Home Tests

The two most important home tests to do when trying to assess whether or not it is in your pet's best interest to proceed with euthanasia are the Quality of Life test and the Pain list.

First, lets look at the Quality of Life Scale:

A scoring system for life quality called the HHHHHMM Scale was developed by Dr. Alice Villalobos. The letters stand for: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More Good Days than Bad. It is an excellent tool for evaluating and keeping track of your pet’s Quality of Life as the disease or end of life process progresses. For more information, please visit our Quality of Life page. In order to perform this test, assign scores from 0-10 on each of the criteria on the scale. A score of 35 or more indicates acceptable Life Quality.

Quality of Life Scale: The HHHHHMM Scale

Hurt

Adequate pain control, including breathing ability, is of top concern. Trouble breathing outweighs all concerns. Is the pet's pain successfully managed? Can the pet breathe properly? Is oxygen supplementation necessary?

Hunger

Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?

Hydration

Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.

Hygiene

The patient should be brushed and cleaned, particularly after elimination. Avoid pressure sores and keep all wounds clean.

Happiness

Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be close to the family activities and not be isolated?

Mobility

Can the patient get up without assistance? Does the pet need human or mechanical help (e.g., a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)

More good days than bad

When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision for euthanasia needs to be made if the pet is suffering. If death comes peacefully and painlessly at home, that is okay.

Total

Pet caregivers can use this Quality of Life Scale to determine the success of pawspice care. Score patients using a scale of 1 to 10. As a reference point, a 10 would be given to a pet who is exhibiting the appetite, happiness, mobility, etc... of a 2 year old pet in the prime of his/her life. A score of 1 is extremely poor. The lowest the score, the worse the Quality of Life. A score of 35 or above represents acceptable Life Quality. In order to get as accurate a score as possible, please refer to the text in the Quality of Life Page which gives additional information regarding each of the criteria below.

Adapted by Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN, 09/2004, for Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, by Blackwell Publishing, Table 10.1, released 2006.

**For help in assessing the "Hurt" criterion, see the section on "Understanding Pain".

It is recommended to start keeping track of your pet's Quality of Life scale score as soon as you know that he has a terminal disease or as soon as you realize that he has a chronic progressive condition (such as arthritis). Keep a journal with his QoL scale score and the date. You can repeat the test monthly, weekly, daily... depending on how fast his condition is progressing.

I also recommend that you make a sort of a contract with yourself early on. Sit down and think of your pet's favorite activities, the things he enjoys most, his current condition... and think of how far into the illness you want to take your pet. Write down some of the things that are likely to happen as the condition progresses and what you wil not permit to happen (for example, that you will make the decision before the time comes when he cannot get up anymore, or list some of the things your pet likes to do and make a contract with yourself that once he ceases, for example, to be interested in his favorite toy, won't wag his tail at your arrival, doesn't enjoy his walks... etc... those are just examples. Make the list personal according to your baby's favorite things.)

Pain indicators

In order to assess if your pet is in pain, you can scan the list below and see if your pet exhibits several of those pain indicators. For a more precise use of this list, as in the case of seeking to achieve optimal pain management, it is recommended to print the list, date it and place a score from 1-10 on each of those pain indicators (0 being that the symptom is absent and 10 being maximum manifestation of the symptom). Then repeat the test periodically after initiating pain management or modifying your pet's pain management protocol. Keeping track of these symptoms and how their intensity varies throughout the course of the disease will help you monitor the progress and the success of any pain management being conducted. You can compare the scores gotten from week to week by looking at the prior results and put them in date order in a folder. And it will also enable you to see when pain management is no longer effective and when it may be time to let your pet go.

Pain Indicators list

Questions	1	2	3	4	5	6	7	8	9	10
1. Droopy head	1	2	3	4	5	6	7	8	9	10
2. Droopy ears	1	2	3	4	5	6	7	8	9	10
3. Tucked tail	1	2	3	4	5	6	7	8	9	10
4. Does not want to play	1	2	3	4	5	6	7	8	9	10
5. Lack of social interaction	1	2	3	4	5	6	7	8	9	10
6. Does not enjoy games	1	2	3	4	5	6	7	8	9	10
7. Subtle lack of alertness gradually increasing to a deep apathy (early sign will be subtle)	1	2	3	4	5	6	7	8	9	10
8. Diminished appetite	1	2	3	4	5	6	7	8	9	10
9. Body tension	1	2	3	4	5	6	7	8	9	10
10. Facial tension	1	2	3	4	5	6	7	8	9	10
11. Accepting treats or food gingerly (particularly if pet used to accept them enthusiastically)	1	2	3	4	5	6	7	8	9	10
12. Lack of interest in walks	1	2	3	4	5	6	7	8	9	10
13. Doesn't respond when called	1	2	3	4	5	6	7	8	9	10
14. Worried or sad facial expression	1	2	3	4	5	6	7	8	9	10
15. Ears pulled back or flattened	1	2	3	4	5	6	7	8	9	10
16. Eyes wide open to expose “white of the eye”	1	2	3	4	5	6	7	8	9	10
17. Avoidance of direct eye contact	1	2	3	4	5	6	7	8	9	10
18. Lips may be retracted, exposing the teeth in a submissive grin (dogs)	1	2	3	4	5	6	7	8	9	10
19. Almond shaped eyes (caused by facial tension)	1	2	3	4	5	6	7	8	9	10
20. Whiskers pulled back against cheeks (caused by facial tension)	1	2	3	4	5	6	7	8	9	10
21. Uncomfortable when resting	1	2	3	4	5	6	7	8	9	10
22. Shifts frequently when resting	1	2	3	4	5	6	7	8	9	10
23. Head held abnormally low	1	2	3	4	5	6	7	8	9	10
24. Difficulty getting up	1	2	3	4	5	6	7	8	9	10
25. Excessive panting (particularly when it is not hot)	1	2	3	4	5	6	7	8	9	10
26. Shivering/trembling/shaking	1	2	3	4	5	6	7	8	9	10
27. Unsettled	1	2	3	4	5	6	7	8	9	10
28. Pacing	1	2	3	4	5	6	7	8	9	10
29. Difficulty moving after a long rest	1	2	3	4	5	6	7	8	9	10
30. Difficulty lying down	1	2	3	4	5	6	7	8	9	10
31. Slow or unusual gait	1	2	3	4	5	6	7	8	9	10
32. Limping	1	2	3	4	5	6	7	8	9	10
33. Hunched back	1	2	3	4	5	6	7	8	9	10
34. Compulsive licking or rubbing of a certain body part	1	2	3	4	5	6	7	8	9	10
35. Looking at sides or other body part suddenly and/or worriedly	1	2	3	4	5	6	7	8	9	10
36. Suddenly running away from “nothing in particular”	1	2	3	4	5	6	7	8	9	10
37. Can't jump on couch or bed	1	2	3	4	5	6	7	8	9	10
38. Reluctance to lie down	1	2	3	4	5	6	7	8	9	10
39. Sleeps in a position that avoids a certain body part from touching the ground or bed	1	2	3	4	5	6	7	8	9	10
40. Any change in normal sleep patterns	1	2	3	4	5	6	7	8	9	10
41. Purplish tongue color (NOT gums: tongue)	1	2	3	4	5	6	7	8	9	10
42. ”Guards” a particular body part	1	2	3	4	5	6	7	8	9	10
43. Reluctance to be touched in a certain area	1	2	3	4	5	6	7	8	9	10
44. Reluctance to be picked up	1	2	3	4	5	6	7	8	9	10
45. Lying down at a distance from everybody and somewhat isolated	1	2	3	4	5	6	7	8	9	10
46. Disinterested in surroundings	1	2	3	4	5	6	7	8	9	10
47. Unusual attention seeking	1	2	3	4	5	6	7	8	9	10
48. Flinching when touched in a certain area	1	2	3	4	5	6	7	8	9	10
49. Doesn't rest easily when lying down	1	2	3	4	5	6	7	8	9	10
50. Aggressive behavior to protect a particular area	1	2	3	4	5	6	7	8	9	10
51. Aggressive behavior on a usually docile pet	1	2	3	4	5	6	7	8	9	10
52. Crying when a particular area is touched	1	2	3	4	5	6	7	8	9	10
53. Wakes up at night	1	2	3	4	5	6	7	8	9	10
54. Does not sleep well	1	2	3	4	5	6	7	8	9	10
55. Refusal to go on walks	1	2	3	4	5	6	7	8	9	10
56. Moaning	1	2	3	4	5	6	7	8	9	10
57. Whimpering	1	2	3	4	5	6	7	8	9	10
58. Refusing to eat	1	2	3	4	5	6	7	8	9	10
59. Pressing head against wall (if head pain is present)	1	2	3	4	5	6	7	8	9	10
60. Unable to get up	1	2	3	4	5	6	7	8	9	10
61. Crying in pain	1	2	3	4	5	6	7	8	9	10
62. Teeth clenched, biting down on an object (particularly cats)	1	2	3	4	5	6	7	8	9	10
63. Howling/screaming uncontrollably	1	2	3	4	5	6	7	8	9	10

Home Tests

First, lets look at the Quality of Life Scale:

Pain indicators

Pain Indicators list

My pet is suffering, what do I do?

Find out more