Dog Guide to Assessing Quality of Life - Cloud 9 Vets

WHEN IS IT TIME TO PUT MY DOG TO SLEEP

THE DECISION TO PUT MY DOG TO SLEEP

The decision to put a beloved pet to sleep is always a tremendously difficult and heartbreaking one. Sometimes a sudden and significant deterioration in the pet’s state of health will make that decision for us eg certain cancers can cause internal bleeding, or a crisis point may be reached due to advanced progressive heart disease. But in many cases, we have to decide against a background of gradual age related changes. It can be difficult to know at which point our pet's life was ok yesterday, but not ok for today, especially as their condition can be very up and down from day to day, or even within the same day. At these times, it can be extremely useful to assess the dog’s quality of life in an objective way. Discussion within the family can be helpful, although it is important to remember that different people may vary in their opinions as to what is acceptable and can be coped with by the dog and his or her carers. And of course, it is an emotive subject, there is a natural reluctance to accept that a dog is reaching the end of their life. For some, religious beliefs may also impact on such decisions. It is wise to seek the advice of your vet at this time, to allow a review of your dog’s clinical condition, any medications, and, most importantly, how you feel your dog is coping. It may be that some alteration or addition of medication could potentially provide a meaningful improvement to the dog’s quality of life. In particular, a multi layered approach to pain relief can be effective for conditions causing discomfort, such as osteoarthritis.



There are a number of scales available online by which a subjective judgement can be translated into a numerical value to allow objective scoring. This can be repeated over time to gain an insight into whether a dog's condition is deteriorating- incremental fluctuating changes can make it hard to judge this when we spend each day with our pet. Essentially, although we cannot judge an elderly dog's quality of life in the same way as we would a younger animal, there are some essential basics.that he or she should be able to fulfil in order to be experiencing a meaningful and comfortable life

It can be helpful to score each of these factors out of ten, one denoting severe uncontrolled symptoms, and ten being an absence of that symptom, or where it is being managed well by medication. Using this scale, overall a score of greater than 30/60 suggests that quality of life is acceptable at present, but lower than 30/60 would trigger significant concerns and justify discussion with a vet regarding further medical options, or whether euthanasia should be considered.

AS PET OWNERS WE KNOW

we know our dog or cat's normal behaviours, and sometimes it is enough to empathetically consider if they are enjoying life, and overall if we feel they are still having more good days than bad. If the answer to these questions is a negative, and particularly if the pet’s health issues are following a predictable trajectory of deterioration, with a limited chance of stabilisation and improvement with medication or palliative care, then it is kind and reasonable to consider to put your dog to sleep

It is important to take a holistic approach to put your dog down. While the pet’s quality of life is of fundamental importance in the decision making process, the owner’s quality of life is intrinsically woven into this decision too. For some owners, feeling relentlessly anxious, overwhelmed or stressed by a pet’s condition is a concern, and there may be physical, emotional and/ or financial difficulties associated with trying to meet the needs of the pet. It is not uncommon for some form of time constraint to be present also, most often that the owner is going away in the near future, and this may influence the decision with regards to timing of euthanasia. It may be considered unkind to leave the ailing pet in an unfamiliar situation, or under the care of someone who doesn’t know him or her well. And it could be unfair to rely on a friend or neighbour to make the decision about euthanasia should the pet deteriorate whilst owners are away.

In assessing quality of life, there are a multitude of factors to consider. By definition, none of us want to make the decision to euthanase our pet, so when we start the process of thinking about it seriously, that in itself tells us something significant. It is important to remember that although we feel distressed by these thoughts, our pets are unaware and do not anticipate their own death. The most frequently reported regret surrounding the decision to put a pet to sleep is that it was made late. The old adage of better a week early than a day too late is very true. And never feel that you have to make the decision alone. Having a detailed and honest conversation with a vet who is experienced in quality of life assessment and end of life care can be enormously helpful and reassuring.

WHAT TO LOOK FOR

• Eating. It doesn’t have to be a huge amount, but enough to maintain themselves. Many older animals are more sedentary so do not require as many calories as in their younger days.

• Drinking. But it is important to remember that although drinking very little can lead to dehydration, some conditions such as kidney problems and diabetes may also result in dehydration even though the pet is drinking excessively.

SIGNS OF PAIN?

or other unpleasant symptoms – these may manifest as the pet vocalising ( whining or crying ); becoming uncharacteristically irritable, restless, snappy or aggressive; displaying a drawn facial expression; repetitive licking eg of sore joints; behavioural changes including loss of interest in their surroundings, walks or food; or reactive/ hypersensitive to touch or any other stimuli, sometimes hiding away to avoid being petted.

CONTENTMENT?

A dog must be able to rest and sleep peacefully, and not be experiencing any distressing symptoms such as vomiting or breathing difficulties when awake. A dog who seems withdrawn, depressed or lacking in interest may be experiencing pain, low energy levels due to an underlying illness, or cognitive dysfunction (senility type symptoms). It is important to note that breathing problems causing a noticeable increase in respiratory effort or rate (especially accompanied by excessive panting in dogs or open mouth breathing in cats) are a strong indicator of poor quality of life and require urgent veterinary attention.

HYGIENE?

Loss of continence can be managed medically in some pets, but in others it can be a source of persistent stress to both the animal and owner, and can lead to secondary problems such as skin irritation and soreness, especially in patients with poor mobility. Ulcerated or infected external growths or pressure sores are very serious, and can potentially impact on the welfare of an animal. The problems associated with hygiene issues increase in the summer months due to the risk of fly strike.

MOBILITY?

Arthritis is a very common problem in older dogs and cats (and even in elderly rabbits and small furry pets ), resulting in a reluctance to walk, run or play, stiffness, lameness, and a general slowing down. It is worth assessing options for management (eg use of ramps, rugs on slippery floors to allow movement between rooms, shorter more frequent walks for dogs to stimulate the muscles and joints but not strain them, and provide mental interest ), the use of joint supplements, and multi-modal pain relief. Physiotherapy, hydrotherapy and acupuncture can also be helpful.