Hi Elizabeth,

  I saved this article from another post and it is regarding "Quality of Life".  If you have already read it, then it will serve as a reminder of things to consider and if you havent read it, then it will be a good resource for helping you to answer your difficult questions.

Defining "Quality of Life"
        by Moira Anderson Allen, M.Ed.

Whenever one considers the painful choice of euthanasia, one is always advised to take the pet's "quality of life" into account. But what is "quality of life"? How can you determine whether a pet is still experiencing a good quality of life — or whether its level of suffering is no longer acceptable? That decision is individual to every pet, and every owner. Following, however, are some factors to consider when attempting to assess a pet's quality of life:

Mobility:

An older pet often loses mobility. A dog may no longer be able to climb stairs or hop into a car; a cat may lose the ability to jump onto a bed or chair. At this stage, however, your pet may still be healthy and happy, and you can easily make accommodations for its reduced ability.

If, however, your pet can barely move, that's another matter. Can your pet get to its feet without assistance? Can it sit or lie down without collapsing? Can it walk? Can it handle basic functions, such as squatting on a litterbox? Does it whimper or growl if you attempt to move it? I've seen dogs so crippled with hip dysplasia that they literally had to drag their immobilized hindquarters across the floor; this hardly represents the "quality of life" I want for my pets.

Appetite/Eating Ability:

Is your pet able to eat? Can it consume enough food (or digest that food) to remain properly nourished? Does it regurgitate immediately after eating? Is it unable to chew, or does it have difficulty swallowing? Does it enjoy eating, or do you have to coax every bite past its lips? A pet that is unable to eat or gain sufficient nourishment from its food is on a slow road to starvation.

Breathing:

A number of illnesses, including cancer, can affect the lungs. When a condition causes the lungs to fill with fluid or foreign matter (such as cancer cells), a pet quickly loses its ability to breathe easily or comfortably. You'll notice that your pet may seem to be panting, or that it is laboring to breathe; often, you'll see its stomach or flanks "pumping" as it can no longer breathe with just the chest muscles. It may also experience wheezing attacks. If such symptoms occur, ask for a chest x-ray to determine the condition of the lungs. If the problem is due to an allergy, infection, or asthma, medication may help; if it is due to fluids that are the result of cancer or a heart condition, however, little can be done.

Discomfort:

It can be difficult to determine whether a pet is in pain, as animals instinctively mask discomfort as much as possible. You can pick up clues, however, by watching its posture and expression. Does your pet's face appear furrowed or "worried", rather than relaxed and happy? Does it sit hunched or "hunkered" and tense, rather than relaxing and lying down? Lack of mobility can also be a sign of pain.

Another indication of pain is "denning." An animal in pain will seek a safe place where it won't be disturbed by other animals. If your pet has forsaken its usual territories or sleeping places for the back of the closet or a spot under the bed, this may be a sign that it is pain or distress and feels vulnerable.

A more obvious indication of pain is a pet's reaction to touch. If your pet responds to touch by flinching away, hissing, snarling, or even snapping, this is a clear indication of pain. Sometimes this can indicate a localized pain; if the pet doesn't want to be touched at all, however, it may indicate a broader discomfort.

Incontinence:

Many pet owners feel terribly guilty over the natural annoyance they feel when a pet becomes incontinent. They feel they should be more loving, more patient. Incontinence, however, can also be stressful for the pet. As a basic survival mechanism, animals learn not to "mess where they sleep" (for the smell would draw attention to the location of one's den). When an animal can no longer control when or where it urinates or defecates, you can be sure it is not happy with the situation.

Mental Capacity:

Older pets occasionally develop signs of diminished mental capacity. They may seem to "forget" things, such as where a toy is located or what a command means. Such a pet may become confused by its surroundings, and this confusion can develop into fear. (In some cases, this "confusion" may be the result of hearing or vision loss, to which both you AND your pet can often adapt.)

Happiness:

Determining whether your pet is "enjoying" life is certainly a subjective decision. However, if you have been a keen observer of your pet's behavior and attitude during its lifetime, you are likely to be able to determine when it no longer seems "happy." You'll know when it no longer seems to take any pleasure from its food, its toys, its surroundings — and most of all, from contact with you and the rest of its family. Most pets are tremendously easy to please; when it no longer becomes possibly to raise a purr or a tail-wag, you can be fairly certain that your pet is receiving little joy from life.

Response to Treatment:

When a pet becomes ill, our natural response is to provide whatever treatment we can. This may mean tests, medications, even surgery. But drugs have side effects, repeated trips to the vet cause emotional distress, and more invasive treatments take a physical toll. Eventually, we may conclude that our efforts to treat a pet's illness are more stressful to the pet than the condition itself — and that our efforts to save a pet's life are actually diminishing, rather than enhancing, the quality of that life.

Making a Decision:

Assessing a pet's quality of life is an ongoing process, not a one-time decision. Initially, we're likely to attempt to compensate for the problems we see. Pain medication may relieve a pet's discomfort and improve its mobility. A change in diet may improve a pet's appetite or provide better nutrition. We may resolve that we're willing to clean up after a pet and carry it wherever it needs to go, for as long as necessary. But eventually such measures will cease to be effective. The process of assessing "quality of life" is really a question of determining (and deciding) when that point has been reached — and what you intend to do next.

It is often tempting, at this point, to postpone a decision still longer by deciding to "let nature take its course." Before choosing that course of action (or inaction), however, it's important to understand that, as a pet owner, you have been thwarting the "course of nature" from the beginning. By ensuring that your pet has food and shelter and is protected from predators, you have already guaranteed that nature will not take its course. By providing medical treatment, you have prolonged the life of your pet far beyond what it could have expected if left to "nature." In nature, an animal that becomes too ill to obtain food or protect itself will perish quickly, though not necessarily comfortably.

Nor does nature necessarily offer an "easy" death even if you choose to let it "take its course" in the comfort of your home. An animal that cannot breathe easily, cannot eat or digest food properly, cannot control its bodily functions, and can scarcely move or enjoy human contact because of pain, is hardly dying "comfortably."

This is really what the "quality of life" issue is all about. By usurping nature's role throughout the life of our pets, we must sometimes also accept its role in determining (and bringing about) the death of a pet. To accept this, we may also have to accept that, in some cases, the quality of life we're really trying to protect is our own: That we're allowing our pet to suffer out of a desire to avoid the anguish we know that we will experience when it dies. And that, ultimately, is the most unselfish act of 

Hi Elizabeth,

  I see it more as a list of considerations for defining your dog's quality of life.  Is Shy living or just existing? I will give an example from my own experience.

Our dog Bonnie (over a decade ago this happened) was diagnosed with lymphosarcoma (cancer of the lymphnodes). It first presented itself as golf ball sized lumps in her throat.  Since she was healthy apart from that, my mom decided to have her undergo chemo with for a few months (6 recommended session).  And we thought that was that.  Almost a year after her diagnosis we noticed her hair was still thin, she had lost her appetite (remember been off chemo for months now), she didn't really like to play or even walk around, and most importantly she lost that sparkle in her eye.  She would still thump her tail when we pet her, but her "quality" moments were probably 5% of the time.  We took her to the vet and found she had some lung mets.  In her case, she had already deteroriated to the point of "existing" rather than living.  In the end we decided to put her down.

Now, I am not experienced with having a dog with dementia (though Chloe acts like a goofball head), so you will have to assess whether Shy's life state right now is still "quality" and "living" rather than "degraded" and "existing".  Letting a dog go is a heart wrenching decision, so I would try the new meds, look for any change or improvement and then reassess the situation.  All you can do now is just continue to love her like you do and be a supportive dogmamma.

Wishing you the best of luck.

-Nicole

Elizabeth,

I know everybody says "you will know when it's time." And heading into a situation where your love-pup's health is declining, you want to let them go as long as possible, while still providing a humane exit at the "right time." I truly believe that you WILL know. This is why:

Before Rio, there was Nakita. My husband and I got 'Kita and Shasta on the same day from the same pet store. Nakita was for all intents and purposes a black lab mix. I actually picked Shasta, and my husband fell in love with Baby Kita. However, they had other plans. Shasta ended up being my husband's heart and soul, and Nakita was mine. We are certain that Nakita was a puppy mill pup. She had a variety of emotional issues in addition to some genetic disorders. By the time she was two, she had a lot of pain in her hips from arthritis and dysplasia. She was on Rimadyl, Tramadol, etc. for the pain, and finally we decided to proceed with TPLO surgery. It went well, life went on, she turned six, then seven. In January of 2005, we took her in for routine senior screen, vaccinations, etc., and they said her liver numbers were in decline. We were upset, but then we got home, and she seemed fine, everything was pretty much the same as before....

Cut to October of the same year. My husband and I were heading to Disneyworld with his parents for a vacation. The day before the folks flew in from Oregon, Nakita wasn't interested in her food. I had always joked that if 'Kita wasn't hungry I would seriously worry about her. She had always been a HUGE chow-hound. So that day was here. I gave her "special food" and she finally ate, but then it came right back up about 20 minutes later. She also developed a bad case of diarrhea. Could she have picked a more inconvenient time? Really?? I have to say, I was totally annoyed with her timing. And I didn't take it very seriously... Okay, she wasn't feeling well. Maybe she was stressed because we were leaving. The whole kidney thing had been so far from my mind for so long, that it didn't even occur to me that this might be the problem. I told my dog-sitter that she'd been having trouble, gave her a letter for the vet in case she needed to take her in, jumped on a plane and went off on vacation....

We'd barely arrived in Florida when I got a phone call from the sitter. Nakita wasn't keeping anything down and was pooping uncontrollably. I told her to take her in to the vet, and I called the vet to let them know she was arriving and that we were out of town and would settle our account when we got home.

Long story short, tests were done,'Kita was put on IV fluids and dialysis because the tests showed that her kidneys had failed. The call with the vet was the most heart wrenching conversation I've ever had. He was not the best "bedside manner" to say the least, but he was honest with me. He told me that she was done. I said, "I'm not ready to say goodbye." He told me that it didn't matter if I was ready or not.

I flew home the next day to be with my girl. I took her home, thinking that we would face the inevitable "not today." I didn't want to think about having to make this decision for her. She was still happy to see me, still tail wagging, still smiling, still my girl. That night, in the wee dark hours, she wanted to go out to potty. I let her out, as usual, but after about 15 minutes, she still hadn't come back. I went out looking for her, and found her laying down in the backyard, too tired to walk back inside. I made the call to the vet in the morning, and spent the entire time until they arrive laying on my girl's bed with her, holding her, and breathing her in.

I know it was her time, but I still feel guilty -- six years later -- I second-guess if it was the right time, if maybe she might have rallied, if I should have just let time do the deed for me..... But deep down, I know it was the right thing to do for her. I know because she told me...

So trust me when I say, Shy will tell you when it's time for her. You will know. It won't stop the "human" emotions -- guilt, self-doubt, sadness, depression -- but you will know when it's time.

All our best,

Micki and Rio

Prior to the cancer, Charlie was exhibiting ‘old man’ signs. I would catch him standing there, obviously confused. So I started preparing myself and the family that Charlie was old and wouldn’t be with us much longer.

Then bam! Cancer. Well, that journey has been chronicled, but the end was different. I agree with whoever posted regarding the dogs ‘personality’.

Charlie was too independent to allow for bed rest and he was miserable not being mobile. The decline was so quick. I was more than willing to do whatever it took for him to have bed rest for those 8 weeks (we were going to do another surgery, not cancer related. Some might remember that I even purchased and laid sod on half of my deck so that he could have a potty area with no stairs.), but he couldn’t do it. He couldn’t handle not being able to do things on his own.  One weekend of him not being able to do what he wanted and we knew.

Now, compare that to the police dog that was stabbed here inSt. Paul. He’s paralyzed, however totally full of life! In all honesty, I struggle seeing another dog do what I wish Charlie could have done, but know that Charlie informed us with his misery that he could not go on.

Although we didn’t exhaust all treatment options (another surgery), the time had come. I was at peace with the ultimate decision because I knew I did everything I could, but it was his time.

With your girl, you are facing a decision that is difficult, but will come and you will know. Again, most of us have been there and understand the angst you are feeling.

Side note: What is the name of the other, expensive medication? Might be someone that has some of that, too.

Hugs to you and Shy!

VQ and Spirit Charlie

p.s. my bad for the novel.