Expert: Jana Connell RVT, CVT - 7/25/2010

Question
Hi,

We are from Australia. My dog Harvey is nearly 14 years old. He's a maltese x shitsu x pomeranian. In the past he has had 2 hernia's, he was desexed at 10 years old. After he was desexed, he was diagnosed with cushing's syndrome and was medicated for it, I can't remember the name but we had to use gloves to touch the medication. He recovered, and we stopped the medication. Earlier this year the symptoms came back and he is now taking vetoryl which has stabilized the cushings syndrome. Also earlier in the year he was diagnosed with arthritis which got worse and he is now taking metacam, a liquid anti inflammatory pain killer which gives him some relief. The most concerning thing is that he is also suffering from heart failure, the valves in his heart are pushing fluid back into his lungs and he coughs. He is also taking frusemide (urex), vetmedin and fortekor for this. However, once a month or so his coughing comes back really bad and I take him to the vet and they put him in an oxygen tank for the day doesn't seem much better until the next day after he spends a night at home. However, the vet's keep telling me he's not going to get better and that he is suffering but when I am with him at home, he looks sad but has moments of excitement and still loves my hugs. He loves it when I take him outside and sometimes walk down the street. But sometimes he throws up and his appetite is sometimes quite low, which makes it hard to give him his medication. The vet's say it's time to let him go but when I see how he is at home, I just can't do it. At the moment I think his good days and bad days are just about equal. It is breaking my heart knowing I have to make a decision and I don't want to make the wrong one. It is also very costly and I feel like I can't work much cos i need to take care of him. I miss him everytime I'm away from him. Would you please give me some advice what to do and do you think, even if he isn't showing any symptoms of pain or coughing, but he looks sad and lethargic at times, does he still have life left in him or will he be better off in peace?

Answer
Hi Iloni,
I know that is a very difficult time for you. It is one of the hardest decisions you will ever make- so you need to think about it in a new light.

Harvey is your loving companion and he looks to you for food, water, walks, love, care etc. But he also looks to you for one more thing- ending his suffering if he is incapable of doing so himself.

A dog or cat will tell you when it's time to say goodbye. They will stop eating,or pick at their food. They will have more bad days then good ones. They will look at you a certain way that you can see in their eyes.

The look of sadness that you describe is him telling you that he isn't happy.He isn't feeling well and we all know that when we don't feel well life isn't fun. The bottom line here is what is Harvey's quality of life?

Not to be harsh about it but there is a chart I got from a place that does hospice for pets. I use it for owners that are having a hard time making this choice. With this chart you can look a bit more objectively at the situation and be rational about a very irrational and emotional situation.

The list is short as I have changed it some, but it gives you the general idea.

HURT - Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet's pain successfully managed? Is oxygen necessary?

HUNGER - Is the pet eating enough? If the pet is refusing food then it's telling you that it is time. Force feeding will not change this.

HYDRATION - Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.

HYGIENE - The patient should be brushed and cleaned, particularly after elmination. Avoid pressure scores and keep all wounds clean.

HAPPINESS - Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be close to the family activities and not be isolated?

MOBILITY - Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does the pet feel like going for a walk?  Is the pet having seizures or stumbling?  (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)

MORE BAD DAYS THAN GOOD - When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.


Now remember that this is used in a hospice setting so some of the answers use the term caregiver.
Just remember Iloni, that when you make the choice to help Harvey have peace, you are giving him a gift of love that we cannot even give each other. It will hurt a lot, but knowing that you gave him this gift and that he is grateful to you for that will be a small consolation to you. I just went through this with my 15 yr old cat and I know that even though I cried myself to sleep for a week, in my heart I knew she was in peace and pain free.

That is all we can do and all we can give Iloni. So be at peace when you finally make the choice and don't back out from it. Harvey is depending on you.
My thoughts are with you both.