Monday, March 31, 2008

Euthanasia - Easing the Final Transition

EUTHANASIA: Easing the Final Transition

Whether your horse is in perfect health or facing the challenges of age, illness or injury, the reality is that any horse owner can be forced to confront the heart-wrenching issue of euthanasia at any time. Making the decision to end a beloved horse’s life is never easy, but if you haven’t prepared yourself for this eventuality before it actually happens, the experience can be even more difficult. For this reason, it is worthwhile to become educated about the process of euthanasia so that if and when the time comes, you will be as ready as possible to help your horse – and yourself – through that final transition.

MAKING THE DECISION

For many people, the most difficult aspect of euthanizing a horse is deciding whether or not to do it. Veterinarians can tell us if a horse is suffering and recovery is unlikely, but they can’t make the decision for us. If there is even a slight chance at recovery, we may feel compelled to keep trying – despite the fact that treatment may be impractical, of questionable value, or far beyond our means. Even in hopeless cases of catastrophic injury or devastating illness, many horse owners struggle with the idea of “giving up” and letting go. Such reluctance is natural when contemplating the loss of a treasured companion animal, but ultimately, the horse’s welfare must take precedence over our own emotions. To help owners with this difficult decision, the American Association of Equine Practitioners (AAEP) recommends that horse owners discuss the following questions with their veterinarian:

- Is the horse suffering?
- How long will the horse experience the current level of pain or debility?
- What is the likelihood of recovery or at least a return to pasture soundness or some level of usefulness?
- Does the horse continue to show an interest and desire to live, or has it become depressed or despondent?
- What kind of special care will the horse require, and can you meet its needs?
- Can you continue to provide for the horse financially?
- What are your alternatives?

Veterinarian Christine King, of Bellevue, WA, advises horse owners to focus on the animal’s quality of life (QOL) – especially the issue of pain – when wrestling with the prospect of euthanasia. As she explains, “If the animal appears to be in severe pain, but the condition is such that the pain can be managed and there is a reasonable chance for a comfortable life in time, then it is fair to keep trying - as long as the horse is on board with that decision. If, however, the pain is severe and unmanageable, and there is little hope for improvement, no matter how long you keep at it, then I feel the most compassionate course of action may be euthanasia.” As for indicators of pain, one should look for abnormalities of movement such as reluctance to move, severe lameness, or a hunched stance, as well as decreased appetite and a depressed attitude. “These are reliable indicators of QOL in horses,” King says, “but there are others. If you know the horse well, it's pretty easy to tell when he has had enough.”

Many horse owners, in fact, have felt that their horse made it clear to them when the time had come to say goodbye, and King encourages people to trust their intuition on this. “I find animals to be very eloquent in their desires,” she asserts, “if we're paying attention.” Unfortunately, King and many other vets have witnessed numerous instances where people are so determined to save a horse that they prolong its suffering beyond the horse's will to go on. “That's the bit that distresses me the most,” she says. “There are worse things than being dead, and living in severe and unrelenting pain is one of them. It is a selfish act to make a horse go through that, just because you don't want to let him go.”

Sometimes, however, we may not be sure what the horse is feeling, or we may simply not have a thorough enough understanding of the horse’s prognosis to feel comfortable making such an irrevocable decision. It is important to know that it is okay and quite normal to have doubts, or to waver back and forth in your decision making process. In this situation, your best ally is information, so ask your veterinarian as many questions as you need to.

UNDERSTANDING THE PROCESS

Krista Dickinson, CVT, is a veterinary technician who works and teaches at the equine hospital at Colorado State University Veterinary Medical Center. Part of her job involves teaching senior veterinary students how to perform various medical procedures, including euthanasia. She is passionate on the subject, and is actively involved in developing new protocols to make the process as stress-free as possible for the horses being euthanized, and for the people performing and observing the procedure.

For horse owners, Dickinson believes that one of the most important aspects of the process is education. “Once euthanasia has been determined to be a potential treatment option,” she says, “then education about the procedure needs to begin. For most owners, the decision to euthanize a horse is complicated, emotional, stressful and sometimes agonizing, even if it is the best or only option for their animal. It requires clear, concise communication between the veterinary professional and the owner about what is to happen. End of life issues are forever, so this is the time to minimize regret around this event if possible.”

To that end, Dickinson makes sure that horse owners understand how euthanasia takes place, and what they may witness if they choose to be present while it happens. As she explains, “I ask the client if they have witnessed the euthanasia of a horse before. This gives me an idea of their level of understanding, but even if they have seen the procedure done, the explanation continues regarding how the procedure is handled here at CSU. If possible, I show them the anesthesia induction area where we conduct most ofour euthanasias, particularly when clients are going to be present. This provides a visual for the owner to help them understand the process, and it also gets them into a quiet environment so they can focus on the important decision at hand. I tell them that this area is where we will place the catheter to ensure drug delivery, and if the horse seems distressed, we can administer some sedation first to calm him.

“Once the horse is sedated and the catheter is placed in the vein, the horse will be moved into the induction stall, just a few steps away. I like to show the client how the horse will go into the stall, where the head will be and where the client will be able to stand. After the horse is quiet and settled into the induction stall, the client may stand athis head. At this point, the client can spend some time with the horse if theywould like. They let us know when they are ready, and we will begin.

“Before administering the euthanasia solution we ask the client to move back a few steps. This is a safety precaution, as the horse drops down upon losing consciousness. The euthanasia solution we administer in the vein is an overdose of an anesthetic drug which will bring on unconsciousness within moments. When unconscious, the horse will go down. If in an induction stall they stay sternal, but if they are standing, they often sit back and then go down in the front end or fall to the side. Someone will be guiding the head down with a lead rope. Once the horse is unconscious, he will no longer be in pain or aware of what is going on.

“However, once the horse is unconscious and down it may take several minutes for the drug to stop the heart and breathing. Unconscious horses can have some physical reflexes which may be seen at this time. The eyes may stay open, and there may be paddling or stiffening of the legs, some deep breaths, muscle twitching, urination and/or defecation. After the horse has been pronounced dead by checking for pulse or heart beat and checking corneal reflex, the client is allowed to spend some time with the body if they wish.” The process Dickinson describes is what can occur under ideal circumstances, but she points out that even in a hospital, it does not always happen that way. “The euthanasia of a horse can be complicated by a variety of factors such as severe trauma, urgency due to overwhelming and uncontrollable pain, body condition, multiply organ failure or the inability to move the patient to a safe area.”

There are also emergencies or remote situations where getting a vet out to perform a lethal injection is not an option. In such cases, the next best choice is to dispatch the horse with a correctly and carefully placed gunshot. Considered humane by the American Veterinary Medical Association and the AAEP, euthanasia by gunshot can nevertheless be very disturbing for the horse owner to witness. As Dr. King explains, “If euthanasia is to be performed using a bullet to the forehead, expect that the horse will drop suddenly to the ground as soon as the gun is fired, unless the horse is already lying down. Perimortem limb movements and breaths are more likely with this method, and there may also be bleeding from the ears and/or nostrils. This form of euthanasia is humane, as death is instantaneous. However, in our society the use of firearms is all too often associated with acts of violence, so people witnessing this form of euthanasia must be prepared for the shock of hearing a weapon fired and seeing the horse fall if it is standing at the time of death. It can feel like a violent act to an observer, even though it is a humane form of euthanasia when performed correctly.”

As stated in the UC Davis booklet The Emergency Euthanasia of Horses, “The proper location of gunshot penetration is important in the destruction of the brain and minimizing suffering. The optimal site for penetration of the skull is one-half inch above the intersection of a diagonal line from the base of the ear to the inside corner of the opposite eye. The firearm should be aimed directly down the neck, perpendicular to the front of the skull, and held at least 2-6 inches away from the point of impact. When performed skillfully, gunshot induces instantaneous unconsciousness, is inexpensive, and does not require close contact with the horse.

“A .22-caliber long rifle is recommended, but a 9mm or .38-caliber handgun will be sufficient for most horses. The use of hollow-point or soft nose bullets will increase brain destruction and reduce the chance of ricochet. If a shotgun is the only available firearm, the use of a rifled slug is preferred.

“This method should only be attempted by individuals trained in the use of firearms and who understand the potential for ricochet. Care must be taken to minimize the danger to the operator, observers, and other animals. Personnel must comply with all laws and regulations governing the possession and discharge of firearms; local ordinances may prohibit the discharge of firearms in certain areas.”

The only other methods of euthanasia considered to be humane are the penetrating captive bolt (a method commonly used in abattoirs) and exsanguination (massive blood loss). Exsanguination is caused by severing the carotid arteries and jugular veins on both sides of the neck, but as this causes both pain and distress to a conscious animal, it should only be performed if the horse is already unconscious. Methods considered unethical and inhumane include manually applied blunt trauma to the head, injection of chemical agents into conscious animals (e.g., disinfectants, certain electrolytes such as KCl, non-anesthetic pharmaceutical agents), air embolism (e.g., the injection of a large amount of air into the circulatory system), and electrocution with a 120-volt electrical cord.

DO YOU WANT TO BE PRESENT?

Fortunately, in most cases it is possible to have a veterinarian perform the euthanasia, and people generally have some time to consider when, where and how it will take place. Nonetheless, not everyone is comfortable witnessing the euthanasia of a horse, no matter how well controlled it might be. Says Dr. King, “It is a highly personal decision whether or not to be present, and wherever possible I try to honor the individual's choice, even if it's not the choice I would have made for them. Some people absolutely want to be present, no matter how difficult it may be to witness, mostly out of loyalty to their horse, I think. Other people know they won't be any use to their horse and may even distress the horse by being so upset, so they choose to say their goodbyes and then leave before the horse is euthanized. I respect both of these decisions.”

King also feels that it can be beneficial for children to be present during or soon after the euthanasia. “Death is a natural process,” she says, “and although euthanasia is an unnatural intervention, death itself comes to us all sooner or later, in one way or another. I think euthanasia can be a useful time for parents to instruct their kids about death and loss. But again, it all depends on the child and on the parents.”

Dickinson adds that being present doesn’t have to be an all or nothing scenario. “I have had some clients be there up until the euthanasia solution is injected and then they step out. They then return when the horse is down and spend time with the body. Meeting such end of life wishes for clients is an important key to help decrease regret about the euthanasia process. That’s why I feel education is so important, as information will empower the client to make the right decision for their particular situation.”

As many people do want to be present, Dickinson stresses that it is important for the veterinarian to minimize the risk factors that can make equine euthanasia difficult for the patient and distressing or even hazardous for the owner. These factors are reducing patient anxiety prior to the procedure, ensuring drug delivery, controlling body recumbence at the time of death and minimizing reflex activity. “To make the process as easy as possible for all involved,” Dickinson says, “we prefer to sedate the horse prior to administering the euthanasia drug. This calms the horse and allows us to place a catheter, which ensures that the euthanasia drug will be delivered completely.” Many veterinarians, in fact, are beginning to implement catheterization as a standard procedure. Says Dickinson, “Things can really go wrong if you are administering the drug with just a needle and syringe, as the horse may move suddenly and disrupt the delivery of the drug.” Some veterinarians still avoid the use of sedation, as it can slow the effects of the euthanasia drug in some cases, but many feel that the benefits outweigh this potential side effect.

In addition to advocating for sedation and catheterization, Dickinson has been exploring a new method that may make the euthanasia process even smoother. “Recently,” she says, “an equine medicine clinician and I have used a protocol where we give the patient sedation for catheter placement and movement into the induction stall, then induce unconsciousness with the same drugs used to anesthetize horses. Having the horse down and unconscious provides a small window of time for the owner to safely say a final goodbye before the euthanasia solution is given. This seems to provide for a smooth transition into the unconscious state, although it may take a bit longer.” The increased safety of this protocol may ultimately allow more owners to stay close to their horses in the final moments, which is currently against policy in some hospitals due to the potential dangers of a falling or struggling horse.

BODY CARE

Another factor best considered before the need for euthanasia arises is how you will dispose of the horse’s body, once the procedure is complete. It is easiest to take care of this right away, as delaying can make disposal more difficult and unpleasant due to rigor mortis and/or decomposition. Burial is the most common method for the management of a horse carcass, and if you have your own property, you may prefer the idea of burying your horse in a favorite spot in the pasture. However, it is important to find out what the regulations are in your area, as some jurisdictions have bylaws that specify where and how you can bury a large animal, and some do not allow burial at all. If you do intend to bury a horse at home, it is best to have the hole dug in advance, if possible, and to have a plan in place for moving and placing the body in the grave. You must be sure to choose a spot that won’t contaminate a well or water supply, and to bury the horse deep enough so that it won’t attract scavengers or spread disease.

If home burial is not an option, there are rendering services in someareas that will pick up and dispose of the carcass, and some pet crematoriums are set up to handle horses. Your veterinarian will likely be able to inform you as to what is available in your area. Again, it is best to gather this information and the necessary contact numbers before you ever need them, as this will help to minimize your stress during what is likely to be a difficult and emotional time.

COPING WITH GRIEF

Horses, once considered little more than tools to help with farm work or transportation, are now often seen as treasured pets, friends, or even as part of the family. Many of us spend hours a day with our horses, and their presence is an integral part of the fabric of our lives. As such, the loss of a horse can engender tremendous grief, a fact that is becoming much more widely recognized and accepted. If you allow yourself to grieve and those close to you respect the depth of your feelings, you may find that you have enough support from family and friends to cope with the natural progression of the grieving process. If, however, you feel overwhelmed by your emotions or you are not getting the support you need, grief counselors specifically trained to help people cope with the loss of a beloved animal are now widely available, as are pet loss support groups, online grief information and support, and telephone hotlines (see sidebar). Make use of these services if you need them, as there is no shame or weakness in seeking help for a loss that can be completely life-altering.

Resources available to help those grieving the loss of a beloved horse include:

- The Ontario Veterinary College’s Pet Loss Support Hotline, (519) 824-4120 x 53694, www.ovc.uoguelph.ca/petloss

- The UC Davis School of Veterinary Medicine's Pet Loss Support Hotline, (916) 752-4200, www.vetmed.ucdavis.edu/petloss

- The Argus Institute at Colorado State University, (970) 297-1242, www.argusinstitute.colostate.edu.

The Association for Pet Loss and Bereavement, (718) 382-0690, www.aplb.org

REMEMBERING YOUR FRIEND

How you cope with the loss of your horse will be unique to you, but many people find that they want to do something as a tribute to their horse’s memory. Says Dr. King, “At some point, it can be really helpful to have a little ceremony to celebrate the horse's life and the bond you shared. Depending on the circumstances and the beliefs and feelings of those involved, the ceremony can take place before, during, or after (even years after) euthanasia. It can take any form that you like; it just needs to be a celebration of life and the completion of its cycle.”

To give horse owners a special place to remember their horses, legendary Canadian horsewoman Joy Richardson spearheaded the creation of a unique memorial garden, situated in a beautiful pastoral setting in Langley, British Columbia. It was when a very special horse was nearing his end that Richardson first conceived of the Spirit of the Horse Memorial Garden, which is made up of meandering brick walls, granite benches and a memory lane of inscribed bricks leading to a central courtyard which currently displays over 300 memorial plaques and personal messages. As she recalls, “My outstanding AQHA Champion, Hyline Gentry, at 27 was suffering with his feet and could not chew to any effect. He was my best friend and I hated seeing him suffer. For about a week before he died, Gentry and I had long conversations through our eyes, when I sat in his stall stroking him and we connected closer than ever. It was at this time that he suggested I help other people to remember and give tribute to their horses by creating The Spirit of the Horse Memorial Garden.”

Unique in Canada, the garden is a quiet haven for horse lovers to contemplate and celebrate memories of their faithful friends. Says Richardson, “I often visit and find people sitting on the benches with their memories and thoughts. Frequently, they will have found another person doing the same, which aids so much in the grieving.” She encourages people to think about starting a similar project in their area, or even to just create a personal place of their own devoted to the memory of their horse. “Having a special place and allowing ourselves time to just sit quietly, we remember so many things we did with our beloved horses, which helps bring them closer,” Richardson says.

Now in her 80s, the lifelong horsewoman has dealt with euthanasia on a number of occasions, and has this advice on the subject: “What I say to all horse owners is that if you really love your horses, you will want them sent off to Horse Heaven kindly and without suffering. Be with them if you are not too emotional, which they will pick up on, or ask someone else to be with them and leave the property. Always tell the horse what you are doing for them, as they do think and understand. After a while, do something meaningful to you to carry on the memories.”
Keeping such thoughts in mind may help you should you be facing the prospect of euthanizing a horse. It will never be easy process, but if you understand that a good death is a gift of love, you will be able to make peace with your choice.

1 comment:

Anonymous said...

Taking a keepsake of mane or tail hair is a wonderful way to keep their physical presence with you.