When Is The Right Time To Say Goodbye?
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This is the first part of Dr. Jeff Werber's three-part series on end-of-life issues for pets. Dr. Werber is an Emmy Award-winning, nationally renowned veterinarian and former president of the Association of Veterinary Communicators. For more from Dr. Werber, find him on Facebook or on his website at www.drjeff.com.
Wow, sometimes this is a very tough call! When is the right time? How do we really know? Is he suffering? Uncomfortable? In pain? The truth is, we often don’t really know—and, unfortunately, we can’t ask him.
I am faced with this dilemma quite often, and, over the years, have tried to help hundreds of pet parents through this difficult time—doing my best to lend a viewpoint that is not as emotionally attached. The sad truth is, most of our pets do not simply pass in their sleep, so most often the decision to let them move on does rest on our shoulders!
The best I can do (and have done) is to provide some criteria to help a client sift through the emotional distress and hopefully come to some rational decision (and, even though more rational, still very difficult!).
I’ll often ask pet parents to ask themselves the following questions or try to think about certain criteria: Does your pet seem happy? Does he still seem to get excited when you come home every day? Is he still eating, or even interested in food? Is he looking emaciated? Is he too weak to be able to get up and move around, especially to relieve himself? Does he have infected pressure sores from not being able to get up? Do you often look at him and actually feel sorry for him? If the answer is “yes” to many of these then, sadly, it might just be that time. I think we can all agree that we would NEVER want our loyal, faithful, four-legged friend to suffer! I’ve always felt that when nearing that inevitable time, you can’t be faulted for making that decision a day early—but it could be awful to make it a day too late!
I’ve had pets all my life, and, of course, have had to make this decision before with my own. Let me share with you my experience with Woody, my second Labrador. Woody was an amazing black Lab, that we got when Thor, my first black Lab was getting a bit older and we wanted to get him a buddy. They were inseparable, and definitely brought some life back into Thor. Thor finally passed when Woody was about a year and a half of age, and seeing how much he missed Thor, we didn’t wait too long before bringing Chester home, a stunning yellow Lab who happened to be Woody’s half brother (they had the same dad). What a difference Chester made in Woody’s life! Beautifully, they were growing old together, and when Woody was about 11 years of age, we noticed him clearly slowing down—not wanting to run around as much, getting up more slowly, not wanting to jump onto the bed as was so accustomed to doing. Though radiographs of his hips and lower back looked pretty good, we still chalked it up to his breed and age. As the months went by, his condition was progressing more rapidly than one would expect from arthritis or age alone, so we were really concerned. By this point, Woody, from his front end up, was Woody! Total Lab—loved to eat, still animated, very alert and loving, etc., but could barely move his hind end! He would do the “army crawl” to get to his food, and he could hardly sit up to relieve himself. We could see he was distressed. Knowing something was clearly wrong, but unable to see it on plain x-rays, we performed a myelogram (this was years ago before CT or MRI scans were readily available), and sure enough we sadly found our answer. Woody had a large tumor growing inside his spinal canal in the lower part of his neck. Well, this explained it all—his head and brain were still perfect, but the neurological signals were no longer making to his hind end. In essence, the back half of his body was no longer attached to the front. Our poor guy was miserable, and was no longer the Labrador he, and we, knew he once was. What was devastating us even more, was that his brain, and personality was still the Woody we knew and loved. Though one of the toughest decisions we ever had to make, we knew, given the diagnosis, Woody’s prognosis, and seeing his frustration, what we had to do. I brought home the “injection,” brought him outside where he spent countless hours playing ball and running around, placed him on his favorite bed, and said our last goodbye.
I often tell my clients that they, as did I with Woody, will usually know when it’s time. I hope my practice experiences, and Woody’s story, will give you some guidelines that can help you.
Stay tuned for Part II, in which we’ll talk about the actual (and difficult) euthanasia process.
If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.
Knowing the Right Time to Say Goodbye to a Pet
Posted by PUP on Apr 5, 2019 in Puppy Up! Blog
End-of-life decisions for animals are difficult. A veterinarian has developed a scale to help clear up the confusion.
Nearly 14 years ago, my daughter and I were grieving the death of my mother, and it seemed nothing could lift our spirits. Then we got Fluffy, a bouncing bundle of gray and white puppy, and everything changed.
Fluffy kept us busy with pee pads and squeaky toys. She made us laugh in spite of our sadness, and the gray clouds of grief began to recede.
Over the years, our 10-pound fluff ball was a constant in our lives. We dressed her up in holiday sweaters, celebrated her birthdays and scolded her for sneaking food from the cat’s dish. But in recent weeks, as our walks slowed down and her naps grew longer, it became clear that our time together was limited. I hoped that in the end, Fluffy would have a natural death, drifting off to sleep for good on her favorite soft pillow.
A natural death is what many of us hope for with our pets. They are members of our family, deeply enmeshed in our lives, and for many of us, thoughts of euthanasia seem unfathomable, so we cling to the notion that a natural death is desirable.
But my veterinarian advised me that my end-of-life scenario for my dog wasn’t realistic. In most cases, a natural death, she told me, means prolonged suffering that we don’t always see, because dogs and cats are far more stoic than humans when it comes to pain.
Dr. Alice Villalobos, a nationally recognized oncology veterinarian based in Hermosa Beach, Calif., said that many pet owners idealize a natural death without thinking about what a “natural” death really means. A frail animal, she noted, doesn’t linger very long in nature.
“When animals were domesticated they gave up that freedom to go under a bush and wait to die,” said Dr. Villalobos. “They become very quickly part of mother nature’s plan due to predators or the elements. And yet in our homes we protect them from everything so they can live a long time — and sometimes too long.”
Dr. Villalobos has dedicated her career to helping pet owners navigate end-of-life issues. She created an animal hospice program she calls “pawspice.” She coined the name because she doesn’t want to confuse end-of-life care for animals with the choices we make for human hospice.
Her program is focused on extending a pet’s quality of life. That might mean treating a cancer “in kind and gentle ways,” she said. It can mean supportive care like giving fluids, oxygen or pain medication. In some cases, it might mean hand-feeding for frail pets or carrying an animal to a water dish or litter box. And finally, she said, it means a “well death.”
Dr. Villalobos has advocated what she calls “bond-centered euthanasia,” which allows the pet owner to be present and play a comforting role during the procedure. She has also championed sedation-first euthanasia, putting the animal into a gentle sleep before administering a lethal drug.
To help pet owners make decisions about end-of-life care, Dr. Villalobos developed a decision tool based on seven indicators. The scale is often called the HHHHHMM scale, based on the first letter of each indicator. On a scale of zero to 10, with zero being very poor and 10 being best, a pet owner is asked to rate the following:
- Hurt: Is the pet’s pain successfully managed? Is it breathing with ease or distress?
- Hunger: Is the pet eating enough? Does hand-feeding help?
- Hydration: Is the patient dehydrated?
- Hygiene: Is the pet able to stay clean? Is it suffering from bed sores?
- Happiness: Does the pet express joy and interest?
- Mobility: Can the patient get up without assistance? Is it stumbling?
- More: Does your pet have more good days than bad? Is a healthy human-animal bond still possible?
Dr. Villalobos says pet owners should talk to their vet about the ways they can improve a pet’s life in each category. When pet owners approach end of life this way, they often are surprised at how much they can do to improve a pet’s quality of life, she said.
By revisiting the scale frequently, pet owners can better assess the quality of the pet’s hospice care and gauge an animal’s decline. The goal should be to keep the total at 35 or higher. And as the numbers begin to decline below 35, the scale can be used to help a pet owner make a final decision about euthanasia.
“Natural death, as much as many people wish it would happen, may not be kind and may not be easy and may not be peaceful,” Dr. Villalobos said. “Most people would prefer to assure a peaceful passing. You’re just helping the pet separate from the pack just as he would have done in nature.”
I discovered Dr. Villalobos’s scale as I was searching for answers for Fluffy in her final weeks. When she did get up, she often stumbled and seemed confused. Sometimes at night, I heard her whimper.
I had reached out to two at-home vet services, VettedPetCare.com and Instavet.com, that both offered compassionate guidance and confirmed my fears that no treatments were available to improve her condition. Fluffy was a very old dog, and they suspected her decline was a result of some combination of kidney and liver failure, but discouraged extensive testing since the physical symptoms were obvious. One visiting vet gave Fluffy subcutaneous fluids to help with dehydration and make her more comfortable and advised me to spend a final happy day with my dog before calling her for a final visit to end her suffering.
I trusted her judgment, but my tears and the fact that Fluffy still ate a little and wagged her tail when I stroked her clouded my thinking. I turned to the end-of-life scale and was able to see how poorly she was doing, despite the tail wag. I took my vet’s advice and spent a quiet day with Fluffy, giving her the cat food treats she so loved, without any scolding. I revisited the scale several times, just to remind myself that I was doing the right thing. The scale allowed me to make a more detached assessment of Fluffy, and it was a tremendous source of comfort during a very difficult time.
It wasn’t an easy decision or a pleasant one. But it was the right decision. And in the end Fluffy did drift away on her favorite soft pillow, just as I had hoped.
When Is The Right Time To Say Goodbye?
Sickness, injury, or old age. These are often the final battles we fight for our beloved pets. Being confronted with the decision to let them pass-on is one of the most painful experiences a pet owner may go through. This is Mandy’s story.
Mandy’s mum Bec says, “We adopted Mandy when she was already 10 years old. We knew what we were signing up for, an elderly dog with strange lumps, an unknown history, and terrible teeth! But we loved her endlessly, and the moment we met her we knew she was ours. She repaid us with trust, so many happy memories and a love we didn’t know we had in us. We are forever grateful we met although we only had 4 years together, in this time she left an indelible mark on our hearts.”
“I knew in my heart that soon she would need us to help her pass without fear, without pain, and with dignity.”
This is Bec’s journey with Mandy and her tips to help you when it’s time to say goodbye to your beloved pet.
Good days journal
One of the most common age-related diseases for dogs and cats is arthritis. We managed to slow its cruel advance, but eventually it caught up with our girl.
We started keeping a “good days journal”. This helped us face the reality of what she was going through. We all celebrated the good days, when she would insist on a chariot ride outside, play with the neighbor’s dog, or scoff her dinner with gusto. We also supported her on her bad days, when her legs were wobbly, her body was tired, and she needed more medicine, comfort and sleep. When there were more bad days than good, and there are no more options left to take, we started to think about what was right for Mandy. She deserved all the good days.
Quality of life list
We noticed Mandy’s interest in doing the things she used to love was waning over time. Once her good days journal wasn’t looking great, we started to focus on her “Quality of life list”.
We listed all the things she still loved to do. Going for a ride in the car. Cuddles in bed. Going for a ride in her pram royal chariot. Eating warm roast chicken. There was a long list! Eventually, we got down to just 3 or maybe 4 items on that list that she could still enjoy. It was heartbreaking to see her quality of life declining so much. One thing that never changed on the list was, “she loves us”.
This list was probably one of the most helpful things we did to really understand where she was at. We loved her so very much, we wanted to keep her going for as long as we could.
Preparing for goodbye
With a deep sadness, we understood that our girl may not make it much longer. We cancelled weekends away, spent more time at home with her, and made our heart-rending plans to help her pass when the time came.
We made a bucket list of “Mandy’s favorite things to do” in her final weeks. I was planning on taking her to see the ocean again, to give her roast chicken dinner every night, to take her for walks in the chariot to her favorite café, and take leave from work so we could spend days laying in bed together. When some families make the decision to say goodbye, they may have a final week together to do all these beautiful things, and this becomes a special memory to help you through the grief. Mandy developed pneumonia and was very sick in her final days. We tried to get through as much of her list as we could, knowing she was in a fragile state, and I felt better knowing I had a plan. All the while we were hopeful of her recovery and more precious time together.
We consulted with our vet about options for helping Mandy pass should we need to make the call sooner than we hoped. We wanted her trusted vet to come to our home so she was in a comfortable environment, surrounded by loved ones. You will find many vets can come to your home to help your pet pass in their bed, or in the backyard in a favorite spot, so their death is not fearful or stressful.
A final act of kindness
Mandy had a seizure. We rushed her to the emergency vet. We were advised that due to her pneumonia, advanced arthritis and now these seizures, it was probably time to say goodbye. Her body just didn’t have the strength to keep going. It was with anguish we decided to euthanise her that day, rather than risk more painful seizures and stressful tests. The emergency vet couldn’t come to our house, so we took her bed down to the garden near the vet clinic, let her sniff the air, feel the sunshine on her face, and lay on her bed next to us. It was there we held her, told her how much we loved her, and she snored gently in my arms as she passed from this world.
Through the despair of losing her, we still had to make arrangements for her little body. The kindness and compassion of the RSPCA got us through. The Pets at Rest team received Mandy that evening, and we were able to take her there ourselves. This was a choice we made, but it is not for everyone. We know she was treated with respect and dignity. Her ashes were returned to us in a beautiful urn we keep close to us at home. Knowing the anguish of goodbye, I am still grateful for every moment we had with her.
Mandy, thank you for your love, your trust and your ongoing presence in our lives. You were the goodest girl, our sweetest panda bear, and your memory is a mighty one that lives on with your family, who love you as vastly as the sky itself.
Helping them pass on without fear, without pain, and with dignity is the final act of kindness we can do for our pets. We hope our story has helped you with your journey in some way.
If you need help to prepare to say goodbye to your pet, talk to our supportive RSPCA Pets at Rest team during your time of need.
My 15-year-old Golden Retriever, Aspen, is starting to slow down and not eat as well. I know that I will be faced with the tough choice to put him to sleep at some point. Can you give me some advice on how I know it’s time to say goodbye?
We’ve all been there. Our beloved pet is getting old. He’s sleeping more, moving a little slower and he doesn’t seem to be hearing as well. He still likes to play ball but not as vigorously as he used to and he tires more quickly.
We start to wonder, is it time?
Having pets in our lives is a great joy. From the first introduction into our household to becoming part of the family to growing older, our pets are beside us every step of the way. We don’t think about tomorrow or “what ifs.” We just enjoy the time we have.
Our pets age many times faster than we do. A 10-year-old dog or cat is about 56 human years and larger breed dogs age even more rapidly. So while our pets are still kittens or puppies in our hearts, they are actually quite a bit older.
What do we do when we are faced with the declining health of our pet? What factors come into play in deciding when is the right time and how far do we go? The decision is a very personal one and different for each pet owner.
It all comes down to quality of life. Quality of life is very subjective. It depends on your pet’s disease process, his/her personality and your own personal beliefs. There are, however, some things to consider when evaluating the quality of your pet’s life.
- Pain Assessment: Pain can be divided into three types:
- Classic Pain — i.e. arthritis
- Pain of Disease — not acute pain but general malaise. We see this type of pain with diseases like chronic renal failure, hepatic disease and some cancers.
- Anxiety/Distress — This is mental pain and can often be worse than physical pain.
It is important to evaluate your pet with regard to these types of pain as well as our ability to address and control that pain.
- Appetite: Is your pet eating? Does he eat something new for a day or two then stop? Is he refusing food altogether? Pets can physiologically survive for several days without food or water. This can be a sign that the body has begun to shut down. Appetite stimulants may be effective, but it is usually a short-term response.
- Uncontrollable Incontinence: Incontinence is the involuntary excretion of urine or bowel contents. It is often as much of a concern for your pet as it is for you. Urinary incontinence has many effective treatments, however, when it can’t be controlled it can lead to pain from bed sores and systemic infections if they are not kept clean and dry.
- Mobility: Arthritis and ability to get around are common problems as our pets age. You may notice pacing, falling, inability or difficulty standing, stiff/stilted gait, difficulty urinating/defecating and panting heavily. This can lead to anxiety for your pet as well as cause significant discomfort. If anti-inflammatories and other medications no longer work, quality of life should be a concern.
- Happiness: You are the best judge of your pet’s happiness. You know what is normal behavior and attitude. When your pet no longer shows interest in food, toys, the surrounding environment or he/she starts to dissociate from you and the family, you should be considering the quality of life they are experiencing
Another tool to help assess QOL is “The Rule of Five.” Think of five things they normally love. If they are not interested in more than three of the five, quality of life is impacted. You can also look at good versus bad days. If the bad days outnumber the good or the bad days are getting worse and the good days not as good, consider quality of life.
There are a few online tools to help you as well. Dr. Alice Villalobose has put together a quality of life scale on her website pawspice.com and Lap of Love has a quality of life scale and diary at lapoflove.com.
Making end of life decisions can take an emotional toll on pet owners. This can lead to grief, depression and guilt. As veterinarians, we can almost always make recommendations about tests to run and/or treatments to consider but ultimately it boils down to your pet’s quality of life, what you want for him/her and how much you want to put them through. Deciding on a stop point (that line in the sand that you do not want to cross) ahead of time can be helpful. Knowing in advance what you are willing to let your pet go through can help alleviate the guilt and make the decision clearer at a time when emotions are high. And remember, you are not alone. We are here to help you make the kindest, most compassionate decision for you and your pet.
It is never easy to say goodbye to someone that we love. But know that many times, loving them enough to let them go is the greatest gift we can give.