How to assess dog quality of life?
January 7, 2020 6:29 PM   Subscribe

Our elderly dog is not in terrible pain or beset with any serous illness or injuries, but she is plagued constantly with smaller recurring health issues. Over the past year, she has declined at an accelerating pace. How will we know when her quality of life is no longer good or even okay?

Our poor sweet girl. Where to begin? We've known for some time that she was on the decline. She's already 2-4 years past her breed's life expectancy, so we've been blessed with a lot of good years.

Over the past year, she's gone from dragging us on 45 minute long walks to barely wanting to step out the front door. She used to inhale any and all food, searching around and under her bowl for any morsels that might've escaped, but recently lost her appetite entirely. We switched her to a mix of wet and dry food that she enjoys and eats up, but we were very alarmed by the change in appetite while we were figuring it out.

She has a rotating array of minor but uncomfortable infections and maladies that seem to come and go like whack-a-mole... eye infections, ear infections, skin allergies and infections, UTIs, interdigital cysts, diarrhea, vomiting. We take her to the vet, she gets treated, and as soon as we are finished with one course of treatment, the next issue pops up. She hates having all the various drops, creams, ointments, etc. applied, and it is sometimes a struggle that leaves all of us frustrated.

She doesn't get on with other dogs and hasn't for some time. She still plays with her toys, and especially enjoys tug of war, but her daily playful streaks have waned in frequency and duration. She's showing clear signs of senility, like barking at nothing, staring at nothing, waking up multiple times at night and acting disoriented. She sleeps a LOT, even for her. Her x-rays show arthritis that is to be expected at her age and size.

Since Christmas, she's begun having frequent accidents. Luckily I'm not working right now, so I'm at home to let her out frequently, and to clean up after her when we have a miss. But it's bad. We used to get a few good weeks or months after clearing up one infection before the next hit, but now it's one after another.

My question is, when there isn't a clear terminal diagnosis like cancer or liver disease, and when she isn't in obvious serious pain or unbearable discomfort (but still uncomfortable nonetheless), how do we know when the right time is? We adore her beyond measure, but don't want her life to drag out into a series of interminable vet visits, or go on watching her suffer from one bout of illness after another. The vet has yet to bring up euthanasia, so it feels like there is more to be done. But years ago, I had a very bad experience with a vet who pressured me into agreeing to expensive and painful surgery for a pet who ended up passing away within hours of the operation. It's one of my greatest regrets that I put my friend through that instead of having her mercifully put down. None of the many vets we've brought our pup to have been particularly great as to earn my trust on this issue.

This has been keeping me up at night, so I'm turning to the AskMe mind for perspectives.
posted by keep it under cover to Pets & Animals (16 answers total) 8 users marked this as a favorite
When my cat was nearing the end of his life and I asked the vet what to do, they gave me a questionnaire (like this one but specifically for cats) that let me think through the variables in a more clear way than I was capable with a single big question like "Is it his time?!".

The vet encouraged me to do it periodically to note changes and at some point it just... made sense that I needed to make a hard decision that was in HIS interests over mine.
posted by marylynn at 6:50 PM on January 7, 2020 [3 favorites]

Is she still a dog, albeit an old, slow dog with frequent health issues?

She's old so she won't be the dog she was four years ago. But is she miserable? Or is she simply not a pup and often ill?

What do you mean "still uncomfortable nonetheless"? Does she actively seem unhappy or distressed most or even much of the time? Or is she just movin' kinda slow?

Have you talked to the vet about Cushings? I'm very sorry that you do not have a trusted vet.

I don't know how to explain this but, if she's merely a feeble old-lady dog, then try to keep her comfortable and enjoy her. If she's just a shell and cannot live her life, on any terms, then it's time.

Not to answer your question, but the last pet I had to put down was approaching crisis because of sudden lack of muscle control, from age, and not from the cancer. He needed help getting up and was rapidly being a dog who couldn't walk. After I'd been watching for months, constantly reviewing the checklist of "Oh no, the cancer is out of control" symptoms.
posted by Lesser Shrew at 6:51 PM on January 7, 2020 [2 favorites]

I'm sorry. I'm less than a year out from our most recent loss, and his two companions are seniors themselves; we think about this a lot.

It sounds like you need to go back in for whatever's happening now anyway, and it's time to have an initial QoL conversation with the vet. Because they will likely not tell you it's time - people flip the fuck out to the point of being dangerous when the vet initiates that conversation, outside of a real dire emergency situation. You need to say the E word, you need to explain your stance on extraordinary measures, and you need to voice your concern about the amount of intervention necessary right now and ask the vet to help you draw a line and figure out what "too much" looks like.

Truly, it is helpful to the vet to know where you stand, because they have no way of knowing if you're a "every possible treatment, damn the cost or discomfort" or a "this dog's lifetime deductible has been met" or a "we will do things that have a high possibility of prolonging quality of life but draw the line at anything with general anesthesia or chemo" or whatever (which is where we were when ours was dx with at least one if not two serious cancers).

You are in the very greyest of areas right now, and I know how frustrating that is. Having this last one so recent on my mind - and even we went maybe two weeks longer than we absolutely should have, but he had a history of rallying prodigiously so we waited just in case - I feel like in your shoes I would be setting a tentative date a month from now with the intention of having a wonderful time for that month and then stopping before it gets real bad. Yes, you might be sacrificing a few more good days (over a few more meh months), but I still think it's better than waiting until things abruptly get horrific or you frog-boil yourself into a far worse situation than you would have found acceptable.

That end date is, of course, fungible right up until the deed is done. But it will give you some clarity, to have it on the table over the next few weeks.

In the end, either your dog will not know she is dead, or she will know and will also understand how you came to that decision.

I think for me the deciding point would be the amount of veterinary intervention required at this time. My dog didn't enjoy going to the vet, and was difficult to transport (as in I couldn't do it alone, one person had to drive and the other had to keep him steady in the back), and honestly it was kind of magical once we declared "palliative care" - we could call in for more gabapentin, gapiprant, or antibiotics to manage the low-level stuff without bringing him back in, and were able to keep him pretty comfortable for another 6 months that way. We never went back with him after that conversation; we had an outside service come and do the euthanasia at home when it was time.

I think the amount of intervention you're requiring at this point would make me a lot more comfortable with setting that date, but I do think you should go one more time and have this discussion, flat-out tell them you're considering setting this firm date and asking about palliative care for that duration. If they try talking you out of it, ask for real reasons why that you can consider before you make a decision.
posted by Lyn Never at 6:58 PM on January 7, 2020 [6 favorites]

We've just been through this. Our rescue (best guess, going on an unbelievable 24) died late last week. No matter how you go about it it's hard. That being said we had a lot of time to ask these questions and, basically, we resolved a few guiding principles:
  • She's family, shit happens to family, but you only preemptively destroy property.
  • Was today a lot like yesterday? Then it's not an emergency.
  • If heroic measures are required, all bets are off.
We all get older, some of us get very old. We did a lot of laundry the last 2 years. We never put her down because she just kept moving; just slower.

Her last 2 weeks, well, she wasn't doing well. We knew her time was imminent and it was. She died in my step daughter's arms - the person she loved most in the world. It would have been harder if she got sick, but she just got old. And then she died, surrounded with the familiar. And it's sad but I don't think it was wrong.

She wasn't a working dog, she never weighed more than 2kg. We didn't acquire her, she was rescued from a mill at 7 or 8. Our social contract was, I believe, fulfilled.

These are the things we considered; it sounds like you're having similar conversations. It's hard because we (and I presume you) care and that's the way it should be. We could have had her put down earlier and felt guilty about it... and maybe that would have been easier. I don't think it would have and I'm glad we didn't.

posted by mce at 7:22 PM on January 7, 2020 [8 favorites]

Our dog is in her last few months, and our vet advised us to identify a few things that are hallmarks of her quality of life. (For ours, it's always been food.) Our vet said when those qualities start to disappear is when you know it's time. What does your dog love to do? When is he happy? Is he still able to enjoyment from those things, frequently? If not, it's probably his time.

I'm sorry you had a bad experience with your last vet. My previous dog's death was traumatic, and years later it still haunts me as I prepare for this dog's end of life. I have been pretty clear in this last month that I'd rather let my girl go a too early than risk it going too long, and it's been helpful to have that clarity when I talk to the vet (with both sets of vets, in the case of my current dog). It sounds like you haven't had that conversation with your vet yet, understandably. But I encourage you to have it, especially before you think it's your dog's time. I think veterinarians are pretty wary about how to have the end-of-life talk, and the most common failure mode is to not want to be the first to talk about euthanasia. If you initiate that conversation and be clear about what you want, I think your vet will be better able to help you avoid your worst-case scenario.

I've had this conversation with two vet clinics in the last month -- they both loosened up considerably once I laid out my terms and were able to give us clearer advice about pain management, signs, and preparations about things like what if happens over a weekend or something. I was pretty blunt about quality of life is most important, and I wasn't afraid to let her go or to spend money if the vet things it would help. I cried through both meetings, but they were pretty helpful with laying out options.

I'm so sorry you're going through this. I'm glad your dog has a good steward to help them through this time. Snuggle your pup extra tonight.
posted by lilac girl at 7:22 PM on January 7, 2020 [1 favorite]

I'm so sorry you are having to deal with this. I just went through it with my 13 year old dog. There is no correct time to do it. If the dog is not suffering terribly at the time, the doubt is there that maybe we should have waited and given them a bit more life. But if we wait till the suffering is undeniable, then we've allowed them to suffer and that is so hard to accept.
Lyn Never gives excellent advice. Talk to your vet, making it clear what you want. Some vets won't initiate the "it's the end of the road" conversation no matter how bad things get, I suppose because of the unpredictable way people react.
Find out whether the procedure can be done at your home. That's what we did and I'm eternally grateful, it was so calm and easy.

It helps me to think that, based on what I have observed, dogs have a very different experience of pain and suffering than humans. They endure stoically what would devastate a human. As long as they are with you, all is as it should be in their world because that companionship is so important to a dog.
Be kind to yourself. This is a very hard thing to live through. I hope the rest of this journey goes smoothly and peacefully.
posted by Zumbador at 7:23 PM on January 7, 2020 [1 favorite]

One of my kids is a vet, and I like the way she puts it--essentially we need to remember that dogs exist purely in the now. They have no sense of the future, no sense of things ending or being over.

When we make these decisions, the hardest part is that we're putting it through our human lens of death, knowing what that means, knowing we will miss them, knowing how much we love them, but we need to remember that dogs really do not know what that means. They're just here (which is why they are so awesome). The concept of not being here makes no sense to them. (I'm tearing up writing this, because it's just the worst.)

She advises her clients to focus on right here, right now.

That's the framing. They're here. Are they doing okay here and now? It seems like maybe not. Is this a blip and we can expect that this will improve? Again, probably not.

So we remember that the dog has no concept of tomorrow, and we consider that their today is not a way any creature would want to live, and we make that decision for them.

It's both the worst feeling and best thing thing we can do for our pets, but always keep remembering that your pup has no concept of not being here, so it is pure kindness to end their pain.
posted by yes I said yes I will Yes at 3:31 AM on January 8, 2020 [10 favorites]

Dogs are stoics. Only in the most dire situations do they show pain. One key indicator is eating.
posted by tmdonahue at 5:22 AM on January 8, 2020 [2 favorites]

I am not a veterinarian, but I have worked in a number of veterinary hospitals, and I have many friends who are veterinary professionals (including my wife, who has been a veterinary nurse for over 20 years).

It is very unlikely that your veterinarian will start the end-of-life discussion, and they will almost never directly suggest euthanasia, but the vast majority of them are very happy to have the conversation, and will be understanding and empathetic. Keep in mind that I have never known a veterinarian who has not lost one of their own pets.

It is important to understand that veterinarians do have an ethical responsibility to offer their clients and patients the highest and best level of medical care available. This can take the form of heroic, high-risk treatments that they would not undertake for their own pets, but they need to let you know that it is an option. Sometimes this can feel like pressure (and sometimes it can be pressure - there are plenty of bad vets out there), but in the end, it is your incredibly hard decision to make. It can be helpful to ask them about the possible prognosis after a given treatment, if they don't readily explain that.

Another thing I will note is that most pet owners consider incontinence a selfish reason to consider euthanasia, and often leave it out of the decision making process around that decision. I disagree strongly with that approach, as I believe, based on my own experience, that incontinence is a terrible burden for the pet as well. For dogs, because their sense of well-being is often built around following their training - they feel bad when they make a mistake, to the point of seeming "guilty". Correct elimination is the first skill dogs learn, and for many it is the only skill that they really master. Losing that skill must feel horrible. For cats, it is crucial to their well-being that they hide their eliminations. Even feral cats bury their waste. To not be able to do that must weigh on them heavily. This is all to say nothing about the unpleasant physical feelings of urine or feces on their skin.

In general, the thing that people regret is waiting too long to free their pets from suffering, so I advise people to consider their pet's day-to-day quality of life, and whether it includes more pain and discomfort than it does joy.
posted by Rock Steady at 8:48 AM on January 8, 2020 [3 favorites]

I'm sorry you're going through this.

Tons of good advice in this thread already. I lost both of my dogs in the past year+change and read through a lot of similar questions when I was making decisions. What yes I said yes I will yes said was incredibly helpful for me. Your dog knows this day, this moment, with you. They aren't thinking about the past or what they're going to miss out on when they're gone. It's awful for us, but our job is to make it as easy and peaceful as possible for them.

I echo the suggestion to talk to your vet as candidly as possible. Once *I* said the words "quality of life" and "euthanasia," my vet was a lot more candid with me. Ask them what they'd do with their own dog--every vet I've known will err on the side of "too soon" rather than risk "too late" to save animals from suffering.

I made the decision for my dog last July when he stopped getting up. He was still wagging his tail; he was less interested in food than he had been all his life, but still ate. But he couldn't stay upright to go to the bathroom and he no longer tried to greet me at the door. I don't know how to describe it other than the light had dimmed. I didn't have a crystal clear moment of clarity, more of a sinking realization that it wasn't going to get better, and I could save him some pain. He probably could have gone on for a few more weeks, a couple months, but those days would have been for me, not him. So we gave him one great day with a visit to the park and an ice cream cone, and said goodbye at home surrounded by his favorite people and things.

Almost six months on, despite missing him terribly, I know we made the right choice. The thing is, it didn't necessarily feel like the "right" choice at the time. Sometimes there's not an obvious moment, just a series of signs that point in a general direction we may or may not feel ready to travel. It sounds like that's what you're struggling with now. It's counter-intuitive to end a life, even if we have all the evidence in the world that this is one of the most humane, loving things we can do for our companion animals. But with both of my dogs, though the decision was agonizing, after it was over, it was over. My overwhelming feeling was gratitude--that we had this life together, and that I was able to help them transition out of it. I'm not worried about them anymore. I wish you the same peace.
posted by adastra at 8:58 AM on January 8, 2020 [4 favorites]

I have an almost 15 year old dog with similar issues - skin allergies, frequent UTIs/accidents, dementia. She doesn't want to go on walks and doesn't want to play anymore either. She sleeps 98% of the day. The only highlight of her day is eating.

Recently I was questioning her quality of life. She doesn't have bad days per se, but she doesn't really have good days either. I talked it through with her vet and she said some people might euthanize now. She said it's ok for her to just kind of exist if her issues are under control (they are right now).

We euthanized our other dog just over a year ago and his quality of life was not good. She's nowhere near as bad as he was, so I take some solace in that. As long as she wants to eat and her health issues are under control, we're going to keep doing that.

Talk to her vet about quality of life and see what he/she thinks.
posted by disaster77 at 10:18 AM on January 8, 2020

Best answer: I hospice foster small dogs for several rescues, it is usually up to me to decide when “it’s time”. I’ve lost countless dogs over the past decade being a foster and it’s always really hard. But. I approach it rationally, and with the understanding that a humane peaceful death a day too early is dramatically better than a crisis a day too late. Eating, desire to be social, ability to sleep comfortably...meds are typically comfort care in my home, pain being the primary issue I heavily medicated. And senility is something no one talks about in animals but it can be very very distressing for the animal so I often have to decide to let them go even if they are physically ok-ish if they are emotionally suffering to a degree that can’t be controlled. I love all my dogs (and cats) very much and give them the best quality of life possible but that includes letting them go when it’s good for them not me because honestly it’s never going to be good for me. And again, avoiding the middle of the night ER vet trips for euthanasia is my goal, that sucks for everyone even though it can’t always be avoided.
posted by yodelingisfun at 11:22 AM on January 8, 2020 [2 favorites]

My 4 year old rescue chihuahua was just diagnosed last Friday osteosarcoma of his shoulder. The little bump I discovered right before Thanksgiving is now the size of a small orange. The vet was wonderful and explained things like chemo, radiation and extremely aggressive surgery since amputation is not an options due to location of the tumor. I declined all of these options for my pup. When Inish can no longer curl up in his plush bed to sit in the warmth of the sun on a chilly winter afternoon that is when I know it is time. The vet has been extremely supportive of my choices and even discouraged any more diagnostics tests since there will be no treatment.
posted by sunnypup at 4:44 PM on January 8, 2020

It may be time to start researching vets who will do euthinasia in your home. One of the greatest gifts we can give our pets is a comfortable end of life, at home, surrounded by the people they love and trust. We waited too long with my last dog and had to take her to an emergency vet. They accidentally hurt her when they examined her, and I will never get over my regret that she was upset and in pain before she died. Have a vet visit a couple times in your home if possible, so your dog is comfortable and relaxed with the vet. It will make things easier for both of of you.
posted by WalkerWestridge at 6:53 PM on January 8, 2020

I recently went through something similar with my 20 y/o cat. My vet tech said something that was super helpful: Your cat's last day doesn't have to be her worst day. I asked for an in-home euthanasia vet referral and she was great. It was hard but it was the right thing. My heart goes out to you.
posted by elmay at 7:24 PM on January 8, 2020

My boyfriend had a dog (a St. Bernard) that was elderly, by big-dog standards, at approximately 8 years old. He made it to 13.5 years, but during the last 18 months or so, he had multiple episodes where he suddenly excreted indoors. He seemed to have no idea that something had happened. The turning point, for us, was when the dog appeared to acknowledge he was ill or in pain. Dog awakes from sleep, stretches, and sharts? This doesn’t impact his quality of life; in fact, he doesn’t even notice it’s happened. So we’d clean up the mess, tell him he was a good boy, and pat him on the head as he ambled toward his food bowl.

Ultimately, he reached a point where he couldn’t stand without crying out, and although he wanted to sniff and explore, he could only manage a couple of steps before stumbling, falling, and crying. This was very very quick - he was ambulatory and comfortable one day (albeit slow and clumsy), and obviously struggling and in pain the next day. When he wanted to go outside, but couldn’t take more than a couple steps without collapsing or expressing pain, that’s when we knew it was time.

Is your dog happy and comfortable? Even if they’re declining, are they trying to do the things they usually do, or are they hurting? If the dog is unaware of their condition (blind, deaf, incontinent) but otherwise acting like their usual self, it’s probably not the right time. But if the dog is in pain and expressing discomfort during basic activities like eating, going outside for bathroom breaks, or transitioning from resting to low-activity, yeah, it might be time...
posted by ortoLANparty at 9:37 PM on January 8, 2020 [1 favorite]

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