Losses and Saying Goodbye

I have been following a cardinal bird family that chose to grace a vine on my back patio with its babies. Every morning while drinking my coffee over the last couple of weeks I have chosen to be seated close to the nest to witness the anticipation, hatching, feeding, and parent consternation of the family. There was such a lovely pattern to my day to check on the family from a distance, yet in such close quarters. The morning serenade followed by flitting from tree to tree distracted me from completing my papers. The feathers were just starting to appear on the babies as they vocalized their hunger pains.These decisions are all about our pets, and keeping their best interest and needs to live well should be our primary concern. Most pet owners would choose to keep their pet alive for a longer period of time. The problem is figuring out what point "living well" stops. The disease (pain, cancer, dementia, illness) is already destroying the pet's quality of life. Humanely, the only choice that's left is HOW we want our pets to pass away: comfortably rather than alone.
The best outcomes will be realized through the partnership of your primary care veterinary team, the patient's family, and referring veterinarians. This collaborating team must set the benchmark to never be complacent. Rather as a collective they should approach the quality of life concern to ensure everything possible in the best interest of the patients and their families. They should make sure their approach to life and death is offered and conducted in compliance with the highest ethical standards.
Thinking I had many more days of this visual and auditory splendor, I went to my sister’s home in Kernersville overnight for a Belmont horse race hat party.
Today I returned to an empty nest: no parents, baby birds, or singing. The loss, although seemingly silly, is profound. We have a black snake that found close by the scene, and my husband heard a loud commotion of parent distress shortly before I arrived home.
Did they suffer or did they go quickly, I may never know. It makes me reflect on the decisions many of my clients face with their own pets and mortality.
What is the most common question client ask when facing life threating issues with their pets?
With debilitated patients, one common concern of pet owners is suffering. Terminal illness, obesity, pain, and a combination of infirmities have made daily living difficult. In discussions, client will struggle to verbalize the overwhelming emotional, physical, and in many circumstances financial burden of caring for their dear companion.
Is there a way to document or score the quality of life of a pet?
It is difficult to put a score on something as intangible as the life a living being: one that gives us unconditional love, conditionally. The simplistic phrases, “You will know when it is time because your pet will tell you,” or “The good days will be outnumbered by the bad days,” do not provide supportive, measurable scoring. Issues such as mobility, more good vs. bad days, happiness, hygiene, hydration, hunger, and hurt are critical to monitor. As an overview, I have listed the following questions.
1. Is the pet suffering (and isn't going to be getting better)? These indicators include: Loss of interest in what they usually like - food, walks, toys, treats.
2. Significant weight loss especially if due to lack of appetite not due to nausea, which is quite common as death approaches. Appetite loss (so long as we anticipate and prevent nausea) is not painful and is a natural step in the dying process.
3. Inability to stand and/or walk (especially if the pet is made anxious or is at risk of injury, bedsores, etc. due to its inability to move adequately). To lower risk of falling, adaptive changes in the environment can be made, such as non-skin floor surfaces (Sam’s club has a “jigsaw puzzle” spongy floor squares that make great temporary floor covering). Also raised food/water dishes and even taking these to your pet when no longer ambulatory help. Frequent turning of recumbent pets laying on orthopedic or memory foams to lower risk of “bedsores” is essential. Prevention of access to stairs unless supervised and assisting the pet is critical to lower risk of falling. Use of slings and vests with handles such as from http://www.ruffwear.com ,http://helpemup.com , and http://www.gingerlead.com websites are helpful to assist pets in rising & mobility and lower the risk of lower back injury in pet owners.
4. Pain control is a significant concern, and clients cannot use human standards such as crying as a benchmark. For discomfort, regular pain assessments by your veterinarian are ESSENTIAL for a pet approaching the end of his/her life to make sure multi-modality pain management (variety of treatments) are utilized.
5. Frequent seizures/altered mentation (behavioral changes) that impair quality of life.
6. Of the top 10 things that a beloved family pet loved to do, if down to <5 that is a quality of life issue.
7. Sleeping 100% of the time and it is a struggle to get up to eat, go outside, or interact with family or other pets.
8. Owners living in fear of what they will find of their pet's condition when returning from being away from the house.
9. Being engaged with family activities and actions seems to be decreasing. Try taking the “games” or interactions to your pet (tug-of-war, fetch). Create “hang out” sites around family gathering spots and outside in favorite areas.
It is hard to let go of a beloved family member. Dr. Betsy, what wisdom to you have about this from your 33 years of veterinary practice in speaking with pet owners ?
For additional help, the quality of life metric scale http://aplb.org/resources/quality_of_life.html , created by Dr. Alice Villaobos is helpful to quantify observations.
Betsy Sigmon DVM