End of Life Care

Quality of Life Assessment

The topic of a Hedgehog’s End of Life is an important one.

 I have had many questions regarding end of life for our “quillie” buddies over the past 8.5yrs of breeding… 

We as owners are responsible for making their medical decisions for them, they cannot speak for themselves. When they are seriously ill, we want to do the very best we can to keep them from suffering. This can be a very difficult decision to make. When faced with medical issues regarding our pets how do we assess the decisions we make for them? 

I would like to share some of my ideas as well as excerpts of a very well written article on the subject:

Quality of life assessments are being used to assist in end-of-life care for pets. These assessments can be pivotal in the decision making process about euthanasia. The purpose of the QOL assessment is to determine how much an animal is suffering and in what ways, with an eye toward seeing what we can do to make them more comfortable. It is important, then, that they be as thorough and careful as we can possibly make them.

There are 4 basic elements to consider: 

Baseline: A baseline gives us a starting point and enables us to compare changes over time. What we are looking for, in QOL assessments, is a trend. Not a snapshot in time, but the trend over time: up or down or level (with bumps)? Sadly, for many ill or elderly animals, the trend will be downward. But how steep is the downward trend? Has a rather gentle decline all of a sudden turned sharply downward? One bad day, in the midst of mostly good days, is tolerable. But we might notice a trend toward more bad days. And when the good days disappear, or when they become very infrequent, or peppered in with really, really awful days, then QOL might be considered poor.

A Journal: A daily journal can include things like their mood; whether she seems to be uncomfortable or restless; activity level “seemed to get very tired”. And yes: pay attention to body fluids! Is he/she defecating and urinating normally Do they have diarrhea? Are they constipated? Is there blood in the urine? How much are they eating? Are their eating behaviors changing? Changes in activity level, eating or elimination patterns can be really important information for your veterinarian. Often these changes—even subtle ones, like walking a little more slowly—can be a sign of pain or discomfort. Our pets can’t ask directly that we take them to the vet, and the daily log reminds us to pay careful attention to what they tell us through their behavior.

QOL Scale: One of the most popular scales is what’s known as the Pawspice scale. Developed by veterinary oncologist Alice Villalobos, this scale asks you to make a numerical rating of your animal, on a scale of 0-10 (with 10 being good) in 7 categories: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More Good Days than Bad. The Pawspice scale is simple, straightforward, and relatively objective. But it has limitations (as will any QOL scale): it places an equal numerical scoring on things that don’t really seem equally important (e.g., hygiene is rated the same as pain and labored breathing), The Pawspice scale, though, is a good example of the kinds of questions we need to ask. One important piece of information that is hard to capture with any kind of QOL scale is an individual animal’s “will to live.” “Is this animal suffering?” and “Does this animal still want to live?” are two distinct questions we need to ask.

Working together with your veterinarian: QOL assessments involve a partnership between your veterinarian and yourself. This is why it is important for you to build that relationship early in your animal’s lifecycle. You are the one that monitors your animal from day to day, and keeps track of changes. The information gathered by you is indispensable to the veterinarian. Likewise, veterinarians are in the best position to assess the medical condition of an animal. We often don’t know exactly what to look for, nor are we necessarily familiar with all of the subtle ways in which pain can manifest itself. A vet can usually pick up on things that an owner has missed. Another really important thing your vet can offer is perspective: it is often hard for us to see our animal declining, and our “vision” or perception of our animal’s health can get clouded by our own anxiety, denial, fear or grief. 

Credit  Jessica Pierce Ph.D. Psychology Today