Euthanasia difficulties.

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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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.

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.