Not a nice subject but one all pet owners will face sooner or later. Maybe you have an elderly dog or a dog with serious health issues and you are concerned about what quality of life your dog is having. It is an exhausting and constant internal battle of emotions, denial and hope. Having recently had to make the biggest decision of a pet owner's life, I understand the toing and froing that this decision involves.
I made the decision to euthanise my old boy, Bud, a 15 year old Jack Russell Terrier, last month.
For the past two years there had been a noticeable but slow decline in Bud's health. At first, he was displaying the signs you would expect in an aging dog- stiffness, tiredness, partial blindness and a slower pace which was easily managed with pain medications (he was prescribed Tramadol and Metacam). The last few month's of his life, the decline escalated and he started to display more neurological signs such as restlessness, anxiousness, confusion and memory loss and to manage this he was also prescribed Diazepam. This concoction of drugs didn't sit well with me and I started to consider what would be in his best interests, in my mind he was never going to get better, worse actually, and the only way to keep him alive was to pump him full of sedatives and pain relief- what kind of life is that?
My worst fear was having him euthanised too early and cutting his life short and at the other end of the scale I was worried about prolonging his suffering. I planned biweekly vet visits to assess his progressing aging and ensure his medication was altered accordingly so he was comfortable.
During the vet visits the vet told me about the HHHHHMM Scale developed by Dr. Alice Villalobos, DVM. The scale helps you objectively determine if euthanising your pet is the right choice for them at this time.
For each category, you will rate your dog on a 0 to 10 scale, with 10 being the highest rating and 0 being the lowest rating. It is suggested that you complete the scale assessment three times over three consecutive days to get the most accurate reading.
HURT – Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet’s pain successfully managed? Is oxygen necessary?
HUNGER – Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?
HYDRATION – Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
HYGIENE – The patient should be brushed and cleaned, particularly after elimination. Avoid pressure sores and keep all wounds clean.
HAPPINESS – Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet’s bed be close to the family activities and not be isolated?
MOBILITY – Can the patient 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, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)
MORE GOOD DAYS THAN BAD – This is my favourite because it is more of a feeling. This when bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
TOTAL= A total more than 35 points is acceptable.
Or you can use this method:
Quality of Life assessment. How to assess your pet.
Many animals do not complain in obvious, visible ways.
Many animals (especially cats) will hide their discomfort.
Consider the following:
YES/NO My pet hurts.
YES/NO My pet limps (if it didn’t hurt, he wouldn’t limp.)
YES/NO My pet pants frequently, even at rest.
YES/NO My pet’s respirations are forced, exaggerated, or otherwise not normal.
YES/NO My pet licks repeatedly at one site on her body or at a site of a cancer/tumour.
YES/NO My pet guards or protects and area of his body and may snap if that area is approached or touched.
YES/NO My animal’s posture is abnormal or different than normal.
YES/NO My pet shakes or trembles sometimes during rest.
YES/NO My pet is on pain medication and it doesn’t work.
Appetite is one of the most obvious signs of wellness. Most animals are normally vigorous eaters. Consider the following:
YES/NO My pet doesn’t eat his normal food anymore.
YES/NO My pet picks at her food now but never used to do this.
YES/NO My pet walks over to his food and looks at it but won’t eat or walks away from the food.
YES/NO My pet doesn’t even want good stuff (treats, human foods, snacks) anymore.
YES/NO My pet acts nauseas or vomits.
YES/NO My pet is losing weight.
Hydration status is equally important as appetite. Dehydration can contribute to weakness and not feeling well. Consider the following:
YES/NO My pet doesn’t drink as much as she used to.
YES/NO My pet frequently has dry, sticky gums.
YES/NO My pet is vomiting or has diarrhoea.
Animals that don’t feel well, especially cats, do not have the energy to maintain normal hair and skin. Consider the following:
YES/NO My cat doesn’t groom herself any more.
YES/NO My pets hair is matted, greasy, rough looking, dull, or foul smelling.
YES/NO My pet has stool pasted around his rectum or in his hair.
YES/NO My pet smells like urine or has skin irritation from urine.
YES/NO My pet has pressure sores/wounds that won’t heal.
Changes in normal activity can be due to mobility problems, pain, illness, or aging (arthritis). Consider the following:
YES/NO My pet cannot get up without assistance.
YES/NO My pet had a hard time getting around and/or limps.
YES/NO My pet lays in one place all day long.
YES/NO My pet does not want to play ball, go for walks, or do the things he used to do.
YES/NO My pet falls frequently.
Another important area of consideration is your pet’s mental status and happiness. Consider the following:
YES/NO My pet does not express joy and interest in life.
YES/NO My pet does not respond to the people that he used to respond to.
YES/NO My pet does not want to play with toys or do other things that he used to enjoy.
YES/NO My pet seems dull, not alert, or depressed.
GENERAL BEHAVIOR PATTERNS
Changes in normal behavioural patterns are often a key indicator of how your pet is feeling. Consider the following:
YES/NO My pet is hiding or sleeping in odd places.
YES/NO My pet doesn’t greet me when I come home and he used to.
YES/NO My pet is overly clingy and is following me around and he never used to do this.
YES/NO My other pets are treating my pet differently and they are overly attentive or ignoring him completely.
YES/NO My pet doesn’t care about what is going on around him.
Many times you, the ‘parent’ or owner is aware that your pet is suffering but do not want to give up on them. Consider the following:
YES/NO I wouldn’t want to live if I were in a similar situation.
YES/NO I would be painful if I were in a similar situation.
YES/NO I have made appointments for euthanasia for this pet cancelled or didn’t show up.
YES/NO I am holding onto this pet for a sentimental (personal) reason.
YES/NO My pet is having more bad days than good days.
Adapted from Quality of Life Scale, Veterinary Practice News, June 2006, pg. 24
For me, I knew it was time to say goodbye to Bud when he was having more bad days than good days and the vet confirmed my decision after examination. If anyone is interested in the euthanasia process and what to expect on the day leave a comment below and I will write a post about that.