The 'Sudden Farewell' to a Beloved Pet and the Reality of Pulmonary Edema

It is very important to discuss 'how to face the end' while your pet is still healthy.

There was a recent story that gave me pause for thought.

A manager rushed Lady Dewi's beloved dog, Taro, to the hospital after his condition suddenly deteriorated.
The hospital staff did everything they could to save his life, but unfortunately, it is said that Taro never regained consciousness.

It was reported that the owner was confused by the sudden event and even confronted the veterinarian.
There are very few people who could remain calm when faced with their beloved pet covered in blood. It is a completely natural reaction to be distraught and not know where to direct your anger or sadness.

However, upon closer investigation, it is considered that there is no truth to the claim that Lady Dewi committed acts of violence against the veterinarian or the manager.
It cannot be denied that only a portion of the information may have been taken out of context and spread, claiming she 'screamed' or 'went on a rampage'.

When we encounter news like this, what we are forced to reconsider is
the importance of discussing how to face a pet's end while they are still healthy.

What should the owner have done 'at that moment'?

If your precious family dog or cat were to suddenly collapse, start bleeding, or begin struggling to breathe,
most people would rush to the hospital in a panic and scream, 'Please, do whatever you can to save them!'

However, medicine has its limits. No matter how advanced the treatment, there are lives that cannot be saved.
And then, the heavy question arises:Is continuing life-prolonging treatment truly what is best for the pet?

Ideally, while your pet is still healthy, you should share the following with your family:

• To what extent do you want treatment (intensive care, artificial respiration, cardiac massage, etc.)?

• In the case of a disease that causes severe pain, whether or not to include euthanasia as an option.

• Whether to care for them at home or have them spend their final moments at the hospital.

• Information on hospitals to contact in an emergency and night-time emergency services.

If you discuss these things in advance, you can avoid making decisions based solely on emotion during a sudden crisis, and you can significantly reduce the risk of trouble with the hospital.

'Never giving up hope until the end' versus 'not letting them suffer'

When a pet is battling a serious illness, many owners struggle with this conflict.

• Wanting them to live even a little bit longer.

• But I don't want to prolong their suffering

You find yourself torn between these two wishes.

For example, here are some of the options available:

• Continue treatment as much as possible and hold onto hope until the end

• Refrain from aggressive treatment and prioritize watching over them peacefully at home instead

• If the suffering is severe and the chances of recovery are low, consider euthanasia

There is no single 'right' or 'wrong' answer.
The important thing is to aim for a 'choice with fewer regrets' based on the pet's personality, age, the progression of the disease, and the family's values accordingly.

In particular, pulmonary edema, which we are covering this time, is a disease where the suffering at the end of life tends to be extremely intense.
That is precisely why owners need to think about 'what they want to do for their pet' from an early stage.

What is pulmonary edema?

Pulmonary edema is a condition where water (part of the blood components) seeps out and accumulates inside the lungs.
The lungs are originally responsible for 'taking in oxygen and releasing carbon dioxide,' but when they are filled with water, they can no longer perform that function.

As a result,

• sufficient oxygen cannot be sent to the blood

• the entire body enters a state of oxygen deprivation

• eventually leading to cardiac arrest

—a very dangerous state.

Main causes of pulmonary edema

1. Causes from the heart (cardiogenic pulmonary edema)

   • If there is heart disease such as 'mitral valve insufficiency,' which is common in small dogs,
     the flow of blood sent from the heart stagnates, pressure is applied to the blood vessels in the lungs, and water seeps into the lungs.

2. Non-cardiac causes (non-cardiogenic pulmonary edema)

   • Severe trauma

   • Lung tumors

   • When inflammation from other organs, such as pancreatitis, spreads to the lungs

   • Severe stress or external pressure from excessive training (muzzle control), etc.
     Fluid can also accumulate in the lungs due to these factors.

Tests performed include:

• X-ray examination

• Cardiac ultrasound (echocardiogram)

• Auscultation for heart murmurs

However, the examination itself can be a significant burden for a severely ill pet. Therefore, veterinarians are required to 'determine the necessary tests within the necessary scope.'

Predisposed Dog and Cat Breeds

The following small dog breeds are prone to developing pulmonary edema from heart disease:

• Chihuahua

• Maltese

• Pomeranian

• Miniature Dachshund

• Toy Poodle

• Yorkshire Terrier

• Cavalier King Charles Spaniel

Additionally, there are cat breeds genetically predisposed to cardiomyopathy, which can result in progression to pulmonary edema.

• Maine Coon

• Ragdoll

• Norwegian Forest Cat

• Persian

• American Shorthair

• Scottish Fold

If you own these breeds of dogs or cats, regular heart checkups from middle age onwardsmay lead to early detection.

The final stage of pulmonary edema is 'suffering like drowning'

As they approach the final stage of pulmonary edema, dogs and cats enter a state as if they are struggling in water.

• Water in the lungs increases, making it impossible to take in oxygen

• Breathing becomes shallow and rapid as they desperately try to inhale air

• Even so, there is not enough oxygen, and the entire body falls into a hypoxic state

At this time, common symptoms include:

• 'Open-mouth breathing,' where they breathe with their mouths wide open

• 'Cyanosis,' where the tongue, gums, and mucous membranes turn bluish-purple

• Vomiting foamy or pink, blood-tinged fluid from the mouth or nose

• Becoming lethargic and unable to stand or move

and so on.
This sight is extremely shocking for the owner as well, and is 'painful to watch.'

Many heart diseases that cause pulmonary edema are difficult to cure completely and are conditions that must be managed over time.
The average life expectancy after onset, depending on the condition, is often considered to be about a few months to a year and a half, and
there are cases where physical strength is gradually sapped while repeating recurrences.

Main symptoms seen in the final stage of pulmonary edema

Here, using cats as an example, I will organize the progression of terminal symptoms.

1. Severe dyspnea

• Breathing with the mouth open and panting (open-mouth breathing)

• Throat making rattling or wheezing sounds with every breath

• Chest and abdomen moving in large, undulating motions

Just by looking at them, you can imagine how painful it must be.

2. Taking a comfortable position and becoming immobile

To make breathing even slightly easier, cats often adopt the following postures:

• The 'sphinx position,' where they extend their front legs forward and expand their chest

• Facing downward and barely moving

This is a behavior they adopt because they feel this position is the most comfortable for them.
Forcing them to lie on their side or picking them up can actually worsen their breathing.

3. Cyanosis (bluish-purple discoloration)

• The tongue, gums, and mucous membranes in the mouth change from light pink to bluish-purple.

• This is a sign that the oxygen concentration in the blood has dropped significantly.

This stage is already quite dangerous, and immediate oxygen administration and emergency response are required.

4. Blood-tinged foamy liquid

• Pink foam or a blood-tinged, phlegm-like liquid may come out of the nose or mouth.

• This is a state where blood and water have mixed in the lungs and are being pushed out through the airways.

While this is a very shocking sight for an owner, it is not an uncommon symptom in the terminal stages of pulmonary edema.

5. Clouded consciousness/paralysis

• Becoming unresponsive to calls and losing the spark in their eyes

• The body becomes limp, unable to stand or move

• If a blood clot caused by heart disease travels, the hind legs may suddenly stop moving (such as in arterial thromboembolism).

Once it reaches this stage, the time from a sudden change to sudden death is often short.

The reality that many cases involve sudden death amidst intense suffering

The end stages of pulmonary edema are said to be:

It is said that this is often the case.

For both dogs and cats,

• Wheezing while sitting with the neck extended in an 'orthopneic' posture

• Gradually losing physical strength while repeatedly being hospitalized and discharged

• One day, suddenly taking a turn for the worse and being unable to breathe

It is not uncommon for them to follow this progression.

It is painful for those watching, and the individual (the cat or dog) is also suffering greatly.
That is precisely why you need to think carefully about 'how you want them to spend their final moments' from the early stages of a pulmonary edema diagnosis.

What owners can do — Euthanasia is also an option

What an owner must consider for a pet in the terminal stages of pulmonary edema is not simple.

• How far to continue treatment

• How to reduce pain

• At what point to switch from 'curative medicine' to 'palliative care'

• Whether to include euthanasia as an option

In reality, 'doing everything possible until they pass away naturally' = a peaceful end is not always the case.
Pulmonary edema, in particular, often involves suffering akin to 'drowning while alive,' and
one must carefully consider whether a 'natural death without intervention' is truly the kindest choice for that pet.

Points to consider

• Discuss specifically with your veterinarian how to reduce suffering

• Depending on the situation, seriously consider euthanasia

• Decide as a family whether to provide end-of-life care at home or at the hospital

• Share information with other family members so that the decision does not fall on just one person

I believe many people feel strong resistance to the word euthanasia.
However, from the perspective of whether to prolong a state where there is no hope of recovery and intense pain continues it is also important to face it calmly, strictly as 'one of the means to minimize the pet's suffering.'

Discuss the 'end-of-life policy' with your veterinarian early on

When pulmonary edema worsens, it becomes a race against time.
Rather than panicking and deciding when that moment comes, if possible, discuss the following points with your veterinarian in advance.

1. Use of an oxygen chamber (oxygen cage)

• Spending time in an environment with high oxygen concentration can reduce the burden on breathing.

• There are methods such as hospitalizing the pet in an oxygen chamber or renting an oxygen house/oxygen concentrator for home use.

• If you choose to provide end-of-life care at home, an oxygen chamber can be a reassuring support.

(Example of rental services)
It is reassuring to research information in advance by utilizing service links such as 'renting an oxygen chamber'.

2. Administration of diuretics

• Diuretics such as furosemide are used to excrete excess fluid in the body as urine and reduce fluid in the lungs.

• While effective, this is not a 'fundamental cure' but merely a measure to alleviate symptoms.

• Because it increases the burden on the kidneys, you must strictly follow the veterinarian's instructions regarding frequency and dosage.

3. Palliative Care and End-of-Life Care at Home

• Some people think, 'I do not want any more aggressive life-prolonging treatment, but rather want them to spend time with the family while reducing their suffering as much as possible.'

• In that case,

  • painkillers

  • sedatives

  • oxygen supply

  • adjusting body position and keeping them warm
    and other care that prioritizes 'gentleness' will be the focus.

Whichever method you choose,frankly communicating your wishes and anxieties to your veterinarian is more important than anything else.

Things you must do if you want to provide end-of-life care at home

Many owners think, 'I want them to spend their final moments in the familiar comfort of home.'
In that case, be sure to share the following points with those around you in advance.

• Inform your veterinarian of your intention that 'basically, I want to provide end-of-life care at home.'

• Share the policy and emergency contact procedures with family members living with you.

• If they have a sudden change in condition and are taken to the hospital,

  • how far do you want them to go with treatment?

  • Some hospitals have you leave a 'directive' in advance regarding whether you wish for cardiac massage, artificial respiration, or life-prolonging measures.
    

A veterinarian's job is fundamentally to 'save lives.'
Therefore, for a pet that has been brought in, the choice to just watch without doing anything is extremely difficult for the veterinarian as well.

That is precisely whycarefully communicating the owner's wishes in advance is beneficial for both parties.

Do not rely solely on social media; seek out accurate information

The internet and social media are overflowing with personal experiences and emotional opinions.
While these can be very helpful, at the same time,

• the information may be inaccurate

• cases with different conditions may be generalized

• a specific hospital or veterinarian may be unfairly criticized

and other such problems are not uncommon.

What is important is,

• Consult directly with a trusted veterinarian

• Cross-reference information with veterinary books and multiple professional websites

• Do not jump to conclusions based on a single opinion

is the approach to take.

In particular, topics such as 'pulmonary edema,' 'heart failure,' 'euthanasia,' and 'palliative care' are extremely delicate areas that require both medical knowledge and ethical judgment. Making decisions based solely on emotional information should be avoided;

taking the time to learn for yourselfwill help reduce regrets.

So that your beloved cat or dog can pass away 'as comfortably as possible'

No matter how much you think, discuss, and prepare,
there is no '100% correct' way to face the end.

Even so,

• wanting to minimize suffering

• wanting to ease fear and anxiety as much as possible

• wanting to say, 'I'm so glad you were here'

—these feelings are surely shared by every pet owner.

That is why,

• talking about 'what if' little by little while they are still healthy

• getting early checkups for dog and cat breeds prone to heart disease and pulmonary edema

• thinking about treatment plans and end-of-life care plans together once a disease is discovered

• learning from veterinarians and professional books rather than relying solely on social media

Each of these steps helps you choose the kindest end for your pet when the time comes.

So that your beloved dog or cat, who is family,
does not 'struggle for a long time in pain,' but instead
'departs as peacefully and securely as possible'

Please, try to find a little courage and
discuss how to approach the end of life with your family and veterinarian.