Quality-of-life Scale and end of life support links
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    Wonka & Nilla's Avatar
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    DefaultQuality-of-life Scale and end of life support links

    I wanted to share this on here for anyone who may be in the position of trying to decide if their pug's Quality-of-Life is still good or if it is declining. For those of us with older pugs or sick pugs, it is something that may need to be evaluated daily.

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    From: https://aplb.org/resources/quality-of-life-scale/
    If it is feasible, we suggest filling this scale out three times, on three successive days, to get a more accurate appraisal.
    We can be too emotionally involved and subjective to easily make a clear decision. The following Quality of Life Assessment System is a means designed to help you make a more objective evaluation.
    It is strongly suggested that you confer with your veterinarian, in deciding on that last accommodation.
    Permission to print the following scale has been generously granted by the author, Alice Villalobos, DVM.

    Quality of Life Scale
    Pet caregivers can use this Quality of Life Scale to determine the success of Pawspice care. Score patients using a scale of: 0 to 10 (10 being ideal).
    Score
    Criterion
    0-10
    HURT
    Ė Adequate pain control & breathing ability is of top concern. Trouble breathing outweighs all concerns. Is the petís pain well managed? Can the pet breathe properly? Is oxygen supplementation necessary?

    0-10
    HUNGER
    Ė Is the pet eating enough? Does hand feeding help? Does the pet need a feeding tube?

    0-10
    HYDRATION
    Ė Is the pet dehydrated? For patients not drinking enough water, use subcutaneous fluids daily or twice daily to supplement fluid intake.

    0-10
    HYGIENE
    Ė The pet should be brushed and cleaned, particularly after eliminations. Avoid pressure sores with soft bedding and keep all wounds clean.

    0-10
    HAPPINESS
    Ė Does the pet express joy and interest? Is the pet responsive to family, toys, etc.? Is the pet depressed, lonely, anxious, bored or afraid? Can the petís bed be moved to be close to family activities?

    0-10
    MOBILITY
    Ė Can the pet 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, but an animal with limited mobility yet still alert, happy and responsive can have a good quality of life as long as caregivers are committed to helping their pet.)

    0-10
    MORE GOOD DAYS THAN BAD
    Ė When bad days outnumber good days, quality of life might be too compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware that the end is near. The decision for euthanasia needs to be made if the pet is suffering. If death comes peacefully and painlessly at home, that is okay.

    TOTAL
    A total over 35 points represents acceptable life quality to continue with pet hospice (Pawspice).

    Original concept, Oncology Outlook, by Dr. Alice Villalobos, Quality of Life Scale Helps Make Final Call, VPN, 09/2004; scale format created for authorís book, Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond, Blackwell Publishing, 2007. Revised for the International Veterinary Association of Pain Management (IVAPM) 2011 Palliative Care and Hospice Guidelines. Reprinted with permission from Dr. Alice Villalobos & Wiley-Blackwell.
    -------------------------------------------------------------

    .
    Also, I wanted to share links for these two (long) videos that were helpful to me when Nilla was "winding down" and we were trying to come to terms with the inevitable. https://healthypets.mercola.com/site...n-webinar.aspx
    As she says in the article accompanying the videos:
    By Dr. Becker
    As incredibly difficult as it is for us to contemplate the end of our animal companionís life, as we all know and many of us have experienced, the end does one day come. And it always seems to come too soon, doesnít it? As I discuss this final chapter in your dogís or catís life, Iíd like you to keep a few things in mind:
    Life is a process. Death is a process. Grief is a process.
    Itís normal to have intense emotions and to cry. Donít try to push your feelings aside, and donít imagine thereís some unwritten rule for how much or how long you should grieve.
    Learning what to expect at the end of your petís life, and what you can do to help him ó and yourself ó in his final weeks, days and hours is empowering.
    Try to view this last chapter in your furry companionís life with feelings of gratitude and peace, rather than fear.
    And last, if you are struggling with coming to terms with your pug's approaching death or recent passing, there is help available. https://aplb.org/ This link is for a group in North America, but there are grief counselors and support groups in many countries that may be able to help you through this process.
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    Hunny-n-Chou's Avatar
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    You are such a kind and caring person -- to take time to help others as you make your way through the wakes of your own pain...

    Thank you for taking the time to post this information for everyone. I'm sure it will help many.

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    This is great thank you!

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    Quote Originally Posted by Hunny-n-Chou View Post
    You are such a kind and caring person -- to take time to help others as you make your way through the wakes of your own pain...

    Thank you for taking the time to post this information for everyone. I'm sure it will help many.
    Very well said and I agree 100%. Thank you, Amy.
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    We never touch people so lightly that we don't leave a trace.

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    Rugbysmom is online now Village Royalty
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    Sending along more hugs for you & Andrew, & hope your broken hearts are starting to heal.....I don't feel able to watch the videos at this point, but thank you for posting them for people who are struggling with the decision that none of us wants to make.

    The Pet Loss Support Group is wonderful, also......
    Rugbysmom

    Rugby 7/10/02 - 9/28/15 Miss you, little girl! You're always in my heart!

    Molly DOB: 7/6/04



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    Quote Originally Posted by Rugbysmom View Post
    Sending along more hugs for you & Andrew, & hope your broken hearts are starting to heal.....
    Thank you. I know that you are grieving as well and so I'm sending a hug right back at you.
    I'm not crying as much as I was, but it's still hard... every day I expect to see Nilla in her "spot" on the couch or chair, or in one of her many beds, and when she's not there I feel a bit startled and then sad all over again. Each day I put a tiny bit of food or some redi-whip in her bowl at dinner time so that I don't have to face the empty bowl and so that Wonka can lick out her bowl just as he has done for nearly 12 years (after she was finished eating he would lick her bowl clean). I am able to take some comfort in knowing that we did all that we could for her though and that we made her final months, weeks, days and hours as comfortable and happy as possible. It has also been an incredible source of comfort to have the support of all our PugVillage friends and to be able to share my sorrow and sadness on here. It means so much to us that Nilla touched so many lives and her memory will live on in all of you. Thank you to everyone for all your kind words of sympathy and support.

    Quote Originally Posted by Rugbysmom View Post
    I don't feel able to watch the videos at this point, but thank you for posting them for people who are struggling with the decision that none of us wants to make.
    Yes, warning for all: The videos are VERY HARD to watch! Wait until a time when you feel emotionally strong and can sit and process the information. Also, they are long videos... like an hour each or a bit longer. I watched them about a week before Nilla left us - I cried and cried at parts of each video.... At that time, I thought Nilla had more time with us, maybe weeks, maybe a month if we were lucky, but I wanted to be prepared and have the information I needed.... especially about how to have the "best" euthanasia possible. The videos did help answer a lot of questions I had and made me feel more prepared and at peace with what was coming.... I just didn't know it was coming so soon. In the video she talks about how sometimes a pet will have a chronic condition and they are going gradually and peacefully, fading over time... but then there will suddenly be a "crash" of some sort (an acute/emergency situation, an organ bursts or there is a heart attack or a bad seizure that they can't recover from) and that's it. They are gone. At the time of watching the video I was grateful for Nilla's slow decline and peaceful fade... but a week later it did happen and it was like a "crash" - she went downhill so quickly, practically overnight and, although it was still such a horrible shock, I was glad that I had watched the video and had a bit of a "warning" that this might be how it goes.
    Our vet was so compassionate and caring through the final goodbye and that helped a lot as well. They have a special "comfort room" for euthanasia and that was very helpful. She gave us the time and distance we needed, but checked in regularly to see how we were doing. She shared her own thoughts and memories of Nilla with us and she helped make the euthanasia as peaceful and gentle as she could. Although I would still give just about anything to hold Nilla again and bury my nose in her fur and stroke her soft ears... I know that her death happened "when it should" and that we didn't wait "too long" (something I was very afraid of doing), and I know that we did all that we could to make it comfortable and loving for her, with a special treat in her tummy and her family around her telling her that she was loved. So while I still grieve for her every day, I can take comfort in knowing we did all we could.
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    In my opinion those videos are required viewing for anyone who has an elderly dog. I came across them about 3 months before we lost Snifter.

    The main way in which they helped me was to understand just how fast the dominoes can fall once they start. That was absolutely the case with Snifter. One day he was fine; within 36 hours he had gone.

    Because I was armed with that knowledge I made an appointment with our vet to discuss what I wanted to happen if the dominoes should start to fall at a time when he was with his pugsitter, should I be uncontactable. I did not want the vet and the pugsitter flailing around wondering what best to do, especially since it was likely that their approach would be to keep him alive at all costs until I could make the decision, when in fact my decision, based on his quality of life, was that no heroics were to be performed and he was not to be put through anything uncomfortable. As it happens, I was there, but it did mean that I felt more comfortable making any trips before we lost him.

    I would say that anyone who is having to evaluate quality of life should be having an end of life conversation with the vet. It is also worth making sure that all vets in the practice are on board with with the general thoughts are. I am not happy with how things ended for Snifter. Our main vet had already made it clear that any time I said the word he would perform euthanasia without argument. He said so again when we first took Snifter in with his tummy problem, but we both agreed it could be something minor and we should see how he went overnight. Unfortunately the main vet was off work the following day. When I took Snifter in the following morning I was braced for the end. It was clear that he was not fighting and was more than ready to go. The vet I saw was very kind but was adamant that we "should" put him in for an x-ray, and "ought to" conduct investigations, and at the very least we "must" admit him for a drip and observation. Since any investigations required a general anaesthetic and any resultant diagnosis would have required an operation, which I was not prepared to make him undergo, and since I had to tell her point blank that I was not prepared for him to spend his last hours in a hospital cage she finally agreed to send him home with more anti-sickness meds and more pain meds and see how the day progressed. I knew in my heart of hearts that he would not rally but after arguing with her about her suggestions I'm afraid I didn't have the strength to order her to put Snifter to sleep then and there (and in any case I have a feeling she would have refused). The silver lining to the cloud is that my husband was unable to attend the morning appointment but was able to come with me that afternoon to say goodbye. The down side is that the pain meds which had kept him comfortable overnight were not kicking in quite as well and while he was not in serious pain he did end up spending 7 hours in some discomfort, especially towards the end. Those hours were of no real benefit to either of us, if I am honest. He didn't want cuddles and I ended up just lying next to his bed all day feeling guilty. He couldn't even keep water down so giving him a yummy treat was out of the question. He was simply not interested.

    So, while I am basically reasonably happy (if that is the right word) about how things ended, it could have been better. Had I not seen those videos and discussed the issue with our main vet I would have been very ill-prepared to withstand the other vet and poor old Snifter may have been put through much more.

    Think about the unthinkable, and have a plan. I can't stress it enough.


    Bella, mummy to Snifter and Toddy!

    http://avrilmunson.wordpress.com









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    Bella, Thanks for sharing your experience. I'm sorry that it wasn't an "ideal" ending for Snifter. Shame on that vet for arguing with you about your fur-baby!!! Euthanasia is a hard-enough decision to make for any pet parent without having to face a vet that won't respect our wishes. I'm so sorry that Snifter's final hours were not what you wanted for him. But as you said, at least your husband was able to come with you in the afternoon and be there for you both.


    P.S. I "liked" your post not because of the sad story, but because I appreciate you sharing your experience and for your final words about having a plan.
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    Oh gosh reading all this brings home yet again the sadness we all must face at some point-whether natural or assisted. I commend you all for your heartfelt commitments to your pugs who as far as we are concerned are family members of course. That being said, the last best thing we can do is facilitate a peaceful ending. I think we all do everything we can to help prolong life and end pain, but unfortunately we sometimes are faced with that so hard decision. I cannot even write this without tears, thinking of not only my loss but everyone else. Snifter I am utterly destroyed by the callous vet at that office-records alone should have attested to all you had done and if you had finally made this hard decision, it should have been eased by a caring vet. I agree with Wonka and Nilla mom-once that decision is reached based on quality of life criteria then with a heavy heart we have to let go. Its not like they can make that decision or even tell us-only by watching can we know when the time has come. It is a courageous and heartfelt decision but when the time comes, it is up to us. No matter how sad and hard-and I do not say that easily as I was faced with this very decision last August. Petey was only 11, but we had done everything we could-or wanted to put him through (and that is a huge decision as well-as we constantly asked ourselves-to what end-what will he gain?) But I think for most of us, that day will arrive and you somehow just know, it is time. This forum is an awesome resource in so many ways and this is just one of them.

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    This hits so close to home now, Aggie our 15.2 yo miniature dachshund has been having issues the last year and they are progressively getting worse but just when I think I canít do this anymore itís not fair to her she then has a few good days. Granted she is having less of the good lucid days. How do I decide when to let go. With Tucker it was very clear and I knew he was suffering but with her I have no clear cut feeling. I know she has congestive heart failure, I know she has Demetia, I know she can only control her bladder while on high doses of meds. Her poo is pencil thin which they tell me is a sign of a blockage, she is supperskinny, her teeth are have rotted, but then she has that one lucid day where she knows who I am and doesnít bark at me and I think Iím such a bad person for thinking I should let her go. I always thought it would just be so clear when it came to it.


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