End of Life
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Afterlife
When your dog is nearing the end of his/her life, the emotional weight that falls upon you can be tremendous.  The
endearing habits, the joy, the unquestioning devotion your animal gave you fill your heart as you confront the expected loss.

Many of us view our dog as a beloved member of the family to whom we have made a commitment to care for.  
Unfortunately, there may come a time when this honorable commitment takes a different path.  The medical options may be
exhausted or the continued care might be unmanageable or too expensive and the best you can do for your dog is to let go.

The hardest decision you may have to make is determining when the quality of your dog's life is compromised to the point
where it's not worth going on.  It's especially difficult to determine when is the right time with dogs because we just don't
always know when they are suffering and ready to leave this life. I have been faced with this decision three times.  My
veterinarian always told me that I would know when the time was right, but I'm not sure that's necessarily true in all cases.  
You may second guess your decision - did I wait too long?  Was my dog suffering and I didn't know it?  Could he have had
a few more weeks?  As long as you do not allow your dog to suffer, you made the right the decision.  

The Quality of Life Scale contained in the section below is presented to help guide your decision.  I hope it will provide you
with peace and comfort at this difficult time.

While we all hope that our dogs will pass quickly and peacefully at home, this is
often not the case.  Many dogs with cancer will face a slow decline and at some
point a proactive decision may have to be made.  Some dogs will exhibit obvious
signs that it is time to let go such as whimpering, crying, the inability to move or
eat, vomiting and other symptoms of distress.  Please do not let your dog suffer.
 Your veterinarian will be able to help you decipher if these symptoms are just
temporary and can be controlled with medication or if it is the beginning of the
end.

When the decision is made to euthanize, you will need to decide if you or
anyone else wants to stay with your dog.  Neither decision is right or wrong, it
depends upon the individual.  I have always stayed with the dogs I had to
euthanize because of cancer and found an element in peace in being there will
them.  Knowing that they were surrounded by love and not with strangers as
they took their last breath was important to me.  I also saw that they died very
quickly and peacefully and that also was a comfort to me.  However, I know many
people who just can't bring themselves to deal with the emotional aspects of
watching their dog die, and that's ok too.

Euthanisia is nothing more than the administration of an overdose of
intravenous anesthetic.  The vet will insert a fine needle into a vein (usually in a
foreleg) of the dog and push the anesthetic through the veins.  The dog will
often take a deep breath, lose consciousness within 5-15 seconds and quickly
thereafter, the heart will stop beating.  It usually goes very smoothly and quietly,
however there have been cases noted where not enough of the drug was
administered the first time and a second dose was needed or the dog's body
seemed to jerk in a uncontrolled manner.  This is a rare occurrence.

When you make the appointment for euthanasia with your veterinarian, it is
often recommended that you request a time late in the day or at off-hours.  This
will allow you to spend some additional time alone with your dog for the last time.
 You will also need to consider what you what to do with your dog after he or she
passes.  Options include mass cremation, private cremation, a burial at a pet
cemetery or a private burial at your home if allowed in your municipality.
Euthanasia
Rainbow Bridge
Association for Pet Loss and Bereavement
The Pet Loss Grief Support Website
Cornell University Pet Loss Support Website

Cornell Pet Loss Support Hotline:  607.253.3932
Tufts University Pet Loss Support Hotline:  508.839.7966
Michigan State Pet Loss Support Hotline:  517.432.2296
Ohio State University Pet Loss Support Hotline:  614.292.1823
The Iam's Company Pet Loss Support Hotline:  888.332.7738
Florida Animal Health Foundation Pet Grief Support Hotline:  800.798.6196
Pet Loss Support
Products to Honor the Memory of Your Dog
Recommended Reading

When your dog passes, it can be a time of overwhelming grief and sadness.  It
can take weeks or months to even begin the healing process.  We never forget
our dog friends, but time helps to lessens the severity of the pain.

In an effort to make you feel better, some people may say to you that 'it was just
a dog".  Clearly, these people never had the opportunity to open their hearts to
the love of a dog and understand the tight bond people have with their dogs.
For them, I feel sorry.  They have missed out on one of life's great joys.  
However, I believe they are attempting to help at this difficult time so don't be
overly distraught if some people just don't understand why you are so sad or
why it's taking so long to get over your grief.  There are many of us who have
been through this and do understand that it takes a very long time.

We hope that the memories you have of your dog will fill you with comfort in
times of sorrow.  If you need to talk with someone, we have listed some pet loss
hotlines below and encourage you to call one if you need to talk to someone.  
Also, please send us a photo of your dog and we will post his/her picture on our
Memorial page, along with anything you'd like the world to know about your
cherished dog.  Many people find great comforting in doing something positive
for another dog in need to honor the spirit of your dog even though a bright
light in your life has gone out.

Other ways to help deal with your grief include:

Holding a small memorial service

Lighting candles in honor of your dog's spirit.

Creating a memory box or photo collage with pictures plus objects like collars,
tags or small toys that were part of the dog's life.

Making a contribution to pet-related charity in honor of your dog's memory.

Volunteering at an animal shelter.

Planting a tree in honor of your dog's memory.

Writing a memorial tribute and posting it online
Traditional Decorative Urn - Maple
Photo Urn - Walnut - 4 x 6 photo holder
Information and Inspiration when you need it most  
                                       
or chronically ill pet is a hard decision to make for many pet owners. This handout
has been designed to help you consider the quality of life of your pet and to help make
you aware of some of the additional options that exist if it is not the right time for
euthanasia. Answer each of the questions in each section with a yes or no.


PAIN

Pain control is essential. Many animals do not complain in obvious, visible ways when
they hurt. Many animals will hide their discomfort. Consider the following:
____My pet hurts.
____My pet limps. (If it didn't hurt, they wouldn't limp.)
____My pet pants frequently, even at rest.
____My pet's respirations are forced, exaggerated, or otherwise not normal.
____My pet licks repeatedly at one site on his/her body or at a site of a cancer/tumor.
____My pet guards or protects and area of his/her body and may snap if that area is
approached or touched.
____My animal's posture is abnormal or different than normal.
____My pet shakes or trembles sometimes during rest.
____My pet is on pain medication and it doesn't work.

Possible interventions for yes answers: start pain medication, change pain medications,
combinations of pain medications from different drug classes, surgical intervention,
non-traditional medicine (acupuncture, etc.), treat the underlying disease/condition.

APPETITE

Appetite is one of the most obvious signs of wellness. Most animals are normally
vigorous eaters. Consider the following:
____My pet doesn't eat his/her normal food anymore.
____My pet picks at his/her food now but never used to do this.
____My pet walks over to his/her food and looks at it but won?t eat or walks away from
the food.
____My pet doesn't even want good stuff (treats, human foods, snacks) anymore.
____My pet acts nauseated or vomits.
____My pet is losing weight.

Possible interventions for yes answers: hand feeding, heating food, adding moisture by
soaking food or using canned varieties, careful addition of human foods, syringe
feeding, stomach tube placement, medications for appetite stimulation, medications for
nausea.


HYDRATION

Hydration status is equally important as appetite. Without adequate water consumption,
your pet can become dehydrated. Dehydration can contribute to weakness and not
feeling well.
Consider the following:
____My pet doesn't drink as much as he/she used to.
____My pet frequently has dry, sticky gums.
____My pet is vomiting or has diarrhea (fluid loss can also contribute to dehydration).

Possible interventions for yes answers: add moisture to the diet, subcutaneous fluid
administration, medications to control vomiting or diarrhea.

HYGIENE

Animals that don't feel well, especially cats, do not have the energy to maintain normal
hair and skin. Consider the following:
____My cat doesn't groom herself any more.
____My pets hair is matted, greasy, rough looking, dull, or foul smelling.
____My pet has stool pasted around his/her rectum or in his/her hair.
____My pet smells like urine or has skin irritation from urine.
____My pet has pressure sores/wounds that won?t heal.

Possible interventions for yes answers: regular brushing and grooming, frequent
bedding changes, adequate padding for areas where the pet spends a lot of time,
appropriate wound care, treat the underlying disease/condition.

ACTIVITY/MOBILITY

Changes in normal activity can be due to mobility problems, pain, illness, or aging
(arthritis). Consider the following:
____My pet cannot get up without assistance.
____My pet had a hard time getting around and/or limps.
____My pet lays in one place all day long.
____My pet does not want to play ball, go for walks, or do the things he/she used to do.
____My pet falls frequently.

Possible interventions for yes answers: pain medication addition or adjustment, physical
therapy.

HAPPINESS/MENTAL STATUS

Another important area of consideration is the pet's mental status and happiness.
Consider
the following:
____My pet does not express joy and interest in life.
____My pet does not respond to the people that he/she used to respond to.
____My pet does not want to play with toys or do other things that he/she used to enjoy.
____My pet seems dull, not alert, or depressed.


GENERAL BEHAVIOR PATTERNS

Changes in normal behavioral patterns are often a key indicator of how well and animal
feels. Consider the following:
____My pet is hiding or sleeping in odd places.
____My pet doesn't greet me when I come home and he/she used to.
____My pet is overly clingy and is following me around and he/she never         used to
do this.
____My other pets are treating this pet differently, they are overly attentive or ignoring
him/her completely.
____My pet doesn't care about what is going on around him/her.


OWNER PERCEPTIONS

Many times an owner is aware that their pet is suffering but does not want to give up on
their pet. Consider the following:
____I wouldn't want to live if I were in a similar situation.
____I would be painful if I were in a similar situation.
____I have made appointments for euthanasia for this pet cancelled or didn't show up.
____I am holding onto this pet for some sentimental reason. (ex. the pet belonged to a
now deceased family member, the pet helped me through a hard time in my life, etc.)
____ My pet is having more bad days than good days.


Count the number of yes and no answers that you have marked. ____Yes
____No

Unfortunately, there isn't a simple point system or scale that will tell you exactly what do
for your pet. However, the more yes answers you have, the more likely it is that your pet
has a poor quality of life. This list has been significantly expanded and altered from an
article on quality of life. The original scale uses 50% as a cutoff.  If this information is
extrapolated, it would imply that more than 21 yes answers means your pet has a
diminished quality of life. If this is the case, you have two options:
1. Make major changes to try to improve your pet's quality of life (like some of the
things listed above) or 2. Euthanize your pet to relieve his/her suffering.

The information provided is for educational purposes only and is not
intended to take the place of your regular veterinarian. Please do not hesitate
to contact your regular veterinarian if you have questions regarding your pet.

Very loosely adapted from Quality of Life Scale, Veterinary Practice News, June 2006,
pg. 24.

Karen Blakeley, DVM, MPH
1 December 2006
www.allpetsmacomb.com
Pet Loss/Grief
Quality of Life Scale