Is It Time? Assessing Quality of Life

The human animal bond is sacred and strong, and it is not unusual for people to feel more emotionally connected to their pets than to some of the people in their lives. Our pets play a large role in our overall emotional lives, and this often becomes especially apparent when facing their end of life. No one wants their pet to suffer, and yet many times people are unprepared when faced with the decisions surrounding death and dying.

There are several things to think about when assessing your pet’s quality of life.

1. 1. Respiratory Effort: Breathing is of the utmost importance for all of us. This may seem obvious, but because changes often happen gradually, sometimes it may be difficult to assess. Is your pet able to breathe comfortably and effectively? If not, are you implementing treatments to help your pet’s breathing? Tracking resting respiratory rate and respiratory effort can help monitor how your pet is doing. A hospice veterinarian can help guide you with this. If nothing is helping, and your pet continues to struggle for breath, quality of life is seriously compromised, and it may be time to consider humane euthanasia.
   2. Pain: Is your pet experiencing any pain? Some signs of pain are hiding, decreased mobility, losing interest in activities previously enjoyed, growling when touched, restlessness (especially at night), crying/whining/moaning, and refusing to eat or drink. If your pet is experiencing pain, have you been able to manage it effectively? Hospice veterinarians can help assess your pet’s pain level and implement pain management. Some treatments include pain medication, supplements, acupuncture, and gentle massage. If your pet’s pain becomes unmanageable, euthanasia becomes an option in preventing further suffering.
   3. Hunger/Thirst: Is your pet eating and drinking normally? Does your pet seem interested in eating or drinking, but is unable to for some reason? Is your pet eating or drinking more or less than normal? Changes in eating and drinking are strong indicators that something is wrong. Dehydration can be serious and should be monitored closely. A hospice veterinarian can help you address these issues and help you determine how your pet’s quality of life might be affected.
   4. Mobility: Is your pet able to get around comfortably? Is (s)he able to jump/climb/walk? Is (s)he able to get to favorite resting spots? Is (s)he still interested in moving? Still interested in daily walks, playing, etc.? Sometimes mobility can improve with pain management. Mobility is only one of the factors in considering quality of life, but if your pet seems happiest when they can be mobile, it becomes an important component when gauging quality of life.
   5. Attitude: Does your pet seem happy? Is (s)he still finding joy in his/her day? Journaling to keep track of good and bad days can be helpful in assessing your pet’s happiness. There are several free apps that allow you to journal your pet’s progress. You can also share your journal with your hospice veterinarian, and she may be able to help you find ways to increase your pet’s joy. When your pet’s happiness is significantly decreased, it may be time to consider euthanasia.

When considering quality of life, it is also valuable to recognize how your pet’s condition is affecting you and your family members, both human and other species. Some things to think about:

1. 1. Caring for your pet: Do you feel that you have a good understanding of your pet’s diagnosis and know what to expect as the disease progresses? Do you feel confident in your ability to physically, emotionally and financially care for your pet? Consider each member of the family including other pets when answering these questions.
   2. Euthanasia: What are your feelings about euthanasia? Have you had a pet euthanized previously? What was that experience like for you? How do your family members feel about euthanasia? What are their prior experiences? If you choose to euthanize, what components do you want included in the experience?

Some tools you may find helpful as you seek to monitor your pet’s quality of life include keeping a journal, remembering your pet before the illness, making a “favorite things” list, and completing a quality-of-life assessment.

Keeping a journal can help you chart your pet’s progress. Grey Muzzle is an app that tracks your pet’s good and bad days. Looking back over several weeks/months of journal entries can help paint a picture of how your pet is doing overall. Human memory and perception are affected by emotions, and sometimes what we think about our pet’s progress and what the journal shows are different. When your pet is having more bad days than good days, it may be time to consider humane euthanasia.

Chronic medical conditions and the death process can happen gradually. We are highly adaptable creatures, both humans and dogs/cats, and we can adjust to “new normals” quite effectively. Looking at old photos or thinking about activities your pet used to enjoy can help remind you of what normal looked like before his/her illness.

When my cat Sushi was sick, I worried that I would wait too long to have him euthanized. He was terribly sick, but extremely good at hiding it. So, I decided to monitor his weight. His normal weight was 9 pounds, and I decided than when he got to 6 pounds, I would choose to euthanize. I honored my decision, but then I worried that maybe I had euthanized him too soon. He was still eating and drinking and appeared happy. But a few months after he passed, I saw a photo of him that had been taken a few months before he was euthanized. Looking back at that photo, I could clearly see how ill he looked, but at the time the photo was taken I didn’t see it so clearly. This experience illustrated for me how we gradually adjust to a “new normal,” and can become blind to the reality of the illness’ effects. This experience also helped me feel better about the timing of my decision to let him go.

Another tool in determining overall quality of life is making a “favorite things” list. Choosing 3-5 activities that your pet loves and watching for when those activities begin to dwindle can be enlightening. Maybe your pet can’t go for daily walks anymore, but still enjoys playing with a favorite toy. When your pet’s enjoyment in life begins to diminish significantly, it may be time to let him/her go.

Several quality-of-life assessments are available. The HHHHHMM scale can be found at:
https://vetsocialwork.utk.edu/wp-content/uploads/2016/03/Quality-of-Life.pdf 

Journey’s Pet also has a good one:
https://journeyspet.com/pet-quality-of-life-scale-calculator/

Consulting with a veterinary hospice professional can help with addressing some of the quality-of-life issues that may arise. We have ways to help manage pain, improve mobility, maintain your pet’s happiness, and address any issues with breathing, eating, drinking, etc.

Deciding when to euthanize is a deeply personal decision that can only be made by you and your family. There is no perfect moment in time. It can be challenging to know when, but by utilizing these quality-of-life assessment tools, consulting with a veterinary hospice professional, and listening to your own intuition, you will be able to find a time that feels right for your pet, your family and yourself. Maybe you choose to euthanize on a good day because you want your pet’s last moments to be when (s)he is feeling good. Maybe you are watching your pet for some sign that (s)he is ready. Maybe your pet’s condition progresses quickly or is very painful, and you want to prevent suffering. Maybe you want to keep your pet comfortable and allow him/her to die naturally. Every pet and every family are unique.

As veterinary hospice professionals, we want to help find what is right for you, your pet, and your family. We offer telemedicine quality of life consultations with a veterinary nurse and in-home hospice evaluations with a doctor. However you choose to proceed is perfect because it is decided by you. Please reach out to us. We would be honored to help you and your pet.