Quality of Life Scale for Pets--Help with the Euthanasia Decision - Doberman Forum : Doberman Breed Dog Forums
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post #1 of 14 (permalink) Old 10-17-2014, 12:51 PM Thread Starter
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Quality of Life Scale for Pets--Help with the Euthanasia Decision

From Pawspice - Advanced Veterinary Cancer Care Center in Southern California. 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.

Last edited by melbrod; 11-11-2014 at 11:50 AM.
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post #2 of 14 (permalink) Old 10-17-2014, 01:35 PM
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Very interesting. Thanks for posting it.
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post #3 of 14 (permalink) Old 10-17-2014, 04:00 PM
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Made it a "sticky". Good information.
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post #4 of 14 (permalink) Old 10-17-2014, 04:37 PM
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Thank you!! This will be helpful for those that have to make that hard decision. I know I would use it as a guide when trying to make that call.
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post #5 of 14 (permalink) Old 11-11-2014, 11:45 AM
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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

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.
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well said sir.
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post #7 of 14 (permalink) Old 09-23-2019, 02:55 PM
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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/i...mOABey1-MJLiic
__________________________________________________ ___________
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.
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post #8 of 14 (permalink) Old 09-23-2019, 03:19 PM
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Thanks MeadowCat--wonderful advice given in these posts to the answers of the eternal question "How do I know when...?"

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post #9 of 14 (permalink) Old 09-23-2019, 07:59 PM
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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.

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I think that is one thing I try to ask myself at some point...how much am I just trying to hang on to a dog so I won't have to deal with not having him in my life anymore, not wanting to think about being alone--rather than thinking about what might be better for the dog.

It's such a tough decision and so easy to second guess yourself.
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post #11 of 14 (permalink) Old 09-24-2019, 05:06 AM
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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
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post #12 of 14 (permalink) Old 09-24-2019, 09:44 AM
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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.
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"Lots of people talk to animals...Not very many listen, though...That's the problem. " ~ The Tao of Pooh
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post #13 of 14 (permalink) Old 09-24-2019, 10:30 AM
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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!

Hoss
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post #14 of 14 (permalink) Old 09-24-2019, 09:29 PM
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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.



Kin's Sweet Revenge aka Sugar December 31/18

Coco Loco RIP April 16/09 to December 21/18
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