quality of life

Pets have so many amazing qualities.

They are resilient, and love unconditionally. They are good for our health; reducing stress and lowering blood pressure in people and they can even help decrease rates of allergies and asthma in children who grow up with them. Pets make our lives better, and that is why this one tragic flaw is all the more heart breaking—they just don’t live long enough. Saying good-bye to a beloved pet is one of the hardest things a person has to do and with an average life span of 10-15 years for most dogs and cats, it is something that many of us have to do several times in our lives. To add insult to injury, most of the time we need to be the ones to decide when to end their lives.

So when our pets are ailing and emotions are running high, how can we expect to know what the right decision is? How do we know when it’s time to let our pet go peacefully? Your veterinarian can, of course help give you input and insight into the decision, but ultimately euthanasia is a personal choice, and the answer is different for every pet and every family. That’s where the HHHHHMM Scale comes in. It is a list of criteria, which are important to your pet’s wellbeing. It can help you assess your pet’s quality of life, and help make an emotional decision more objective.


“Is my pet in pain?” This is one of the most commonly asked questions I get when I see a very sick pet. No one wants their pet to hurt or suffer. Most pain can be managed, so if the answer to the question is “yes,” there still may be options.

Managing pain is a complex process, and involves an integrative approach that may include a variety of medications as well as physical therapy, acupuncture, weight control, and sometimes even surgery. Talk to your vet about which methods will help your pet and decide what you are and are not willing to try.   For example, if your dog has bone cancer, leg amputation is a viable option for pain control, but it doesn’t mean you’re a bad pet owner, if you say no to major surgery on your terminally ill dog. It is best to be up front about this, though, so that other methods of pain control can be implemented as early as possible.

Your pet’s inability to breath, while not strictly “painful” does fall into the “hurt” category as well and it is the most important issue that needs to be addressed. If your pet is having trouble breathing, they may need oxygen supplementation, either in an oxygen cage, or with a tube in their nose until the underlying problem can be controlled.


Maintaining adequate nutrition is also essential to your pet. Many chronic illnesses can cause weight loss and muscle wasting, a condition called cachexia. Achieving adequate nutrition is essential in slowing this process down. In addition, many sick pets lose their appetite, or develop vomiting and diarrhea which can contribute to malnutrition. If your pet isn’t eating well, the first step is figuring out why. Is there a mass compressing the stomach and intestines? Is there a blockage in the digestive tract? Are toxins building up in the body causing nausea? Is it from your pet’s medications?

Once the reason is identified, it can be addressed. If it cannot be dealt with directly, then palliative measures with anti-nausea medications and appetite stimulants can be tried. If your pet is still not able to eat, it may be necessary to decide whether or not you want your veterinarian to place a feeding tube.


Dehydration can occur for many reasons in ill pets. As with “Hunger,” “Hydration” can also be affected by your pet’s food and water intake. It can also be caused by water loss through vomiting and diarrhea, or with severe skin disease such as large, third degree burns.   Many illnesses can also affect the kidney’s ability to hold on to water. Depending on the severity and cause of dehydration, your pet may need to be rehydration with IV fluids, or your vet may be able to teach you how to give subcutaneous (under the skin) fluids at home. Your pet’s temperament may also play a role in this process as some animals will not tolerate sitting through fluid administration.


Hygiene is especially an issue for pets with poor mobility. Is your pet able to get up and go to the bathroom? If not, they will need to have their bedding changed and be cleaned frequently to avoid skin infections from urine and feces scalding. Pets that spend most of their time lying around can also develop pressure sores. They will need to be turned frequently to avoid this, and if they do develop, it is essential to keep the wounds clean. Ill pets are also less likely to groom themselves, so they will need to be brushed frequently to prevent painful mats.


Is your pet still happy? Do they get excited to see you when you come home from work? Do they still play with their toys? Do they express interest in what is going on around them? Are they lonely? Board? Scared? Every situation is different here, so figuring out what you can do to help may be difficult, and you may need to think outside of the box.

Can you move their bed to be closer to the family? Provide them with new toys that they can use and will enjoy if they can’t run after a ball anymore? Can you provide them with a quiet environment if they are becoming sensitive to noise? Can you arrange your schedule so that someone is home with the dog more often? Figure out what makes your pet happy, and try to make accommodations to help keep up their emotional and mental well being .


How well is your pet getting around? Do they want to go for a walk? Are they able to get up the stairs? How about to their food and water bowls? Are they able to get up on the couch or bed if these are places they are traditionally allowed? Are they slipping and falling a lot? Are they having seizures?

Some adjustments can be made to improve their ability to get around. They made need assistance walking with a sling or a mechanical cart. Adding non-slip matts to hardwood and tile floors can help prevent slipping, and adding steps onto the bed or couch can help them get to their favorite places. Keeping their food, water, bed and toys in close range can help keep them from getting bored, hungry or lonely. Limited mobility is tough, but a pet can still have a good quality of life if there is the commitment and resources to modify and enrich their environment.

More Good Days Then Bad

I have had many clients bring their pets in for euthanasia, only to suddenly have second thoughts because their pet seems so much better that day. It’s hard to see them perking up and not start to question your decision and find yourself hoping that maybe they’re starting to turn around. One good day is not enough. When your pet is no longer having more good days then bad, quality of life may be compromised to a point where we must accept that it may soon be time to say good-bye.

Give Your Pet a Score

If you are in the heart-wrenching position of dealing with a terminally ill pet, this can be a very helpful guide. Go through each of the criterion and give your pet a score from 1-10. If your pet’s total score for all 5 categories is less the 35 and you have done all you can do (do not confuse this with doing all that can be done. Every situation is different, and medical decisions that are right for one family or one pet, may be wrong for another) it is probably time to consider euthanasia. Make sure you have a great support system in place to help you through this difficult time. If you are struggling with grieving your pet, be assured that there is help out there. Ask your vet about pet loss support groups and hotlines or grief counselors who specializes in pet loss.

*The HHHHHMM Scale is created by Dr. Alice Villalobos and Adapted from Canine and Feline Geriatric Oncology: Honoring the Human–Animal Bond, Villalobos A,Kaplan L—Hoboken, NJ: Wiley-Blackwell, 2007



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