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4 Ways to Know When It's Time to Say Goodbye -- Cone of Shame with Dr. Andy Roark

hey guys

hardest question that

get as a veterinarian

is when people asked how do I know when

it's time to put my dog to sleep and

they usually asked me with tears in

their eyes and it's an emotional

conversation and it's a hard

conversation what I wanted to do today

is tell you what I tell these people and

just walk you through what I believe in

hopes that if you are having these

thoughts and having these questions this

might be of comfort and it might help

you come to your own decision on when is

the right time to use an eyes a pet a

couple of days ago I was putting an old

dog to sleep in its owners were there

and it was this really nice couple and

the man looks at me at one point and

said I bet this is the hardest part of

your job and I just kind of smiled at

him I'm just you know we were having a

good a good conversation I want to be

supportive of them the truth is it is

probably not really in most cases when

we come to the end of the life

euthanasia is a gift and a blessing for

dogs that are suffering or in pain and

so I don't see this as a terrible thing

sometimes I honestly believe in a lot of

cases honestly I believe that this is

the kindest thing that we can do and I

just want to say that up front

as far as the hardest part of being a

veterinarian from me anyway the hardest

part is telling people that the pet that

they love has got a terminal illness or

is suffering or will be leaving this

world and you see the emotions on their

face and and it's just it breaks my

heart

and it's a hard thing for me to do but

it's an important thing for me to do I

remember the first time that I had to

tell someone that I had to tell someone

your dog is going to die I'm worried

about your dog's suffering and being in

pain

it was there was this guy he was a

middle-aged guy and he came in with his

two children the first time and he was

great and his dog was an eight-year-old

Rottweiler and the dog's name was stone

and I liked stone

but stone did not like me he just he

didn't he didn't he didn't want to be at

the vet clinic and I get it

the owner brought stone in because he

was limping and that's when the guy

thought hey this might be a problem and

stone not a fan not a fan of mine and

when I pressed into his shoulder that

was the end of the opportunities for us

to be friends he would he was done with

me he was really painful in that

shoulder and so I took some x-rays and I

had to tell this this guy and and and

his kids and I was very gentle and how

and how I talk to the children of course

but you know one-on-one conversation

with with the man I said listen your dog

has osteosarcoma in his shoulder and

osteosarcoma is a terrible terrible

illness is a bone cancer it is hard to

treat they're kind of limited options

there are things that we can do but

they're not easy things and it's painful

bone cancer really hurts and he you know

for a couple of reasons we were not able

to to do surgery amputate this dogs like

we knew we were not going to do

chemotherapy or radiation like that's a

decision that we'd come to and that's

just where we were and so together he

and I decided that we were going to do

everything we could to keep stone

comfortable and to practice palliative

care and he said to me I don't want

stone to suffer when it is time I want

him to pass from this world because I do

not want him to hurt and I said I agree

with you I am with you and we will make

that happen and he said to me how do I

know when we're at that point when it is

time for stone to cross the Rainbow

Bridge and that was the first time

anyone ever asked me that question and

since then I have tried again and again

to get better and better at answering it

I got four ways that I look at this I'm

gonna lay enough for you every pet

illness and situation are different okay

what your dog is experienced is

different from any other dog so just

know that going in just because your mom

felt differently when it was her dog or

your neighbor did something differently

when their pet had this certain disease

or condition that doesn't matter

okay this situation for you is special

and so every pet every situation is

unique here's what I want you to do if

this is a medical condition there's an

illness that your pet has get as much

information as you can about that

illness right learn what you can about

the disease process is this progressive

does it tend to move quickly is it

painful is it uncomfortable what can you

expect in the future because that

knowledge is power and that will help

you see into your crystal ball what's

coming in the future and that will

empower your decision so know that your

pet and your situation are special

understand what is gonna happen as best

you can because that will help you make

this decision and the last thing that I

say to people that's a huge help I

believe is don't be afraid to get

perspective from an outside person get

someone who knows you and knows what you

what you care about and sort of how you

feel about things that knows your

relationship with your pet and see what

they think because they will not be as

deeply emotionally involved as you are

and we all know that sometimes having

that perspective that's a step away they

can have more clarity they can help us

see things in a way that we can't see it

when we're really in this decision so

don't be afraid to get an outside

perspective from someone that you trust

and who knows you and who knows your

relationship with your pet pets live in

the moment one of the most wonderful

things about our dog is that they are

fully involved in the present they don't

think about what the past and how things

used to be and they don't worry about

the future they are just here in the

present I think about my dog is this old

Vizsla and he was with me for years and

years and every time I came home he just

celebrated just through his own one dog

parade and it didn't matter that I'd

come home a thousand or five thousand

times before

the fact that I am home right

now that meant the world to him because

he was fully invested in this present

moment that's one of the things to

remember about the world of the dog when

our pets suffer their point of view is

on the present they don't think about

the great days in the past they don't

worry or ponder the future all they know

is how they feel right now that's their

perspective and that's what matters so

the question is how is your dog right

now ask yourself important questions

sometimes articulating or writing down

your thoughts can make everything so

much more clear when you go back and

read them some of the questions that

tend to help people that I work with are

things like why do I think it might be

time to euthanize what are my fears and

my concerns about euthanizing whose

interests beside my own am i taking into

account while I'm making this decision

what are the fears and the concerns that

the people around me have what are they

saying or what are they worried about

just so I have it in my mind and the

last thing is am I making this decision

because it's what's best for my dog or

am I making a decision because it's

what's best for me and those are

questions that I put to people just to

get them thinking and there's no right

or wrong answer but walking yourself

through those questions can provide a

lot of clarity and the last thing I like

to think about is try to measure quality

of life quality of life is just simply

how good is life right now and that is

hard to figure out sometimes when we're

dealing with dogs that they can't talk

and they can't tell us how they feel

there's four different techniques that I

like to use to help me get an idea of

what is this dog's quality of life in a

walk you through the first approach that

a lot of veterinarians take in assessing

quality of life is called the five good

things and so the way it works is this

take a piece of paper and write

the five things that your dog loves to

do more than anything else his or her

favorite five activities in the world

pay close attention to whether or not

your dog is doing these things the scale

that looks like this in some ways if

your dog stops doing one of the five

favourite things that's a big deal if

your dog stops doing three out of her

five favorite things we've lost a good

amount of quality of life and it may not

be worth going on at this point a lot of

vets say three out of five that's when

they start to really think about

euthanasia the second approach is good

days versus bad days and this is really

simple a lot of times I have pets that

have good days and bad days and people

say I don't know how will I know when

it's time and one of the things that can

help is to visually look at how many

good days and bad days are we having

because that gets lost in our mind

sometimes so go to the calendar get a

paper calendar the old school paper

calendar put check marks big check marks

on the days that we had a good day and

put x marks on the days that we had a

bad day and if you're looking and your

dog is having more bad days than good

days again that is a big indicator for a

poor quality of life the third technique

that I like a lot is from a doctor that

I have great respect for her name is dr.

Allison Villalobos and she has what's

called the HH h HH mm scale so five H's

and two M's okay

the HS stand for hurt hunger hydration

hygiene and happiness okay hygiene is

the ability to keep themselves clean the

M stands for mobility and more as in

more good days and bad days which is

what we just talked about so five H's

are two M's

dr. villa-lobos recommends writing down

these seven things and then give your

dog a score on a scale of one to ten

where one is they have absolutely no

quality of life in this area and ten is

they have perfect 100

quality of life they doing this

completely and they are happy doing it

score your dog on those seven things for

dr. Villalobos if the majority of those

categories are scored as a 5 or higher

then going on and continuing supportive

care is acceptable if that's how you

feel we should go however if it's less

than that this dog is probably suffering

and and needs to be put to sleep if you

want to learn more about this scale

there's a link right here and I'll put

it down in the comments for you as well

and the last technique that I like for

looking at quality of life is a pet

Hospice Journal if this is something

that you're wrestling with having it

down in writing and saying everyday how

was your pets behavior how did they feel

how do their appetite how well are they

sleeping and just making some notes

about those types of things that can

really help you track over time and see

if there's a trend and see how quickly

our condition is progressing or to see

if we're losing quality of life as the

days and weeks go by there is a

fantastic online Pet hospice journal

that's totally free it's at Pet hospice

journal dot-com it also has an

integrated quality of life scale so take

a look at that or feel free to go the

old-fashioned way and just keep a

written log guys just so you know stone

didn't suffer when the time came and he

was obviously painful and we couldn't

control that pain his owner made the

right decision and he crossed the

Rainbow Bridge in the arms of his family

he was remembered with dignity he was

remembered as the strong protector of

those children and he was remembered

with love I remember his owner for being

a strong person and making the right

decision when it came time I hope that

you and I and everyone else will have

that strength to make that hard decision

because our dogs deserve it and we want

to protect them the most important thing

in life is koala

of life it's not about quantity and

getting the most days possible gang take

care of yourselves if you're watching

this episode because you recently made

this decision and you're second-guessing

yourself or you're wondering if you did

the right thing I want you to know that

those questions are totally normal the

fact that you've watched this whole

video and thought about all of these

things that says a world about how

seriously you took this decision I am

sure you made the right choice

also if you are thinking about this

going forward I'll tell you one last

thing I put my own dog to sleep he was

almost 16 years old it was last year at

the end of the year and I wrestled with

that decision so much and now I had the

same thoughts that I hear all from pet

owners all the time I have never had a

pet owner come back to me and say I wish

I had waited longer to make this

decision I never once I have had lots of

pet owners and I think I probably am one

who say I wish that I had put my dog to

sleep sooner because as I look back I

don't think he had quality of life at

the end of the year I don't think he was

happy thanks for watching this episode I

really hope that it will be useful for

you and for others in the future if you

have a story about your dog crossing the

Rainbow Bridge feel free to put it in

the comments and share sometimes it

feels really good to share I promise

I'll read what you write this stuff is

important and so let's be supportive of

each other if you think that this is a

video that would help someone that you

know please share it with them help me

get the word out and let's support

people as best we can because this is a

terrible experience to go through but

it's something that every dog lover must

go through I hate to say it but guys

this is the cost of admission when we

let the dogs into our heart we know that

they're going to pass away from us and

so let's be supportive of each other and

just do our best when that day comes all

right take care of yourself bye bye