Determining “Quality of Life”

Lizzie at the foot of Dwayne's desk ... looking good after the morning at the groomer.

Lizzie at the foot of Dwayne’s desk … looking good after the morning at the groomer.

Our Bichon Frise turned fifteen years old in November.  That’s 105 years old in “dog years.”  Actually it’s about the average lifespan for her breed.  She is suffering from cataracts, severe arthritis, a heart murmur, various skin irritations, and her hearing seems … well, “selective” at best.  About a year ago she was diagnosed with Lyme disease, and, while the infection was treated with an antibiotic, she has had what appear to be reoccurrances every now and then.  At the last reoccurrence, we didn’t even take a blood test, though.  The vet said, let’s just try the pain meds and antibiotics.  It should make her more comfortable.  So, I mustered my courage and asked the vet, “how do we know when it’s time?”  We’ve put down two other dogs, both Collies, and in both cases the vet told us … it’s time … it was clear.  This is a new vet, and I don’t know now, it’s just not as clear.  How do we know when it’s time to euthanize?

The vet asked a few pertinent questions.  Does she eat well?  Is she having bladder or bowel problems? Does she still greet you at the door when you come home?  Does she get motivated for a treat?  And then she handed us a piece of paper titled, “Quality of Life and the Decision to Euthanize.”

The decision to pursue additional medical treatments or consider euthanasia for a sick 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.

Then there are series of categories and statements that we can mark with a “yes” or “no.”  The categories relate to pain, appetite, hydration, hygiene, activity and mobility, happiness, general behavior, and the owner’s perceptions.  At the end of the form is says, “Count the number of yes and no answers that you have marked. _____ Yes  ______ No.”

It’s a hard decision, but most of us agree there will likely come a time when the decision to euthanize our Bichon will be the compassionate choice.  When the pain of keeping her alive outweighs the joy of life itself.  When even the most expensive medical options don’t offer any real change in her quality of life.

My brother’s Dachshund lived to be 19 years old before they decided to put him down.  At the end of his life, he could no longer walk or climb stairs, he couldn’t control his bladder or bowels.  If you ask me, I say that I would have put him down about three or four years earlier.  But, frankly, now that we’ve got a fifteen year old, I understand.  It’s really not an easy decision.  Nor is it something that can be clearly objective.  We love Lizzie.  Lizzie was our daughter’s puppy.  We got her in Texas when our first exchange student, Amy, was with us.  Kate was 11 years old and in the seventh grade.  It was before 9/11.   It was before iPhones, even.  Lizzie’s moved with us twice.  She used to get out of the fenced yard when one of our two collies unlatched the gate, and together the three of them would stroll around the neighborhood.  She was also a great player of “come and get me.”  We’d have to trick her by bouncing a tennis ball to get her back.  She loved tennis balls more than running.  Letting go of Lizzie, when the day comes, will not be a simple task.  In fact, I’m hoping I won’t have to make a decision to put her down.  I would rather she have a heart attack in her sleep, or run away, or … anything that would take that decision out of my realm of responsibility.  Like a form … an evaluation … a quiz.  Is it time?

Lizzie has been falling down the stairs more often … not making it down the foam staircase we bought her to get up on the sofa.  Today on the way into the house from the car (she just came back from the groomer and looks as good as she can these days) … on the way up the porch, she slid down the stairs … one step up, one slide down … she has good days and bad days.  So, again, I took out the paper from the vet … “Quality of Life and the Decision to Euthanize.”

PAIN

✓  My pet hurts.

✓  My pet limps. (If it didn’t hurt, they wouldn’t limp.)

✓  My pet pants frequently, even at rest.

✓  My pet licks repeatedly at one site on his/her body or at a site of a cancer/tumor.

✓  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.

ACTIVITY/MOBILITY

✘ My pet can’t get up without assistance.

✓  My pet has 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.

Ugh …

APPETITE

✘ 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.

Hmmmm …

HAPPINESS

✘ My pet does not expressly 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.

This doesn’t really make it easier does it?  It’s clear my Lizzie is suffering, but it’s also clear that she enjoys eating, she enjoys being with us, and she still has an interest in life.  The paper from the vet concludes:

Unfortunately, there isn’t a simple point system or scale that will tell you exactly what do do for you pet.  However, the more yes answers you have, the more likely it is that your pet has a poor quality of life …

This isn’t the whole of the questionnaire … for us, it is still apparent that while Lizzie’s quality of life is suffering, the overall joy of living is still worth it for her and for us.  And for others.  She’s really good with children now.  When our 18 month old nephew came to visit, it was Lizzie who would let him pet her.  Our five year old Schnoodle would run and jump and frighten the toddler.

Why am I writing all this about my dog?  I’m seeing a correlation with congregational life.  I spoke with leaders from two congregations this week alone, saying that their churches are contemplating moving from a full-time pastor to a part-time pastor.  I’ve had conversations about the very real future of three of our congregations in the past year.  What questions would be on the sheet from the vet for congregational life?  How do you discern the “quality of life” and the “decision to euthanize” a congregation?  I’ll take a stab at that in my next post.

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