We've all been there. Our beloved pet is getting old. He's sleeping more, moving a little slower and he doesn't seem to be hearing as well. He still likes to play ball but not as vigorously as he used to and he tires more quickly. We start to wonder, is it time?
Having pets in our lives is a great joy. From the first introduction into our household to becoming part of the family to growing older, our pets are beside us every step of the way. We don't think about tomorrow or "what ifs". We just enjoy the time we have.
Our pets age many times faster than we do. A 10 year old dog or cat is about 56 human years and larger breed dogs age even more rapidly. So while our pets are still kittens or puppies in our hearts, they are actually quite a bit older.
What do we do when we are faced with the declining health of our pet? What factors come into play in deciding when is the right time and how far do we go? The decision is a very personal one and different for each pet owner.
It all comes down to quality of life. Quality of life is very subjective. It depends on your pet's disease process, his/her personality and your own personal beliefs. There are, however, some things to consider when evaluating the quality of your pet's life.
A. Pain Assessment: Pain can be divided into 3 types:
1. Classic Pain - i.e arthritis
2. Pain of Disease - not acute pain but general malaise. We see this type of pain with diseases like chronic renal failure, hepatic disease and some cancers.
3. Anxiety/Distress - This is mental pain and can often be worse than physical pain.
It is important to evaluate your pet with regard to these types of pain as well as our ability to address and control that pain.
B. Appetite: Is your pet eating? Does he eat something new for a day or two then stop? Is he refusing food altogether? Pets can physiologically survive for several days without food or water. This can be a sign that the body has begun to shut down. Appetite stimulants may be effective, but it is usually a short term response.
C. Uncontrollable Incontinence: Incontinence is the involuntary excretion of urine or bowel contents. It is often as much of a concern for your pet as it is for you. Urinary incontinence has many effective treatments, however, when it can’t be controlled it can lead to pain from bed sores and systemic infections if they are not kept clean and dry.
D. Mobility: Arthritis and ability to get around are common problems as our pets age. You may notice pacing, falling, inability or difficulty standing, stiff/stilted gait, difficulty urinating/defecating and panting heavily. This can lead to anxiety for your pet as well as cause significant discomfort. If anti-inflammatories and other medications no longer work, quality of life should be a concern.
E. Happiness: You are the best judge of your pet's happiness. You know what is normal behavior and attitude. When your pet no longer shows interest in food, toys, the surrounding environment or he/she starts to dissociate from you and the family, you should be considering the quality of life they are experiencing
Another tool to help assess QOL is "The Rule of Five". Think of five things they normally love. If they are not interested in more than 3 of the five, quality of life is impacted. You can also look at good vs bad days. If the bad days outnumber the good or the bad days are getting worse and the good days not as good, consider quality of life.
There are a few on-line tools to help you as well. Dr. Alice Villalobose has put together a quality of life scale on her website www.pawspice.com and Lap of Love has a quality of life scale and diary atwww.lapoflove.com.
Making end of life decisions can take an emotional toll on pet owners. This can lead to grief, depression and guilt. As veterinarians, we can almost always make recommendations about tests to run and/or treatments to consider but ultimately it boils down to your pet's quality of life, what you want for him/her and how much you want to put them through. Deciding on a stop point (that line in the sand that you do not want to cross) ahead of time can be helpful. Knowing in advance what you are willing to let your pet go through can help alleviate the guilt and make the decision clearer at a time when emotions are high. And remember, you are not alone. We are here to help you make the kindest, most compassionate decision for you and your pet.
It is never easy to say goodbye to someone that we love. But know that many times, loving them enough to let them go is the greatest gift we can give.