The Meaning of Quality of Life for Dogs and Humans
Quality of Life for a Dog
When my dog Buddy stopped making the trips with us to feed the horses at the first of the year, I knew something was seriously wrong. He was always excited about the twice daily trip, venturing out to the perimeter around the barn to see what he could find. He had it timed just right to make it back inside the second barn in time to get a drink of water from the watering bucket. Sometimes he would stand outside “Little Man’s” door and eat a little of his grain. He is a curious horse who often looks over the door to watch what we’re doing, spilling nearly as much of his feed outside the door than he actually eats.
Increasingly, Buddy stopped making the trip to the second barn. At first, he waited at the top of the hill until we came back up. Then he started staying closer to home. At thirteen years of age, he had already passed the high-end of the life expectancy for golden retrievers. I thought he was feeling the symptoms of old age. But when he stopped eating and started gaining fluid in his abdomen, I knew it was something more.
The veterinarian suspected cancer since this breed is so vulnerable to the disease. It wasn’t. Buddy had an enlarged heart. We could treat the symptoms and buy some more time but there was no way to reverse it.
The vet put him on water pills and another type of heart medication. They also gave me the option to order another medication for him, pimobendan, that would help his heart beat stronger. They had to get it from a compounding pharmacy, and it was expensive. It would give me some more time with him, they told me. I wasn’t ready to lose Buddy. No one who ever loves a pet really is. But more than anything, I wanted him to feel well enough to do what he enjoyed longer.
After researching pimobendan online, I found stories about how the drug had helped younger dogs live for years after a similar diagnosis as Buddy’s. Some had been very active and acted their young ages. I knew that wasn’t going to happen in Buddy’s case. I knew he was miserable, lying around and not wanting to do the things that made him happy. So we ordered the pimobendan and started him on it right away.
We called it a pimobendan drug when Buddy jumped up and went to the barn with us the next day after starting it. He wasn’t the same as he had been, not the enthusiastic, energetic dog who could chase down a full-grown rabbit. We could make him well and we couldn’t make him younger. Only better and happier.
I couldn’t have been happier with the results of the “wonder drug.” But not only is it more expensive than most, it isn’t the easiest to give correctly. That fact was further compounded by the fact that Buddy was an outdoor dog. I know, I know, everyone wants you to keep your dogs in the house. I honestly don’t thing he could have tolerated it. For one thing, he was already an outdoor dog when he came to my home. Being outdoors, his golden coat had grown thick and warm. My dogs were happiest when the temperatures dropped, running and playing, especially in the occasional snow. Being outdoors also ensured getting involved in everything that happened. Buddy loved being on a farm and being involved in everything from putting up hay to loading the horses in the horse trailer.
I have a kennel with a dog house inside that I completely winterize during cold weather. Every evening, I would put Buddy and my female golden “Bell” up when I fed them to keep them warm and safe during the night. I let them back out of the kennel of the morning. Sometimes they ran out enthusiastically while others they were in no rush.
Once Buddy got sick, the routine changed drastically. The pimobendan had to be given exactly 12 hours apart on an empty stomach. Since it was winter, that meant going out to the kennel in the dark during the morning or during the evening. Buddy needed to eat about 30 minutes after taking the medication to keep it from irritating his stomach.
Since his heart wasn’t working efficiently, his circulation was poorer, and he wasn’t as warm as normal. It was still too much of a change to bring him indoors, so we hooked up heat lamps inside the kennel and gave him a heavy quilted comforter to lie on. When the temperatures dropped lower than normal, Buddy started staying in the kennel more. When it was warm enough that he wanted to be outside, he stayed on his bed on the front porch with a fleece blanket wrapped around him. Still, he made the trip to the barn for weeks after he initially got sick.
Then there was his diet. I’ve written about dog food and raw food diets and such many times as a writer. That makes it even more amazing to me that there aren’t better food choices for dogs with this kind of illness. My veterinarian advised me to avoid feeding Buddy salt due to the fluid retention. I also had to cook meat and veggies to supplement the dog food. He needed high protein to help prevent muscle loss.
Buddy had a really good week before he got worse. I would often catch him just lying on the ground and looking back at the property where he had enjoyed so much of his life. Then he stopped eating again, and the fluid started to build up. Once again, he stopped making the trip down the hill. That’s when I called the veterinarian, fearing that we had run out of options. He told me it was time to start thinking about “quality of life” and considering which options were best for Buddy. It was the decision I had hoped I’d never have to make. I told the vet I wasn’t ready to make the choice that day. I’d call him back tomorrow and see.
It turned out to be a lot easier decision than I expected. Buddy was now vomiting whenever I gave him his medication. Until he got sick, he was lying in his dog house in the kennel wrapped up in his blanket. I spent time hanging out with him, talking to him, singing to him, and petting on him as much as he could tolerate. Placing his head in my hand was as much effort as he felt like making. I knew it was time.
Quality of Life for Humans
I’ve said for a long time that it’s sad that we don’t have the same options for humans that we do for animals. Anyone who has watched a loved one die from a chronic illness knows the agony of having to stand back and let death takes its course. I have never felt any guilt whatsoever for having Buddy euthanized. It was a much more peaceful experience than he was having at home. His quality of life was gone and it wouldn’t be back.
Determining quality of life for a person is different. When a person gets older and can’t do the same things they always have, you can’t bring their life to an end because they no longer have the same options. Even when someone is chronically ill and in pain, the only choice is to make them as comfortable as possible until death claims them.
But what about people who get older and sicker but are still able to maintain some quality of life?
For those of you who read my article on “Think Twice Before You Sign a Power of Attorney” already know about my friend “Bob” who was stuck in a nursing home against his will. It’s been quite the adventure trying to get a man back home who doesn’t want to spend the rest of his life in what we now refer to as a “medical prison.”
If you haven’t read it, I strongly urge you to do so before considering signing one for yourself. People are often advised to put a POA in place in case they become incapacitated. But it is a powerful document that gives another person control over every aspect of your life.
I’m happy to say that Bob finally made it back home yesterday. We had a wheelchair ramp built to his home, cleared out anything that might be an obstacle, and arranged for in-home care. We’re all worried that he will fall and get hurt, but most of us agree. One week in his own home is better than a year in the nursing home that he deemed a “hell hole.”
Bob was so happy yesterday he couldn’t stop talking to his sister when she called. It was a long day for someone who has been confined to a tiny room for seven months, six of which he had no physical therapy and wasn’t even permitted to go outdoors.
It took the better part of the day to get all of his affairs back into order and back into his own control. We had no idea what to expect when he gained entry into his home. I worried that his bed and appliances might be gone. With one family member living in his downstairs basement and the others who had kept him imprisoned with full access to his home, his bank account, and everything he owned, it was a real possibility. They didn’t want him to ever come back to his home again.
The furniture was there, but they had emptied out the kitchen cabinets and the drawers. The refrigerator was unplugged and cleaned out. All of Bob’s belongings were piled up in stacks throughout the house. It didn’t take Bob long to figure out that his family never intended for him to come back home. Another month, and I doubt there would have been anything to come home to other than an empty house.
Along the way, we, his friends, had to answer the question of “Why did you take him out of the nursing home?” Everyone keeps telling us that he needs someone with him 24/7 to “take care” of him. So this is the area where quality of life comes into play.
There is nothing wrong with Bob’s mind. He never faltered when, time after time, he had to submit his social security number, telephone, number, and address for the various places we took him.
He knew where he was at the nursing home, and who had put him there. I thought of him often during the legal struggle of trying to get him out. I’m not sure I could have kept my sanity, waking up every day in a room so small that his wheelchair barely fit between the bed and the wall. Nothing to do all day but watch the small TV on the wall turned up to full volume with closed captioning turned on too.
At 82 years old, Bob had hearing problems before he ever had the stroke. He had the really good hearing aids that charged overnight. The charger had gotten lost somewhere along the way. His old ones needed cleaning, so they only provided minimal help. It took a while for us to learn how the hearing aids worked (or didn’t) and what we needed to do to help him hear. People used his inability to hear and communicate as evidence that he was no longer competent. It’s amazing how quickly the answers come now that he can hear the questions.
The nursing home where Bob was placed has below average ratings in every category. His family placed them there citing “money” as the reason and never bothered to check it out. They brought him his meals each day which he often sent back because he didn’t like the food. They wheeled him into the shower room regularly, although I’m not sure how often. All I know is that he always seemed clean.
A nurse brought Bob his medicine when needed. Other than those few things, he took care of himself. He went back and forth between his small bed and his wheelchair. He made his bed up. He went to the restroom by himself. And he thought about being in his own house, sitting on his front porch and working out in his garage. That’s how Bob wanted to spend the rest of his life, however long that might be.
We didn’t have to sign Bob out of the nursing home. The doctor gave him a medical release. He has nurses that come each week to take care of his medications and any medical needs that might come up. They are starting to give him physical therapy to help make him stronger. Hopefully. It’s more difficult to make progress after seven months without it, they tell me.
I’ve thought about my dog Buddy a lot while going through this ordeal with Bob. I’ve thought about how important it was to me to make an animal as comfortable as possible and help him enjoy the best possible quality of life during the time he had left. I spent a lot of time and money on his care; I would have spent a great deal more if needed. The question is, why do we look at caring for people so differently?
I’ve never heard anyone say that they want to be put in a nursing home when they get old. No one wants to be put in a box where they’ll be safe from falls or injuries that could cause them pain or shorten their life. That’s because their quality of life drops so dramatically once they are taken out of their home.
Every person has different interests and enjoys different past times. Some people are more sociable while others prefer to keep to themselves. In spite of their differences, most people prefer being in their home to any place else. At what point does another person have the right to make that decision for them?
Bob still has the same interests that he had before the strong. He is just as strong mentally as he ever was. The only difference is that he is still shaky when he walks with a cane and he has little use of his left arm. He has a disability, but we don’t think of him as disabled.
He’s been home for two weeks now. He’s spent time on his front porch and in his garage. You can’t visit him for any length of time that someone else doesn’t show up to do the same. Bob has a lot of friends from all walks of life. Many of them didn’t even know what had happened to him. More than one tear has been shed over their happiness to have him back. He’s a good person who has done a lot for a lot of friends and neighbors. The shame of the situation is that he’s done the most for the same family members who decided to lock him away instead of taking some time to help.
We don’t have the same option to end a person’s life peacefully when they become painfully ill. I always thought it was a shame that some people have to lie there and die a miserable death. Now, I can see the potential for premature deaths if someone had the option to make that decision based on their own needs or desires and not those of the loved one.
Bob’s real friends and relatives agree that any time that he has in his own home is better than having many times that in the nursing home. He is surrounded by people who love him and want him to enjoy the best quality of life possible. In the nursing home, he was surrounded by sick people who were immobile, unaware of their surroundings, and incapable of interacting with others.
Quality of life matters. Although there are many differences, it matters to animals and to people. For Buddy, making the trip to the barn to feed the horses and walking the perimeter in search of a stray squirrel or rabbit to chase was the best thing in the world. He knew his limits on how far to go and how fast to travel. No one tried to tell him to do anything differently than he felt like doing. We wanted him to be happy every minute that he had left.
We want that for Bob, too. His friendship has made a lasting impression on a lot of people. He deserves to enjoy the rest of life in the home that he worked for and built. Nothing warms my heart faster than seeing him smile or hearing him laugh. Life is good.