End of Life Care
Many pet parents struggle with knowing when is time to say goodbye to their faithful friend or when their pet's quality of life is still okay. Your veterinarian wants what is best for you and your pet and will be with you every step of the way through the decision making process to the final moments. Below are some tools and information you can use to guide you through this difficult time. To learn more please visit Lap of Love
“Doc, how will I know when it’s time?”
We have heard from countless pet owners that the death of their pet was worse than the death of their own parents. This might sound blasphemous to some, but to others it’s the cold truth. Making the decision to euthanize a pet can feel gut-wrenching, murderous, and immoral. Families feel like they are letting their pet down or that they are the cause of their friend’s death. They forget that euthanasia is a gift, something that, when used appropriately and timely, prevents further physical suffering for the pet and emotional suffering of the family. While surrounded by their loved ones in a quiet, comfortable area, they can pass with dignity, Making the actual decision is the hardest part of the experience and the most often asked question is, “Doc, how will I know when it’s time?” Let us shed some light on this difficult discussion.
As veterinarians, our job is to assist the family in the decision-making. There is not one perfect moment in time in which to make that ultimate choice (unless the pet is truly suffering, something we are trying to prevent in the first place). Rather, there is a subjective time period in which euthanasia is an appropriate decision to make. This time period could be hours, days, weeks, or even months. Before this subjective period of time veterinarians will refuse to euthanize a pet because a good quality of life still exists. After this period, however, we may push for euthanasia due to obvious sustained suffering. During this larger subjective time however, it is truly dependent on the family to make whatever decision is best for them. Some owners need time to come to terms with the decline of their pet while others want to prevent any unnecessary suffering at all.
Everyone is different and entitled to their own thoughts. After all, pet owners know their pet better than anyone, even the vet!
Pain and Anxiety
Pain is one of the most important topics that we discuss in veterinary hospice care. Many professionals believe that carnivorous animals, such as cats and dogs, do not “hide” their pain, rather pain simply doesn’t bother them the same way it bothers humans. Animals do not have an emotional attachment to their pain like we do. Humans react to the diagnosis of cancer much differently than Fluffy does! Fluffy doesn’t know she has a terminal illness, it bothers us more than it bothers her. This is vastly different than prey animals like rabbits or guinea pigs, who must hide their pain to prevent carnivorous attacks. If you’re interested in learning more about pain and suffering in pets, grab Temple Grandin’s book “Animals in Translation” and read chapter 5.
When discussing the decision to euthanize, we should be just as concerned about anxiety in our pet as we are about pain. Frankly, anxiety is worse than pain in animals. Think about the last time your dog went to the vet. How was his behavior? Was he nervous in the exam room? Did he give you that look that said “this is terrible!”? Now think back to when he last hurt himself, perhaps scraping his paw or straining a muscle after running too hard. My dog rarely looks as distraught when she’s in pain as she does when she is anxious. It’s the same for animals that are dying. For example, many end-stage arthritis canine patients begin panting, pacing, whining, and/or crying, but many of these symptoms are due to anxiety, usually arising secondarily from the pain. This is akin to being stung by a bee but not seeing the bee itself; you may be more anxious at the lack of knowledge of the origin of the pain (and therefore about the unknown duration or potential augmentation by more bees) instead of strictly the pain alone. Due to hormonal fluctuations and other factors, these signs of anxiety usually appear worse at night. The body is telling the carnivorous dog that he is no longer at the top of the food chain; he has been demoted and if he lies down, he will become someone else’s dinner. Anti-anxiety medications can sometimes work but for pets that are at this stage, the end is usually near.
Waiting Too Long
An interesting trend is that the more times families experience the loss of a pet, the sooner they make the decision to euthanize. Owners experiencing the decline or terminal illness of a pet for the first time will generally wait until the very end to make that difficult decision. They are fearful of doing it too soon and giving up without a good fight. Afterwards, however, most of these owners regret waiting too long. They reflect back on the past days, weeks, or months, and feel guilty for putting their pet through those numerous trips to the vet or uncomfortable medical procedures that did not improve their pet’s quality of life. The next time they witness the decline of a pet, they are much more likely to make the decision at the beginning of the decline instead of the end.
What about a natural death?
Yes, there are those pets that peacefully fall asleep and pass naturally on their own, but just as in humans, this type of peaceful death is rare. Many owners fear their pet “passing alone” while others do not. Occasionally we are asked to help families through the natural dying process with their pet. For different reasons, these families are against euthanasia. We explain everything we possibly can, from how a natural death may look, how long it may take, what their pet may experience, etc. Inevitably, almost all of these families regret doing this. Most of them comment afterwards “I wish I would not have done that, I wish she didn’t have to suffer.” A natural death can be difficult to watch, especially for non-medically oriented people. Most people can watch a human family member in pain much more easily than they can their pet. To an extent, we can talk other humans through physical pain or discomfort, but there is no comforting a pet that is suffering. Families take this guilt difficultly and we do our very best to not only readily suggest euthanasia when appropriate, but prepare families for a “worst-case” scenario should they chose to wait. (Of course death is nothing to be fearful of and if your pet does happen to pass on his or her own, it is certainly not a bad thing; it happens in nature frequently!)
Weigh Your Options Carefully
If the most important thing to you is waiting until the last possible minute to say goodbye to your baby, you will most likely be facing an emergency, stress-filled, sufferable condition for your pet. It may not be peaceful and you may regret waiting too long. If a peaceful, calm, loving, family-oriented, in-home end of life experience is what you wish for your pet, then you will probably need to make the decision a little sooner than you want. Making that decision should not be about ceasing any suffering that has already occurred, but about preventing suffering from occurring in the first place. Above all, our pets do not deserve to hurt.
We are here to help make this time a bit easier on everyone. Veterinary hospice care is aimed at maintaining comfort, quality of life, and the human animal bond for as long as needed; we are here for you!
Assessing Quality of Life
You have probably heard the term “quality of life” spoken by your veterinarian or others close to you. This can be very subjective terminology and is highly dependent on the disease process your dog or cat is experiencing, your pet’s personality, and your personal beliefs.
Just like humans, every pet will experience and react to changes in their body differently. This is also highly dependent on the disease process at hand, which is why in-depth discussions with your veterinarian are so important. For example, the decision to euthanize a Yorkie with congestive heart failure will need to be made before painful symptoms (such as difficulty breathing) arise. Alternatively, an older Labrador with arthritis can be maintained at home with adequate pain management for an extended amount of time. It’s important to understand the disease process your pet is experiencing in order to properly evaluate the quality of life. Your veterinarian can help you understand the particular situation your pet is facing, their prognosis, and treatment options.
Quality of Life Scoring Tools
Concerned about your pet's quality of life? There is not one simple and correct way to evaluate your pet's quality of life. It's also not as simple as saying 'when he stops eating' or 'you'll just know'. Below is a list of some of the most common factors that are taken into consideration when determining and evaluating the quality of life of your pet and what roles they play in the difficult decision for euthanasia.
Many people like to say that pets “hide” their pain. Some research has concluded that this may not be the case. Carnivores like cats and dogs do not have a reason to hide their pain like prey animals do. Instead, they simply lack the emotional attachment to their pain like humans. Yes, they feel discomfort… they simply don’t care about it like we do. With this understanding, it’s important to realize that when pets in hospice care DO show us outward displays of pain (see LIST), we should be reaching for strong medications like opioids, not just anti-inflammatories (like aspirin). If you’re interested in a much more in-depth look at pain in pets, pick up Dr. Temple Grandin’s book Animals in Translation and read Chapter 5 “Pain and Suffering.”
Common signs of pain in cats and dogs: Pacing, excessive panting, hiding in unique areas, not seeking interaction with family, growling, snarling, snapping, immobility, whining, not eating, flinching when touched.
Human hospice has a saying “food and water are for the living.” Pets can physiologically survive for many days without food and water, although the lack of appetite or thirst can be a sign that the body has begun shutting down. Appetite stimulants can sometimes help restore the appetite for a certain period of time. Talk with your regular veterinarian or Lap of Love for more information. Also keep in mind that some pets may never lose their desire to eat. In many cases appetite can be a good indication of the internal function (or dysfunction) of the pet.
Many pet owners feel terribly guilty over the natural annoyance they feel when their pet becomes incontinent. This is normal; keep in mind pets do not like to “soil their den” and as a result may experience anxiety which may be visible by increased panting or appearing uncomfortable. If left unkempt incontinence can lead to bed sores and eventually systemic infection in severe cases.
Arthritis and mobility issues are common as our pets age. Usually, these signs first become evident at night when the pet begins to pace around the house. It may progress to falling, unable to stand, unable to urinate/defecate, and panting heavily. During the later stages you may find your pet very anxious. As they (usually dogs) begin to understand that they cannot get up and down on their own accord, their natural anxiety level rises as they start to feel like “prey” instead of being the predator. They can no longer protect their family as they once did. When anti-inflammatories and other medications cease to work, quality of life should be a concern.
If you have been an earnest observer of your pet's behavior and attitude during his or her lifetime, you will be the best at determining when they no longer seem "happy." You'll know when they no longer enjoy food, toys, or the environment around them. Most of all, they no longer enjoy or seek out contact with you and the rest of its family. Most pets are tremendously easy to please, so when it no longer becomes possible to raise a purr or a tail-wag, you should be considering what kind of quality of life your pet is experiencing.
There are a variety of tools to help you and the pet's entire family evaluate quality of life. One tool developed by Lap of Love is the first app to journal your pet's days on your iPhone/iPad and Android.
Simply download the Grey Muzzle application from the app store and create your pet's profile. Then everyday mark if your pet had a good day, bad day or neutral day. This way you can keep track of those bad days. You should mentally prepare yourself for when your pet has more bad days than good and speak to your veterinarian about intervention. Or you may decide as a family that if your pet has 30% bad days, that it is appropriate to say goodbye. The quality of life can be different based on the disease the pet is struggling with, the pet's personality and the families beliefs and abilities to care for their pet during this time.
The Grey Muzzle application has a calendar so you can visualize the month at a glance as well as a summary page to see a pie chart of your pet's progress. It is simple to use and free! Grey Muzzle App Download
The Process of Euthanasia
Many people may have misconceptions about the actual process of euthanasia or had a negative experience in the past. Sometimes the unknown is the scariest part. We are animal lovers too and have experienced this emotional time with our own pets, so we understand what you're going through. Every effort is made to make sure the euthanasia process is as stress-free, painless, and respectful for you and your beloved pet. You are welcome to be present for as much of the euthanasia as you wish. Your pet can stay with you the entire time, they do not have to be taken "to the back" for any part of it. First, your pet will be given an injection under the skin (similar to a vaccine) of sedative mixed with pain medication. They may experience a brief sting or pinch, but then they will be relaxed and comfortable for the remainder of the process. The sedation can take several minutes to take full effect. In the mean time they can be fed delicious snacks, snuggled and kissed, or simply lay peacefully on a soft bed. When you are ready, the final injection will be given, usually in a back leg vein so they can focus on their loved ones. This stops their heart almost immediately so there is no awareness, panic, or discomfort involved. Your pet will pass with dignity in a blissful, pain free state. After they have passed they will be handled with the utmost respect and love. Depending on your wishes, they may be taken home with you for burial, or remain with us for private or communal cremation.
If you have any questions regarding the end of life care for your pet, are struggling with the decision making process, or want to know more about the euthanasia process or what happens afterwards, please do not hesitate to contact us.