End of Life Decisions
By Carolyn Cockroft
End of Life Decisions
Thanks to advances in veterinary care and improved diets, pets are living longer. The pleasure of enjoying our pets for additional years, however, comes with age-related conditions.
Cats and small dogs are considered geriatric at the age of 7, according to the American Veterinary Medical Association (AVMA). Larger breed dogs are considered “seniors” when they turn 6 years of age.
Senior pets have similar medical issues that face aging humans, such as diseases of the heart, liver, kidney, and urinary tract. Many suffer joint weakness or pain, diabetes, and senility. Consequently, they need additional care, including more visits to the veterinarian, dietary changes, or adjustments to their surroundings.
Signs of Aging
Common signs of aging in pets are increased anxiety, vocalizing or reaction to sounds, confusion, changes in sleep patterns, house soiling or reduced self-hygiene, and hearing loss. While these are not necessarily cause for immediate concern, no one knows your pet’s habits and patterns better than you do. Your daily interaction with each other offers you an essential role in spotting early signs of deteriorating health.
If an older pet appears to be in pain, arthritis may be the cause. A veterinarian can offer treatments to ease discomfort and improve joint mobility:
- • Changes in diet, supplements and exercise to reduce extra weight on your pet’s limbs
- • Using orthopedic beds, stair steps for assisting access to higher places, and a raised feeding dish.
- • Over-the-counter medications, such as glucosamine or chondroitin sulfate or Omega fatty acids
- • Nonsteroidal anti-inflammatory drugs (NSAIDS), similar to human pain relievers. Do not give human pain medications to your pet without first consulting your veterinarian, as these can be fatal for pets.
When is it Serious?
Contact your veterinarian if you see any of these changes, which may indicate kidney, urinary or heart disease or cancer, the cause of almost half of the deaths of pets over 10 years of age.
- • Straining to urinate
- • Sudden changes in appetite/weight
- • Abdominal swelling, lumps or discolored skin
- • Bleeding from the mouth, nose or other body openings
- • Difficulty breathing or eating
- • Non-healing wounds
- • Persistent diarrhea or vomiting
- • Unexplained swelling, pain or lameness
When “Senior” Becomes “End of Life”
Probably the most stressful experience an owner will face is when a pet is diagnosed with a terminal illness. This means choosing either to delay the loss of a cherished friend or to prevent any more suffering. Whatever we decide, our human emotions are in a turmoil.
Palliative care, through use of medications, may be an option if the pet is not in any pain or emotional discomfort. Although not designed to prolong life, this treatment offers a good quality of life, as long as that animal appears to take pleasure in living. Dr. Alice Villalobos, a veterinary oncologist, developed the “HHHHHMM Quality of Life Scale: Hurt, Hunger, Hydration, Happiness, Hygiene (keeping the pet clean from bodily waste), Mobility and More (as in, more good days than bad). Grade each category on a scale of 1-10 (1 being poorest quality of life and 10 the best). If most of the categories are ranked as 5 or above, continuing with supportive care is acceptable. (Use the scale here: https://www.nytimes.com/interactive/2019/03/19/well/family/19petgoodbye-quiz.html)
One tool for discerning what is best for a pet is the Rule of Five Good Things. Pick the top five things that your pet loves to do (such as eating, self-grooming or being groomed, playing with toys, going for a walk). When he can no longer do three or more of them, quality of life has deteriorated to a level where many veterinarians would recommend euthanasia.
When is it Time to Let Go?
The thought of euthanasia, or the act of “putting to sleep”, often produces feelings of guilt in a pet parent. A normal wish is to hope the pet will die naturally, perhaps when asleep, but waiting for this to happen usually prolongs the pet’s suffering. When treatments fail to ease persistent pain, euthanasia is the kindest option.
“Pets live in the moment,” explains Dr. Andy Roark, veterinarian at Cleveland Park Animal Hospital in Greenville, SC. “They don’t reflect on all the great days they have had before or ponder what the future will bring. All they know is how they feel today. By considering this perspective, we can see the world more clearly through their eyes. And their eyes are what matter.”
Michele Pich, veterinary grief counselor at the University of Pennsylvania’s Ryan Veterinary Hospital suggests thinking in terms of the give and take of the human-animal bond. “Euthanasia is the pet owner deciding to take on the emotional pain of letting their loved one go, to help prevent their pet from feeling any more physical pain.”
Often the veterinarian first administers a sedative, which makes the pet relaxed and drowsy, perhaps unconscious. Next, a fatal dose of sodium pentobarbital will cause the pet’s brain and heart activity to cease. The procedure is painless and quick. A death without suffering or fear—a death with dignity.
When my cat Ashley was diagnosed with lung cancer, I delayed the inevitable. I thought only of my anguish of losing her and watched her linger for two days struggling to breathe. I will never forget the compassionate words from Dr. Mayo, my veterinarian, when I finally brought Ashley to be euthanized: “The fact that Ashley has lived for 20 years is a testament to your excellent care and affectionate for her. And now, you are giving her this last and selfless gift of love.”
Quality of Life Should Determine Decisions
Age-related problems are natural and to be expected as your pet matures. Your attentive and loving care are essential to your furry companion’s living a happy, healthy and active life, especially in the senior years. Most of us will outlive our pets, and we have an ethical responsibility to provide the most humane care. For this reason, quality of life should be one of the most important guides when determining any treatment—including the more difficult end-of-life decisions.
BIO: Carolyn is a volunteer at King Street Cats and enjoys being ruled by her two cats, Marigold and Butterbean.