Decision Making

When a pet is diagnosed with a chronic debilitating condition or a terminal or incurable disease, we are faced with choices. Do we attempt to manage the pets’ symptoms, their pain, their environment and attempt to improve their quality of life (until we no longer can) or do we choose euthanasia? No easy decision for a heart broken family. Let me guide you through this process and attempt to answer your questions and ease the emotional burden along the way.

• It is normal to feel overwhelmed and paralyzed in your ability to make decisions.
• Planning with a hospice care and palliative care veterinarian can give you a sense of strength and control.
• Utilize tools to help determine whether your pet is in pain. (From Dr. Shea Cox)
  • Pain Scale For Dogs
  • Pain Scale For Cats
• Assess your pet’s Quality of Life (QOL Scale)
• Factor in your own Quality of Life: Do you have the time, resources, social networks, other responsibilities, and stresses that impact your ability to manage your pet’s illness and care?
• Time to reach out for support from friends, family, clergy, and mental health professionals.

Decisions need to be made that are in the best interest of your pet. Often families are overcome with “anticipatory grief” and the strong emotions of denial, anger, anxiety, and sometimes guilt.

• Work with your current veterinarian and seek out the assistance of a veterinary practitioner certified in hospice and palliative care.
• Ask questions/take notes.
• Research the disease/condition.
• Define your treatment goals.
• Make a list of all available treatment options: consider side effects, benefits, and consequences of each option, costs, and expected survival time with or without treatment.

The goal of palliative and hospice care is to meet the physical and emotional needs of a pet until the pet dies naturally or the owner chooses euthanasia. This path is chosen when we no longer are interested in pursuing curative treatment (surgery, chemotherapy, radiation, etc.) or when a disease condition is non responsive to current treatments or when it interferes with a pet’s day to day function.

• During our initial phone interview, we will attempt to define goals for your pet.
• During our at-home assessment, we will go over past history, current concerns, and perform an examination. Lab work may be recommended (blood work, urine, fecal, and cultures).
• It is best if all family members involved in the decision making process can be present.
• Initial visits typically last 1-2 hours and encompass many topics.
  • Topics Covered
    • Treatment goals
    • Assessment of pain and suffering
    • Environmental modifications
    • Emotional well-being
    • Dietary changes
    • Alternative treatments (Reiki, Acupuncture, Laser, Massage, Music Therapy)
    • Preparations for euthanasia
    • Back up plans when emergencies happen
    • Unique personality quirks of pets and owners that need to be honored

Reassessment of Quality of life can be done by family members daily and recorded in a journal. When the bad moments in a day start outweighing the good, the care plan needs to be revised. Pain management is often the key. If your pet is experiencing uncontrollable pain or suffering than he/she is most likely experiencing a poor Quality of Life. We will reach a point in a pet’s care where we will need to focus on the quality of their death. I can play an integral part of this process.

Pain is a physical and emotional sensation that can be complicated to assess. Expression of pain can be unique to the individual pet. There are many Pain Scoring Charts that can help you assess your pet daily based on the following characteristics.

• Breathing (normal, panting, increased effort, open mouth, distressed)
• Trembling or shaking
• Slow to rise/slow to lay down
• Whimpering, whining, vocalizing, or silence (out of character)
• Change in appetite (decrease to complete inappatence)
• Restless, unsettled, unable to get comfortable (especially at night).
• Non-weight bearing on a limb
• Different body posture (hunched, resents being touched)
• Changes in routine (won’t get up to greet you or declines going for a walk)

Suffering is more than whether a pet is in pain. It focuses on a pet’s Quality of Life and whether the pet is adapting to its new normal and content with the situation. Emotional suffering is a greater priority than pain. Pain can be managed. Emotional well-being is harder to improve. It is about unique characteristics that define who your pet is. The following can help an owner assess a pet’s Quality of Life.

• Is your pet eating and drinking well?
• Can your pet urinate and defecate on their own and in an appropriate location?
• Can your pet rise and lay down without assistance?
• Is your pet interactive with family members or withdrawn?
• Does your pet play with toys or participate in favorite activities?
• Can your pet sleep through the night?