Quality of Life

I seem to be drifting, or maybe rolling along kicking and screaming, I don't know - toward trying to find acceptance of the potential loss of Scruffy.  It's clearly inevitable - despite the apparent remission and disappearance of the lymphoma tumors, his kidneys are overtly on borrowed time.  Special food, fluids,  phosphorus binder, (and a new addition, a probiotic intended specifically for CRF cats given to me by Choy-Foong) - and yet, the kidney bloodwork just gets worse and worse and worse.  I don't want him to suffer; I don't want to keep him alive just because I  need to have him here. And yet, despite the hopelessness of the situation, and the stress of trying to maintain him as best I can, I am convinced that he's not ready to leave yet.

This is the Quality of Life Scale, developed by a vet named Alicia Villalobos:

Quality of Life Scale1         The HHHHHMM Scale
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.
Score	Criterion
H: 0 - 10	HURT - Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet's pain successfully managed? Is oxygen necessary?
H: 0 - 10	HUNGER - Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?
H: 0 - 10	HYDRATION - Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
H: 0 - 10	HYGIENE - The patient should be brushed and cleaned, particularly after elmination. Avoid pressure sores and keep all wounds clean.
H: 0 - 10	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?
M: 0 - 10	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.)
M: 0 - 10	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 needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
*TOTAL=	*A total >35 points is acceptable for a good pawspice

                                                        
1.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.

I can't bring myself to sit down and do this, to assign points to Scruffy's life,  right now.  Just looking over the categories, I think strongly that I'm right, he's not in the lower ranges at this precise moment in time. There is, I have to admit, some comfort in thinking that somewhere along the way, this chart could be helpful in pushing me to make a reasoned determination that we can't go on.  But not now.  For now, we'll keep doing what we can do.  I am seriously considering giving up the chemotherapy.  It's incredibly expensive, it's starting to seem to have side effects that are unpleasant for Scruffy, it may be contributing to the kidney failure (although the oncologist has said that the drugs they're using are not kidney-toxic...), and I have to keep reminding myself why I am putting him through this.  Which is a good question, of course.  Why?  Not just "because I can."  Sincerely, I want to allow Scruffy to be here as long as he wants to, and as long as it's possible for him to be comfortable.

When this whole nightmare began - can it be only a few weeks ago? - and The Puffer ended up in the hospital, I was desperate to find an animal communicator to talk to him - to tell him that I would come and get him, because I didn't even get to say good-bye to him - and to find out if he thought he wanted to go on.  Two communicators talked with him.  He was saying then that he was just tired, "drained".  While he was still in the hospital, he seemed to be more hopeless, more ready to give up.  Once he came home, and he resumed what was pretty much his old life, with the addition of a whole bunch of medication and vet appointments and the occasional insulin shot again, he just was himself.  Wandering around with that ploofy, untouchable tail in the air, sleeping in my hand, eating enthusiastically.  I keep saying,  "If you didn't know he was dying, you'd never know he was dying."   And that's still true, although his appearance is getting pretty sad, with all the shaving and the weight loss, particularly in his little face.  He doesn't jump as well, but then, he's old, and he's got horrible diseases - what do I expect??  The essence of my ScruffyPumpkinPattyPaws is still there, still as oblivious to pretty much everything but me and food.  So, I feel like, as long as there isn't pain involved, as long as he can still enjoy his food, and the contact and affection I can offer him in huge quantities, we're still in the game. I don't know for how long, and I wish I could arrange the end to be the way I want it to be, without the vet and his cold stainless steel table, but.....  What's the Alcoholics Anonymous motto?  About changing what can be changed and accepting what cannot?  I guess that's where we are. Reaching somewhat desperately for acceptance of something that should never have even happened.  It stinks.  (Obviously, I have a ways to go to find that stupid acceptance....)

My sweet boy, on the day that we learned that the tumors were gone.  Very short-lived euphoria......