WHEN TO LET YOUR PET GO

By Virginia Kilmer

It’s never easy to decide when it is time to let your pet go and you worry that it’s too soon or you hope that they will pass peacefully on their own so you put off making the decision.  I have had to make that decision for my own pets and over the past 24 years of operating Perpetual Care, I have had to make the decision many times for our resident pets, and it is always difficult to decide when it is time. 

Here are some guidelines that may help you when you face that decision with your pet.

GENERAL GUIDELINES-MEDICAL DIAGNOSIS

1.      The first rule is to always talk it over with your veterinarian.  Having advised that, I will also advise you to weigh your vet’s opinion carefully because I have also seen vets who have been quick to move from a diagnosis to euthanasia.

Herbie’s story:

Herbie is a German Shepherd resident dog here at Perpetual Care.  His owner went into assisted living and had not been able to care for him for some time.  He had not been to a vet in over 3 years.  We gave him veterinary care and treated his terrible skin condition and we were ready to put him up for adoption when he started to have trouble walking and he developed a urinary tract infection (he had never been neutered).  From there it became a health care battle for Herbie between osteoarthritis, UTI’s and difficulty walking.  At the point when an ER vet diagnosed treated him, they recommended euthanizing him that day.  We took him home because I did not think it was time for him yet.  A couple of weeks later, He developed another UTI and I took him to the Urgent Care Center.  The vet diagnosed him with a tumor in his bladder.  She said that he probably only had weeks or at most a month or two to live.  In the meantime, she put him on a new medication and told us to just let them know when we were ready to let him go.  Well, it has been 7 months since that day when he was put on Galliprant, and for Herbie, it was his saving grace.  He has been walking on his own and happily eating very well, although he can be a little weak in the back legs at times.  We watch him for signs that he is in pain and believe he will let us know when it is time to let him go.

That brings us to a general guideline of indicators of pain and suffering

2.      Not Eating or Drinking. Not eating or drinking are the clearest indicators that your pet is suffering, however, it can be a temporary situation and indicator that you need to get them to the vet or it can be telling you your pet is at their end of life.

3.      Vomiting, Choking or Diarrhea. Symptoms of vomiting, choking or diarrhea will depend on whether or not you have already received a diagnosis and these are end of life symptoms. Generally, vomiting or diarrhea can be due to simple changes in food or something temporary, but if it continues for 24 hours, you will want to get your pet to the veterinarian.

4.      Unable to Urinate or Frequent Urination. Never wait if your pet is unable to urinate and get them to a veterinarian. Frequent urination may take time for you to recognize, but when your observe it, make an appointment for your pet to see the veterinarian.

5.      Scratching, Biting or Pawing. Scratching, biting at themselves or pawing themselves are telling you that our pets is probably in pain or suffering from something. Biting and nipping at others can also indicate pain, such as a toothache or something worse.

6.      Sleeping Excessively. This is more likely an indicator for senior pets and becomes more concerning when associated with not eating or drinking.

DOGGIE DEMENTIA

It is difficult enough to make the decision if it is time to let your pet go when it is a physical issue, and it is even more difficult when they are dealing with dementia.  Your pet may be able to walk, eat and drink, but they start to show signs of dementia frequent pee and/or poop accidents, getting “stuck” and standing in a corner for long periods of time, sundowners or possibly becoming aggressive when touched.

Many of their symptoms negatively affect our quality of life and can be frustrating because our pet is no longer the pet we once knew and loved.  This is the same process we go through with our human loved ones as they age.

The General Guidelines still apply, but it is more difficult to determine the quality of life because more often than not they are still functioning with the basics of eating, drinking and peeing and pooping.

If you are dealing with a pet with dementia, it will help you to add much more subjective factors that affect their happiness and joy.  Do they let you give them affection?  Sometimes a pet won’t even sit still anymore to allow you to pet them or hold them. Are they sleeping all day and wandering around all night (and having accidents)?  Have you come home to find them “stuck” under a chair not knowing how to get out from it?  Are they unusually aggressive at times, when touched or picked up? Do you find them laying in their own pee or poop while sleeping?

Consider the issues your pet is dealing with from their perspective and ask what kind of qualify of life they are experiencing.  Perhaps from your perspective, you don’t mind dealing with their issues and they are still eating and drinking and while they may need help getting out to pee and poop, they are walking on their own.  I love dedicated pet owners who care for their dementia pet and have done so here at the Perpetual Care Life Care Center.  In the dementia cases the turning point may be when they no longer eat or drink before making the decision to let them go.

QUALITY OF LIFE SCALE

At Perpetual Care, we use the standard Quality of Life Scale (below) to evaluate pets in order to try to make sure we are looking at the decision from our pet’s perspective more so than our emotions. 

Quality of Life Scale

Using a scale of 0 to 10 (0 = Unacceptable, 10 = Excellent), evaluate your pet’s quality of life.

Score Criterion:

1.      Hurt—Is the patient in pain, including distress from difficulty in breathing?

Can the pet’s pain be successfully managed? Is oxygen necessary?                                  Score:______

2.      Hunger—Is the pet eating enough? Does hand-feeding help? Does the pet

require a feeding tube?                                                                                                            Score:______

3.      Hydration—Is the pet dehydrated? Are subcutaneous fluids once or twice daily

enough to resolve the problem? Are they well tolerated?                                                 Score:______

4.      Hygiene—The pet should be kept brushed and clean, particularly after

elimination. Does the pet have pressure sores?                                                                     Score:______

5.      Happiness—Does the pet express joy and interest? Is he responsive to things

around him (family, toys, etc)? Is the pet depressed, lonely, anxious, bored, or

afraid? Can the pet’s bed be near the kitchen and moved near family activities

to minimize isolation?                                                                                                              Score:______

6.      Mobility—Can the pet get up without assistance? Does the pet need human

or mechanical help (a cart)?  Is she having seizures or stumbling? Note: Some

caregivers feel euthanasia is preferable to amputation, yet an animal with limited

mobility may still be alert and responsive, and can have a good quality of life as

long as the family is committed to quality care.                                                                    Score:______

7.      More Good Days than Bad—When bad days outnumber good days, the pet’s

suffering is appreciable and quality of life might be too compromised. When a

healthy human-animal bond in no longer possible, the caregiver must be made

aware that the end is near.                                                                                                           Score:_______

Total: A total of > 35 points is acceptable quality of life for pets.     TOTAL: _____________

Adapted from Canine and Feline Geriatric Oncology: Honoring the Human–Animal Bond, Villalobos A. Kaplan L—Hoboken, NJ: Wiley-Blackwell, 2007, with permission.

For a printable copy of the Quality of Life Scale visit our website at: https://www.perpetualcare.org/quality-of-life-scale

If you complete the form as objectively as you can and the score is above 35, but you are not comfortable with your answers, you can ask someone else to complete it and compare their answers to yours or go over it with your veterinarian.

Also ask insightful questions to figure out Quality of Life

Imagine whether your pet wants to live. Put yourself in your pet’s paws. Empathetically imagining yourself as your pet, consider whether you would want to continue living. Write down your response in a journal and take it into account in conversations with your veterinarian.

Consider whether your pet still enjoys life. Empathetically imagine yourself in your pet’s paws. Would you still be enjoying life?

For example, you could tell your veterinarian: “If I imagine myself as Sam (insert your pet’s name), I think I would still enjoy life right now. That may change, but I think I would still be enjoying life.”

1. You could say: “If I imagine myself as Sam (insert your pet’s name), I think the pain would be too much to handle and I probably wouldn’t be enjoying life anymore.”

Reflect on whether your pet is ready to go. Empathetically imagine yourself as your pet. Thinking about their quality of life score and the pain they experience in their everyday life, consider whether or not they are ready to move on to a better place. Write your response in your journal.

1. If you have family or friends who share your pet, you might want to share your reflection on whether or not they are ready to go.

2. If you think your pet is ready to move on to a better place, talk to your veterinarian about euthanasia.

3. If you think your pet is ready to go, you could tell your veterinarian: "Imagining myself as Sam (insert your pet's name), I can't believe I would want to keep on living with all of the daily pain, not being able to eat, drink water, or play with friends and family anymore. I think it is time to move on."

Give your pet permission to let go if they are ready.  I have actually talked to my pet and told them that I am okay for them to let go if they are ready.  I believe pet can feel when we are holding on to them and they fight to be with us so it can help to tell them it’s okay to let go. 

You may wonder if you make the decision too soon or you may wonder if you make the decision too late.  That is normal and all you can do is to make the best decision you can for your pet by considering it from their perspective and not your own.

Waiting too Long?

I’ll give you an example of when I saw someone I believe waited too long because their pet was clearly suffering and had no quality of life at all.  I was visiting a potential kennel caregiver for my pets because could not find someone to pet sit for me in my home many years ago.  As she gave me a tour of her facility, we entered a room where there was a small Chihuahua dog lying on the floor. It was so still that I thought one of her dogs had just passed away.  When I asked if the dog was okay, she said, “Oh he’s okay, he’s just elderly and he has not passed yet.”  She went on to explain that she did not believe in euthanizing animals and that they should live their life and pass naturally on their own.  She also told me that she had to give the dog water using an eye dropper and that he usually pee’d and pooped while lying there.  My heart broke for what I considered to be a very painful and slow death for that dog.  I believe she was not seeing how much her dog was suffering while she waited for him to die naturally but she thought she was being a good caregiver for her dog.  Sometimes we don’t want to take on the emotional burden of making a decision to take their life, but rather than looking at it through our needs, if we consider the pain and suffering of our pets, we can focus on how we can them a peaceful passing.  Needless to say, I did not select them for my boarding services. 

Molly’s Story

This is an example of a premature decision to euthanize and a veterinarian who recognized it and refused to accommodate the owner’s request.  We once took in a beautiful black miniature poodle named Molly from a woman who was fed up with dealing with her having pee accidents and said she was getting aggressive.  I asked if she had taken her to her vet and she said she did and the vet refused to euthanize her. She also mentioned she could not afford to pay for her vet care.  I understood that to mean that she just took Molly to the vet and asked them to euthanize her, not give her vet care.  We took her in and then took her to the veterinarian for evaluation.  It turned out that Molly had a UTI which was the cause of the pee accidents.  She did have some signs of slight cognitive decline, but once we treated the UTI, she stopped having accidents.  She was also not aggressive so we attributed her previous bad attitude to her pain.  We also gave her access to a doggie door 24/7 to accommodate her sundowners and tendency to wander aimlessly at times when she began to show more signs of dementia.  Molly lived happily for another year, until she experienced a sudden and significant decline and would not eat.  It was at that point that we brought the mobile vet to our home to give her a peaceful passing at home.

The Euthanasia Process 

If we can save our pets from a long suffering, painful passing I think it is a gift we can give them and the final gift is to be there with them when they pass.  At the Perpetual Care Life Care Center, we want our pets to be as comfortable as possible and to not feel stressed when it is time to help them pass.  Most pets, whether cats, dogs, horses or other animals become stressed by getting into a vehicle and going to the vet’s office and they are most comfortable when in their home so we have a mobile vet who comes to our home for euthanasia.  We spend time with them giving them treats and affection so they are comfortable.  If they have dementia and have not allowed you to pet or hold them, this is the final time they can experience affection and our kind vet gives us all the time we want to share that with them. We find that it is truly the most peaceful passing we can give them.