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Quality of Life Scale for Pets--Help with the Euthanasia Decision

15K views 20 replies 13 participants last post by  JamesBrown89 
#1 · (Edited by Moderator)
From https://my.vetmatrix.com/0033049/storage/app/media/pdf_files/QualityofLifeScale.pdf. My Vet gave this to me last night to help with deciding when it is time for Toby, and I thought it might make a good sticky?

Quality of Life Scale
(The HHHHHMM Scale)
Pet caregivers can use this Quality of Life Scale to determine
the success of Pawspice care. Score patients using a scale of:
0 to 10 (10 being ideal).
Score Criterion
0-10 HURT - Adequate pain control & breathing ability is of
top concern. Trouble breathing outweighs all concerns.
Is the pet's pain well managed? Can the pet breathe
properly? Is oxygen supplementation necessary?
0-10 HUNGER - Is the pet eating enough? Does hand
feeding help? Does the pet need a feeding tube?
0-10 HYDRATION - Is the pet dehydrated? For patients
not drinking enough water, use subcutaneous fluids
daily or twice daily to supplement fluid intake.
0-10 HYGIENE - The pet should be brushed and cleaned,
particularly after eliminations. Avoid pressure sores
with soft bedding and keep all wounds clean.
0-10 HAPPINESS - Does the pet express joy and interest?
Is the pet responsive to family, toys, etc.? Is the pet
depressed, lonely, anxious, bored or afraid? Can the
pet's bed be moved to be close to family activities?
0-10 MOBILITY - Can the pet get up without assistance?
Does the pet need human or mechanical help (e.g., a
cart)? Does the pet feel like going for a walk? Is the
pet having seizures or stumbling? (Some caregivers
feel euthanasia is preferable to amputation, but an
animal with limited mobility yet still alert, happy and
responsive can have a good quality of life as long as
caregivers are committed to helping their pet.)
0-10 MORE GOOD DAYS THAN BAD - When bad days
outnumber good days, quality of life might be too
compromised. When a healthy human-animal bond is
no longer possible, the caregiver must be made aware
that the end is near. The decision for euthanasia needs
to be made if the pet is suffering. If death comes
peacefully and painlessly at home, that is okay.
*TOTAL
*A total over 35 points represents acceptable life
quality to continue with pet hospice (Pawspice).
Original concept, Oncology Outlook, by Dr. Alice Villalobos, Quality of Life Scale Helps Make Final Call, VPN, 09/2004; scale format created for author’s book, Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond, Blackwell Publishing, 2007. Revised for the International Veterinary Association of Pain Management (IVAPM) 2011 Palliative Care and Hospice Guidelines. Reprinted with permission from Dr. Alice Villalobos & Wiley-Blackwell.
 
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#5 ·
Originally posted by Meadowcat: I have personally found this article helpful: How Do You Know When It's Time to Euthanize a Pet (text copied below) (How to Say Goodbye | DrAndyRoark.com):
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How to Say Goodbye

Just last week, while I was performing euthanasia for a critically ill patient, the pet’s owner looked at me and said, “I bet this is the hardest part of your job.” That gave me pause.

For me, putting animals to sleep is not one of the hardest parts of being a veterinarian. That’s because euthanasia is often a blessing and gift to a suffering animal. In my experience, the hardest part of being a veterinarian is telling owners that their beloved pet has a terminal illness and will soon be leaving this world. The emotions that pass across their faces, even if they have suspected the worst for some time, are heart-wrenching.

It’s Never Easy
I still remember the first person I had to share this terrible news with. He was a nice, middle-aged man with two small children and an 8-year-old Rottweiler named Stone. Stone was a member of the family, and when he started to limp, his owner brought him straight in to be checked out. Stone was a wonderful dog at home, but he was not a fan of the veterinary clinic. My best dog treats did nothing to warm his heart, and when I manipulated his painful left shoulder, well… that ended our chances of being best friends.

Even though Stone was not an admirer of mine, I liked him, and I really liked his owner. That made it so much harder to discuss his diagnosis: osteosarcoma. Osteosarcoma is a painful bone tumor that responds poorly to treatment. In some cases, treatments involving limb amputation and/or radiation therapy can be beneficial. In Stone’s case, these options were not feasible.

Together, Stone’s owner and I decided to provide him with the best palliative care we could, and we promised each other that we would not let Stone suffer. When the time came, we would do the right — if tough — thing and put him to sleep rather than allow him to live in increasing pain.

Stone’s owner was the first person I ever had an end-of-life discussion with, and he was also the first person to ask me a question I have heard hundreds of times since: “How will I know when it’s time?”

The most recent person to ask me this question was my own mother. Her Miniature Schnauzer has battled long-term health problems and was recently diagnosed with diabetes. Unfortunately, she initially responded poorly to treatment. She lost her love of food, began soiling her bed and was generally acting pitiful.

How to Decide
Over the past few years, I’ve heard a lot of veterinarians give wonderful advice to people who are wondering when it is time to give their pets the gift of a peaceful passing. Here are four of the best pieces of advice I’ve heard, and they are the same ones I passed on to my own mother for her consideration.

Every pet, illness and situation is different. There is no single rule that can be followed for when it is time to help your best friend “cross the rainbow bridge.” Getting input from your veterinarian on the specific medical conditions that your loved one may face is vital for doing what is best for your pet. You may also benefit from having a caring friend who is not as emotionally involved in the situation as you are to help you gain perspective and really “see” what is happening with your pet.

Remember that pets live in the moment. One of the most wonderful things about animals is how they embrace the present. Every time I walk into my house, my faithful Vizsla throws a one-dog ticker tape parade. The fact that I have entered the house thousands of times before, or that I will leave again in a few hours, means nothing. All that matters to him is the joy that he feels right now.

When our pets are suffering, they don’t reflect on all the great days they have had before, or ponder what the future will bring. All they know is how they feel today. By considering this perspective, we can see the world more clearly through their eyes. And their eyes are what matter.

Ask yourself important questions. Sometimes, articulating or writing down your thoughts can make the right path more apparent. Some questions that help pet owners struggling with this decision include:

Why do I think it might be time to euthanize?
What are my fears and concerns about euthanizing?
Whose interests, besides those of my pet, am I taking into account?
What are the concerns of the people around me?
Am I making this decision because it is best for my pet, or because it is best for me because I’m not ready to let go?
Measure their quality of life. This is no more than trying to determine how good or bad our pet’s life is at this moment. Trying to assess this can be difficult, but there are some ways you can try and evaluate it. Let’s take a look at a few of my favorites in the next section.

Is Life a Joy or a Drag?
Our pets may not be able to talk to us and tell us how they are doing, but if we pay close attention, there are many clues that can help us answer that question.

The Rule of “Five Good Things”: Pick the top five things that your pet loves to do. Write them down. When he or she can no longer do three or more of them, quality of life has been impacted to a level where many veterinarians would recommend euthanasia.

Good Days vs. Bad: When pets have “good days and bad days,” it can be difficult to see how their condition is progressing over time. Actually tracking the days when your pet is feeling good as well as the days when he or she is not feeling well can be helpful. A check mark for good days and an X for bad days on your calendar can help you determine when a loved one is having more bad days than good.

HHHHHMM: Dr. Alice Villalobos is a well-known veterinary oncologist. Her “HHHHHMM” Quality of Life Scale is another useful tool. The five H’s and two M’s are: Hurt, Hunger, Hydration, Happiness, Hygiene (the ability to keep the pet clean from bodily waste), Mobility and More (as in, more good days than bad). Dr. Villalobos recommends grading each category on a scale of 1-10 (with 1 being poorest quality of life and 10 being best). If the majority of categories are ranked as 5 or above, continuing with supportive care is acceptable.

Pet Hospice Journal: Keeping a journal of your pet’s condition, behavior, appetite, etc., can be extremely valuable in evaluating quality of life over time.

A Tale of Two “Endings”
Thankfully, my mother's Schnauzer, Zoe, eventually responded to her therapy. As a perpetual optimist, I like to think that she may be with us for some time to come. Still, the reality of having older pets is that we must be vigilant in their care and aware that every day is a gift.

In the case of my long-ago patient, Stone, with whom I first walked this path, I am glad to say that he did not suffer unnecessarily with osteosarcoma. His owner made a good decision, and Stone crossed the rainbow bridge while in the loving arms of his people. He was remembered by them as a strong, loving protector of the children in his family, and I will always remember his owner for having the strength and wisdom I hope we’ll all have when the time comes to say that final goodbye.
 
#7 ·
Going to add another really good read to this sticky. (Dianna is a forum member, although she doesn't post anymore)

Original post is here: https://www.dogsportuniversity.com/...ealaq4bDVj57Fs218fgftko7kC1reBpmOABey1-MJLiic
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Saying Goodbye
Dog Sports Training Dianna L. Santos Monday, 23 September 2019 19 Hits 0 Comments

​The most heartbreaking aspect of sharing our lives with dogs is having to say goodbye to them. The final act of advocacy and love is a horrendous burden for us to bear, but a necessary one nonetheless.

Facing Truth and Reality
Our dogs never live long enough. Whether they are lucky enough to make it to their golden ages, or are robbed of a full life due to illness or injury or accident, they will always leave us sooner than we wish. This is an ugly truth of dog ownership that we all must face and come to terms with.

When you are in the final stretch of the journey with your dog, all of the most difficult choices will fall squarely in your lap. What treatments to undertake. How long to do those treatments. Which activities to continue doing and for how long. Then, when and how you will say your final and painful goodbye.

None of this will be easy nor will the answers be the same from dog to dog or person to person. However, you must face these realities and not allow wishful thinking to cloud your judgment.

Our dogs, by design, will mask any pain or discomfort they are in. Some breeds and individuals are amazingly stoic. This makes your job harder. For if you wait until they are visibly suffering, where they are regularly not eating, cannot move, are distancing themselves from you, it may well mean they've been suffering for far too long already.

This is even further complicated when our dogs are accustomed to doing activities with us, activities they thoroughly enjoy. Our dogs will do everything in their power to continue playing that game or activity with us, even if doing so hurts them. They will try to hide that pain as best as they can.

Thus, it is our job to be aware of these possibilities and make the best decisions we can for our dog's sake. Even if it means curbing our own dreams and desires. I cannot stress just how incredibly difficult all of this is.

Trust me, I speak from experience.

Adjusting Expectations
Having a dog who can quite literally do it all is a wonderful gift. It is that much more sweeter when their physical aptitude matches their emotional love for everything they do.

However, this can be a double-edged sword when that very same dog becomes terminally ill or injured.

This was the problem I was faced with the my boy, Valor. He was ridiculously young when he was recently diagnosed with terminal mast cell cancer. At a mere 6-years old, he was supposed to have at least four fun-filled years ahead of him. That all came to a screeching halt with his diagnosis.

Here's the rub: he didn't know he was sick. One day we were going a million miles an hour, training multiple times a day, playing a variety of dog sports, going on adventures, attending trials and competing and the next, I am sitting in a puddle of my own tears.

It was my job to adjust what we would do and how we would do it, without limiting his joy. What a horrible task to be assigned.

In the beginning, this basically meant letting him do whatever he wanted. There were a few bucket-list items on our list that we checked off, such as going to the beach and allowing him to romp around off-leash. If he went over to the agility equipment that was stored on the side of the house, I would pop him over a few jumps. He wanted to go for a walk to pull, pee and hunt for lizards? Let's do it. Put himself into heel position while we were messing around in the backyard? Let's do some obedience.

It got harder as time went on. You have to understand, I am home 24/7 and watched him like a hawk. I could see the changes, as slight as they were initially. The way he would put more effort into his breathing. How he would trot less or moan more when he would lay down, which was happening more and more. When he would turn his nose up to his favorite toy in the whole world, which he NEVER did before, only to be game for it a few hours later. It may seem as though this was all happening fairly quickly, over a course a few short months. But day-to-day, it was a tortuous roller coaster, with my having to constantly reevaluate where he was and what we would do.

For instance, he loved chasing the plastic bunny for CAT or FASTCAT tests. My hope was to allow him to do one run at an upcoming FASTCAT. Not for a title, just to have fun. Yet the day of the test, he was tired. Didn't want to do much. Wasn't as interested in his empty plastic water bottles. It was also super hot on that day and he was having to try that much harder to pant.

Yes, I wanted nothing more than to give him the gift of chasing the bunny. He probably would have loved it! It also would have been beyond horrendous if he couldn't recover from it afterwards.

Now, some people will argue he was essentially dying anyway, what difference does it make?

How his life ultimately ended was something I could control. I wasn't going to have him die in a panic, unable to breathe if I could avoid it. Since that was a possibility, we didn't do that FASTCAT run.

This is the tightrope you will have to walk.

It will make you crazy. You will over-analyze every little thing. That being said, personally, I would rather be in that camp and be far too careful than to be naive or blind to what is going on around me. Is it harder on me? Absolutely. That is a burden I will bare for my dog.

Grant Yourself the Opportunity to Say Goodbye
I spent the last two and half months with my boy saying goodbye.

Don't get me wrong, we still had lots of fun and made wonderful memories I will hold onto forever. It was not all tears and wailing, although there was plenty of that too.

No, during this time, I set aside other things in my life and tried to appreciate my dog as fully as I could. To see how he took up the space with his cheerful presence. How he would go around our backyard always in one direction, searching for lizards or bugs to harass, rarely the other way around. The way he would look up into the sky to watch the passing planes, helicopters or birds. How he would come over and plop that big Doberbutt on my knee when I would start sniffling too much.

I didn't want to be in denial. I didn't want to miss out on the opportunity to maximize on this limited time we had together. Furthermore, my goal was to not wait until the last minute to go though all this, where I may push him to stay longer than he should simply for my sake.

All of this is excruciatingly painful. I would not wish this process on anyone, especially anyone with a young dog. That being said, our dogs still deserve for us to buck up and take this on for their sake.

It will hurt. It will knock the wind out of your lungs. You will be unable to sleep. You will lose your appetite and then overeat. You'll second-guess yourself a million times a day.

Then they will come over to give you a snuggle, or do some antic that will make you smile and laugh, only to burst into more tears because you know this will be gone soon.

Simply put, this whole experience sucks. It sucks to know what is coming. But I implore you, please don't deny or ignore this knowledge. Don't hide from it. Because if you do, you will be robbing yourself the opportunity to properly say goodbye.

Here is why that matters: saying goodbye in the vet's office on that final visit is simply too late. The myriad of emotions you will feel and go through cannot be properly processed in that last moment. Depending on how familiar you are with the process of euthanasia, what you see can startle and shock you out of your grief. You don't want those images paired up with your final memories of your best friend.

Instead, I would urge that you spend some time saying a proper goodbye to your friend, if you are given the chance.

The Aftermath
​Losing a dog is painful. There is an emptiness that goes along with it that is hard to describe.

For myself, Valor took up about 99% of my day, if not more. Coming home without him was a shock to the system. No Dobernose waiting as I opened the door. No spins, rushing to grab the nearest and loudest toy to announce my return. No running down the hall, to parkour off the hallway wall to propel himself into the kitchen. No sweet pokes with that sweet Dobernose of his on my hand as I headed to the backdoor to let him outside.

Instead, there was just silence. An eerie quiet. That joyful and larger-than-life presence was gone.

It has been one full week since I said goodbye to my boy. I am crying as I write this blog, so you can say I am still grieving. There are times I will catch myself looking over at his bed to check on him, or will see if he wants to go play a game or go outside. These habits and routines are hard to break.

Will it be awful forever? Probably not. While I am crying now, it is not the same hysterical "I am about to vomit" weeping I did the day after. I am not waking up in the tears anymore.

The fact is, his passing was a huge loss. But his being in my life was a huge gift. He taught me so much. So, I make sure to look at his photos, to watch his videos. To smile and laugh at his ridiculous to antics. To be thankful that I got to spent five years with him. To allow myself to be angry it was cut short, but then focus on the fun again. To allow myself to be sad it is over, but then focus on our adventures again.

This is not my first loss. Unfortunately, I have a lot of experience in that department. I know how this process will go, roughly speaking. It will just take time.

With all of this pretty much guaranteed pain, does this mean I am done with dogs? No.

I can understand how people can come to that conclusion, that it would be better to avoid going through all of this pain again! The gifts Valor gave me far outweigh the pain I am feeling now.

So in time, I will open my heart again to another. That will be wrought with its own challenges. Guilt. Fears that I will be trying to replace Valor or will constantly compare the new dog to him. It is all normal part of the process and a different type of the seemingly never-ending cycle of pain that goes along with all of this.

Yet, there will be new memories to be made. New adventures to go on. New lessons to learn. New opportunities to smile and laugh.

With time, the pain will fade into the background, and the memories of Valor will stand side-by-side with the new adventures. Instead of being drowned out with tears and heartache, they will be met with smile and joy.

Our dogs give us so much. At the end of their journey with us, it is up to us to give them the best send off we possibly can. Regardless of how painful it is for us. We owe them that much.

Dianna has been training dogs professionally since 2011. She has done everything from teaching group training classes and private lessons, to specializing in working with fearful, reactive and aggressive dogs, to being a trial official and competition organization staff member.

Following a serious neck and back injury, Dianna was forced to retire from in-person dog training. But she was not ready to give up her passion! So, she created Family Dog University, Dog Sport University and Scent Work University to provide outstanding online dog training to as many dog handlers, owners and trainers possible…regardless of where they live! Dianna is incredibly grateful to the amazingly talented group of instructors who have joined FDU, DSU and SWU, and she looks forward to the continued growth of FDU, DSU and SWU and increased learning opportunities all of these online dog training platforms can provide.
 
#9 ·
I truly believe that it is better to make the decision to euthanize a little early than a little late. I sometimes follow the process of a dogs illness on Facebook and think that I would have made that decision at a significantly earlier date. However, it is such a personal decision that I try very hard not to judge people who let it go a bit too late.
 
#11 ·
Wow , what a article that Dianna wrote !

Quote from Dianna :This is the tightrope you will have to walk.

It will make you crazy. You will over-analyze every little thing


This was me . One day , I would wake up and say this is the day , then 10 minutes later Ali was up and doing better , it was back and forth , The vet called me one night and we had a great talk , He said like others on here had said , Ken , she will tell you , and that is what happened , she did .

Grant Yourself the Opportunity to Say Goodbye

This what we did and so happy we made that work , I only left to take care of business that had to be done on the farm , The wife and I spent all the time we could with her , she loved being outside and that's what we did , we would go out at 6:30 am and come in when she was ready , then again in the evening . This was very important to us all . She knew something was wrong and that we were loving on her to help .

I will say that in this article , it was like Dianna wrote everything and emotion we went threw here . The only thing I will add is that even with this kind of info and help from others , you will never truly understand till you go threw it yourself , which I pray that nobody has to

Thanks for posting this up Meadowcat
 
#12 ·
MC, thank you so much for sharing this. This is what I have to share with my daughter who is still in so much pain with the loss of Duggan. We all are, but her especially. She is taking the pain on herself and feels like she failed her dog. I know this will help her and it helped me. What a sensitive, well written article for all that ever face this loss. It couldn't have been said any better.
 
#13 ·
Yes great article MC........it seems as humans (no matter what) we are always seeking a miracle during times of death......and when its all over ...then we blame ourselves. It seems that when our dogs pass away ....I always read stories on rainbow bridge of that last sign from our pups...... that sign that we get from our pets confirming that ...It's OK........a paw... a lick.....always something that helps us as humans finally let go.
They give till the end........and it appears ....so will we!
 
#14 ·
Thank you for this sticky. I read it when Coco's time was coming. I like everyone else was so worried that I wouldn't know exactly when the time was right. Like Doc said you don't know until you're in the situation with them and then they let you know when they are ready to go.

I would give anything for one more day with Coco but I have never regretted letting her go when we did and this brings me peace.
 
#15 ·
Adding another excellent post to this always hard topic. From here (text copied below for convenience). Author credit to Dr. Mel Newton: https://melnewton.com/2019/the-good...LWPFlV28wwG8zsW1HhVD0-5b6prsc-3vX14cifEpcL1ZA
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The Good Death
November 14, 2019 Posted by Melinda under Uncategorized
32 Comments
Print Friendly, PDF & Email

A good death.

That is our responsibility to the animals under our care, if we can possibly give them one. It isn’t always possible – they get lost, hit by a car, burned by a fire, swept away in a flood, poisoned by contaminated feed. It’s a dangerous business – this thing called living.

Sometimes we get lucky. Those under our care live a full and happy life until they drop dead seemingly out of nowhere – an undiagnosed heart condition, an aneurysm. It’s over so fast that it leaves you reeling. Just yesterday they were fine! I never knew anything was wrong.

Other times the choice is clear. Your horse is writhing on the ground in pain from a colic episode. Surgery isn’t an option and medical management has failed. Euthanasia is the only option so you give your partner the relief they need.

This post isn’t about any of those deaths. This post is about when we have to do the agonizing job of choosing the time of death after receiving a terminal diagnosis, or trying to decide when to call it quits after a long gradual decline of chronic illness. Or maybe it’s a younger animal with a disease that won’t hasten their death but calls into question of what the “right” decision is moving forward – life or death?

Of course we want the decision taken out of our hands. “I want them to die in their sleep, at home.”

Yeah. You, me, and everyone else.

I can practically guarantee that if we are having this conversation, they won’t and they don’t.

I’m sorry. Really sorry.

It really sucks and don’t let anyone, including me, tell you differently. These are the hard cases.

“When will I know?” is the most common question I get from clients and friends who want to talk to me about it. Is it when they stop eating? Get down to a body condition score of a 1 out of whatever number scale you want to use? Can’t stand? Can’t get up the stairs? Don’t want to go on walks? Is it the look in their eyes? When they are so confused they are head pressing in the corner of their stall or their living room? Or is it the day before you leave on a long vacation because you can’t stand the idea of getting a phone call from the pet or ranch sitter in a week and having to make it happen when you aren’t there?

When do you make the decision to end a life that has nothing to do with putting food on the table or war?*

*the only other culturally acceptable times I can think of to end a life, with the exception of a few states where there is an end of life dignity laws.

People want me to give them the formula. “When they stop eating for X days it’s time,” or, “body condition score of 1 means it’s time.” Or maybe it’s when various body fluids are pouring out of various orifices with varying amounts of control.

The problem is, every animal is an individual, has different priorities in life, and deals with the suffering and limitations of old age or their condition differently.

Here’s the thing.

Most people wait too long.

Concerned with cutting a life short unnecessarily, or guilt-wracked with should-of’s and could’ves, they hang on to their pet’s continued existence as proof that this is not a convenience euthanasia.

But, we need to remember that animal cares nothing for our intentions, or whether there is some small hope of a better future. An animal lives in the present. Any decision to prolong suffering should be because there is a significant hope that a life that can be well-lived on the other side of that suffering.

So, let’s set aside the guilt, sadness, and all those other complicated human emotions that are important and real, but don’t matter to the animal in front of us.

When is it time?

Let me ask you another question.

What are you waiting for?

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..



Are you waiting for them to not be able to get up, to be found 6 or more hours down in the mud with signs of struggle as they tried again and again to make their arthritic joints obey their still young-at-heart spirit?

Are you waiting for your dog to take one last swim in the swimming pool, the love of their life, and not be able to get out this time because their hopes just can make that last leap?

Are you waiting for them not to eat for a couple of days?

Are you waiting for there not to be any more good days?

Are you waiting for the day they can no longer rise to relieve themselves and your once fastidious animal soils itself for a couple of days while you wait to make sure it’s time?

I know these are upsetting to read. They are hard to even write. The thing is, I’m not making any of these up. These and more are actual scenarios I’ve personally been a part of.

I think considering the question “what are you waiting for” instead of “when is it time” clarifies a lot of things. It often brings to mind the scenarios that we don’t want our animals to experience if it is in our power to prevent it.

I can’t think of anything more awful than waiting to euthanize my arthritic old horse until they are down in the cold mud, struggling and panicking for hours.

I will gently put her to sleep on a warm day when the sun is shining, while she is standing and her last hours will be filled with love and gratitude for the years of service she gave to me.

I will I will not wait until the bad days have squeezed out all the good ones until there is only suffering. That isn’t fair and that is as selfish as euthanizing too early. Somewhere between convenience and a love too great to let them go is a happy medium where the needs and suffering of the animal are considered independent of the human’s needs.

I told you, this “right time” stuff is tricky.

Here’s what I’ve learned in my very short five years of being a veterinarian and listening and seeing clients talk to me about death and wrestling with this question.

You know when it’s time.

Your gut is very intuitive.

Your job is to listen to your gut. It starts with a small voice. “Someday,” it says. Not today, not tomorrow, and not next week. But it’s coming.

I look at Farley, 21 years old in a couple of months, a tad stiffer than she was a year ago. Still maintaining weight despite crappy dentition that’s barely kept in check by regular dentals. Her death at my hand is a long ways off (unless she makes some uncharacteristically poor life decisions…always a considerations with horses) but at 21 it’s unlikely she has more years left than what we’ve had so far. I can’t afford to get complacent. Do what I can to mitigate the decline and give her a pat on the nose knowing that I’m unable to see the future and she could have a decade left, or (probably, statistically) a lot less.

At some point “some day” turns into “soon.” Not today, not tomorrow, but it’s time to turn a critical eye towards the question of “what are you waiting for?” That will help define the end markers.

Maybe it took an extra try to get up in soft footing after that roll. During turn out she falls. She’s never done that before. Now when she runs in the arena there are no wild gallops.

How long do I wait? Depending on circumstances I try controlling the footing, medication, management, but at some point all that can be done in the specific circumstances has been done (which doesn’t mean that everything has been tried because time and money is never unlimited, at least in mine and my client’s lives. And that’s OK too.). Now there’s evidence that one night she struggled for a prolonged time trying to get to her feet.

But she’s fat and shiny and nickers at me when I go out to the barn.

Is it time?

Your gut hurts. You can barely think through the decision and your mind slips off sideways when you think about doing it even as you try to grab it with both hands you can turn it over and see it from all angles. You think about the judgement of social media and others looking in from the outside. “You could have….”, “You should have….”, “Why didn’t you just…” Will others think you euthanized for because it was easy? You just bought a new car and your new baby is taking up a lot of your time. You have a big vacation planned and you fly out next week.

Folks, these decisions aren’t easy.

I can’t give you an algorithm where you plug-in numbers and it gives you a result.

Here’s what I can offer for comfort.

I’ve done literally hundreds of euthanasia’s as a vet so far in almost every species imaginable. Only twice have I turned someone away and said “no, I will not euthanize your animal.”* That’s because you, as an owner know your animal well. Sometimes you need me to chat with you about your decision, but usually I’m able to validate your gut feeling. Most of the time, it was time to make the decision to let them go a week ago, but you couldn’t bring yourself to do it and waited.

*These “no’s” were people who insisted that I euthanize their animal and I refused to do so, believing based on a lot of different factors that the requested euthanasia had nothing to do with the well-being of the animal, and everything to do with being asked to euthanize under false pretenses. One I believed was a vindictive family member, the other was a breeder who had gotten a new male and didn’t want to her older male for breeding purposes any more. I very much doubt any of my readers fall into either of those categories. Other’s have come in for a euthanasia, only to find out there was some cheap and easily controlled disease to treat. It doesn’t happen a lot but it does happen sometimes and every one definitely goes home happy when it does! I don’t count those as euthanasia failures, those are just joyful misunderstandings!

For all of us, including our pets, life is always too short. It doesn’t matter if you squeeze another week in. If it’s a week of suffering it doesn’t mean anything. If there’s a terminal diagnosis and quality of life will only get worse, it’s OK to say goodbye now while life is still good. It will never be enough time, you will always wish there had been one more ride, one more picture, one more walk. There will always be regrets. Don’t make holding onto an animal longer than what is fair to them be one of them. Under the guise of “life” there are things worse than death. Give them the gift of a good death.

If you are struggling with the decision and evaluating quality of life, here are some good resources:

How Do I Know it’s Time? Ohio State University: https://vet.osu.edu/vmc/sites/defau...ionAnimals/HonoringtheBond/HowDoIKnowWhen.pdf

Quality of Life Scale Quiz from Journeys Home Pet Euthanasia

Welfare of Aged Horses – Chapter 5 is especially relevant (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513472/)

Time to Say Goodbye from the Horse.com (https://thehorse.com/151225/time-to-say-goodbye/)

It goes without saying that your veterinarian can be a good (and necessary) resource. If at all possible, chat with your vet about their philosophy of end of life care prior to having to make a big decision like this. Veterinarians are individuals and we hold varying opinions on the giant grey area of the timing of a good death. Your vet can be an ally in this situation and help shoulder some of the stress of deciding when it’s time to say goodbye.
 
#16 ·
Thank you Meadowcat. People need to be able to read this when the time is coming to make that selfless decision for our loveys.

I read these articles so it reinforces that we made the right decision at the right time for Coco. The night before I was going to be selfish and cancel the appointment and then she screamed trying to get on the couch. She sat in my lap and we both cried and I knew I could not cancel that appointment. The next day my husband had a meltdown and begged me to cancel the vet coming to our house and I said I can't do that to Coco. It hurt but it was powerful because I knew in my heart I had to do that for her because I loved her so much.
 
#17 ·
Ah MeadowCat,

Thank you so much for letting us share this vet's thoughts about knowing when it's time. It's nearly two full months since I took Toad for his last trip to the clinic where he grew up, where he was thrilled to visit because he had a lot of friends there and because I wanted to be around people who knew both of us when I sent him wherever the good dogs go.

I've had a good many Dobermans, an Australian Shepherd and many cats euthanized and it was one of the cats--a white cat who showed up in the back yard when I was weeding a flower bed who taught me a lesson I've never forgotten. She was thin, and so dirty she was the same color as the reddish tan soil of that part of California. I had a lot of roommates in that house. When I went in a few of them were hanging around the guy who was the cook that day--they looked at the cat hanging out on the patio--looking hopeful.

No feeding that cat I told them--they looked at the cat, they looked at me and they looked at the cook. I went and got my car keys and the cat and took her to my regular vet. The vet said that the cat was maybe 13 or 14 months old. Unspayed and very thin but if I was going to keep her I might want to try to get some weight on her before I had her spayed. The vet and I looked at each other--we both knew that one good meal was going to have that cat in season and 24 hours later she'd be bred and she was in no shape to be dealing with a litter in her state even if I did keep her.

Four days later I picked her up--neutered but nice and the cat was delighted to see me. The vet remarked that my new cat sure had a big uterus for a scrawny little kitty--guessed that she'd had a couple of litters before turning up in my back yard.

She turned out to be a great cat--and she was negative for FELV and seemed otherwise healthy. I gave her a bath--she was still the color of California dirt even though I don't usually bathe cats I really didn't think licking all of the dirt off was necessary--she was very white under the dirt and one of the roommates realized that one eye was sort of pale blue and the other was sort of pale greenish brown--made her look like a ditzy blonde. At 7 she started leaving bloody stools for me to scoop out of the litter box. The vet said, let me do some tests. She did and my Christmas bonus that year went for an endoscopy of her gut. The results weren't good--IBD--she was already loosing weight. She was never a big cat--weighed around 8 pounds in her best condition. Most of what she wanted to do when she got down to 5 pounds was to curl up on or next to me and purr.
But one day I picked her up to put her on the bed where I'd been reading--she weighed nothing--all I could feel were bones. We went to the vet--she weighed 3 pounds--I held her on my lap when they euthanized her--I really, really did not want to let that cat go.

But she taught me something really important--I will never let a pet of mine get into a condition like that--she could no longer even jump up on the bed. I will let them go too early rather than keep them too long. And I don't. Most of my dogs and all of my cats have been taken, by me, for their last trip to the vet. I hate it. I hate leaving with one of my pets and coming home without them

I always think about that stray cat I took in when I take another pet to the vet and wait with them during their last minutes. Toad was the hardest--he may have been 14 and he may have had cardio but it was well controlled on medication and old as he was he was a happy dog. He looked good and felt well right up to the day I took him for his last trip to the vet. It was tempting to see if any of the vets thought I should maybe wait and see if we could improve his breathing. But I knew--that it would be no kindness to Toad who I'd waited for a long time (a show quality fawn Doberman--go figure) He gave me fourteen years of joy and pleasure--waiting, just in case, would have been no kindness for a dog who was entitled to so much more. So I said my good byes and the vets and tech's and receptionist's who had known him since he was puppy came and said their good byes. And I went home..

The house was very empty--the younger cat who fondly believed that Toad was HIS dog looked for him--he went through the house twice--thinking I guess that he'd missed him the first time through. I lasted 3 days in that very empty house with Toad's cat rushing to meet me at the door because he was sure that I'd have his dog this time.

The following Saturday I went to an Obedience, Rally and baby puppy show. The upshot of that was that I borrowed a puppy from a Mt Hood Doberman Pinscher Club member--Joey, a Toad grandson and with much the same charm that Toad had.

He's not a replacement. But puppies are just a lot of work--they're busy-- and they get into trouble if you don't pay attention to what they are doing--Joey now actually belongs to the cat (who is still trying diligently to teach a rowdy puppy how to behave around the cats.) I've gotten to the point where every thought about Toad is not a pang--now I can think about the good times and the fun and goofy things that Toad did. When, in fact, the loaner puppy gives me enough time to dwell on it.

For the record--I've only had one of my dogs die at home...and that dog went to an Agility trial on a Saturday morning--ran a couple of courses, got a lot of treats, came home all wags and grins--went out to get a drink of water and came back and sat down which was so unusual for him I looked to see what he was doing. We didn't quite make it up to the clinic--it's only 20 minutes from me but half way there I saw that he was up (he was in the back in the canopy and I could seen him in the rear view mirror when he went down.) I knew he was gone. The vet confirmed it when I got to the clinic. In some way's it was harder on me that sudden death--but that dog would have hated being an invalid--so I thought it was very lucky that he went his own way--full of bounces and bean's for nearly 10 years and had a bad 15 minutes then he was gone.

It's always hard but I don't ever have to feel even worse about losing a pet that I kept too long--that was a really hard lesson to learn and learning it the way I did was awful.

Thanks again Meadow cat--that was a great addition to a pretty sad but informative bunch of posts.

dobebug
 
#18 · (Edited)
Thanks Meadowcat for posting this !

Aung Bug - A very good post from you - from the heart and from real life Experience , to me , that's the hard part , Because you have already lived it and the feelings that go with it , A learning process , a tuff one at that .

I still question myself , Did I wait to long to let Ali go ?? I still can not answer that question . I did do as the Vet in the above article asked ? to lean on our Vet , He had Doctored Ali since a puppy - He knew her well , He told me she would let us know - I also asked what the sign's would be ? I know , You are saying why would I do that ? Well we have been blessed , we never had a Dog that had , had cancer before - How would it affect her in ways I may not see or know . The Vets also put her on some meds that may slow the progress of the cancer - they had seen it add 6 months to a years to there lives and they would still carry on a somewhat normal life . I personally thing , looking back at that " Hope " I may have waited a few days more than needed to be , The " Hope " it would work and it takes time for the Meds to work , Which in my eyes , they did not have any effect .

Now on the flip side , Ali was Ali , that was till the night before we let her go , The signs the Vet had told me to watch for all came to a head that night . The next morning , I paced and I paced , I sat outside crying in my coffee , I came in and told Mrs Doc . I'm going to call Doc . It was time to say our good byes . It was the hardest thing I ever did in my life - to make that call . It was Doc's day off , He had told me that would never mater what day it was - just call the office and tell them to get ahold of him -- Stat ! That may not sound like much to some , Yet it took off some of the pressure - The pressure that it is time and that you may have to really hold on to long and cause her much more pain . Yes , I could have called the day before his off day , Yet she did not really fall into what Doc had told us , This is a point I question myself as I said before , Looking back - yep , I think I should have , then she would have had to go threw that bad night - But you know what - It was something to learn from , Just like reading the post from Aunt Bug , It's Experience ! Something that Bug has more than I .

I will be honest here , I sent Bug a PM along with my phone number , to call me , I needed her opinion , as we had not traveled this road before , I just wanted to do the best and to be the best dad from Ali girl . Much Like Coco was doing for her girl . It's just so hard , that first time . I also leaned on MC , She had that magic word to - Experience ! What was so hard on me , was to put my best friend asleep - To end it with a shot , To do this to somebody that followed me from the time we got up , till we went to bed - to make that call . We always did what we thought was best for her and what was best for her now was to let her - Like Aunt Bug says - to let them go where good dogs go .

Doc
 
#19 ·
The only dog Scott and I had to put down was our Border Collie and she was 14 years old.
It was the first dog that Scott and I had raised together.
She rarely had any problems.
As she approached 10 years old my vet started warning me......just like humanas as we get older we begin to have more physical problems.
At eleven he noticed a difference in her eye sight......
Then her ability to get up and down was much slower.
But at 14 she could not get up and down.
Then stopped eating .
So Scott stayed home with her and took her to the vet at noon.
Scott petted her until the last breath.
He swore he would never get another dog.
But then we realized that we would never experience that joy of owning a dog and along came Mafia.
Mafia dies of sudden death at 8 years. We were blessed that day because the decision was not placed on our shoulders.
So that takes courage! Do not ever be to hard on yourselves
 
#20 ·
Another excellent addition to this thread. Tough watch, but really, really good. This is made for vets, but worth watching for us owners, too.

 
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