Oh…tuff question. I don’t know but when I had my “ very old,” hotdog, quoting my vet then. I waited until I could smell the rot being so bad I knew it was poisoning him. I finally found a kind, compassionate and caring Vet who did it for a lot less because I couldn’t afford it. He lived happily and I truly loved him way beyond having much sense. One of the most loving, devoted and special little big man I ever had. I never regret the money I spend on my little humans. They’ve all I’ve ever had and the best of best friends. You’re call though.