Deciding when it is time for euthanasia is tough
COVID-19 has changed many things. Businesses, like restaurants and gyms, may be going out of business, unless they have embraced a new component of service because of COVID-19.
Turns out that people staying home is good for people serving pets. People are noticing more about them, caring more for them and because they are not spending money on as many other things there is more disposable income for most people.
It is not all “happy wellness care or save my pet being a hero” though. We have had an increase in euthanasia and cremations. When I have worked shifts at the ER, they have seen even more increase in euthanasia.
People always ask when is it time. They want me to make the decision for them. Usually, I cannot. Most of the time, it really depends.
It depends on the bond of the owner and the pet.
It depends on the prognosis of the pet. And, unfortunately, it depends on financial and care/time constraints of the owner.
I do not know all of those things.
If I had a Great Dane that was down, I would not be able to lift it by myself and take it out. If it had a poor prognosis and needed specialist care, I might choose to not treat.
Although that could depend on the individual pet, if it were Isaac, I probably would treat.
There is a quality of life scale to help owners make that decision. The HHHHHMM scale asks seven questions that are scaled on a range of zero to ten. Then these are added up for a total score.
• 0-10 HURT Adequate pain control (including breathing ability). The first H is for pain or comfort of the animal. If there is cancer (very painful), is the pain such that it can be controlled. Not all pain can be. Likewise, not all pain is permanent.
A German Shepard bit me and broke my thumb. Yes, it hurts, but it is unlikely to hurt at this level forever. And Naprosyn does a great job of controlling the pain that I have. (Naprosyn is very toxic to dogs, never give it.) I would hate to be euthanized for a temporary thing.
If the pain is mild, there is a lower score. If it is more, there is a higher score.
• 0-10 HUNGER Is the pet eating enough? Does the pet require hand-feeding or a feeding tube?
There are drugs that can be given to assist with the appetite.
We have gotten very good at dealing with those with our chemotherapy patients. But at a point, they don’t work as well. That would be a higher point on the scale.
• 0-10 HYDRATION Is the pet dehydrated? Does it need subcutaneous fluids? Is there a reason to do IV fluids in the hospital? Dehydration messes with all body systems and the electrolytes. Electrolytes that are off can cause patients to feel ill or in severe cases to have a heart attack or die.
• 0-10 HYGIENE Pet needs to be brushed and clean, especially after elimination. This can seem like a caretaker issue, but it also is a pet issue.
If they don’t like to be brushed and they don’t feel up to grooming, there are going to be problems.
If they are leaking or having frequent accidents there are puppy pads and special pet dry fleece pads to help keep them clean.
• 0-10 HAPPINESS Does the pet express joy/interest? Does it respond to its environment? Does the pet show signs of boredom/loneliness/anxiety/fear?
If Buster loved to sit under your desk and won’t move to get there, it may be a sign.
If Teddy loved to play fetch and won’t go out, it may be a sign.
A happier pet would get a lower score. An unhappy pet may be asking to be let go.
• 0-10 MOBILITY Can the pet get up without assistance? Does the pet want to go for a walk? Is the pet experiencing seizures/stumbling?
There are things that can be done to help mobility. We can guide you toward a special harness. Paw friction products help on slick floors. Yoga mats, bathroom mats or welcome mats in a path around the house can help a pet stay mobile longer. A half step or ramp may help going in or out to the yard.
• 0-10 MORE GOOD THAN BAD When bad days start to outnumber good days, the quality of life becomes compromised and euthanasia needs to be considered.
It is hard to know what the future will bring. Sometimes pets will wax and wane for a bit before the end. Is it a bad day or is it THE bad day can be hard to tell, but when there are few good days, it is probably time.
If you add all of these up a total of 35 points is considered acceptable for a quality of life score. More than that and it is in a very grey zone.
Most of us don’t want to wait until it is clearly black or white, but it is difficult within that zone of grey.
I usually say that if they are feeling good enough to get up and eat, then it is in the grey zone.
The human-animal bond, ability to care for them, financial constraints and the disease process all come together to know where in that grey zone, you and your pet are.
COVID-19 may have increased a few human and animal bonds, but it has always been a difficult decision.
MJ Wixsom, DVM MS is a best-selling Amazon author who practices at Guardian Animal Medical Center in Flatwoods, Ky. GuardianAnimal.com 606-928-6566.
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