Dog Health Care September 8, 2016 Share 9 Tweet Pin 0 Share 1 Loving Too Much? Know When to Say Goodbye to your Dog Do you love your dog enough to let him go? When a pet is terminally ill, the decision to say goodbye to a much-loved dog is difficult indeed. Guilt, anger, grief, and inadequacy are just some of the feelings that assault us that make clear-headed action even harder. We all want our dog to be pain-free, with a good quality of life, but it can be difficult to set emotion aside and recognize when this is no longer the case. Human nature means we move the goalposts, and what was not acceptable once becomes acceptable over time. Indeed, loving a pet too much can make it unbearable to say goodbye and mean the dog declines beyond what’s fair. So how do you know when it’s time? Let’s take a look at some strategies to help make a painful decision clearer. The one best place to bury a dog is in the heart of their master. Plan Ahead Whether you have a puppy or an active elderly dog, write down a snapshot of what makes for good quality of life. Consider the positives such as: My dog always greets me with a wagging tail My dog loves going for walks He eats enthusiastically His favourite activity is playing tug Brainstorm and write down what makes your dog happy. Now write down the basic requirements that indicate your dog has a dignified life. These might include: He doesn’t soil himself He’s able to use stairs without taking a tumble He participates in play He enjoys family life and isn’t withdrawn He’s not in pain Eat and keep food down Make the list as full as possible, seal it in an envelope, and store it safely to refer to at some unknown future date. When the day comes when you need help making a decision, open the envelope, and compare then and now. For example does your dog now regularly soil himself, but you no longer bat an eyelid. Consider, with fresh eyes, what this means for his dignity. Don’t Decide Alone Don’t take the weight of the decision solely upon your shoulders. Talk things through with friends, family, and your vet. Give those people permission to be honest, so they say what they’re really thinking rather than what they think you want to hear. This often gives a useful fresh perspective. Your vet can guide you on the medical side of when to say goodbye to your dog, but also be aware that they aren’t with your dog 24/7. Sometimes it’s the dog’s lack of interest in life and change in his habits which is the telling that the quality of life isn’t there. Remember, this shouldn’t be ‘quantity’ of life, but the enjoyment the dog gets out of it. An A, B, C Guide to Quality of Life If this all sounds a bit woolly, it may help to rationalize your pet’s health and wellbeing. For example, breathing difficulties are distressing for the pet, and recognizing your dog is struggling can ease the guilt of saying goodbye. With this in mind, here is an A, B, C guide to a dog’s mental and physical welfare. Read each point and answer honestly. If necessary write down your response and refer to it in the future to give you a measure of improvement or deterioration. A: Appetite: The chow hound that loses his appetite in the long term is significant. The dog may feel nauseous or associate eating with feeling unwell. B: Breathing: Difficulty breathing, especially because of fluid build-up in the chest, sap the dog’s energy, stops him eating, and makes him anxious or fearful. Fluid in the lungs is akin to slowly drowning, and needs action to alleviate the problem. C: Cleanliness: A dog’s basic instinct is to be clean and not soil himself. The dog that regularly soils himself is liable to lack dignity D: Dehydration: Dehydration can happen when pain makes a dog reluctant to get up and drink, he feels too weak, he’s struggling to breath, or he loses fluid by constantly urinating. It is not a pleasant feeling and whilst simple actions such as moving the water bowl closer can help, be sure to address the underlying issues. E: Environmental factors: How are your dog’s mobility, his ability to get around the home, and enjoy walks? The discomfort of arthritis has an impact not just on physical health (pain) but on mental well-being if he can no longer move around his environment F: Freedom from Pain: No owner wants their dog to be in pain, and bear in mind that lameness is a sign of pain. Modern veterinary medicine means there are good options for safe and effective pain relief, so discuss these with your vet. G: Good versus Bad Days: All dogs have off days, but you want to be sure the highs outweigh the lows for their long term welfare. Dogs exist in the moment and don’t have the ability to rationalize that tomorrow or the day after may be better, so serious thinking is required if he spends more time sick than well. H: Happiness: Does your dog positively enjoy himself or does he simply ‘exist’? Quality of Life Scale Pet caregivers or dog owners can use this Quality of Life Scale (Pawspice)  to determine the quality of life for terminally ill pets. Score patients using a scale of: 0 to 10 (10 being ideal). Score Criterion 0-10 HURTAdequate 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 HUNGERIs the pet eating enough? Does hand feeding help? Does the pet need a feeding tube? 0-10 HYDRATIONIs the pet dehydrated? For patients not drinking enough water, use subcutaneous fluids daily or twice daily to supplement fluid intake. 0-10 HYGIENEThe pet should be brushed and cleaned, particularly after eliminations. Avoid pressure sores with soft bedding and keep all wounds clean. 0-10 HAPPINESSDoes 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 MOBILITYCan 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 BADWhen 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). And finally, few people welcome the responsibility of ‘playing god’ with their pet’s life. However, by making the right decision at the right time for a sick dog, you show true love is unselfish by saving your pet from suffering. If you have any experiences of pet loss you’d like to share, we’d be honoured if you’d leave a comment below. References:  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. Alice Villalobos, DVM, DPNAP, a renowned veterinary oncologist, introduced “Pawspice”, a quality of life program for terminally ill pets. Pawspice starts at diagnosis and includes symptom management, gentle standard care and transitions into hospice as the pet nears death. Dr. Villalobos developed this scoring system to help family members and veterinary teams assess a pet’s life quality.