Yes and no. Dogs and cats won’t tell us they are in pain by yowling or whining in the majority of cases. Cats in particular, are wonderful at minimizing their displays of pain. Dogs also tend to keep their expressions of pain subtle. In this regard, they do seem to hide their pain. BUT- dogs and cats do not truly, fully hide their pain. We just have to recognize their signs.

Dogs: Rarely vocalize unless pain is sudden and unexpected (like a stepped on toe) or excruciating. They may have a decreased appetite, or become very picky about what they are willing to eat. They may tremble or pant excessively. These may also be signs of anxiety, which often increases with pain. They may have a sad or tense look to their face. Sometimes you will notice that they no longer get up to greet you as they once did. When they are standing, they may have a crouched down posture, or be standing with their back arched up more than usual, and their belly tucked in. They will commonly avoid stairs. Bathroom breaks may be long, they may not be able to squat or leg lift as normal, and they may have to take steps while urinating or defecating. Perhaps the most logical, but overlooked sign is limping or stiffness. This is very common in older dogs with osteoarthritis, but families often fail to connect the the act of limping to the experience of pain. We should think of it like this- we do not limp when we do not hurt. Neither do dogs.+

Cats: They really, really don’t want to be open about their pain. The clues the give are very subtle, and sometimes seem totally unrelated to pain. Perhaps the most universal sign that something is wrong with a cat (pain or otherwise) is that they begin hiding or resting in unusual places. This may be under the bed, behind the couch, in the back of a closet, or a room that is infrequently used. Sometimes they are just much more grouchy than usual. Their ears are flattened and they are in a crouched position. They may not tolerate physical touch that normally be welcome. They may not be grooming themselves normally, and they likely don’t want you to do it either. Their appetite may be decreased. For cats with orthopedic pain like osteoarthritis, it is common for them to no longer jump on to beds or counters or other furniture that they frequented before. They may also struggle with their litterbox behaviors. Sometimes, they will have trouble getting into or out of a box due to their pain, and will instead choose to eliminate just next to it instead. Sometimes they are able to get into the box, but cannot get into the correct position, and therefore only partially hitting their target. Other times it is as subtle as failing to cover their bowel movements, or as dramatic as completely giving up on traveling to the litterbox at all. escription text goes here

The most important thing to remember when you try to answer this question is that suffering encompasses many aspects of a pet’s condition. It is not limited to pain, as we most often tend to think. Of course, unrelenting or severe pain does cause suffering. But if you ask the question “Is my pet in pain?”, and the answer you get from your vet is “no” or “probably not much”, that does not mean that your pet has an acceptable quality of life and is not suffering!

Other forms of suffering are easy to see, once we include the in our definition of suffering.

Nausea (with or without vomiting) is a big one. It has been described by human cancer patients as being worse that pain. It is no less unpleasant for dogs and cats, especially when it is prolonged or recurring. Signs of nausea include vomiting, excessive drooling, lip smacking and turning their head away from offered food or water.

Difficulty breathing is a particularly frightening situation. Breaths may seem more shallow and/or rapid than usual. You may notice that they seem to be moving their abdomen more than usual when they breathe. As you might expect, there may be unusual sounds like wheezing, gurgling or raspy, harsh noises when inhaling or exhaling. They may not be able to get comfortable easily, and may avoid lying down if it worsens their difficulties. When a pet feels like they cannot get an adequate breath, they may stand with their head and neck extended forward and their elbows turned out, away from their chest. When they do lie down, the may stay on their chest, rather than lying on one side, and will extend their head and neck forward. These are instinctive efforts to make a straight path for air to flow from their nose/mouth to their lungs, as well as to provide more room for their chest to expand. Unfortunately, this may make little difference, depending on the cause of their difficult breathing. Sometimes a pet may look wide eyed and frightened when they are struggling to breathe. With good reason, as this is extremely anxiety- inducing.

Psychological/Social suffering is perhaps the most overlooked variety of all. You could think of it like this: you are aware of what is going on around you, but you are no longer able to move on your own. Unless someone moves you, you cannot joint the rest of your family as they move from room to room. You can hear them carrying out the normal routines of life that you use to be a part of, but now you just can’t join them. You are bored and lonely, and in pain. The most comfort you find is from being with your loved ones, but you must wait until they have time to come to you. You become increasingly anxious, worrying that nobody will come to you when you need them to. Since you have been feeling worse, you want the reassuring presence of your loved ones more, but it is up to them to come to you. You are depressed by your isolation. Now let’s put this back into our perspective- “you” are a 14 year old lab mix with severe osteoarthritis. You can no longer bear to pull your legs under you to get up due to the terrible pain in your joints. Even, if you could stand that, you no longer have the muscles to accomplish it. Sometimes your family can help you stand, maybe with a towel or sling, and give you enough support to go outside to potty. Unfortunately, you can’t always stay balanced on those painful legs to finish all of you potty break. And sometimes that means you have a bit of incontinence in the house, wherever you lie. That’s pretty stressful because it is completely unnatural, and against all of your training. Once you are inside and resting again, you are often alone in your bed. You used to lie under the table at dinner time. You slept in the bedroom with your people. You played with your family in the yard, retrieving every tennis ball every tossed. You jumped up eagerly to greet everyone who came to the door. Now you can only woof from your resting place, and maybe give a few tail wags. Your four-legged siblings use to be great friends that you loved to tussle and run with. But they seem unsure of you because you are definitely not yourself. Sometimes they avoid you. Sometimes they want to challenge you, since you are no longer the top dog by virtue of you health. Or maybe you are no longer glad to see them because you fear them stepping on you or jostling your painful body. You growl to keep them away. Everything about your social dynamic is up ended now that you cannot participate normally in your family’s daily events. There are no normal interactions with anyone. Pain and sickness cause anxiety. Boredom and loneliness lead to depression. Loss of normal social dynamics exacerbate both of these. This is truly a tragic, terrible form of suffering that families often fail to consider.

If your pet, regardless of age, has been given a life limiting or terminal diagnosis, they will benefit from hospice support until it is time to tell them goodbye. Most often, hospice care is expected to be for 6 months or less. Pets enter hospice after having received their diagnosis from the regular vet or specialty vet. Having a specific diagnosis is important to providing the best hospice support, both for management of symptoms, but also for supporting the family and being able to answer their questions about what to expect in the coming weeks and months. There is no attempt or intent to cure the condition or to treat aggressively. The only focus is on maintaining a good quality of life for the time that it is possible to do so. Some examples of diagnoses/conditions that would benefit from hospice are cancers, end stage congestive heart failure, end stage chronic kidney disease/kidney failure, respiratory disease, end stage chronic gastrointestinal diseases, orthopedic conditions like end stage osteoarthritis, neurological conditions and end stage cognitive dysfunction. Hospice programs are intensively focused on comfort care and caregiver support, and visit frequency is general dictated by this. As your pet’s condition worsens, visits need to be more frequent in order to adapt to rapidly changing conditions, and to be able to work closely with the family to monitor quality of life and make end of life decisions.

If a pet has a non curable or chronic condition that limits their quality of life, but is not expected to shorten their life as severely, they may benefit from a palliative care program. This means that the focus will be on comfort care and symptom management, but will not be aimed at aggressive treatments or trying to cure the disease. Often, these pets and families do not require as intensive support as those facing the rapid decline of some of the more imminently terminal conditions that warrant hospice, and visit frequency is general much lower. As these patients age and the cumulative effects of their condition and the aging process begin to take a greater toll on them, they may need to transfer into the hospice program.

If you are not sure, just ask us!

In a perfect world, we would always have an exact diagnosis for a pet when beginning hospice or comfort care. That helps ensure proper hospice support and comfort measures. It also rules out the possibility that the real problem is something that could be cured. However, reality does not always work out to this ideal, for a variety of reasons. Even without a specific diagnosis, it is often possible to improve your pet’s quality of life. Scheduling and Quality of Life Consultation allows us to discuss the concerns you have noted, as well as your worries about your pet’s future, and your thoughts or questions about their end of life. If there are overt or suspected symptoms that can potentially be mitigated, we can discuss the options for doing so, and work together to decide what is appropriate for your pet and your family. If there are not options left to give your pet a good quality of life, we will have an honest, but gentle conversation about this.

Sometimes you will hear people say the “just knew” or “she gave me the look”, and there you are floundering in this awful sea, wondering how anyone could find such a clear answer. I think that there are very rarely precise answers that bring the instant peace and clarity we wish we could have. In hindsight, when grief has eased considerably, it can much easier to feel like everything worked out as it should, without questioning your past self’s decision. You can recognize what triggered your decision, and embrace it. I suspect if you asked them how they know in the moment, the same sort of words might come up, but with less of a sense of certainty, and a lot more sadness and fear.

This is truly one of the hardest decisions you will ever make, and one of the most painful losses you will experience. A frightening and confusing time is compounded by all the solicited and unsolicited advice that people always seem to give. “He’s still eating so he can’t be ready to go” or “Why don’t you put her out of her misery?”. “Why are you so upset, it’s just a dog (or cat)?” It is no wonder that this is so overwhelming and no wonder that this is such a common question

The truth is, there is no single set of circumstances that equal “It’s time”. This is one of the reasons we offer Quality of Life Consults. This allows us to help you help us answer this question. As we go through the process together, we will talk about the specific worries you have, and will complete a Quality of Life Scale (see the HHHHHMM Scale link on the resources page). This can be very helpful for channeling subjective and emotional thoughts into more objective information that can provide some clarity. This scale (and others like it) go through a variety of aspects of your pet’s existence, helps identify problems, and allows us to determine if we can make changes that will improve them. Quality of life is not simply appetite. I’ve seen plenty of pets that are very ready to be at peace but are still clinging to the enjoyment of their treats. It is not just mobility or pain, incontinence, confusion. anxiety, or any other symptom. It is about how the various changes in your pet’s body are affecting them overall. How much of what you have always thought of as your pet’s personality disappeared? How many of those were really important traits? What can they still enjoy? Is this as important as what they endure? How much are you comfortable asking of your pet? How they change and how they decline is as unique as they are.

Sometimes it comes down to trusting your gut- and your hospice vet- to guide you. Your heart tends to lie.

Really, nothing during the actual euthanasia. In fact, they are aware of very little after my arrival and greeting time. There are two reasons for this:

1. I ALWAYS give my patients heavy sedatives that reach the level of light anesthesia before doing anything else. I give this by means of a small injection, much like a vaccine. It may sting a little for some pets, while others don’t seem the least bit concerned. Either way, I do my best to distract from this bit of aggravation. After this is given, they get more and more relaxed and sleepy, and more comfortable as the pain medication included in their sedative begins to kick in. During this time, you and your family are able to talk to them, love on them and be their comfort and company. I want these moments to be the last things they know in this world, rather than me poking them with an IV. Generally in about 10-15 minutes, they are under enough sedation that they no longer are aware of anything else that happens. If for any reason, they don’t get as sleepy as I expect, I will always provide more sedative, rather than forcing them to tolerate anything more. I test their level of sedation by pinching their toes to look for any response, as well as assessing their overall relaxation. Only once they have reached a level where they no longer notice a good hard pinch, will I place the small IV that allows me to give the euthanasia solution.

2. Euthanasia solution itself is and extremely concentrated anesthetic. It works by very quickly taking the brain past the level of anesthesia, to the point where all of its processes shut down. That means that their brain passes before the heart and the rest of the body. So there is no possibility of them being aware of anything as the pass.

Definitely! Please give your pet their medications as usual. We don’t want missed doses to make them feel worse than necessary.

As far as feeding goes- let them have anything they want on the day of their appointment. So long as nausea, vomiting or aspiration/choking on food are not concerns for your pet, this is your chance to let them experience anything they have always sniffed after, but never tasted. Or to get full on their favorite treats. Steak, eggs, cheese, ice cream and even chocolate are options today, so long as they want to eat.

Absolutely! I encourage you to hold smaller babies, and to be close to and petting on large babies, to whatever extent you feel comfortable. As long as I can reach one leg, I have all the space I need.

Only worry about things that make you and your pet most comfortable. If they have a particular bed, blanket or toy that helps them feel comfortable, have these on hand. You may also want tissues and a water bottle, or other beverage, nearby for yourself. Some families like to have low lighting (which does not cause me a problem at all), soft music or even candles to help make the environment calm and peaceful. Whatever is most soothing for you and your pet is the way to go.

I will take care of things like blankets and towels for the trip to the crematorium (if this is your choice for aftercare), potty pads and bags for my trash so you can focus on your pet and your family.

This is an extremely personal decision for each family, and one that I am not qualified to answer. I think (as a mom who has faced this question when my kids were very little) that depends on your child’s personality, age, maturity, understanding of the situation, and both your comfort level with the idea, and theirs. I have made a few observations over the years, that may be helpful for you when considering your family’s decision on this matter.

1. The euthanasia process, as I go about it, is generally much more peaceful and quiet that people expect.

2. I will always be glad to answer any questions you or your children may have. With kids, I talk to them more like a mom than a vet, avoiding technical terms, but simply and honestly answering their questions, so long as you are comfortable with me doing so. I will always follow the parents’ lead as far as any descriptions that you may have already used to help them understand, and certainly about any after death beliefs (Heaven, crossing the Rainbow Bridge, seeing relatives or other pets that have already passed). I pick up subtle hints pretty well by now, so if you say something to them, I will go with that flow.

3. Children seem to be much less scared if they have had the chance to talk to you about what is happening (in general) and why it is happening (her body is tired and hurting, because she has gotten old, her body is failing and she doesn’t ever feel good anymore…) One of the best ways to decrease fear is by just enough knowledge. You will know what that amounts to, of course.

4. I’ve noticed that some kids, regardless of age, will come in and out of the room over the course of my visit. I think that is just what some people need to do to balance the need for involvement and connection with the need for an escape valve when the pressure is too much. Very young kids will often behave the same way, but they are often just following their interests of play, since they may not quite understand the gravity of the moment.

5. Some kids want absolutely no involvement. They choose to be in their room, sometimes even before I arrive. Perhaps they are nervous about what will happen, uncomfortable with everyone’s big emotions, or aren’t comfortable crying in front of a stranger. Everyone of us is an individual, and we have to process things like this the best way we can. Fortunately, when your pet’s passing is in your home, it allows more options for privacy and comfortable familiarity.

6. No two children, even from the same family, handle this incredibly tough situation the same way. Actually, no two adults do either. We all process grief and stress in different ways, and that’s okay.

7. As I said at the beginning, I am not qualified to answer the question of whether your child should be present. I’m just a vet with a lot of experience in this environment, including in my own home, with my kids at different ages and stages. Of course, you should always do what is right for your child, as best you can determine. If you have concerns about how your child is handling, or may handle the grief of losing their pet, please talk to your pediatrician or licensed therapist specializing in grief in children.

This is largely a matter of your family’s preference and your healthy pet’s temperament. If they are a comfort to you, or your ill pet, their presence may be very beneficial. However, if they would be an uncomfortable distraction for you, or have a tendency to be to rough around you ill pet, they may not be as helpful to have around. The only situation I would have any preference about is if the healthy pet is aggressive or extremely wary of strangers. Not only do I not want to have reason to change my focus from your ill pet, I would not want to create more agitation for an already emotionally charged situation.

Regardless of whether your other pet’s are present throughout my visit, it can be helpful to allow them to see their friend after they have passed. While they do not have the curse of anticipating their own death, they do seem to recognize death. When given the opportunity, some pets will be extremely interested in sniffing and inspecting their friend. Others are very focused on their human family and seem concerned by their emotions. Other pets will take a quick sniff and then are immediately off to something else (often my bag or shoes or clothes- I bring in all the interesting smells). Some do not approach at all, but instead pause and carefully sniff the air as the step into the room. Each of these responses is normal, and in every case, they realize death has occurred. Like us, they all have their own ways.

Having opportunity to see their deceased friend may lessen the grieving they go through later as a result of missing their buddy. Some pets will show grief (lethargic, clingy, decreased appetite, searching) regardless of what you do, but in most cases, it improves over a week or two. If it does not, or other signs of illness are noted, consult with your regular vet right away.

This is another extremely personal matter. While I would encourage you to stay with your pet, at least until their sedation is fully in effect and they will not know that you are absent, I understand that this is more than some individuals can handle, for a variety of reasons. If for any reason this is the case, consider asking a family member or close friend with whom your pet is familiar, to stand in for you. A familiar face can provide so much peace for your pet as they become drowsy with their sedation. They can also provide you with a trusted report that your baby passed peacefully. If this is also not possible, rest assured that I will be as gentle and loving to your pet as I would be with my own. I will make sure they are loved on and spoken to softly as they drift into their sedation, and then beyond.

HOW LONG DOES EUTHANASIA TAKE?

The euthanasia appointment will usually last between 45 minutes to an hour. This includes the time needed for introductions and discussion as needed, answering questions, signing forms and handling payment before hand. Afterwards, there is time for making clay paw impressions if you would like, and readying your pet for the trip to the crematorium if you have chosen to have us handle this. The process of the actual euthanasia consists of 10-15 minutes to allow a sedative to help your pet relax and become unaware of their surroundings, while your family is close by, loving on them and talking to them. Once your pet is fully sedated, I will place an IV, and once it is ready, the euthanasia medication can be given. This is generally done over 1-2 minutes. This medication works very quickly, and often, a pet will have passed by the time I am done administering it, or very shortly thereafter. I will then spend a few minutes as necessary to listen carefully to your pet’s heart so I can assure you that all is quiet and that your pet has passed.

Sometime this does happen. A pet may release urine or stool when their body becomes completely relaxed with their passing. In order to manage this, I bring disposable pads to place underneath them once they are sedated and comfortable. On much rarer occasions a pet may have fluid in their lungs or stomach due to their illness. In those cases, some fluid may flow from their nose or mouth as well. If this is likely, I will place a pad or towel under their head as well. If you would like to hold your pet during their passing, I will offer a pad for you to place in your lap, or you may choose a towel or blanket if you prefer.

There are a few options for the aftercare of your pet.

Burial at Home- This is a common choice for families. There are a few things you should keep in mind.

1. You are responsible for knowing and local city or county ordinances or HOA rules about burial of pets on residential property.

2. Graves need to be deeper than you think. There should be enough depth to allow for 3 feet of dirt above your pet’s body. I do not recommend burial in a box, as it makes achieving this even more difficult. I also do not recommend plastic bags, as they do not allow Mother Nature to do her job of returning your pet’s remains to the earth. Instead, use a cotton blanket or sheet as a respectful, natural way to shroud them.

3. Once you have filled in the grave, it is helpful to cover the entire area, going passed the margins of the grave by 6-12 inches, with hardware cloth or chicken wire, and weight it down very securely with bricks, cement blocks or large rocks. This prevents other pets or wildlife from disturbing your pet’s grave. Should another pet or wild animal manage to disturb the grave of a pet that was euthanized, not only would it be an emotionally devastating situation, if would also be fatal to the that animal if they were to ingest any of the remains. In the case of some wildlife species, this can result in you being heavily fined. If you are unable to bury your pet well, another option would be more appropriate.

Burial in a Pet Memorial Garden or Cemetery- There are a few places that offer this service, but the only one I have worked with is Deceased Pet Care’s Oak Rest Pet Gardens, located in Bethlehem. This is a beautiful, peaceful place, worthy of the fallen K9 officers that have been buried there. If you would like to look into this further, there is a link to their website on my resources page.

Cremation- This is probably the most common choice made by families. There are two options here.

1. Private Cremation- This means that your pet, and only your pet will be cremated. This means that their ashes can be collected and returned to you, and you can be assured that no other ashes are mixed in. If you would like to have your pet’s ashes returned, you will need to make this selection.

2. Communal or Community Cremation- In this case, your pet will be cremated with other at the same time. Therefore, their ashes will be intermingled and cannot be returned to you.

For either of these options, you can use the links for Deceased Pet Care and Paws Whiskers and Wags on my resources page to find more information about their services and pricing.

* Please note- I do not collect the fees for private cremations, but rather you will pay these to the crematorium directly. If you would like me to transport your pet to the crematorium after their passing, I am happy to do so for an additional transportation fee, separate from the euthanasia fee. I provide complimentary communal cremations with the transportation fee. See the services and fees page for more details.*

Or statements like “This must be the hardest part of your job”. “I couldn’t do this.”

It can be very hard sometimes. And there are vets that will avoid this if at all possible. It is the hardest part of their job.

For me, it is a beautiful balancing act.

It is hard when you see a teenager break down because his life long friend won’t be in his room at bed time. Or when a woman shares that the dog before me stepped between her and an abusive husband. Or that they cat that saw her from her teens to her thirties helped her through some difficult times of serious depression. Or a purple heart recipient explains how this dog saved her when she came home, and protected her from falls as a result of her injuries. Or when an elderly gentleman must say goodbye to his late wife’s dog.

And too many more unique moments to list… It is hard because my heart breaks with them, for them. It is hard because it is a pain that I know I cannot take away.

But it’s not so hard to do this when I see a pet that has been so strong for his family, despite the terrible pain he is in due to his bone cancer. Or one that has become lost in their cognitive dysfunction. Or the nauseous and dehydrated kitty with kidneys that have completely given up. This part is not so hard, because I get to bring them peace and freedom. Theirs is pain that I can take away.

The balance between the hard and the not hard is the place I stay. It is an honor to know that you trusted me to end your pet’s suffering, and it is an honor that you trusted me with your grief. It humbles me every time. It reminds me that what I do, the hard parts and the not hard parts, is a calling given to me by God, and that purpose is the reason I can do this every day.

Thank you to all who have or will invite me into your lives at such an important, hard time.

~ Dr. Kristen Arp