Quality of Life Questions
One of the most common requests I get from owners, is to maintain an honest and open conversation about the quality of life their pet is experiencing. They want as much time with their pet, but they don’t want to be selfish and prolong a diminished quality of life for their beloved dog or cat. The idea of “quality of life” is a very subjective topic and is argued across the scope of human and veterinary life. We all have a different idea of what quality looks like. Recently, I had a wonderful client come to me with this same concern. Despite her absolute and unrelenting love for her dog and her dedication to his weekly treatments for osteoarthritis and back pain, she was burdened with the idea that she was possibly asking him to live in pain. What is important to remember in medicine, both veterinary and human, many times we cannot completely eliminate all of the pain…the main goal is to manage the pain so patients can still enjoy life.
We had a good discussion about this subject, so I decided to share a part of our discussion in hopes it may help another. For clarification, the opinion and beliefs I am expressing only reflect my personal beliefs as a veterinarian for the last 23+ years…no one else’s.
Pain, both emotional and physical, is an absolute in life…you cannot escape it. We all work to find ways to manage it and deal with how it will influence our quality of life in that moment, hour, day, etc. With our pets, especially our older ones, they are most likely in some form of pain…I am not trying to convince you, I am stating it. I hear “they don’t show pain” but they do, you just don’t know how to identify it…but that is another discussion. My point is they have good and bad days just like us. Yes, it isn’t as complex as our days, but they have a lot to process. Our pets have emotions and how they are feeling and the environment they are living in will flux just like yours. They pick up on the weather, the storms, the noises, your moods and the moods of those in your house, your routines and their routines, food changes, smells…it all affects them…then add in the pain of osteoarthritis or chronic stomach/intestine issues or skin allergies or dental disease or ear infections…they have their own little life going on. So how do you look at the quality of their life and making decisions on their behalf, especially when it comes to big life decisions?
As a mother of three boys, when they were younger they would come home with little reports depicting their behavior in class. I can’t remember which child, or which teacher, or even which school it was…but I used to have to sign a calendar at the end of each month. On the days of the week there were the options of a smiley face, a neutral face, and a frowning face. The faces were to communicate the overall behavior of my child on that day. Other teachers used colors such as red, yellow and green…but I remember the calendar the most. Many times there was a small note if a teacher felt an explanation was needed, but it was a very quantitative look at how my child was behaving in class. I tried not to point out any individual day to my child…because they rarely would remember anything about that day…but it did give me a ‘big picture’ summary of things. The reason I am describing this in such detail, is that I told my client that we should resist the temptation of making decisions on quality of life for our pets based on any one particular bad day. My recommendation is to keep a calendar of faces, and on days that are good… if her furry soul mate was eating and drinking, wagging and walking, and joyful in her presence then he gets a smiley face. If he has a neutral day where it was neither great nor bad, then record a neutral face…and obviously if he seemed more uncomfortable, reluctant to move and not taking treats, record a frowning face. Get a bigger picture of how things are, and remember your impression of his days will be greatly influenced by the pain and struggles of your own day. If there are more bad days than good, it becomes a more convincing illustration of his quality of life. My last recommendation was on the days that are not great, just be his friend. Try not to project your emotions of dread or sadness or doubt on him, rather assure him of your love and support and the promise of a better day tomorrow.
The interesting thing about what I have written is that it doesn’t just apply to a child’s behavior or the quality of life your pet is experiencing. If inclined, you can use this very simplistic approach to evaluating a job, friendship, relationship, marriage, etc. I cannot set the parameters for you on what constitutes each face, you will need to do that, but obviously if you see more frowning faces than smiling…you are not living your best quality of life and you may need to make some changes.