Monday, October 13, 2008

When to say goodbye and the HHHHHMM scale

One of the most difficult things as a veterinarian is advising an owner when to say "goodbye" to their pet. Thanks to excellent nutrition, more responsible ownership (leash laws, cat curfews) and advances in medicine, we now see a lot of geriatric animals with chronic diseases. We can manage cardiac disease and renal insufficiency - to a point of course. The sad fact is that animals don't tend to just die quietly in their sleep at the right time. They may become gravely ill, inappetent and experience suffering for some time. Euthanasia gives them a dignified, peaceful death and prevents ongoing suffering. But picking the right moment is a hard call: is the animal in the terminal stages, or is it having a major "crash" from which it can recover? Sometimes its a matter of instituting treatment and monitoring the response.

Ultimately the owner needs to make the decision, its our job to provide information about the animal's physical status and prognosis. One of the most common questions I'm asked is "how long do you think he has got?" The truth is this can be very difficult to predict in old, unwell animals. The owner is often concerned that they do not want to steal any "good days" by letting their animal go too early. It boils down to the quality of life of that animal. One of my colleagues often asks the owner to list five things their pet really loves to do eg eat fish, walk in the park, lay in the sun etc. If they can't do these things, or will be unlikely to do these things with treatment, that is when to let them go.

I was doing some research today and found that Dr Alice Villalobos, a US Veterinarian, has developed a quality of life scale called the "HHHHHMM Scale" - this stands for Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad. The owner and vet ascribe a score for each. I think this is an excellent framework for determining a humane end-point and it incorporates all of the things most vets would discuss with clients when talking about euthanasia. Doesn't make it easier and it doesn't mean you shouldn't grieve. I was inconsolable when a very special companion earlier this year, even though I'd done everything I could for him and he had a terminal condition, and I still miss him. I had to get my colleague to administer the final injection and I cried like a baby.
And peeps - the cat in the photo is not nearing his end or requiring euthanasia. He's just lying around. I just thought it would be much nicer to accompany the post with a picture (if you have a pic you want to see online - with your name acknowledged of course - submit a comment! I won't post your email address).