Why do they call it heartworm? Because the worms live in the heart. I'm not saying that to be silly, but anything that lives in the heart is obviously going to be detrimental. These worms can get pretty good-sized. Believe it or not, they can reach six to eight inches long, so that's a pretty good size. If you get one or two, it’s probably not a huge deal. If you get 10 or 12, it’s starting to become a big deal now. If you get more than that, well, you can imagine. Common sense would tell you that's going to begin to affect how efficiently and effectively that the heart can pump. Can those valves seal off? Is blood flow going to be impeded in going to the lungs to get oxygenated? All that stuff is a factor, so there are some very significant signs associated with the disease itself. And some of those changes are irreversible if they've been there for long enough, even if the dog is treated.

I get asked that one every now and then as well. The simple answer is, no. I can't really justify a reason for me to say that's better. I've been doing this for over 20 years and I can count maybe not on one hand, but probably on two hands, how many times an animal has died peacefully on their own at home. It just doesn't happen very often. They fight. They hang on. They just don't let go the way that we would want them to let go. So oftentimes it stinks, but we as veterinarians and sometimes you as owners have to make that hard decision for them. I encourage people to think of it not as being cruel because I, too, struggle with that. What gives me the right to do that? What gives me the power and the right to decide if an animal lives or dies? It's a weird power to yield, but I've come to realize that it's the last bit of love that we can give them. It really is. When you know that the end is there, there's nothing else you can offer and there's nothing that's going to make this animal turn around. Isn't it kinder to let them go with dignity, pain-free, in a controlled, loving setting where their owner can be right there with them, holding them, talking to them? I would like to go that way. I hope that that can be done for me one day, and I know it can't, but who wouldn't want to pass that way in that situation. So, yeah. I think it is much more feasible and humane for the animal to ease them in their passing, as opposed to drawing it out and just waiting and waiting and waiting for them to pass at home.

The reality is most of these cats are going to show you much more subtle early signs, and you're probably going to take the cat to your veterinarian to have them checked—to have lab work or x-rays—whatever it takes to diagnose what the underlying problem is. So again, with that information and the advice of your veterinarian and their staff, a group decision will typically be made in reference to what treatment options are. Euthanasia is usually the last thing that we can do to ease their suffering. So once all other treatment options have been exhausted and there is no improvement or the animal continues to decline, that's when the time for euthanasia.

Euthanasia would be us as veterinarians easing the passing of said cat, or maybe not easing, but causing the passing. There are drugs that we use injectably that, there's no polite way to put it, but that will stop the heart of a cat. And obviously in their life, that way it's very humane. It's very quick. It's very peaceful. It is quite literally an overdose of an anesthetic. So there's no pain involved with it. It's just, again, when we know that an animal (a cat in this case) is at the end of their life and there's nothing else we can do, there's no point in allowing that animal to suffer and to die a long, drawn-out, painful death. There's no point in that at all. So it's our responsibility as veterinarians to ease that suffering. And that's how it's done.

Thankfully, that's not as grim of a question to answer. So pain can be as simple as vocalization. It can be carrying their body posture differently. If it's arthritic type pain, they will be carrying themselves differently. Maybe they're hunched back. Maybe they're walking with real short steps because it hurts to walk. Maybe it's that you go to pick them up or you touch them in a certain area, and they either vocalize or they try to bite you or something like that. If they have a tender or painful spot, they’re going to lick or bite at that area a lot because it hurts and they can't figure out why, and they don't understand it. So they just want to lick and lick and lick or bite at that area.

That's truly a good question. And I'll be honest with you. One that I had to look up myself to get the answer, but so the way I know it now, and the way I think of it is this. Palliative care is when you were trying to control the pain or suffering of an animal, but there is still hope of a recovery or a cure, whereas hospice care is still the ultimate goal is to try to make an animal comfortable, to remove whatever pain and suffering that cat might be going through. But with hospice care, typically there is no chance of a resolution or a cure. You have reached the end of your treatment options, and you're just trying to make the cat comfortable until they pass or can be put down.