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Knowing When

Making this last decision for your pet can be hard. Help is here, and you can also talk to Dr. Ivey at 916-250-3239

dog resting on windowsill

Many pet owners have said they wish their ailing pet would pass peacefully in his or her sleep. But it is rare for a pet to pass in this way without discomfort. Near the end of life, most dogs and cats will will experience one or more of the following: pain, weakness, lack of appetite, dehydration, nausea, difficulty breathing, immobility, disorientation, and self-soiling. Symptoms like these, besides being uncomfortable, may cause a pet to feel anxious. Symptoms like these can be subtle at first and slowly increase over time. The unassisted dying process may last for many days.

 

When a pet’s quality of life is severely diminished, few pet owners want to watch their friend decline until the end comes unassisted. When a pet is clearly suffering, the decision to end life may be easier, despite the sadness that goes with this decision. Often, however, knowing when it's time to end a life is difficult. Many pets will experience good days (times of relative comfort and happiness) interspersed with bad days (times when the pet will not eat, seems painful, or is inactive or withdrawn).

 

Here are some things you may consider as you make this important decision. You may find yourself vacillating - this is normal, especially as your pet’s condition will change from day to day.  Please contact Dr. Ivey by phone if you need help evaluating your pet’s quality of life or if you are having difficulty with a euthanasia decision. It is most important that you feel certain that any decision you make is best for your friend.

 

ANSWER THIS FIRST: Is my pet suffering?

This an essential question - if your pet is suffering, this should not continue

What causes suffering? Here are some common causes of suffering:

  • Severe Pain that cannot be relieved by medication (or medication cannot be given). Examples include large bone tumors, many oral tumors, spinal disease, advanced joint disease

  • Labored or difficulty breathing - this is very important to pay attention to. People at the end of life describe this as being worse than pain.

  • Severe nausea/vomiting (that cannot be relieved by medication): inability to keep down food or water for days on end 

  • Inability to urinate (causes include tumors, stones, prostate enlargement, spinal disease)

  • Inability to stand or walk. Exceptions definitely exist, but for most pets, the inability to walk represents severe discomfort and sanitation problems. If your pet has suddenly lost the ability to stand (over 48 hours or less), please consult a veterinarian before making a euthanasia decision. In particular, if your pet suddenly cannot walk and has unusual flicking eye movements, vertigo is a possibility and may resolve. For more information on this, See the section on idiopathic vestibular disease HERE). Stroke is rare in dogs and cats.

  • Other problems, if severe and frequent enough, can cause suffering.

 

Note that many pets cope very well with minor disabilities, such as arthritis and weakness - these do not cause suffering if the condition is mild or can be helped with medication. Some problems, for example blindness, seem to be much less troubling to pets than to humans. Seizures are not painful, and do not usually affect quality of life unless they are frequent (multiple per day) or prolonged (more than 5 minutes).

 

My pet is not suffering, but isn't doing great - What is my pet’s Quality of Life?

  • You may want to start by asking yourself this question: What brought me to this web page today? Make a list of ALL of the problems/symptoms your pet is experiencing. Actually writing them down can help.

  • Is my pet in pain? Sometimes, signs of pain are obvious, such as crying when touched or picked up. But many pets do their best to hide signs of pain. More subtle symptoms of pain include:

    • Mobility changes: limping, difficulty with stairs and/or jumping, decreased willingness to get up, stiff gait or weakness, difficulty settling or lying down, pacing

    • A change in demeanor: dull or worried eyes, lowered or flattened ears, tucked tail, hunched body posture, increased aggression, increased muscle tension - especially when touched

    • General signs of pain (these have other causes in addition to pain): Decreased appetite, decreased overall activity, increased breathing rate, house soiling (due to difficulty getting outside or into the litter box), sleep disturbances

    • In addition, for dogs: panting (when not hot), decreased social interest. For a more detailed description of signs & severity of pain in dogs, click HERE

    • For cats: Hiding, tail flicking (especially when touched), whiskers held forward, dilated pupils, decreased grooming. For a more detailed description of signs & severity of pain in cats, click HERE

  • Does my pet have a good appetite? Poor appetite often signals a decline in quality of life, because many pets will not eat if they feel poorly, are in pain, are nauseated, or overly anxious.

  • Does my pet have enough mobility to get around and to eliminate without soiling him/herself? If mobility is limited, does he or she cry to be moved or to be nearer the family? Are there any pressure sores? If there is soiling of the coat, does he or she mind being bathed frequently? To help your pet’s mobility, see tips at the bottom of this page.

  • Does my pet have labored breathing? This is very important. People with labored breathing describe this as being very uncomfortable, worse than pain.

  • Does my pet enjoy interacting with people and his/her surroundings? Many frail or ailing pets can still enjoy the company of others and passive activities such as looking out of a window or sunbathing. When a pet seems withdrawn and no longer enjoys any kind of socialization or stimulation, we feel that quality of life is diminished. Cats in particular tend to become less affectionate and they often hide when they are in pain or not feeling well. Some pets may cling to owners when they not feeling well. It may be helpful to ask yourself, is my pet truly living at this point, or just existing?

  • Is my pet disoriented or anxious? As with humans, end of life changes can be mental as well as physical. Older pets may experience anxiety, disorientation, restlessness, and other forms of cognitive decline (dementia) that prevent them from enjoying life. Some pets get trapped in furniture or have other problems navigating the home. Many pets seem fine during the day, but are anxious at night (this is known as "sundowners" in humans); this creates an extra dilemma for pet families, who must weigh the good times against the bad.

  • Can my pet’s quality of life be improved, even though an illness cannot be cured? For example, medications to increase appetite and control pain or anxiety can help give a good quality of life. Fluids may be given to help with hydration, and the environment may be modified to help your pet get around comfortably (see below for mobility aids).

  • Are treatments causing distress? Some pets are very tolerant of handling and medication; others experience emotional stress or unpleasant side effects. If your pet is experiencing distress from a treatment, an alternative may be available (e.g. injections rather than pills, a different type of medication, or a different diet).

 

What if my pet still has good days?

Many ailing pets still enjoy good days - this makes an end of life decision especially difficult. We don’t want to deprive our friend of joy in life, but we don’t want them to experience discomfort either. Sometimes a pet is very comfortable at the moment, but has a diagnosis of a disease that will almost certainly cause suffering in the near future (for example, any disease/tumor that will lead to internal bleeding, urinary blockage, or fluid in the chest). We often don’t know what the future will bring. Answering the following questions may help:

  • Right now, do the good days outnumber the bad?

  • Is my pet truly happy on his or her best days? Is he or she suffering on the bad days?

  • Are most days ok, but nights are hard? Many diseases and cognitive changes are much worse at night. If your pet is uncomfortable at night or can't sleep, or is keeping you up at night, you must look at the overall picture.

  • What does my pet have to look forward to? If an activity can be planned that would give your pet joy, that can be a very meaningful part of saying goodbye. If on the other hand, you feel that your pet is getting worse every day, you might not want to wait until there is no joy left at all.

  • What are my Goals for my pet's last days? This question is especially important for diseases that are expected to cause a rapid decline. One emotional aspect of euthanasia is that people have different goals for their pet's end of life. Consider which of these is most important to you and your family. If your pet could tell you, what do you think they would want for themselves? Realize that these goals are somewhat in opposition to each other, it is important to think about what is most important to you. Also, don't assume everyone in the family has identical goals - it's important to talk about what is most important.

    • Is your Number One Goal to have as much time with your pet as is humanely possible? If this is the your Goal, you need to be prepared for an emergency situation if things suddenly become unacceptable. Having a detailed plan in place is important. In-home euthanasia may not be available on an emergency basis, or you may need to make several phone calls to find an available provider. If this is your Goal, you should have a list of home euthanasia vets for your area as well as a list of emergency vet hospitals (some may have a longer wait than others on any given day). Realize that you may be making several phone calls and waiting for people to call you back, at a time when you are most worried about your pet.

    • Is your Number One Goal to prevent suffering? It is absolutely ok to say goodbye before a pet is suffering. In fact, many owners experience guilt about having waited too long. If your Goal is to prevent suffering, a euthanasia decision will have to be made before the pet is actually suffering. This may seem obvious, but it's vital to really, think about this as a Goal rather than as an abstract concept.

      • What specifically should you be watching for: what will be the signs that suffering could be on the horizon? Most people know to gage their pet's appetite, but there are usually several other things that should be monitored. Specific signs to monitor will depend on the pet's medical condition.

      • Once you start seeing changes in your pet, how long will you have to make a euthanasia decision, before the pet is suffering? Depending on your pet's medical problem(s), this could be weeks, days or just a few hours.

      • Answers to these questions will depend on your pet's diagnosis and individual situation - this is very important to discuss with your vet or Dr. Ivey.​ No one can know with certainty what each day will bring, but a vet can help you know what is most likely, and help you know what signs to watch out for.

    • Is having euthanasia performed at Home very important? In-home euthanasia is usually scheduled several days in advance. While a same- or next-day appointment may be available, this usually can't be relied on.​ If your pet is terrified of vet offices, or if your pet is too large for you to transport should they become immobile, home euthanasia becomes more important and should be planned for.

    • Is it important to know that all reasonable treatment options were exhausted? If your pet hasn't been to a vet recently, you will probably have to bring your pet in for an exam and testing to know this for sure.

    • Do you have other Goals? Many other Goals can influence the timing of euthanasia. Examples include: having all family members present, not leaving a pet when travel is upcoming, making sure everyone in the family is ok with this decision... other Goals may apply to your unique situation. Try to think about what you want for your pet at the end - actually writing this down may help you decide what's most important.

Other ways to think about Quality of Life

If your pet is approaching the end of his or her life, but your heart is still troubled in making a euthanasia decision, try asking yourself these questions:

  • Is there something I am waiting for? Is there something your pet must do (or not be able to do), that would tell you that the time has arrived - and what would this look like? For example, if an owner is waiting until a dog cannot wag his tail anymore, that could mean waiting until the dog is nearly comatose - this owner would probably regret having waited this long. Similarly, cats often purr at the end of life, even if they are uncomfortable. Waiting until a cat can no longer purr would probably make things harder for the cat and the family. Many owners are under the assumption that one should or must wait until a pet has stopped eating; this may be a reasonable plan with many diseases (such as kidney disease or lymphoma), but this is not a reasonable expectation for many other conditions (such as heart failure, arthritis, or dementia) that can cause suffering without a loss of appetite.

  • Hypothetical question to ask yourself: If I had a pill that would keep my pet in the exact same condition (no improvement or worsening of symptoms) for an entire year, would I give it? If the answer is a definite yes, then your pet must have a good quality of life that you wish you could maintain. If the answer is a definite no, then this is an indication that the current situation is not good and should not continue for very long. If you find it hard to answer this question, that suggests that things aren't great right now, but are not awful yet either. In this case, the time to consider euthanasia is when you're at a point where you do not want things to get worse.

  • Will euthanasia prevent suffering? For example, if you feel your pet seems to have increasing discomfort, it may be a kindness to prevent this decline from becoming unbearable. If your pet is having problems with disorientation and getting trapped under furniture, you may be worried that this will happen when you are not home. 

  • Is there a chance for a rapid decline? Some illnesses (for example, heart disease and internal bleeding) can lead to a precipitous decline in comfort. If this becomes an emergency, in-home euthanasia may not be an option. If this possibility applies to your pet, it is very important to think about Goals (see above).

  • Are we at a turning point? Once a pet has not eaten for several days, or becomes very weak, things are probably not going to get better, only worse. Discussing the situation with a veterinarian (your regular vet or Dr. Ivey) can help. In particular, things can progress very rapidly with cats once they become weak or unsteady on their feet.

  • Should I use a Quality of Life (QOL) Scale? There are point systems designed to quantify QOL. While some people find these scales helpful, QOL can be difficult to measure with a number. Please click HERE for more information on QOL scales.

 

What if some family members are not ready?

Difficult decisions are even harder when family members don’t agree on what’s best. Most people, especially children, remember these hard decisions for a very long time. For this reason, it is important that all family members can discuss their feelings. Ideally, the decisions made for a family pet are made together, and everyone is ready when a euthanasia decision is made. Sometimes it helps to remember that euthanasia is not about ending a pet’s life - the pet’s illness is ending his or her life. Euthanasia is a loving gift to prevent suffering, and allows a beloved pet to end life with dignity and comfort. Please remember that the timing of euthanasia is an emotional as well as a medical decision. Feelings of guilt or not being ready to let go are issues that can last for a very long time, even years, after a pet has passed.

 

Is recovery possible?

If you are having trouble with a euthanasia decision because you are not sure what your pet’s prognosis or treatment options are, please contact your regular vet or Dr. Ivey to discuss this. She will discuss your pet’s individual situation with you; this includes not only a discussion of the medical aspects, but also a discussion of what types of treatment may be possible, along with your goals for end of life care.

 

Tips for pets with decreased mobility

Mobility is a significant end of life concern for many pets, especially large dogs. Limited mobility may be due to arthritis, neurological disease, or muscular weakness. Treatments to help mobility and comfort may include:

  • Prescription treatments: this may include medications, such as anti-inflammatory drugs, analgesics, and medications that support joint health. Non-pharmaceutical treatments include acupuncture, laser therapy, and chiropractic care.

  • Environmental modifications: rugs or non-skid mats on smooth floors, ramps over stairs, and ramps/stairs to places like beds can be a big help.

  • Other physical aids: a harness such as the Help ‘Em Up can provide much needed assistance with stairs, walking, and getting into the car. Anti-slip boots or paw pad stickers can increase traction and aid mobility.

  • Help with toileting: ailing or weakened pets may have trouble with house soiling. For dogs, helping them out frequently (especially before bedtime) and/or puppy pads can make a big difference. For cats, a low sided litter box (such as a lid to a Rubbermaid container, or a regular box with the side cut out) can help access. Having litter boxes in every room, or at least on every level of the home, can help.

 

Other concerns

Many other factors can make a euthanasia decision especially hard. Children’s feelings, feelings of guilt, and concerns about the ethics of euthanasia are examples of other issues your family may be dealing with. Don’t forget to consider your own quality of life also: pets that are incontinent, need continuous care, or are up all night can create real problems for their beloved humans. With human hospice, a team of care givers provides care in shifts; 24-7 care does not fall on one person’s shoulders.

 

Many people experience strong feelings of grief at the time a final diagnosis is given, when the pet is still alive. This is anticipatory grief, and it can be just as painful as when a beloved pet dies. This period is especially hard when many big decisions must be made regarding treatment and euthanasia. The Association for Pet Loss and Bereavement has special resources for people with anticipatory grief at the APLB web site.

 

Other Euthanasia Topics:

What to Expect, How to Prepare

Aftercare

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