I’ve always been the vet for my pets, handling their medical needs and surgeries as they aged and ensuring that their care was as Fear Free as possible. When I became a relief vet in 2020, filling in at different clinics around my area, I no longer brought my pets to work. I took on more of a client role, bringing my pets to appointments and consulting with two wonderful vets who help guide their medical care.
However, one thing I was not willing to give up was being a Fear Free advocate for my pets. I medicated them with anxiolytics for their visits, pre-applied EMLA numbing cream to the areas of the skin where they would be getting needle pokes, packed high value treats, and waited in the car until an exam room was ready to avoid the stressful reception area.
A few months ago, I was reminded of the value of being a Fear Free advocate when I was faced with the declining health of our 16-year-old cat, Mr. B. He was already living with multiple chronic health issues, including hyperthyroidism, chronic kidney disease, hypertension, and early heart disease, but all had been stable for years. I only know this because he had a relatively low fear of the vet that could be managed with delicious treats and pre-visit gabapentin, and he was easy to bring in for frequent monitoring and diagnostics.
During a routine visit to the cardiologist, I was shocked to learn his heart disease had worsened, and he had even gone into early heart failure. Within a few weeks of starting diuretics, it was clear his kidneys were being affected and his appetite started to decline. Only six weeks after his visit to the cardiologist, he started getting that dull, tired look on his face that pets get when they’re not feeling well, and I knew it was time to schedule his euthanasia. Even though Mr. B didn’t get that stressed at the vet, I wanted him to be euthanized at home, where he could be as comfortable as possible amid the familiar smells and surroundings.
Based on word-of-mouth from other veterinary professionals, I reached out to Lap of Love, a national in-home euthanasia and hospice company, to learn more about their process. I learned that based on the individual situation, he would either receive his sedation injection under the skin (subcutaneous) or in his muscle (intramuscular, or IM). It’s common for pets to receive sedation before the actual euthanasia injection to make the process smoother for the pet and the humans involved. However, as a Fear Free vet and cat parent, one of my biggest stressors during this time was the thought of Mr. B experiencing pain before he was euthanized. Pain also increases fear, and I wanted Mr. B to have as Fear Free a euthanasia as possible.
I made a Fear Free checklist for Mr. B’s last day and added items to it as his euthanasia day approached. The morning of his appointment, Mr. B (an indoor-only cat) got to have some backyard enrichment on harness and leash, feeling the grass under his feet, smelling the air, and attempting to gnaw on some plants. He always loved being brushed, and he had a nice brushing and some solid lap time.
He got numerous treats, but I was careful to make them small to ensure he would still be slightly hungry leading up to his euthanasia, which is a Fear Free trick recommended before vet visits so pets will still be motivated to eat treats at the clinic. I also used a Fear Free concept called the Treat Ladder, where treats are ranked from lower value (bottom rung) to highest value (top rung). At the vet, Fear Free professionals use lower value treats for less stressful handling, and save higher value treats for more stressful handling so the pet can continue to be distracted and stay calm. While Mr. B got to have a few tiny chicken shreds that morning, I saved a big pile of chicken and packets of Churu in preparation for his sedation. Three hours before his appointment, I gave him gabapentin, and prepped him the hour prior with EMLA cream in the areas where I thought he might get an injection.
When Dr. Kelly arrived, she was supremely compassionate. I told her about my fears of Mr. B receiving a painful needle poke for sedation and shared my Fear Free plans, and we worked together to keep Mr. B as comfortable as possible. I reapplied EMLA cream on his right hind leg and smeared a couple of packets of Churu on a lickmat that I topped with shreds of chicken. I wanted Mr. B to be sedated in the room facing the street because it was his favorite, where he would spend hours every day nestled in his heated cat bed and looking out at the world. A non-slip mat and Feliway-spritzed towel were placed under Mr. B, because I wanted him to have a cozy, calming surface. I put the lickmat on the pet stairs at the level of Mr. B’s face so he could stand comfortably facing away from us with minimal restraint, being mindful of his arthritis and avoiding increasing FAS with excessive restraint. He quickly started scarfing away with gusto, and to my relief, had absolutely no reaction to the needle poke.
As Dr. Kelly slowly administered the injection, within 20 seconds Mr. B’s eating slowed, and his sedation deepened. I carried him over to the couch and held him in my lap, petting him while he was smoothly, humanely euthanized. Afterwards, I was invited to accompany his body to Dr. Kelly’s car to give him one final kiss and say goodbye.
Reflecting back on the experience, I came away with several realizations. One is that as a pet parent, you may never feel 100 percent comfortable with your decision to euthanize your pet at the time. In the few days before I called Lap of Love to make the appointment, I felt myself touching on the idea of euthanasia, but not really accepting it. Mr. B would eat a certain treat, or play for a few seconds, and it seemed like he might be okay for a while longer. I took and retook the quality of life assessments from Lap of Love and The Ohio State University websites, finding that my assessments changed even overnight. Between the Sunday when I made his appointment and the Thursday of his euthanasia Mr. B had declined further, but it was still difficult to accept. It was only after he was gone that I finally knew it had been the right time and the right choice.
Second, I’m so grateful to live in an area where in-home euthanasia services are an option and will have all of my current and future pets euthanized at home when possible. Many vet clinics will also perform housecall euthanasias for clients, so if your pet is starting to have quality of life concerns, talk to your vet about whether this is offered. Finally, don’t hesitate to advocate for your pet in any way that you feel is fitting. You know your pet best, and it’s stressful and even traumatizing to see their emotional health impacted. Communicating your pet’s likes and dislikes with veterinary staff members will help them have a Fear Free experience, just like I did with Mr. B.
It’s now been 2 months since we lost our little grandpa cat. We spread his ashes in our yard so he can continue his adventures, and we think of him often, especially since we’re still finding orange cat hair around the house. As difficult as his final days were, I look back on his euthanasia day with peace, knowing that I did everything in my power to ensure that he had as much of a Fear Free death as he had a Fear Free life.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Dr. Julie Liu is a Fear Free and Cat Friendly veterinarian, speaker, and freelancer based in Austin, Texas. Dr. Liu has a special for a special passion for felines and senior pets, and loves travel. Learn more about her work at www.fluxvet.com.
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Published March 27, 2023