Quality of Life Scale

WOW .. this has helped me tremendously .. as I have been struggling with this the last few days. The feelings of quilt and sadness have become emotionally exhausting and I have lost my sense of objectivity... But since we are living with the " "taking it day by day" mantra , we will try to use this scale to help us with judging Brutus' quality of life.

Quality of Life Scale
Oncology Outlook for VPN June 25, 2004 By Dr. Alice Villalobos

“HHHHHMM” Quality of Life Scale helps decision-making.
There is a real need for assessing various levels of quality of life for aging, ailing and terminally ill pets. Most geriatric animals have one or more abnormal conditions that appeared in their senior years and these conditions generally worsen with time. One third of them are obese. Additionally, half of our nation’s companion animals, over the age of ten, become burdened with cancer and its related treatment issues. Veterinarians are frequently asked, “When is the right time to euthanize my beloved pet? How will I know?” A quality of life scale may help everyone, especially those in denial, to look at issues that are difficult to face. Caretakers can use this itemized scale to ask themselves if they are able to provide enough help to maintain an ailing pet in the proper fashion.

Every animal has certain desires that should be recognized and respected. If we can meet these basic desires at a satisfactory level for our ailing companion animals, then we are justified in preserving the life of the ill pet during its steady decline toward death. The goal in setting up the Quality of Life Scale is to provide a guideline so that pet owners can maintain a rewarding relationship that nurtures the human animal bond. This scale will relieve guilt feelings and engender the support of the veterinary team to actively help in the care and decision making for end of life, “pawspice” patients.

The basic desires that are innate to the quality of life for sick pets should not and cannot in good consciousness be ignored. It is up to the veterinary profession and to the pet’s individual caretaker to design an end of life program (Pawspice) or pet hospice that encounters each factor and deals with it openly and honestly with an achievement of quality of life scale from one to ten. Ten is the best. Below is a proposed list of the basic desires that need both healer and caretaker’s attention. I have christened this scale with the name “HHHHHMM,” so it is easy to remember the desires we want to satisfy: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad days. A score above 5 on most of these Quality Issues is
acceptable in maintaining a pet hospice, pawspice or end of life program. Each pet’s situation needs individualization and a kind, supportive approach.

The HHHHHMM Quality of Life Scale

Hurt—0-10No hurt: adequate pain control is first and foremost on the scale. This includes the pet’s ability to breath properly. Most people do not realize that not being able to breath is ranked at the top of the pain scale so attention to the pet’s ability to breath is a top priority. Some families are willing to provide oxygen therapy at home for their ailing pets and the veterinarian can prescribe it through a medical supply house. Pain control may include oral, transdermal and injectable medications.


Hunger—0-10
Hunger-No hunger: if adequate nutrition is not being taken in by the pet willingly or by hand or force feeding, then placement of a feeding tube needs to be considered. Cats do very well with esophageal feeding tubes. Malnutrition develops quickly in sick animals when the caretaker is not educated. Instruct owners to use a blender or liquid diets to help their best friend maintain proper nutritional and caloric intake.

Hydration—-0-10
No hydration problems. SQ fluids are a wonderful way to supplement the fluid intake of ailing pets. It may take a few sessions for a pet owner to get the hang of this helpful procedure. It makes end of life care a very special event.

Hygiene—0-10
Can the pet be kept brushed and cleaned? Is the coat matted? Is the pet situated properly so that it won’t have to lie in its own soil after eliminations? Pets, especially cats with oral cancer can’t keep themselves clean, so they get demoralized quickly. The odor associated with necrotic, oral tumors can be offensive and cause social rejection by family members. Instruct the owner to use antibiotics to help reduce foul smelling infections. Using a sponge (dampened with a very dilute solution of lemon juice and hydrogen peroxide) the gentle stroking action of a “mother tongue” on the face, paws and legs helps to soothe and clean the
of cats. Dogs love this type of grooming too!

Happiness—-0-10
Is the pet able to experience any joy or mental stimulation? It is easy to see that our pets communicate with their eyes. They know what is going on via their senses and mental telepathy. Is the ailing pet willing to interact with the family and be responsive to things going on around him? Is the aging cat able to purr and enjoy being on the bed or in one’s lap? Is there a response to a bit of catnip? Can the cat bat at toys or look and follow a laser light? Can the ailing pet enjoy the upbeat greetings and petting of loving family members? Can the pet’s bed be moved close to the family’s activities and not left in an isolated or neglected area? Is the pet depressed, lonely, anxious, bored or afraid?

Mobility—-0-10.
Ask, is the pet able to move around enough on its own or with help in order to satisfy its desires? Does the pet feel like going out for a walk? Is the pet showing CNS signs, seizures or stumbling? Can the pet be taken outdoors or helped into the litter box to eliminate with assistance? Will a harness or a sling or a cart be helpful? Is medication helping?

The answer to the mobility question has viable and variable scenarios and the scale score is acceptable anywhere from 0-10. I have met some utilitarian pet owners who are way too rigid in the mobility area. For instance, they are regretfully but willing to sacrifice their pet’s life rather than elect amputation of a limb. Some pet owners have the honest yet teleological feeling that amputation is mutilation and not fair to the pet. Instead, they allow the pet bear a painful limb for months before euthanasia. Then there are cases like 12 year-old, male, 90 pound, Golden Retriever, Krash Pancino of Orange County. Krash’s mobility was already borderline when he entered our pawspice program with osteosarcoma of his left distal radius. His history precluded amputation because of severe DJD, degenerative myelitis, and severe arthritis of both knees and hip dysplasia. Krash wears a splint to offset a pathological fracture
In my opinion, the mobility scale can be variable from 0 to 10. The need for mobility seems dependant on the species and breed. Cats and small lap dogs can and do enjoy life with much less need for mobility ability than large and giant breed dogs. If the pet is compromised and is only able to lie in bed, is there a schedule to change the position of the pet and rotate the body at least as often as every two hours? Can the pet’s bed be moved around the house to keep the pet entertained and in the family’s company? Atelectasis and decubital ulcers must be avoided. The nursing care of large immobile dogs is very demanding. Is the bedding material soft enough? Can an egg crate mattress be used and set up properly to avoid decubital ulcers? Is there a role for a pet mobility cart or an Evans standing cart? These items really make a difference in the Quality of Life for the pet that has limited mobility yet is still alert and responsive.

More Good Days Than Bad Days. 0-10
Ask if there are more good days than bad days. When there are too many bad days in a row, (or if the pet seems to be “turned off” to life), the quality of life is too compromised. Bad days are filled with undesirable experiences such as vomiting, nausea, diarrhea, frustration, seizures, etc. Bad days could be from the profound weakness from anemia, or from the discomfort caused by an obstruction or a large, inoperable tumor in the abdomen This was the situation with my own dear Australian Shepard, Alfie, (VPN, Dec., 2004) who had a huge, undifferentiated mass rapidly overtake his liver. If the two-way exchange needed to communicate and maintain a healthy human-animal bond is just not there, the pet owner must be gently told that the end may be near. It is very difficult for families to make the final decision to end a beloved pet’s life with euthanasia.

This is especially avoided when euthanasia is against the pet owner’s religious beliefs. Sometimes they are not sure about the very last quality of life issues. It can be made more clear to them if the standard scale for Quality of Life is set ahead of time and re-evaluated every couple of weeks or every few days as the situation requires. If the pet is slowly passing on with a peaceful tranquility, then that may be a satisfactory situation. People often do want their pet to pass on naturally at home in their arms or in their own bed. That is Okay as long as the pet is just weakening steadily and not suffering to death. Home euthanasia with a kindly house call vet may be elected. Hopefully, the concept of a Scale for Quality of Life will facilitate the heart wrenching decision that euthanasia truly is. Hopefully our professional guidance can help relieve the angst and regret about a beloved pet’s death that often haunts rest of a pet owner’s life.

Oncology Outlook for VPN June 25, 2004 By Dr. Alice Villalobos