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Hello. Thanks for writing in. My name is***** and I would be happy to help you. When I am evaluating quality of life, I look at their appetite, activity level, interaction with the family, pain assessment, demeanor and bathroom habits. If he is not eating, getting thinner, getting weaker, sleeping all day, doesn't interact with the family, seems painful when getting up an moving around, constantly has stool problems, seems anxious or has urination or defecation accidents in the house; the quality of life is usually starting to get bad. Of course, if you see multiple of these issues forming, I would seriously consider euthanasia. You didn't mention if the vet gave a steroid injection this last time. If not, that may actually help him feel better and increase his appetite. The effects are transient, but it helps. I would also consider starting him on some metronidazole (prescription from your vet) and/or a higher fiber diet to help with the loose stools. Usually a teaspoon of Metamucil or pure canned pumpkin suffices. Please let me know if you have any other questions or concerns. Hope this helps.