HOW DO I KNOW WHEN IT'S TIME TO LET MY PET GO?

Today’s blog is going to focus on ways to help you make the decision of whether or not it is the right time to have your pet euthanized. Euthanasia means “good death”, and when the time is right it is a very humane way to end a beloved pet’s suffering. There is a reason why euthanasia is the term associated with the procedure where we humanely end a pet's life with medications, rather than being associated with natural death. Natural deaths are often prolonged with a large amount of suffering, and they are often not very peaceful either. Often the decline leading up to a natural death is a prolonged period of loss of your pet's independence, dignity, and self.

Although there is no absolute guarantee that euthanasia will be peaceful, as we are most often caring for an extremely fragile, elderly living creature, we do our best to make it so and in the vast majority of cases it is. I am a certified hospice veterinarian (one of only about 300 in the world as of 2023!) and have been practicing exclusively end-of-life veterinary care for over 5 years, and I truly feel that most owners are excellent at realizing when it is the right time to let their pet go – of course we doubt ourselves, and there is almost always some guilt associated with making the decision, but in general owners are better at judging how their pet is doing than they believe. Have faith in yourself! And know that veterinarians are there to help you with your decision.

There is no set formula or test to know exactly when it is time to euthanize (I wish there was!), and no one wants to make the decision too early. However, in my opinion, and that of many other animal care professionals, a day too soon is better than too late. Nearly everyone who has witnessed a traumatic natural death will make a decision sooner with any other pets they may love. The problem is, we don't always know when a sudden, painful, scary natural death will occur, until it is too late to get care. But the odds are that a natural death will not be as peaceful as a dignified, pain-free, fear-free euthanasia experience.

Usually there is a "window" where euthanasia is a humane and appropriate choice, and the longer you allow your pet to remain in that window, the more risk that they may enter a state of crisis or acute, severe decline, and possibly a traumatic (for them and for you as a witness) natural death, depending on the health condition(s) affecting them. Because it is such a fine line, and older pets can deteriorate quickly, Faithful Hearts tries to be as available as possible, including weekends. I am going to talk about some things you should consider and some tools you can use.

The key is thinking about your pet’s overall quality of life. Just because a pet is eating does not mean they feel good and/or are content (it’s very common for owners to want to wait until their pet stops eating to make a decision). Pets have an innate survival drive and many pets continue to eat despite the fact that they are very sick or suffering intensely. And it is especially difficult when your pet is having “waxing and waning” symptoms, with good days interspersed with the bad, because we want to be hopeful that the bad times are temporary and the pet will recover.

THINGS TO THINK ABOUT

1. IS MY PET STILL ENJOYING HIS OR HER FAVORITE THINGS?

Think about 3-5 favorite things your pet enjoys. Can he or she still do over half of those, and seem to enjoy themselves during the activity?

2. IS MY PET HAVING MORE GOOD DAYS THAN BAD?

This is a tough one, because it is so subjective. Think about what you believe your pet would call a good day - what things would they want to be able do? For example, a bad day might be that normally they are able to walk outside and nap in the sun on a nice day, but today was beautiful and they did not get off the couch or their bed because getting up and/or walking was too uncomfortable. A day where a pet who typically loves to eat refuses to, or turns down his or her favorite treats, may be a bad day. A dog who loves to go for car rides being unenthusiastic about one may indicate a bad day. I suggest that after coming up with some guidelines for what makes a good day vs a bad day for your pet, you download the Grey Muzzle app or a blank calendar, and marking every day as good, bad, and/or OK to track trends and know when the bad days are becoming the majority.

3. ARE THERE TREATMENT OPTIONS AVAILABLE TO IMPROVE MY PET’S QUALITY OF LIFE, AND ARE PROVIDING THESE TREATMENTS REALISTIC OR FEASIBLE?

Certain conditions, such as arthritis, may be greatly improved with the addition of treatment (such as medication, acupuncture, physical rehab, diet changes, weight loss, etc) to the point where a pet with an unacceptable quality of life improves enough to get better, maybe even for months or years. You also need to consider if available treatments are realistic. Your cat with renal failure might feel better with an anti-nausea medication, a renal diet, home fluid therapy, etc, but are you able to get him or her to accept the medications? Are you going to lose any potential gain in improving their quality of life by forcing them to endure something very stressful to them on a daily (or multiple times a day) or weekly basis? Are they going to starve themselves because they hate the taste of the renal diet? Furthermore, as new treatments are developed, they may be available but not to everyone due to being cost prohibitive.

You need to talk with your pet's veterinarian about the options available for your pet. If options are not available or realistic, and your pet’s quality of life is poor, humane euthanasia should be considered.

AVAILABLE TOOLS

1. VILLALOBOS (DOG AND CAT VERSIONS) & JOURNEYS QUALITY OF LIFE SCALES

The Villalobos scale can be found online with a Google search, with dog- and cat-specific versions available. It can be confusing trying to figure out exact scores, so don’t get bogged down and just give it your best. Don't be surprised if different members of a household come up with different scores for a pet either - what a great starting point to see if you are on different pages and see what the other person is thinking, perceiving, and feeling! Please note that scores can be skewed in pets that are eating and drinking well.

Another available scale can be found here: Journeys Pet.

2. BEAP PAIN SCALE (DOG OR CAT VERSIONS) & THE FELINE GRIMACE SCALE

Our pets are masters of disguise. As predator/prey animals, they innately hide when they are sick or suffering as a survival mechanism. Cats in particular, as they evolved from solitary hunters, did not need to develop facial expressions to communicate with others. When dogs and cats do show pain, it is often not in the ways that we look for or expect (such as limping or vocalizing). In particular, the most common indication of musculoskeletal pain, such as arthritis, in cats is that they no longer climb or jump vertically onto elevated surfaces. In dogs, your pup that used to be glued to your side may no longer choose to get up and accompany you - they may stay in place and follow you with their eyes instead. They may also take significantly more time and effort when laying down and when standing.

The BEAP Pain Scale is available online (with versions for dogs and cats) and is another way to assess your pet. It is confusing as well, so I tell owners to check off all symptoms they see and decide which category best fits their pet. This scale may also be found through a Google search.

For acute pain, the Feline Grimace Scale app is a free resource that walks you through assessing your cat's facial expression and features to monitor pain. There are quizzes included using photos to teach you what to look for in how your cat's ears, eyes, and whiskers are positioned.

3. OTHER

A previous blog I wrote talked about “doggy dementia”, or canine cognitive dysfunction. Cats can suffer cognitive dysfunction as well. There are some scales available online for assessing your pet’s cognitive decline, such as the DISHAA questionnaire available through Purina here. Common symptoms include restlessness or vocalizing (especially at night), circling or pacing, getting stuck in corners, behind furniture, or going to the wrong side of the door (near the hinges) when they previously did not. Cognitive dysfunction is difficult to treat/manage, and it severely impacts quality of life.

SUMMARY/ ADDITIONAL RESOURCES

If you are struggling to make a decision, it may be helpful to enlist the aid of family and friends and ask them how they see your pet doing. Photos and videos to see physical changes over time may prove beneficial as well, and for most of my hospice patients I recommend caregivers start taking photos and videos from the front, side, back, walking, getting up, etc on a weekly, biweekly, or monthly basis. You will more easily pick up subtle changes on these that you might miss since you see your pet every day. Another incredibly helpful resource for many families is the "How Will I Know?" article from OSU's Honoring the Bond Program, but please note this resource has been difficult to keep an active link for, so we apologize if the link here is broken.

One final thing, if you are up to an heartbreaking, emotional read, this is an excellent article about euthanasia and decisions around it: https://melnewton.com/2019/the-good-death/. It's better to have memories (memories around trauma/grief are particularly strong) of a final day with lots of snacks, napping in a favorite spot, being surrounded by family who could all be there if they chose - whenever that is a possibility.

For those who are opposed to humane euthanasia (no judgment, you are absolutely allowed to have your own beliefs, but you need to know what natural death can look like and involve), I encourage you to study how a natural death occurs, and use every resource at your disposal to help ease that transition.

Thank you so much for reading, I hope this blog was helpful!