eat ALOT of them, even a couple days before she died... but not wet food. I ask this because I dont think she had the typical "loss of appetite or thirst". She wuld come out, even the night before we took her in, and sit at her water dish or sit at her food for a while. I'm sure she was hungry and thirsty, but would not drink or eat. Why would she sit there at her water and food if she had a loss of interest in eating?

Anyway, I think I've used up more than my $8, you've been a big help. I will try to send a little more $ if I can.

Thank you.

Online vet, Dr. Marie

Dr. Marie replied:

Yikes! Sorry to hear about your car!

The amount of water that a cat drinks does not affect the kidney enzymes. However, some cats in renal failure will be very thirsty, simply because the kidneys are letting too much water out via the bladder. I have seen many cats though that did not have a perceptible increase in thirst.

Similarly, most cats with renal failure will have a lack of appetite. But, I have seen cats that will look like they want to eat (i.e. sit at the food dish) but not eat. My thought is that these cats know that they need to eat but when they start eating they feel naseous.

Regardless, the numbers don't lie. Those kidney enzymes were extremely high and I can't see any other possible outcome to her scenario.

Regarding the payment, it is totally up to you, but you should see a button to leave a bonus, if you feel that that is appropriate.

Thanks so much,

Dr. Marie.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.