Understanding Dog Pain During Euthanasia
The Dreaded Euthanasia Appointment
What causes pain during a dog's euthanasia appointment? It's the day all of us dog owners dread, a time we all wish our pets will leave planet earth in a peaceful, pain-free way. They say euthanasia is the ultimate gift of love, the gateway to a place with no more pain and suffering. We imagine our dogs' tired and aching bodies healing and our dogs frolicking over the rainbow bridge. Yet, there are some very rare circumstances, where the euthanasia appointment turns out not being as peaceful as expected. And no, it wasn't the occasional, expected muscle twitch or a sigh to cause concern. Owners report that their dog's pupils dilated and their dogs acted out in sheer terror, panicking and screaming in pain. This is a hub that is not pleasant to write about, but I hope it offers some closure to those who wonder what happened to their pets in their last moments. I also hope it can help those in the process of making this decision understand that there are options to make the procedure more comfortable for pets.
Of course, there is no way to ultimately know what may have exactly happened, as there are several possibilities. Asking the vet, may ultimately be the most appropriate action as he or she may be better able to determine what caused the reaction. Some vets may attest that this has happened in the past and may have some theory as what may have gone wrong, while others may be as shocked as the owners and may be unable to provide a reasonable explanation. I know of many owners though that didn't feel like questioning the vet, either because at the moment they were overwhelmed with sadness or they didn't want to look as if they were blaming their vet for their dog's painful passing. I know of several dog owners who go home, and cannot get the last images of their dog's passing leave their mind as they wonder if their dog was really in pain, if it was perhaps some odd reaction to the drugs or if their dogs was simply just anxious. While mourning a pet is already an overwhelming situation, mourning a pet that has seemingly suffered during what was expected to be the end to pain and suffering, must be very difficult to go through. I can't imagine how it must feel. This hub will hopefully offer some clarity.
Does euthanasia cause a heart attack?
Many people believe that euthanasia stops the heart, causing something similar to a heart attack. This is far from true, explains veterinarian Cherie Buisson. Pentobarbital works by triggering unconsciousness which stops brain function. Because the brain is what tells the heart and lungs to work, when the brain stops functioning, the respiratory center is depressed, breathing ceases and the heart stops pumping. The pet is unconscious, so it's more like dying when being under anesthesia on the surgery table than dying from a heart attack.
Are Dog Euthanasia Appointments Painful?
The euthanasia appointment should be quite a quick, for the most pain-free process. Those who have read my hub about the dog euthanasia process or other articles have heard that it consists of an injection of of pentobarbital, a liquid barbiturate which was formerly popular for being used as a pre-anesthetic. Because this drug is given in an overdose amount, it has the power to put the dog to sleep as if undergoing anesthesia, but in this case, it will cause death by cardiac arrest. The term "put to sleep" is therefore used to depict its similarity with going under anesthesia, the only difference is the dog won't ever wake up from it.
For the most part, the dog euthanasia process is quite peaceful and pain free. I remember the first time I assisted a dog euthanasia appointment, the owner was holding and hugging the dog, and when he said goodbye-- I just remember it as yesterday, he came out of the room teary eyed and hugged his wife who waited outside and told her as he cried: "It was so peaceful." As I continued working for the clinic, and later, volunteering to assist vets, I could hardly tell the difference between a dog that was put under for surgery and a dog that was put to sleep, if it wasn't for the fact that a dog put under had an endotracheal tube in its mouth and was hooked up to beeping monitoring machinery.
Now, there were some times where the pet wasn't much comfortable, but for the most part, these were pets who didn't like going to the vet in the first place, so it was normal to see them anxious and vocalize if they were restrained or pricked with a needle. Even sickly, lethargic pets seemed to come to life, with a last burst of energy to fight the needle. But this was mostly lasting for the prep time only, then as the euthanasia drug took effect, these pets quickly were gone within seconds and you could almost palpate the pet's relief from days of suffering. So are euthanasia appointments painful? Let's see what vets have to say...
Veterinarian Paige Garnett explains how the term euthanasia derives from the Greek terms "eu" meaning good and "thanatos" meaning death. The goal is therefore to cause a death that is without pain or distress. He explains how pentobarbital is fast acting causing minimal discomfort to the pet other than the needle prick. Once injected into the vein, the barbiturate depresses the central nervous system, removing awareness and causing the animal to fall into a state of unconsciousness similar to anesthesia. In this state of deep anesthesia, within seconds the animal stops breathing and succumbs to cardiac arrest.
Veterinarian Chris Bern confirms that most euthanasia appointments go very smooth and quickly with the pet passing on to better life within 10-20 seconds. In some cases though of very sick and debilitated pets with poor circulation, the process may take a bit longer. Generally, according to the Humane Society of the United States Euthanasia Reference Manual, after 5 seconds the pet is unconscious, within 10 seconds the pet is in deep anesthesia, within 20 seconds the pet stops breathing, within 40 seconds the heart has stopped circulating blood, and finally, within 2 minutes the pet is clinically dead meaning that all voluntary/involuntary functions have ceased even though you may still stumble on the occasional muscle twitch
Yet, if the euthanasia appointment is so quick and peaceful, why are there cases of pet owners reporting their pet started screaming as if terrorized or in pain? Why are they unable to sleep thinking about their pet's final moments? And why are some vets unable to give a reasonable explanation? In the next paragraphs, we will look at what some vets have to say about these euthanasia procedures gone wrong.
Dog Euthanasia Appointments Gone Wrong
There are horror stories of dogs dying during flights and horror stories of dogs dying because they ate a food that was tainted. And then there are horror stories of dog euthanasia appointments gone wrong. What do these episodes have in common? Some of them are quite normal occurrences, but several are not the norm, and some are a sign of something going wrong. Luckily, these incidents are quite rare, but let's try to get a grip, at least a possible explanation as to why a dog's final moments were not as peaceful as expected. Following are possible explanations.
Was your pet anxious?
In some cases, as mentioned before, pets may be stressed and agitated when at the vet or when pricked with a needle. These animals may make the procedure difficult by moving excessively, making it difficult for the vet to find the vein and inject the solution. These animals may struggle and vocalize, but usually this happens before the injection is given. Once the shot is successfully given, these pets drift into sleep and pass on. These are animals that for the most part have a history of not liking to go to the vet to begin with, so their behavior has nothing to do with feeling pain because they are being put to sleep, they simply would have behaved the same way whether they were getting their yearly shots or some other procedure done. Of course, we all wished our pets final moments were peaceful, but some pets are anxious and easily stressed by nature. If you own a pet like this and are concerned about the final day, read on as there are some options to make the final day less stressful.
Was your pet in pain?
If your pet was already in pain and suffering, he may have vocalized from the pain of his condition. For instance, a dog with severe arthritis, may yelp when his leg is moved to inject the solution, or for a dog with cancer even just moving may be too much pain. Luckily for these pets, euthanasia is often quick and they will soon be on their way to a pain-free world.
Were your dog's veins hard to find?
In some cases, the veins may be difficult to deal with. For instance, dogs who are dehydrated, have low blood pressure or are very old and sick may have constricted veins that are difficult to find or that may collapse when poked. Repeated attempts to prick the vein only aggravate the situation, causing some dogs to resent being handled, vocalize and put up a fight. At times, these dogs will need to be forcibly held down and restrained, which makes the last moments less peaceful than expected. In severe cases, the vet may opt for deep unconsciousness followed by an intraperitoneal (into the abdomen) or intracardiac (directly into the heart) final injection which is considered humane in an anesthetized pet.
Did your dog react to the sedative?
Many veterinarians administer sedatives before giving the pentobarbital injection. These sedatives can be given under the skin, in the vein or in the muscle. Most vets use tiny needles. The purpose is to relax the pet or even cause unconsciousness before the euthanasia solution is injected. The sedative effects may take up to 20 minutes to kick in. When the sedative is given, after a few minutes some dogs may move their head side to side, the eyes may appear glazed and the dog may appear dizzy or confused.
Veterinarian Mary Gardner explains that under sedatives, some dogs may get loopy and lose control of some functions. She claims "When you get 'sedation' - you (and pets) can get loopy and you lose control of some functions. Some dogs can bob their heads. As a vet - I hate this... NOT because the dog is anxious or feeling scared... but because the OWNER is scared. I know medically - the pet is fine.. but sometimes there are no words of comfort I can give the owners. "
There are several pre-euthanasia drugs vets may use. The best ones are anesthetics, that cause the dog to lose consciousness, just as when you go under surgery. One of the most preferred is what is called called a "pre-mix", a combination of the drugs xylazine and ketamine. These drugs though may cause a stinging sensation when administered intravenously. Telazol ( tiletamine and zolazepamis) is another preferred drug that causes loss of pain and consciousness, and stings less than pre-mix.
Some vets may choose to use sedatives instead of anesthetics but the main disadvantage is lack of pain relief and no loss of consciousness. For this reason, their use is less preferable than the anesthetics. Examples of sedatives are acepromazine and xylazine and they should be ideally be used with anesthetics to lower the chances for reactions. For more on these drugs, see The Humane Society of the United States Euthanasia Reference Manual
And then there are dogs who develop unsightly reactions and side effects to the sedatives. For instance, some dogs may develop seizures as a reaction to "pre-mix." Dogs aren't conscious when they have seizures. Some vets prefer Telazol because there are less chances for seizures. Acepromazine may cause visible balance issues, seizures, excitement and even 'paradoxical reactions' such as aggression. Any animal or human can develop these side effects. Not to mention the fact that since these drugs are given intramuscularly (in the lumbar muscle along the spine or the large muscle of the rear thigh) they tend to sting, but if injected slowly or as an IV injection the chances are lower. Luckily, the pain/reactions/side effects are temporary until the final injection is given.
Did the solution go outside the vein?
If the euthanasia solution is accidentally given outside the vein, it could cause a burning sensation. This occurs because the solution is thick and very caustic to the body's tissues and is meant to go inside a vein. How does it end up going around the vein? Just Answer veterinarian alhdvm theorizes that a vet may be injecting the solution and then the dog moves (but not necessarily has to) and soon there's a hole causing the solution to go around the vein instead of inside. This may cause the dog to cry out in pain. If the screaming reaction happens right after the injection starts, this is most likely the scenario. If instead the vocalization starts after most of the solution has already gone in the vein, there are more chances something else may be going on such as some type of "hallucination".
Another possibility is that the pet simply feels the solution. Just like people "feel" the liquid going in their veins when they are getting IV medications or fluids, dogs may feel the solution often simply because it's not the same temperature as their blood supply and it may feel "odd" to them, explains veterinarian Mary Gardner. Therefore, to an animal this can be quite frightening as they don't know what is happening to them; whereas, us humans can rationalize the happening and reassure ourselves.
* Note: according to Petmd none of these drugs causes an “awake” form of paralysis.
Did your dog react to Pentobarbital?
As with all drugs, dogs may have a slightly abnormal reaction to the euthanasia solution. Let's remember that the euthanasia solution is an overdose of anesthesia. If we look at the different stages of anesthesia as described in the Euthanasia Reference Manual, we will see that there are brief excitement phases characterized by loss of voluntary motion. Because the euthanasia solution is an overdose and takes effect quickly, the stages aren't pronounced as in the case of anesthesia, but they may occasionally pop up, such as in older, sick dogs with poor circulation. In such dogs it may take longer for the injection to take effect and the process may be more pronounced.The sight though is more distressing to the owner than it is to the dog who most likely has lost consciousness and isn't even aware of its behavior. Even humans may act out in odd ways during anesthesia, and they won't recall the event as they were unconscious at the time.
Did your dog have normal reflexes?
Finally, when death occurs, it's normal for some reflexes to take place. Most vets will warn about these. The dog may twitch, gasp, take a final deep breath or vocalize. Some pets may urinate and defecate. Older and sicker pets may engage longer in unconscious breathing. These are normal reflexes that take places as well in natural death, explains Dr. Cherie Buisson. A reflex is not a sign of pain. To the untrained eyes these may appear as proof that the pet is suffering and "fighting for its life" but in reality, these are unconscious, voluntary responses.
Veterinarian Cherie Buisson has her own heartwarming versions of the meaning of such reflexes. She explains that twitches are just like hiccups and the dogs' body way to get rid of energy, heaving breathing is "where they hit the Rainbow Bridge running” and lip twitches are the pups' smiles once they get there. She claims that her clients "love hearing that their dog is at the rainbow bridge smiling."
How to Minimize the Chances for Negative Experiences?
As seen, in many cases, the euthanasia appointment is more disturbing for the people witnessing it than the dog. As humans, we often tend to humanize things and interpret them from our standpoint, rather than a scientific manner. We think "the dog is fighting for its life" when in reality all that the dog is doing is undergoing natural, involuntary reflexes us humans go through as well during the process of dying. Yet, there are a few steps you can take if your goal is to have your dog dying "peacefully"--even though things can't be granted as some reactions cannot be controlled completely. Here are a few tips:
- Euthanize at Home
Some pets get distressed at the vet's office. Even just driving there can be enough for causing stress in sensitive pets. They may have had unpleasant procedures done in the past or simply resent being handled/restrained by strangers in a small room. At home euthanasia may be a viable options for pets who dislike the vet's office and all the negative connotations that have accumulated throughout the dog's life. There are several vets willing to come to your home if you want your pet euthanized at a place he feels more comforted and less stressed. Consider though that if your dog disliked the vet being anywhere around him, he may still be somewhat stressed. Another option some vets offer is euthanasia in the trunk of your car, especially if your pet has mobility problems.
- Ask for an IV Catheter
As simple as it may sound, asking for an IV catheter can really make a difference. Here are 2 main advantages: 1) it prevents the dog from having to be repeatedly stuck with needles, 2) it ensures the solution goes all in the vein preventing it from going around it causing the unpleasant sensations mentioned above. Most vets will take the pet to a back room to insert the catheter. Once the catheter is in place, good vets will flush some saline solution to ensure it flows well before bringing the pet back in the room and injecting the euthanasia solution. However, it's also true that some dogs hate having IV catheters placed. Some vets will work out a compromise by giving the first shot and then placing the IV catheter so they won't struggle or feel pain as they would when wide awake.
- Ask for Anesthetics
If you want your dog unconscious for the procedure, ask your vet if he uses anesthetics. Anesthetics are much more preferred over sedatives or nothing because they make the pet completely unconscious and it "may" reduce the chances for witnessing neurological episodes and muscle spasms, which as we have seen are involuntary reactions and not a sign of pain or a dog "fighting for its life."The two injection approach, which consists of an anesthetic followed by the euthanasia solution is considered more peaceful to both veterinarians and pet owners. Just Answer veterinarian Dr Karen claims "I think many vets do use a pre-sedative because we are trying to avoid the shock of an owner seeing a dog react that way. However stressful these behaviors are, they are not secondary to pain. It was more neurological in nature than a reaction from pain." Yet, there are times where every animal should be treated as an individual case, and some vets may prefer to bypass the two injection approach and go straight to the euthanasia solution.
- Be Prepared
Most vets will take the time to explain what happens during the euthanasia process, but some may be rushed and fail to clarify some important subtleties, which leads to owners getting upset when they witness neurological responses. Some weren't aware their pet's eyes would stay open and were disappointed by it. In reality, even when a pet is put under for surgery, the eyes remain open. Indeed, when pets undergo surgery, vets use lubricant eye drops to prevent them from drying out too much. If the sight of your pet's eyes being opened bothers you, ask to be away when the pet is put to sleep and return when the procedure is done, asking your vet to close the eyelids.
Acknowledging what happens and acknowledging things that may go wrong is helpful. That way if things go well, you'll likely think ""Is that it? That was very quick and peaceful!" and if things don't go very well, at least you know what may likely have happened so those last moments won't haunt you day after day as you wonder if your pet suffered. Truth is, the death of out pets is never pleasant to witness, but it's far better than suffering day after day, and most of all, our dogs will be eternally thankful for this last gift of unconditional love.
Are you tormenting yourself, wondering if you did the right thing? read this comforting letter: Thank you Annie, a letter from an old furry friend.
Alexadry©All rights reserved, do not copy.
For further reading
- Dog Euthanesia: Everything Pet Owners Should Know
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- What to Do When Your Dog Dies at Home
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- What Happens During a Pet's Euthanasia Appointment
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- Dog Euthanasia: Putting a Dog to Sleep at Home
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- Mourning my Cat: In Memory of Miccola, my Beloved Pe...
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