When is it time?

January 7, 2012

Four years ago I thought it was all over for my Border Collie Makeba. She sat under my desk shaking in pain and her back legs were weak and she was stumbling. Something was compressing or damaging her spinal cord. X-rays didn’t reveal much. I was able to control her pain with medications and rest and my colleague, Holley Cone, DVM helped her with acupuncture and chiropractic adjustments, but she still wasn’t quite right. Like most veterinarians, when my own pet is the one in trouble, I become a complete idiot. So, I sought second and third opinions. Local surgeons were hesitant to attempt surgery without the benefit of an MRI to localize and identify the problem, but this was before Charleston had its two veterinary MRI facilities. So we travelled to NC State in Raleigh for an MRI. The diagnosis: twenty one herniated disks of varying severity. Dogs only have 28, so you can imagine my dismay. The worst ones could be surgically managed, but there were so many affected. Meanwhile, just with medical and physical therapy, Makeba was getting better and stronger.
Everyone I consulted with agreed; no need for surgery if she was getting better. And better she got. She never resumed her previous activities like pulling my husband on his bike or running the length of Sullivan’s Island, but she could walk and trot and play with her toys. And after we laid wool carpet on our stairs, she could even go up and down on her own. Life was good again.
To everyone’s amazement, this lasted four years. But in the last few weeks she suddenly lost all she had gained. Now she was 15, and my husband and I had to make the decision that I have helped so many of my clients make over the years. At what point do you say goodbye to a long loyal friend? I’ll share with you some of the things to help you make such a decision, but ultimately, you just know. My husband and I knew that if Makeba lost her ability to get up on her own and if she lost her usually voracious appetite, then it was her time. We said our tearful goodbyes when all she would eat was cat food and she had to be carried outside to eliminate. She was tired.
But, I have clients who decide to euthanize a pet long before and long after these stages. It is such a personal decision that there are no rules.
When discussing this issue, I like to point out two things. One is that age itself is not a disease. We all get lots of diseases when we reach a certain age, but it isn’t age itself that is a disease. So, if your aged pet is slowing down, be sure to have your veterinarian assess him or her to see if there are treatable disease processes going on before you decide to euthanize a pet. Once you know what disease you are dealing with, it is easy to remember that you are not making the decision for your pet to die. The disease process decided that. You are simply helping decide how your pet is going to die. Once you reach this point, you have two choices: euthanasia or hospice care. It is making the decision to discontinue treatment and move into hospice care or euthanasia that is so hard.
The quality-of-life parameters that we use to help us determine if a pet is ready for hospice or euthanasia include his or her appetite, willingness to eat a favorite treat, ability to get to an appropriate place to eliminate, pain, nausea, interactions with others, weight, mentation (stupor or seizures) and playfulness. You can use a scorecard to rank these parameters from 0 (worst) to 10 (normal pet). If most of these parameters are less than an 8, then an end of life decision is warranted. Another way to do this is to start a diary of your pet’s quality-of-life by simply using a frowny face or a smiley face for each day that passes. At the end of 10 days or 2 weeks, if there are more frowny faces than smiley faces, then we must admit our defeat. The disease process is going to overwhelm our pet and we need to help make decisions about his or her dying process.
If you are really stuck, think of three things that make your pet distinct and special to you. For example, Makeba was an intensely loyal dog. She always had to be in the same room as my husband or myself. She was an amazing athlete and could jump through hoops and run with me while training for a marathon. She was also ridiculously smart. She loved training and learning new tricks. Make your own list for your ailing pet. If two of these three things are missing from your pet’s life, then it may be time to make an end of life decision for him or her.
Since we usually outlive our pets, it is likely that we will grieve their loss. I agree with a colleague of mine who pointed out that it is not fair to let our pets suffer longer because we don’t want to suffer sooner. Our pain (grief) is inevitable, but theirs (suffering from a terminal illness) is avoidable.
Even though I am crying as I write this, I know I made the right decision at the right time for my beloved “Sheepdog”. Maybe this will help you when the time comes for you and your lovely pets. May it be eons!!


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