Angels At The End

77 Sycamore Circle
Ormond Beach, FL 32174

(386)562-5329

angelsattheend.com

How will I know when it is time?

Many people who call me are struggling with this question.  It is a very difficult question because it is not just one question but really several questions: Why not a natural death? Is choosing euthanasia somehow failing to care for my pet? How do I know my pet is suffering? What signs do I look for?  I will try to address these questions but you should know that you are not alone in this journey.  The decision on how to care for your pet is ultimately yours to make, but there are guidelines and resources you can turn to for help.  Even veterinarians struggle with euthanizing their own pets.  Just as with your family member, when it comes to our pets, our heart and head are often in conflict. Most importantly, realize that as you ponder what is best you are already grieving. This type of grief is called “anticipatory grief” because we realize that the end of our time with our pets is drawing near. When your heart is breaking, the decision about what to do becomes that much harder. Remember that the bond of love that your pet shares with you is unconditional—they love you no matter what!—and perhaps the last best gift of your life together is to give yourself as much compassion as you are showing to your pet. You are doing the best you can!

I have had many people struggle with euthanasia for their pet because they feel guilty for "playing God" and not allowing a "natural" death to occur.  Please realize that your pet has not led a "natural" life.  Your pet has not had to fight other animals for food or a territory to hunt, provide their own food, find water or drink from unhealthy water sources, suffer from parasites and disease, or need to find a safe place to rest.  You have provided every need for your pet and the rewards have been great beyond measure.  Just as your pet has not led this very difficult and "natural" life, there is not much opportunity for a "natural" death where a predator awaits to make sure of a swift end for those too weak to provide for themselves.  The simple honest truth is that everything that lives must eventually die.  As much as it may hurt us to let go, death is not a failure of our care but quite the opposite, as our care has often greatly extended their lives.  Pets can quietly fall asleep and not wake up.  We all wish for that and it is a wonderful gift to our pets when that happens.  My goal for home euthanasia is just that: to allow your pet to fall asleep surrounded only by those they love and then pass away without being aware of dying.  One client commented to me that just as we have a responsibility to our pets that they not suffer in life, we have a responsibility that they not suffer or linger in death. 

So, how do we tell if our pets are suffering and what signs do we look for?  Animals can be very good at hiding their symptoms, which is an instinct left from the time when they had to fend for themselves.  Our pets do not understand suffering; they just accept it and endure it.   The guidelines set forth by the United Kingdom's Farm Animal Welfare Council in 1965 holds true for all animals.  Their 5 Freedoms are based on the concept that "the welfare of an animal includes its physical and mental state and that good animal welfare implies both fitness and a sense of well-being.  Any animal kept by man must, at least, be protected from unnecessary suffering."  These 5 Freedoms state that quality of life for animals has at least these basic needs:     

  • Freedom from hunger and thirst.  This may not be as simple a statement as it seems.  Of course we provide food and water, but are they hungry and thirsty?  Pets with tooth or mouth problems may find it too painful to eat or drink.  A tumor or disease in their abdomen may make it uncomfortable when their stomach or intestines are full.  Nausea may cause vomiting so that what they do eat or drink comes back up and leaves them feeling even worse.  Diarrhea or other digestive problems may prevent them from absorbing what they do eat.  Weight loss accompanies many diseases, and can be very rapid or slowly progress over weeks and months.  There are some diseases that cause a pet to be dehydrated in spite of drinking plenty of water.  Pets that are having trouble breathing often cannot stop to eat or drink without worsening their struggle to breathe.  Pets with problems moving about may get up only once to eat, drink, and eliminate as a single effort and then lie around for long periods being thirsty, hungry, or needing to urinate or defecate
  • Freedom from discomfort.  We want our pets to rest comfortably.  If your pet is only able to rest for a short time in one position or one place without getting up and moving around to a new spot or position then they are uncomfortable.  Some pets will pace for hours until they collapse in exhaustion because lying down is uncomfortable.  Cats will often crouch low on all four feet rather than lie on their sides as a sign of discomfort.    
  • Freedom from pain, injury or disease.  Even the best of care will not prevent your pet from eventually failing from either old age or disease, but we must prevent them from suffering.  Your veterinarian is a great resource on what signs and average timeline you might expect for your pet as their disease gets worse.  Remember that these are general guidelines, since any disease can have sudden worsening or unexpected symptoms.    Pain can be hard to assess as an animal in pain does not always yelp, growl or "talk" to us.  Pets that are in pain may only show this by a change in behavior.  Some pets become very clingy and always want to be at your side, while other pets will become withdrawn and be found in another room by themselves instead of in the middle of daily activities with their family.  Some pets get grumpy and snap at the people and other family pets whose company they used to enjoy.  They may move away from your attention or not let you touch areas that are painful for them.  Some pets will chew or injure themselves trying to worry at an area that is bothering them. 
  • Freedom to express normal behavior.  You know your pet better than anyone else.  You know their habits and routines, what they enjoy doing with you, and what activities give them pleasure.  This may be going for walks, car rides, playing with toys, greeting you when you arrive home, following you from room to room, or enjoying a relationship with other pets in your home.  For clients beginning their pet's treatment for a terminal disease such as cancer, I used to have them think at the beginning of treatment what would be the point at which they would stop their pet's treatment.  For example, how long would you allow your pet to not eat? 3 days? 5 days? 2 weeks?  (How long would you want to go without eating?) You may want to make a list of a few key things your pet really enjoys and makes life worth living for them.  Only you can decide if the point to stop treatment and consider euthanasia is when they cannot enjoy one, two, three, or all of the things they used to enjoy.  
  • Freedom from fear and distress.  A pet that is blind, deaf and suffers from dementia lives in a world that is small and isolated from what they used to be.   A pet that has difficulty moving (including moving away from their own urine or feces) is, on the other hand, well aware of how limited their life has become and suffers in a different way.  Pets who sense that their time is dwindling may seek to escape outside when it never interested them before, or hide in places where they never used to be, such as the cold surfaces in a bathroom or the dark recesses of a closet.   

I frequently suggest to clients to decide what makes a day a "good" day for their pet.  A good day might be a day without vomiting, without a seizure, without accidents in the house, or a day that their pet was able to get up without help.  On a calendar, give that day a smiley face or a plus (+) sign.  On a "bad" day, where your pet has the symptoms that concern you, mark a frown face or minus (-) sign on the calendar.  In this way, you can honestly track how your pet is doing with a look at the calendar. 

Friends and family may be helpful in providing you with objective evaluation on how your pet is doing.  Be aware that friends and family may also be concerned with the toll that caring for your pet is taking on you as well as seeing the decline in the health of your pet.  In providing house calls, I am often humbled by the extent to which clients will change their schedules, homes, and lives to provide for the needs of their sick pets.

 

Dr. Alice Villalobos is a veterinarian who is a pioneer in the field of veterinary oncology (cancer medicine) and end of life care.   Dr. Villalobos has a quality of life scale that looks at key aspects of your pet's daily life with specific numbers to assign to answers about how your pet is doing.  The HHHHHMM scale stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad days.  Many veterinarians and pet owners alike find the HHHHHMM Quality of Life scale to be helpful.  You can access Dr. Villalobos' scale at HHHHHMM. (click on the blue link with your cursor) 

 

I have had pet owners who chose euthanasia for their pets with terminal illness at the first signs of deteriorating quality of life.  I have also had clients who have chosen to provide nursing care until even exhaustive hospice efforts no longer helped their pet enjoy life. Everyone has a different capacity to help their pet, whether it be time, finances, or even the physical ability to provide care, so do not measure what you are able to do against anyone else’s choice. As long as your pet receives your love and care and does not suffer, the actual time to choose euthanasia can be as individual as the special relationship you share with your pet.  In my years as a veterinarian, I cannot remember a pet owner telling me later that they chose to let their pet go too soon.  I have had many people who told me later that they kept their pets too long and for themselves.  We cannot ask those we love to suffer or have pain so that we can avoid the pain of their loss.  One of my clients told me they knew it was time when their pet was living a life that they themselves would not want to live.   Others reason as to whether their efforts on their pet’s behalf are prolonging a good quality life or prolonging death.  There is a Latin saying " non est vivere sed valere vita est” which translates to “There is more to life than just being alive.” Another client said that they would rather say goodbye on a good day than wait and be too late with a crisis.  As the end draws near, you may only be able to decide on a day-by-day basis what is best for your pet.

The hardest part of loving our pet comes at the end when we lose their daily presence in our lives.  No one is ever truly prepared for that loss.  Our struggle to do what is best for our pets at this time is a testimony to the love that we share.