Quality of Life Scale for Pets--Help with the Euthanasia Decision - Doberman Forum : Doberman Breed Dog Forums
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post #1 of 6 (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.
*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 6 (permalink) Old 10-17-2014, 01:35 PM
Eschew Prolixity
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Very interesting. Thanks for posting it.
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post #3 of 6 (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 6 (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 6 (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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post #6 of 6 (permalink) Old 07-11-2017, 10:50 PM
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well said sir.
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