Understanding How Pets Decline Near the End of Life

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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:

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pain, weakness, lack of appetite, dehydration, nausea, difficulty breathing, immobility, disorientation, and self-soiling.

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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, or they may develop suddenly and progress rapidly. The unassisted dying process may last for 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.

 

 

​​​Why This Decision Can Be Difficult

 

When a pet is clearly suffering, the decision to end life may be clear, 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comfort and happiness) interspersed with bad days (times when the pet will not eat, seems painful, or is inactive or withdrawn).

 

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 end of life decisions. It is most important that you feel certain that any decision you make is best for your friend.

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Answer This First: Is my pet suffering?

 

This an essential place to start - if your pet is suffering, this should not continue. 

 

Most Common Causes of Suffering

 

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

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

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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 very 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 rapid back-and-forth 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 or frequent problems can also cause suffering. Please speak to your regular vet or Dr. Ivey about other symptoms you may be seeing

 

Mild Disability vs True 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, such as 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).

 

If My Pet Is Not Suffering, But Is Not Doing Well: Assessing 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.

 

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:

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

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

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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

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Additional signs in dogs: panting (even when not hot), decreased social interest. For more, click HERE

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Additional signs in cats: Hiding, tail flicking (especially when touched), whiskers held forward, dilated pupils, decreased grooming. For more, click HERE

 

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.

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Mobility

Does my pet have enough mobility to get around and to eliminate without soiling? If mobility is limited, does he or she cry to be moved or to be nearer the family? Are pressure sores present? If there is soiling of the coat, do they tolerate bathing? To assist your pet’s mobility, see tips at the bottom of this page.

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Breathing

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

 

Joy

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 are not feeling well. It may be helpful to ask yourself, is my pet truly living at this point, or just existing?

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Cognitive Changes

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.

 

Prognosis & Medical Options

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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). Hospice options are usually best informed by having a diagnosis for your pet's condition.

 

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).

 

Understanding Good vs Bad Days

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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, a disease 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 the best days?

• Is my pet suffering on the bad days?

• Are 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.

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Your Goals for Your Pet's Final Days

 

One emotional aspect of euthanasia is that people have different priorities for a pet's final days. 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 deeply 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 as possible?

If this is your Main 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?

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 deliberately think about this as a Goal rather than as an abstract concept. It is absolutely ok to say goodbye before a pet is suffering. In fact, many owners experience guilt about having waited too long. Consider:

• What specifically should you be watching for: what are the signs that suffering could be on the horizon? Most people know to watch 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 - make sure you ask your regular vet or Dr. Ivey to know what to watch for.

• Once you start seeing changes in your pet, how long will you have to make a euthanasia decision? Depending on your pet's medical problem, 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 in-home euthanasia very important?

In-home euthanasia is usually scheduled several days in advance. While a same- or next-day appointment may be available, there is no guarantee that an in-home euthanasia vet will be available on an emergency basis (especially if service is needed after-hours, or on a weekend or holiday).​​ If your pet is terrified of transport or vet offices, or if your pet is too heavy for you to lift, in-home euthanasia becomes much more important and should be planned for.

 

Is it important to know that all reasonable treatment options were tired? If your pet hasn't been to a vet recently, you may need 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, such as:

• Having 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 most for your pet at the end - actually writing this down and discussing with the family may help you decide what's most important.

 

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Other ways to think about Quality of Life

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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?

 

Many owners are under the assumption that one should 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.

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If, in your mind, you are saying "I just can't do this because he still can..." write these things down. Talk to your vet or Dr. Ivey. For example, waiting for tail wagging or purring to stop may push the timeline too far, as many pets will do these things until the very end.

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The "Hypothetical Pill" Question

Ask yourself: If I had a pill that would keep my pet in the exact same condition as now (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 rapid decline likely?

Some illnesses (especially 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 anything 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.

 

Do you need a veterinarian to tell you that it's time?

There are many reasons a veterinarian may hesitate to make that final pronouncement. 

• Pets usually become more energetic in the presence of a stranger: what is seen during a vet examination is often not representative of what the pet looks like all day or at night (nights are often the worst time).

• Almost all of the Quality of Life parameters (especially appetite, mobility, comfort, intermittent problems like vomiting or seizures, percent good days, trends over time, and overall joy in life) are best evaluated by the pet’s family over a period of several days or more. These critical parameters are almost impossible to judge during an office visit.

• Many families have different end of life goals for their pets.

• In many cases (especially when a definitive diagnosis has not been made) is is impossible to know for sure what each day will bring, or if improvement is possible.

• Many veterinarians do not wish to be perceived as "giving up" on a patient. And yet, pet families have different limitations: funds, time, physical strength, travel, work and family obligations can place significant limitations on what owners are able to do for pets. Some vets may recommend tests or treatment regimens that are beyond the scope of what a pet owner can do. In addition, some pets are far more resistant to medication and other treatments than others. Your vet might not be aware of everything in your situation that is adding to the difficulty in caring for your ailing pet.

• The family is the foremost expert on their pet's overall happiness - most vets do not wish to be perceived as negatively judging a pet's QOL when the family feels their pet is doing ok.

For these reasons, many vets will say something like "you'll know when it's time," rather than presuming to know, or presuming to dictate to families. This desire to defer to a family's best judgement about their pet's QOL can be bewildering to some pet owners.

If you need more guidance from your regular vet, here are some suggestions:

• Be very clear with your vet about any limitations you have. Not just in terms of costs, but also consider if you are home enough, physically able, and emotionally able to provide recommended care.

• Be very clear with your vet if your pet is resistant or unduly stressed by taking medications, follow-up visits, bathing, or mobility assistance.

• Be clear about your goals, particularly in terms of getting as much time as possible vs. preventing suffering

• If you feel your pet isn't doing well at home, be clear about this as well - this is especially important if your pet perks up for office visits.

 

Should I use a Quality of Life (QOL) Scale?

There are several point systems designed to quantify QOL. While some people find these scales helpful, they often can be misleading, and they cannot quantify every situation. 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 disagree 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:

• 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.

• 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.

 

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.

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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 caregivers 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.

 

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 can 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 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.

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Other Euthanasia Topics:

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What to Expect, How to Prepare

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Aftercare