eileenanddogs

Category: Dog death

Create a Custom Quality of Life Scale for Your Dog

Create a Custom Quality of Life Scale for Your Dog

If you create a scale for your dog, please do it in consultation with your vet. I’m providing a simple form on Google Sheets and sharing my own experience, not medical advice.

Template for custom quality of life scale or symptom tracker

You know generally what’s coming when we talk about quality of life.

In this case, the news is that Zani is terminally ill.

In early August, she started to cough. Clara and my friend’s dog had both just suffered a respiratory infection in sequence, so I assumed it was the same thing, but it didn’t go away. I talked to my vet and she prescribed Zani some antibiotics. About two weeks later Zani started having a GI problem. I talked to the vet and we discussed some options, including a minor surgical procedure. But with her ongoing respiratory problem, she didn’t want to put her under unless she had to, and the condition did seem to stabilize.

Then in the first week of September, something started changing in Zani’s right eye. She already had keratoconjunctivitis sicca (KCS) in that eye—but this was new and different, and the vet said to come right in. There was some color change on the side of her eye. She also noticed swollen mandibular lymph nodes, which I had not. She performed a chest X-ray and Zani’s lungs were full of nodules. These conditions, along with the eye and GI problem, spelled probable lymphoma or one of the deadly fungal diseases dogs can get here in Arkansas. The eye problem is likely caused by an orbital tumor (tumor behind the eye). The symptoms between the fungal infection and lymphoma are oddly similar. The fungal test came up negative.

I wanted to keep my options open in case, for some wild reason, chemotherapy would be appropriate, so they did a needle aspiration biopsy to confirm. But it came back negative for anything—cancer cells or infection. Yet this stuff was growing inside her.

So Zani has something that is very likely cancer, and probably lymphoma, but not definitively diagnosed. The other affected areas of her body would be difficult, impossible, or painful to biopsy. Behind her eye? No thanks. Rectal tissue, lots of bleeding and discomfort, and the area is already being stressed. An ultrasound-guided needle biopsy of her lungs would still be a shot in the dark, trying to hit a nodule and gather enough cells. And it would be risky to anesthetize her for any of this. But these locations: lungs, GI system, and eyes are typical places for lymphoma to develop.

We are proceeding as if it were lymphoma, which is actually the best-case scenario at this point. But it’s not a good prognosis, especially because of the eye involvement. Chemo is generally not as hard on dogs as it is on people, and there are a lot of choices for lymphoma, but it’s still not necessarily easy. I wasn’t crazy about the idea even when it was on the table, and without a definitive diagnosis, the vet and I agreed not to go that route, Zani is getting palliative care: steroids. If what she has is lymphoma, prednisone may even create a remission.

She loves being outdoors

By the way, Zani has no clue how sick she is. She has shown no evidence of pain (the vet agrees). Her appetite has never flagged; she hasn’t had diarrhea. She is doing her usual activities, only at a lower energy level than usual. And while we waited for the results of the fungal test, which seemed to take forever, she got a dexamethasone shot, which took away her coughing and made her very peppy indeed.

An Individualized Quality of Life Scale

Inspired by the two major quality of life scales available online (Pawspice HHHHHMM Scale and Journeyspet), and my friend Blanche Axton’s excellent methods of tracking symptoms and behavior in her dogs, I decided to create a custom quality of life scale for Zani using Google Sheets. Her situation is complex with a lot of factors, but I realized some of them were quantifiable.

You can do this, too, should you need to. Here is my Google sheet: it is shareable. You can make a copy and customize it, or use the idea to make a scale that suits your needs better.

One of the reasons I’m doing this is that I know how badly I have been misled when I haven’t used any recorded observations over time.

I’ve written previously about the tragic death of my cat Alex. What I didn’t mention is that as Alex wasted away with what turned out to be stomach cancer, I did not perceive how much weight he was losing. I saw that he was gaunt, but many days I convinced myself he was “better” and gaining again. (I didn’t have a scale at the time.)

I never want to do that to an animal again. I know a little more about combatting biases now, 20+ years later. I will not let an animal waste away, in pain, as he doubtless was. One ultrasound would have told us what was happening, but those machines were rarer in general practices back in those days.

So I have been thinking about the ways I can help make sure Zani doesn’t suffer, that nothing evades my gaze because of hopes. And I’ve talked to my vet about all her symptoms and what to watch for.

I am shocked and heartbroken, but this is something I can do to help Zani, and possibly some other people and animals out there.

What the standard quality of life scales I’ve seen neglect to discuss is the many ways you can actually measure changes, rather than assigning a numerical score the best you can.

Some Standard Metrics for Quality of Life

The combined issues from the two QOL scales I know are pain, appetite/hunger, thirst/hydration, hygiene, happiness, mobility, respiration, sociability, and “more good days than bad.” (I reworded these a little.) One of the scales also includes two categories scored for the human: uncertainty about the condition of the animal, and the stress of caregiving. I probably won’t include categories for those last two, though I am grateful they are included. I will also not have a row for “more good days than bad,” since I will score every day and it doesn’t need to be a separate row.

We’re still doing our exercises

Zani’s Individual Quality of Life Issues

The following are Zani’s unique issues that are variants on or additions to the basics such as breathing, eating, and not being in pain. Some of them, such as mental health, are considerations in their own right. Others, such as lymph node size, are symptoms of bigger issues. I’m going to share my thoughts on them here.

  • Mental health. Zani is sound phobic, which is well controlled with meds and counterconditioning (check out the video below where she gets on the scale—that beep used to terrify her). In the past, she had almost a year where she also had generalized anxiety and panic attacks. So I will be watching for any precursors or wobbliness in her mental health.
  • Weight. I will weigh her at least every other day. Right now she is gaining. Even before the prednisone, her appetite was excellent.
Zani stations to be weighed
  • Respiration. I have been counting Zani’s respiration since the lung problems started because her breathing was noticeably fast and labored. Here’s a tip: rather than watching your dog’s chest rise and fall while simultaneously checking a stopwatch app, or setting a time with a ding (we avoid dings around here), just take a video of your dog that is an exact length and count at your leisure as you watch the video. I usually use 15 seconds, then multiply the number of full breaths by four. (There are also dedicated apps for this purpose.)
  • Eye with the tumor: appearance. Is the appearance changing? Any abnormal discharge? Her “normal” discharge with that eye is already pretty weird because of KCS and its treatment. Is her eye more or less exophthalmic? Less turned in the socket?
  • Eye with the tumor: irritation. Is it bothering her? Is she pawing at it or trying to wipe it on the grass or upholstery? (She has not done this at all so far.) Orbital tumors are often not painful.
  • Rectal prolapse: appearance. How long after defecation before the tissue retracts?
  • Rectal prolapse: irritation. Is it bothering her? She has never tried to scoot on the ground after it happens. She turned and tried to investigate it a couple of times early on, but I haven’t seen her do that since the beginning. So far it hasn’t been tender when I’ve cleaned it up for her.
  • General GI system. Any blood when I wipe her butt? Abdominal tenderness?
  • Repeated defecation. This is probably tenesmus, the urge to defecate even when bowels are empty. I’m treating repeated straining as a bad sign because it may both be symptomatic of something bad happening internally and also exacerbate the prolapse. But she has seemed to learn when she is done, even though the prolapse must complicate the sensations.
  • Stools. Look for constipation, diarrhea, blood in stool. So far her poops have been great.
  • Vomiting. None so far.
  • Her right mandibular lymph node size. This one is tough for me, but mostly because her nodes are not all that swollen compared to many dogs with lymphoma. I think I will be able to tell if they start to swell, though.
  • Her left mandibular lymph node size.
  • All nodes. Check for anything new.
  • Likelihood of a sudden adverse event with her GI system. See next entry.
  • Likelihood of a sudden adverse event with her eye. I’m using separate categories for these sudden adverse events, separate from the individual tracking of these areas. I don’t want to forget that even if I envision a slow, measurable decline, Zani has at least two conditions that could cause a sudden medical emergency.

New Symptoms to Watch For

  • Limping. This could indicate bone marrow involvement.
  • Excessive balance problems (beyond what is normal for her, due to her spinal cord trauma), seizures, or paralysis. Changes here could indicate central nervous system involvement. That’s my biggest worry because of the orbital tumor.

But in the meantime, her balance and coordination are looking great for her!

See the “Exercise and entertainment” video below for a live demo of backing to the platform

Possible Med Side Effects

Prednisone can cause quality of life issues itself. These are some of the things I’m watching for.

  • Behavior changes such as depression or aggression
  • Restlessness
  • Panting
  • Nausea or other GI problems

Scoring

This is the “Second breakfast is late!” look

Some of the scoring will be counterintuitive any way you look at it. That’s because we naturally want to give high numerical scores to intensity, whether they are positive or negative indicators. But we can’t have an additive system where happiness is a 10 on a scale of 0 to 10 and also extreme pain is a 10 on a scale of 0 to 10. One of them is going to have to be scored in the other direction. So a certain number of categories will be scored counterintuitively. I went for high scores for intense good indicators. Which means on the pain scale, 10 means complete lack of pain.

Also, there will be factors that have actual numerical metrics, such as weight and respiration. I may write a couple formulae to convert the numbers into the 0–10 system. At the very least I’ll write a conversion table.

I’m sharing these thoughts for people who are in the sad position of doing this themselves, but I’m not going to publish my exact scoring system. I don’t think it’s a good idea for anyone to copy my sheet exactly. But above are the concerns I’ll take into account.

I have, however, created a downloadable Google sheet that has a basic setup for symptom tracking. You can view the sheet and make a copy for yourself to edit as you please, putting in the symptoms you need to track for your dog. Be sure to check with your vet about what will be best to track for your dog. I’m sure there are people out there who can make a more sophisticated numerical tracking system. My goal here is to plant the idea of tracking symptoms as objectively as we can with the purpose of noting trends. We can do this successfully even if we have to make a lot of approximations.

Tracking such as this is useful for any dog with a chronic condition. Its use is not limited to dogs who have terminal conditions. For a dog with a chronic, non-terminal condition, the score can be used to determine when a vet visit is in order to discuss a change in treatment or when it’s time for a planned intervention.

Exercise and entertainment

Epilogue

Part of my reason for writing this is therapy. It lets me feel a little bit of control of the situation. But to be honest, I don’t think I will be using my chart for long. Both the GI problem and the eye problem could take a turn for the worse very fast. Her eye has improved from the prednisone Zani is taking now. But eye involvement worsens the prognosis for dogs with lymphoma. And an eyeball that is turning in the socket because of pressure from a growing tumor is going to cause problems sooner rather than later.

Please keep my little dog in your thoughts. This post may come off as cool or detached. Concentrating on symptoms and tracking and making each day a great one for her is how I’m coping right now. But don’t think for one minute that I am not collapsing on the inside at the thought of losing my sweet friend.

Fun in the stump

Copyright 2020 Eileen Anderson

Canine Hemangiosarcoma: Summer’s Story

Canine Hemangiosarcoma: Summer’s Story

Most stories about dogs with the deadly cancer hemangiosarcoma end sadly and this one does too. Just so you know. But I want to tell the story because canine hemangiosarcoma is so sneaky and can be hard to diagnose. For Summer, it all started with a backache, though it turned out not to be the main problem. Continue reading “Canine Hemangiosarcoma: Summer’s Story”

She’s Gone

She’s Gone

A small, visibly old (lots of gray and white on face) terrier is asleep in brown haired woman's lap. The dog's head is hanging over the woman's arm. The woman is wearing a brown mock turtleneck. The dog is mostly black and white with large ears.
17 year old Cricket having a snooze at the office in March 2013

Head’s up: frank talk of euthanasia and some raw language.

Cricket died on May 31st and I am not OK with that.

Elizabeth Kubler Ross’ stages of grief are: denial, anger, bargaining, depression, and acceptance. I guess “nauseated, furious rejection” of the whole idea belongs somewhere among the first two.

It’s just not OK with me. I don’t have strong beliefs about the afterlife (though please, those of you who do, I welcome your comments. I can take comfort from them). She is gone from my life here on earth and I’m not OK with that.

I can’t seem to write, except to write about her. Some for public, mostly for me. Folks have been kindly asking when I would blog about it—I guess I’ll give you the raw story.

It’s not OK with me that I remember so much of the past two years—no wait, that is OK—but I’m frustrated that I don’t have vivid memories of her in her prime. I am going through 800+ unnamed Flip videos that are no longer in a library and finding every one that she is in. Even if she is just barking in the background. Her “prime” means she was about 12 years old!

Cricket has had dementia for two to three years. She also had extreme neurological weakness in her hind end, and chronic, though not extreme, GI problems. For more than a year she has not had the muscle tone to sit in my lap without my bracing her. Her dementia was so advanced that for the past five weeks she could not figure out how to drink water on her own. Her neurological wires had gotten so crossed that she startled at almost any sensory input.  She no longer had the muscle tone in her rear to sit normally; she splayed her hind legs out or let them both go out to the side, and hunched her back.

Yet she had a great appetite and still had pleasures in life. She was on medication for arthritis just to be sure, but I don’t think she was in much or any pain.

I have known for a year that this dog would not die a peaceful death at home. Her heart, other organs, and general constitution were way too strong. I knew I would have to intervene. In the past few weeks she has taken another step down into frailty and I have been waiting for some sign that the balance had tipped.

It happened on Friday. She threw up, then had an extended seizure. She aspirated vomit. She was with me at my office at the time and my coworker helped me care for her. After two hours she was still sputtering and had not gotten out all the matter, but I had already made the decision. If she had seized once, it could and would happen again. And the next time I might not be with her. Every time I left her home, as safe as I made things, there were ways she could hurt herself or suffer. The seizure was probably related to her canine cognitive dysfunction and she was way too frail to experiment with other treatment drugs.

Just like I have long known I would have to euthanize her, I have also known she was not going to go down easily. She’s just not that kind of dog. The last two animals I had to euthanize were both cats and both were seriously ill. One with cancer that had spread to the brain, the other with complications of diabetes. Both slid away from life with relief, one of them still purring.

In your dreams, Eileen. Everything I knew about Cricket said it would not go that way and it didn’t. I had been trying to prepare. Months before, I had asked the vet for an oral sedative to give Cricket before I ever brought her to the vet for her final visit so she wouldn’t be nervous. We “practiced” with a dose one day and I’m glad we did. Cricket got a paradoxical reaction and got all hyped up and anxious and weaved around drunkenly for a few hours. So much for that idea, and for my fantasy that she could already be relaxed and dreamy when we went.

But on Friday she wasn’t very anxious, at first. But she was completely alert and looking around and not liking the doctor, as usual. I didn’t try to give her treats since I was pretty sure they wouldn’t stay down. Though a perfect last meal had been part of the fantasy, too. (She had eaten very well and happily that morning, however.)

I spoke to the vet about giving her anesthesia first before even inserting the IV, and the vet didn’t recommend it, saying it could just lengthen the trauma, so I agreed to the standard procedure. Can’t know if what happened was better or worse than what would have happened otherwise.

The vet first administered anesthesia through the IV in Cricket’s front leg first, as is typical, before giving the drug that stops the heart. Cricket reacted strongly to the anesthetic, startling and whimpering. Damn damn damn. Horror. Then she settled down after it got into her system. After the infusion of the second drug, nothing happened. Cricket sat in my lap looking around. The doctor had given Cricket (who weighs 12 lbs), the dosage for a 30 lb dog and nothing at all happened.

The doctor brought a second dose. This time Cricket didn’t startle, so she must have been starting to get at least a little anesthetized. This dose (we were now up to the dose for a 60 lb dog) made her sleepy and slowed her metabolism. She essentially went to sleep in my lap, although my dear friend who was there said that she was still peeking out at the world. I watched her breathe. It was regular and a little slow, exactly as it was when she slept. And it stayed that way. The vet said her heartbeat was slightly irregular, was all. It was lovely to hold her when she was finally (probably, hopefully!) relaxed and asleep.

The vet got a third dose (up to a 90 lb dog dose now) and injected it directly into a back leg this time. I was desperate that this would startle or hurt her, but she didn’t flinch in the least. I hope it didn’t hurt. I watched her take her two last breaths. I held her close, probably closer than she would have liked were she awake and alive. But her little body felt so right up next to my breast, as always.

I asked the vet, not entirely joking, how she figured to get Cricket’s body away from me.

I asked for her ashes, something I have never done before. I’m an amateur potter and will make a little container.

My other dogs have much more freedom and will get more of my attention. After while. My life is so much physically easier now. But right now I basically don’t fucking care.

It is not all right with me that she is gone. I had 15 months to get ready for this. I thought we were coming to the end of the line ages ago. Perhaps it should have helped me prepare. But actually, I think it let me pretend that I would have her forever. As it should have been. The little Energizer Terrier, who keeps going and going.

Small white, black, and brown short coated rat terrier stand straight and tall and looks straight up at the camera (and her person)
Cricket ready for supper in 2008

Even now as I am sitting here I am waiting for her to walk straight up to me, stiff legged as always, stand straight and tall with those huge ears and look me in the eye, as she always did. Even when she could barely walk and see only fuzzily. (Other dogs hated her body language. Rude little terrier.) Waiting for her to find me wherever I am in the house and bump her nose to my leg just to be sure it was me. She fell away from the other humans in her life because of the dementia, but she always knew and loved me. We were each others’ anchors. And now I am adrift.

Because I remember the old doggie so well and want to remember the little spitfire, I made a video montage mostly from old training clips from when she was about 12. My training skills are rudimentary (why oh why did I repeatedly pull her out of position after the click!), I miss her ears with the camera half the time because I didn’t have a tripod, but it’s worth it to me to watch her. And I hope you all will enjoy seeing what a little ball of fire she was.

Link to the video for email subscribers.

Two years after Cricket died, I released my book: Remember Me? Loving and Caring for a Dog with Canine Cognitive Dysfunction. It won a Maxwell Award in 2016, and is available in paperback, hardback, and all major electronic formats.

Thanks for reading. Please remember my little girl.

Cricket always touched me whenever she could

 

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Copyright 2013 Eileen Anderson

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Cape Town, South Africa