Laurie's Blogs.

"Layla" (Kimicko Blueberry Sunday), March 6, 2005 - September 30, 2019.

Last week started out rough.  We had to put down our 14.5-year-old sheltie.  About 5 days before she suffered a vestibular episode.  No worries! I thought.  I’ve treated plenty of these.  Except that in my dog, I couldn’t affect the nystagmus with the positional movements (Dix Hallpike, Epley, and the Side Lie techniques).  As the days progressed, she was still able to wander around the house, often times bumping into things and sometimes falling.  She mostly chose to lie down.  However, when we’d try to get her up from prolonged lying down she was so much worse – on one occasion she was rolling when you tried to pick her up, on another occasion she appeared to be deaf and blind.  On day four after the incident, we thought that would be the day to put her down.  I did one more ‘side-lie’ technique to try to move displaced otoliths in her ear… and she got up and walked around.  Wobbly, but better.  So, we didn’t call the vet that day.  However…

However, the next day she was worse again.  So that night, my husband and I decided that it was time to let her go.  And that is what I want to talk about in this blog post.  How to talk to clients to help them know when it’s time to let go.

There are two facets of making the decision to euthanize a beloved pet.  Firstly, you have the objective side.  I think that as healthcare professionals, we have an obligation to discuss this with clients.  Especially those that are struggling to be objective about their pet’s current quality of life.  Fortunately, there is the wonderful HHHHHMM Scale by Dr. Villabos.  (For an original, view it at:   https://www.veterinarypracticenews.com/Quality_of_Life.jpg)  It’s a great tool to enable owners to look at their pets objectively.  Just to keep things all on one page, here is a list of the questions that are ranked 1 (poor) – 10 (best), where a score of 35 and below would be considered an unacceptable quality of life.

• 0-10 Hurt—Is the patient in pain, including distress from difficulty in breathing?  Can the pet’s pain be successfully managed? Is oxygen necessary?
• 0-10 Hunger—Is the pet eating enough? Does hand-feeding help? Does the pet require a feeding tube?
• 0-10 Hydration—Is the pet dehydrated? Are subcutaneous fluids once or twice daily enough to resolve the problem? Are they well tolerated?
• 0-10 Hygiene—The pet should be kept brushed and clean, particularly after elimination. Does the pet have pressure sores?
• 0-10 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?
• 0-10 Mobility—Can the pet get up without assistance? Does the pet need human or mechanical help (eg, a cart)? Does she feel like going for a walk? 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.
• 0-10 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.

If you’re given the opportunity to talk with owners early on, before you believe their pet may be ready to move on, I find that that is the best time to give them the HHHHHMM Scale.  I tell them, that I don’t their pet is ready and that he/she seems to still have a good quality of life and is happy, but that there is a helpful questionnaire that they can have to look at to confirm this and/or refer to if things change. 

Now, if on the other hand, you believe the pet is ‘ready’, then the conversation is more delicate.  The owners might not be ready to hear the truth, so you can’t come on too strong in your opinion, or rather how you deliver your opinion.  Wording and phrases such as, “I’m rather concerned about Muffin’s quality of life… pain… physical condition…etc.”, “It appears that Muffin is having a hard time”, or “Are you having any concerns regarding Muffin’s quality of life…etc.?”  Soft questions such as these might enable you to lead into a conversation about quality of life and give you an opening to deliver the HHHHHMM Scale.

When it came to putting down our little dog, we didn’t look at the scale.  We looked at the dog.  She wasn’t getting better… but more importantly, she didn’t appear to have any fight left in her either.  A gut feeling told us that it was time.  We looked at our dog.  We looked into her eyes, and she looked tired.  Like she was just hanging on for us.  We also knew that she could likely keep going on in her current state, but that we’d be continuously yo-yoing back and forth about whether it was time.  Do we call the vet today?  No… maybe tomorrow.  

When it’s near the end it can be hard to accept the objectivity.  This is why I also tell clients, “Look into their eyes and you’ll know.”  I am a believer that all things happen for a reason.  So too is the illness of a pet and/or their time to leave us.  I also believe that it’s okay to tell clients your beliefs.  Our beliefs (as animal healthcare professionals) are perhaps as valid as we might be able to get while we’re here on earth.  I once had a friend call me up.  She was in a bible study group, and at their last meeting, one of the other participants had stated that animals don’t go to heaven.  My friend was distraught at this statement and called to ask me, because she said, “I figured you’d know!”  Well, I don’t proclaim to have the answers to who or what is on ‘the other side’ and I’m not an expert on biblical studies.  But I’m thinking that in MY heaven, there will most definitely be animals.  Lots of animals.  All of my past animals, many of the animals I’ve treated, and others that have heard of me and want to meet me!  (I just added that last part in, spur of the moment… I like it though!)

So, this long rambling blog is just to say that it’s okay to talk to your clients about this topic objectively, subjectively, and personally.  Your job is to not shy away from having the conversations. 

With love and light,

Laurie