UNDERSTANDING THE END STAGE OF
YOUR PET'S DISEASE

As veterinarians we are often asked what signs to look for as your pet's disease progresses and how will you know when you are near the end. This is a difficult question to answer but in general a disease's symptoms will progress based on the organ system that is affected. If your pet has been diagnosed with some form of cancer his or her disease progression will be based on which organ of his body has been invaded by the cancer. Below are some generalities about different diseases based on what organ system is affected.
Of course there is always the possibility that a disease will affect more than one organ system as time goes on. You may not be aware of this occurring so the disease's progress and how it affects your pet may change over time and in unexpected ways.

Also keep in mind that the end stages of an animal's disease may happen in a much more accelerated fashion than what you have been observing over the last few months or years. For survival purposes animals like to hide the symptoms of their disease until they are no longer capable of doing so. Once a disease hits a critical point where your pet's symptoms are becoming more evident and are not controllable with medical therapies than this usually indicates that the disease will progress much more rapidly. Often much more rapidly than we are prepared to accept.

For the most accurate information about your pet's medical condition please consult your veterinarian who knows your pets health status the best.

Diseases affecting the Lungs and Heart - (examples - Heart Failure, Cancer, Pneumonia, Pleural effusion -fluid surrounding the lungs, Asthma)
As these diseases progress you may notice that your pet has decreased energy and appear weaker. They may not be able to play or exercise for extended periods without the need to lay down. Over time the length of these periods will shorten. This is because more and more of the lung tissue may become filled with fluid, or cancer cells, or inflammatory cells and less oxygen is available to the body. Without oxygen your pet feels tired all the time. In the later stages of these diseases you will notice an increase in the amount of work it takes to breathe. Monitor your pets chest wall and see if the excursions of his or her sides seems prolonged or take a large amount of effort for your pet. In the later stages your pet may seem uncomfortable in certain positions and will have to place themselves in odd positions in order to be able to breathe effectively. Often they cannot sleep. This is exhausting to them and they will quickly fatigue.

Increased work of breathing and inability to lay down comfortably are signs that can progress rapidly - hours to days. Not being able to breathe well is one of the most frightening and exhausting experiences. This is a true emergency situation. For your pets sake please arrange a euthanasia as quickly as possible.

Diseases affecting the Stomach, Intestines, Liver or Pancreas -
Animals who have diseases in the above organs are usually showing signs such as vomiting, persistent diarrhea, reluctance to eat and weight loss. These symptoms are usually progressive and with time may not be controlled with medications. Monitor your pet for signs of severe abdominal pain. Abdominal pain may be demonstrated by curling up and withdrawing from normal interactions, stretching or changing positions frequently, pacing, vocalizing or the complete inability to lie down at all because it is too uncomfortable. If medications cannot control severe vomiting, or if your pet has not eaten for more than three days after medical treatment has been tried, or if your pet seems uncomfortable and unhappily withdrawn then it is in your pets best interest to schedule a euthanasia as soon as possible.

Disease Affecting the Brain - (examples - a tumor, meningitis or severe Epilepsy)
Diseases affecting the brain may present as walking off balance, walking in circles, unusual or surprising behaviors, paresis or paralysis of two or more legs, inability to stand, sudden blindness, dull or comatose mentation, unusual aggression or new onset of seizures. It is in the best interest of pets who can no longer stand, who are uncontrollably seizuring, who are unsteady and unexpectedly falling, or who do not have a normal consciousness level to choose to euthanize them. Many animals with brain diseases will continue to eat ravenously until their last breath as a result of how the disease affects their brain. Keep this in consideration when making your decision about whether it is time to euthanize.

Diseases Affecting the Kidneys -
Animals with chronic kidney disease will drink increasing amounts of water, will slowly lose weight, may have intermittent vomiting, and will have a decreased appetite. Animals with sudden kidney failure either from progression of their chronic kidney disease or from a toxicity to their kidneys may stop eating entirely, have uncontrollable vomiting, may not produce any urine or become extremely dehydrated and weak. Severe dehydration and persistent vomiting despite medical therapy are uncomfortable to an animal. When this occurs, for your pets best interest, it is time to choose to humanely euthanize him or her.

Anemia -
Anemia simply means not having enough red blood cells in your body. Anemia may be caused by an inability to produce red blood cells, an abnormal destruction of red blood cells (as in IMHA) or persistent loss of red blood cells (as in hemorrhage).
The simple fact is that red blood cells carry oxygen. Oxygen is what gives our muscles and tissues and brain the ability to function normally. If we do not have enough red cells we do not have enough oxygen to our tissues. Animals who are becoming progressively more anemic are becoming progressively weaker because their tissues and brain do not have enough oxygen. The best thing about this disease is that it is not painful. Animals are weak and lethargic but not in pain. When your pet has stopped eating or is working hard to breathe because they do not have enough oxygen to their tissues then euthanasia would be a fair choice.

Orthopedic Diseases - (examples hip/spine/joint arthritis or muscular or neuromuscular disease)
Animals with this kind of disease usually change very slowly over time. You watch your pet have progressively more difficulty standing up, sitting down, jumping onto furniture or into cars, walking for long distances or profoundly limping. Your pet may also lose his ability to control his urination or defecation or may choose to urinate where they sleep as it is too uncomfortable or difficult to stand. Your pet may become progressively grumpier and may not want to be touched or may become more and more withdrawn. These are all signs of pain. Just because your pet is not vocalizing does not mean they are not in pain. Your pet is not vocalizing in pain because just like a person, they are adapting to their unrelenting pain which does not go away. This type of disease can be the most difficult to make a decision about because often their front end and mind are quite normal and healthy. But their body or hind ends won't work. Often with this kind of disease as long as you are managing your pets pain with medications and managing their hygiene and nursing care you will have a longer time to decide when it is the right time to euthanize him or her.

Sometimes though it is extremely difficult or impossible for a person or family to fairly manage their pet's orthopedic disease. This is a true reality for many people. Keep in mind that it may not be fair to your pet to leave them in a situation where they can fall and get stuck for a prolonged period of time or hurt themselves while you are not around. Also consider that not being able to control their own bowels may be an undignified life for a once independent animal with wild ancestry. Remember that it is only because of all of the loving care and medical therapy that you have provided for your pet that he or she is alive today. It is only because of your loving nursing care and medical therapies that your pet has been happy until this point. But there will come a point when you and your family decide that your pet is no longer happy and living in this condition is no longer fair to any of you. Euthanasia is an appropriate decision when you have comfortably come to that conclusion.