Lap of love and dog of love and animal lover and friend of love

  • Lap of love and dog of love and animal lover and  friend of love
              FANCY TEXT COPY

 hi I'm dr. Jack Daniels one of the most

common questions US hospice

veterinarians get from families is when

will I know it's time to say goodbye to

my pet and assessing quality of life and

in picking that time is very difficult

for not only us veterinarians but also

you know that the families and so I want

to talk about some some things that can

help guide you as you make these

decisions but first I actually want to

start with a patient of ours this is

Duncan Duncan is a hundred and ten pound

red Doberman he was adopted by his

family when he was older when he was six

years old and at the time of us seeing

him he was about twelve and a half now

Duncan his his personality was just you

know protector of the family but just

full force life and there's some things

that made Duncan Duncan and that's the

way he loved to hunt moles preferred

salmon flavored treats

he loved his orthopedic beds his long

walks and and hugging people with his

long neck and some treats of course now

Duncan had not many medical problems but

one thing that was unique to him was

that he was an aggressive drinker so he

drank like a water buffalo he stick his

nose in the in though in the water and

just suck it all up so that's important

as I continue this story but another

note is that he had adoring mom and dad

who loved Duncan and would do anything

for him now at about ten years old he

started to have a little bit of a

clearing of his throat episode so well

his parents then decided to bring him to

the cardiologist just to make sure that

his heart was okay because Dobermans

they commonly get heart disease and so

any coughing dog that's one of the

things that we worry about well actually

he was diagnosed with laryngeal

paralysis and that's just a disease of

the nerves of the larynx and so it

that's why it caused that little tickle

and one of the ways to to treat it is

actually to do surgery and so the owners

were concerned about surgery because of

his drinking habits one of the side

effects of that surgery is what we call

aspiration pneumonia and so as he's

drinking maybe things will go into

lungs versus his esophagus however the

owners really wanted to do the surgery

because they knew his life would would

end shorter if if he was left the way

that he was so they they did the surgery

and almost everything went well although

he did vomit because of this sedation

and anesthesia so he did have a little

aspiration pneumonia post surgery and

here's a picture of Duncan with his with

his I call it the the the air the air

snorkels but he recovered well with no

other problems and the owners are

thrilled and he went back to his mole

hunting life and hugging people and just

enjoying life as a senior so all was

good for about two years except for the

owner started noticing him dragging his

feet a little bit and so in the sand

where they would walk they start to see

just a little toe drag or on the on the

pavement they would hear his toes

dragging and although he had good muscle

tone they just noticed every now and

then that he would start to sink a

little bit and so now you know he's

about 12 years old that by this time and

they they added on some some medications

for his for his mobility issues and so

at a hundred and ten pounds you can

imagine that that's a lot of medications

for them to give Duncan

however they were dedicated to his to

his condition and making sure that he

had he had the best one of the things

that we commonly recommend with Lorenzo

paralysis his acupuncture and Duncan

actually was a very good patient for his

acupuncturist and tolerated treatment

really well however a couple of months

after they started noticing this

mobility issue he started having some

some respiratory increased effort and

increased coughing and just some less

energy that wasn't normal for Duncan so

that's when they you know called their

hospice veterinarian and you know we

work together to work out some of the

concerns that we'd have first of course

is that aspiration pneumonia which is a

common problem with Loranger paralysis

maybe there was a failure of the surgery

site so even though had been maybe two

years since his surgery we wanted to

make sure that that wasn't an

possibility again any coughing dog we

always worry about heart problems

particularly with Dobermans or maybe

there was just something new that was

going on that is just adding on to his

to his problems well at the cardiologist

he was diagnosed with DCM which is

dilated cardiomyopathy he also had

arrhythmias some thickened valves so his

heart was not well on top of his

mobility meds we needed to add some meds

for his heart as well

now the concerns at this point were that

Duncan may actually have an arrhythmia

and have sudden death and you know I had

to talk to the owners to say that's

that's something that could happen where

he dies on his own and it's not painful

but you may not be present and and just

wrapping our minds around that was

something that I had to help the

families with the other is when the

heart isn't well we could it could lead

to heart failure and that's that's

actually fluid buildup in the lungs and

that could lead to respiratory distress

and the owners did not want that because

that's that's anxiety and it's it's a

form of suffering that we definitely did

not want for Duncan but we monitored

hurt him and made sure he was taking his

drugs well and and enjoying his life

except for as the as the week's went on

his appetite started wavering his energy

kept decreasing now he he was starting

to get some diarrhea and then he didn't

want to take those pills anymore and

those were a lot of pills and then he

was peeing and drinking a lot so when

you're on some of those heart meds your

pet will drink drink drink drink drink

and then pee pee pee and at 110 pounds

that was a lot of urine to come home to

so we started to making the you know to

think about making the decisions for for

when to say goodbye now some concerns

are that mom and dad didn't totally

believe the same the same right they

weren't on the same page and that's so

common alright there's there's always a

family member that may want to keep on

going or one family member is done and

they want to say goodbye so there's

rarely a time where everybody's in

agreement so if that's your family

you're not alone now another problem

with this particular case is

mom traveled a lot so most of the

caregiving fell on dad so all those

pills all that drinking and pain and

Mickey dreams going to his cardiologist

appointment that was dad responsibility

and it could it could get difficult now

thinking about when is time again that

the family wasn't always on the same

page now mom wanted to make sure that

she tried everything all that the best

drugs the best specialist the

acupuncturist but she knew she would not

let her boy go into respiratory distress

or heart failure now dad dad wanted his

boy to go like a warrior now what does

that mean so for dad that meant you know

he wanted his boy to still be running

around chasing moles loving on people

still having an appetite not having


he just wanted what what Duncan's

essence was to still be there when he

said goodbye now I'll get back to Duncan

and and and what happened with him but I

want to now focus on this question that

we get so often doc when will I know his

time and if you're having this question

and asking your veterinarian I hope I

can give you some some tips when I'm

asked about when is time I have to put I

have to look at different categories one

is the ailment that the pet has is it a

mobility issue is it is it a heart issue

is that another organ failure is it

their mind and cognition and so I want

to talk to the owners about how that

ailment is going to progress over time

and how they may pass from that

naturally or when it comes time to make

a decision

the next category I'm gonna look at is

the pets personality how well do they

handle all the medications we have to

give how well do they handle being left

at home for 4 hours at a time

you know how well do they handle maybe

other pets in the house and and them

having struggles trying to get out the

door when the younger pet crashes

through the door and pushes them out of

their way so I want to take into

consideration their personality and what

makes them the warrior the next category

I have to look at is the personal

beliefs of the family and like I said

earlier not everybody's going to agree

with when is time or when do we want to

keep on going and so that can be

one of the most challenging parts of all

this the next category are the budgets

and I want to focus a little bit on the

budgets what's the quality of life not

only for the pet but also the family and

that's where the budgets come into play

first off there's the financial budget

of taking care of your pet it's not easy

you know there's there's some

medications there's maybe some pet

sitters or pet walkers that you have to

afford depending on the size your pet

those medications may be more expensive

if you have a hundred and ten pound

Doberman versus a 10 pound Chihuahua so

that's something to you know to

understand it that we have to all

struggle with the next budget is time do

you have enough time to care for your

pet and that's hard Duncan he had to be

let out every four hours because he

would if not pee in the house and that

was hard for the family you know who

here has a job where they could go and

come back every four hours

luckily for Duncan his dad worked from

home but time is always so precious and

sometimes we don't have enough of it to

take care of ourselves let alone a

geriatric or terminally ill pet or maybe

we have to travel for work or travel

just with our family and who best to

take care of our loved ones but

ourselves and so that sometimes starts

to change what we do on vacations or

work the next budget is the physical

budget can you physically handle your

pet in the ailments that that they're

struggling with so for Duncan he had

mobility issues well he's 110 pounds and

so to lift him could become very

difficult but even a small dog is not

always easy to manage or a cat picking

them up to give them their drugs or

their medications can be a challenge the

last budget is the emotional budget are

you emotionally able to handle

everything that's going on whether it's

deciding when to say goodbye bringing

them to the to the doctor seeing them

not themselves and so that emotional

budget and that emotional category is

one that we all forget about but weighs

heavily on us as a hospice veterinarian

I know that if any one of these budgets

done I support the decision of the

family to say goodbye so if they

financially can't manage or can't afford

the treatment that's best for their pet

it's okay

and I'll help them say goodbye if they

don't have enough time to properly care

for their pet I'll help them say goodbye

if they physically can't help pick up

that dog or pick up that kitty cat then

I'll help them say goodbye and if

they're emotionally ready I'll

definitely help them say goodbye now

remember one of the categories that I

talked about which is the pets ailment

when I'm helping a family I want to I

want to consider how the pets disease

process is going to is going to present

itself towards the end and so most of us

or a lot of people say I want my pet to

die in their sleep to die in their bed

and we want that so we don't have to

make that decision and trust me I

understand and I myself I hope I pass at

home in my bed but that's not always the

case and sometimes we as pet parents we

have to make the decision to intervene

so that way our pets don't suffer so

when I'm helping an owner and I'm

talking about the disease they they have

I want to talk about how how they will

passed from that disease and how quickly

we need to make that decision now how

quickly we need to call and make an

appointment for for a euthanasia and so

if we have an imminent disease that

means we don't have a lot of time to

plan and so this is usually diseases

that affect breathing so anything that

that puts our pet in respiratory

distress so for example heart failure

like Duncan or laryngeal paralysis like

Duncan before his surgery maybe a spread

of cancer to the lungs or collapsing

trachea all these diseases affect

breathing and when you can't breathe

that's the worst feeling and so

unfortunately that one that when we get

to that point things things go go really

go really south fast now on the other

end we have non emit diseases where the

elements of those diseases take a very

long time to cause a really bad issue so

for instance kidney failure and

many cats have kidney failure and they

could live for years with with very

minimal ailment from it or symptoms from

it and so maybe a little in a patent

maybe a little vomiting here and there

but they've probably done that their

entire life and so we are we are left

with a lot more time to make that

decision another non imminent disease

that we see so often is is like dementia

but in dogs and cats and so they may

they may act Spacey or not really

coherent all the time so this is not

necessarily a sufferable disease and so

we may be we may be gifted with a lot

more time with them before they they

really start to suffer and somewhere in

between are some of the diseases that

you know what we we don't have a lot of

time but it's not an emergent situation

when that time comes so I want to help

families pick the best time and it's not

always knowing when the best time is but

also the best experience and so if we

need to euthanize our pets if we need to

be the ones that make that decision what

do you want the experience to be do you

want to have maybe an intimate setting

with just a few family members or do you

want to have almost a party to wish your

best friend goodbye with all the people

that they love surrounding them and so

if we want to plan that event sometimes

we have to think about the disease they

have to make sure that we have enough

time to plan such an event now when I

talk to owners about when is time I kind

of break it into three categories first

is quality of life is good for the pet

and for the parent now they may be

struggling with some mobility issues or

crying at night or something like that

but but for the most part their quality

of life is good and the family is okay

and all the other budgets so they're

able to handle that pet well on the

complete other side I see act of

suffering happening and that's what we

want to avoid that and these are

sometimes the worst euthanasia is

because everybody's anxious the pets

anxious the family's anxious the

veterinarians are anxious we want the

very best but when when the body's

shutting down and and suffering is

occurring things don't always go as well

as we had hoped now in between is a

very large area and this is the

subjective time period I call this the

roller-coaster and so you might have

good days and bad days and you just

rollercoaster through the weeks and

months and some days you may say you

know what we had a really bad weekend

and and now it's time but then Tuesday

pops and he's fine and so then you then

you say no no I don't want to do it so

this subjective time period is it's hard

to be in but this is actually where most

of you are finding yourself and that's

why I wanted to do this to help you you


guide yourself along that path now

anytime a pet is in this subjective time

period it's okay to say goodbye and so

where I would euthanize my pet or your

neighbor or your friend or another

family member you know it's irrelevant

it's it's what's best for you and your

family and so at anytime if your pet is

in that subjective time period whether

they're closer to all is good or even

touching the the act of suffering I

support your decision to say goodbye so

if you had that really bad weekend and

Tuesday he's doing better but you know

what you don't want another bad weekend

I'll help you say goodbye now

there's a couple of symptoms that

hospice veterinarians deal with a lot

and these symptoms can change quality of

life quite drastically so mobility for a

dog you know we think about our dog so

it makes them happy and going for walks

and run around the yard and chasing a

tennis ball or something like that and

so mobility for dogs is very important

cats not so much you know they they they

do get arthritis and some mobility

issues but for cats laying on the couch

or laying in a sunbeam is so important

to them so some other symptoms that we

help manage those hydration appetite we

do see the changes of appetite as we get

older hygiene are they able to stay

clean are they urinating on themselves

or they're not able to groom themselves

if they're a cat happiness is important

and sometimes that's hard to decide when

is your pet when is your pet happy and

and this is where I fall on the owners

the most is to help understand what what

makes that pet them what makes Duncan

Duncan what makes you know the cat love

the Sunbeam where some loves to just you

know be a part of

of the family you know events so

happiness is a very unique symptom let's

say to each pet and each family and the

last symptom that we have to manage very

carefully is pain and so almost

everybody is going to say I don't want

my pet to be in pain I don't want them

to suffer and I completely agree except

for sometimes we don't always know

what's going on with our pets and I

don't want to say they hide their pain

but you know they just deal with it

differently most dogs and cats just

don't complain I can get an infected

hangnail and I'm you know shut down for

the whole weekend where

a pet could be limping along with the

worst arthritis but still wagging their

tail and so deciding when this time

based on pain can be tricky because we

don't always know how to read our pets

and so I like to divide pain into three

different kinds of categories or types

of pain first is the pain that we all

recognize like arthritis right so we all

know about that kind of pain or can

imagine what that feels like and so

that's a type of pain that that we see

often especially in larger breed dogs

another type of pain is disease or

malaise just feeling achy this is

usually the cats with end-stage kidney

failure or end-stage lymphoma and so

just having that malaise and ickiness is

is a form of pain the last type of pain

is anxiety or distress and so maybe dogs

with cognitive dysfunction and they're

anxious when their owners leave and or

when thunderstorms are you know what

they used to be upset about

thunderstorms now as an everyday

occurrence or any of those respiratory

distress symptoms that's another type of

pain and so I want you to think about

that that it may not be obvious to you

with the limping dog but maybe if

they're just not feeling good or they're

not that's why they're not eating or

they're vomiting or they're so

distressed all day long that's not a

good quality of life now a lot of people

will think don't worry you'll know when

is time and I avoid that because we

don't always know when is time and

especially when it's you and your own

pet it's hard to understand all these

signs of pain or disease or malaise or

anxiety you know what we we don't

want to say goodbye and so sometimes

it's difficult to assess that now some

people say don't worry they'll give you

a look well there's not always a look

and trust me if you've got if you've got

a Labrador that's got mobility issues

Labradors just never have a bad day

they've got a joy gene that I wish I

could tap into sometimes but they don't

always give you a look alright so don't

don't always think that that's something

that you're going to see now here's my

own cat Herbie and Herbie had a primary

lung tumor which affected his his

breathing and as you know I don't like

that and if you see that one picture

where he's laying on my chest and I look

at his face and I think that's that's a

look and so what I realized though is

that if I'm waiting for for a pet to

give me a look I'm waiting for like what

Herbie did and Herbie was suffering and

even as a educated veterinarian I know

it's so difficult to say goodbye that I

think I waited too long for Herbie and

and and I was waiting for a look and

that that means I'm waiting for a look

of suffering and so I want you to avoid

suffering in your pet and so maybe it's

not cut and dry to just look for a look

now evaluating quality of life can be a

challenge but there's different ways

that we could monitor our quality of

life and so I want to go over some some

common common ways that you may here

first is finding their top five favorite

things to do and maybe that's going for

a walk sitting with you watching TV


I don't know having friends come over

whatever that may be whatever makes your

pet your pet figure out those top five

favorite things and when they're not

doing three of them consistently maybe

it's maybe it's a time to intervene but


I want you to be careful because some of

the diseases your pet may have they will

still be doing these five favorite

things even though they're actively

struggling throughout the day so I see

this a lot with cognitive dysfunction so

they may still be eating and wanting to

go for a walk and doing those things

that you've categorized but 90 percent

of their day their

just standing still staring into a

corner so you have to be careful about

these five favorite things and making

sure you're thinking about the disease

they have and well that disease effect

these five favorite things I also like

to add instead of five favorite things

do four favorite things but add

something that they hate that they're

passionate about

so for Duncan he was passionate about

protecting his family from the Goodyear

blimp that flew over the house at 10:00

and for every day and so when that motor

started to be heard he would get all

worked up and start to yell at that

Goodyear blimp or bark at the Goodyear

blimp to let him know that he's in his

airspace and so I told you you know dad

that you know what if he stops caring

about that Goodyear blimp

it just doesn't care maybe that's where

he's he's not feeling so well and he

can't you know his heart Maeby's is

giving up so much energy that he can't

expend the energy on telling the

Goodyear blimp to go away so add

something they hate to the five now on

the theme of five there's a wonderful

website the ASPCA pro org and they talk

about the five freedoms so I encourage

you to go to this website and learn more

about these five freedoms now one of the

most common things I hear someone say is

you know what when he's had more bad

days than good and I know when is time

but you know if you don't measure what

you're monitoring it's very difficult to

decide is it more is it more good days

than bad days and so one easy way to do

this is and this is very good with

children is get to jars and put the

words good on one and bad on another and

have as a family a decision of was today

good or bad and then put a penny in one

of those jars and at the end of the

month or two months what what jar is

more full and so that's one easy way to

monitor another is simply getting a

calendar out and putting it somewhere

where everybody can see so on the

refrigerator and putting a big red X on

the on the bad days but you have to

decide as a family what is it bad day is

it not sleeping through the night

is it not eating well is it howling

whatever it may be that that is a bad

day for your pet with their with their

ailment and their personality that is

something you have to decide first and

then you

want to check off or put big red X's on

those bad days here's an example

calendar and if you just look at it


it's almost equal right so it's just as

many good days as bad days and so maybe

it's time to to say goodbye in this pets

case another thing that a calendar will

allow you to do is look for trends so

look at Friday what's going on and in

this case it was the garbage truck that

always came and it worked up the dog

into such a panic that the rest of his

day was just downhill and so maybe you

actually can do some some home

adjustments to make them better there's

an app that we've created at lappa love

called gray muzzle and it's free for you

and you can download it on your on your

iPhone or your Android and what it will

do is it'll allow you to create a

profile for your pet and then every day

you could say if it's a good day bad day

or just kind of an okay neutral day and

then there's some calendars or some

graphs that you can visually look to see

how how your pet is is progressing

there's also some quality-of-life scales

and Diaries that we have available on

our website and there's some categories

that we want you to focus on like

mobility or appetite and you're going to

give it a score of like zero one or two

and then you're going to add up all of

those categories and then there's a

chart to go off of to see if if your

quality life is okay or if

interventionists is best this is an

example of a friend of mine in Canada

she's a hospice veterinarian and on her

scale she adds if the pet is giving love

or taking love and this comes to their

personality because sometimes maybe

there's a cat that never get never gave

love and so this wouldn't you know be a

good way to judge that cats a

progression but maybe maybe for your pet

actually knowing if they're if they're

loving on you or wanting you to pet them

that's a good indication of quality of

life this is a family who had gotten

gigantic postie notes and they put it on

the wall and this is for their golden

retriever bogey and every day somebody

from the family would write how well he

slept if he took his medications if he

ate did he have diarrhea and just his

general attitude and similar to labs

golden czar

pretty happy dogs and so they wanted to

monitor how his happiness and how he was

doing and so this was really great

because it was such a big poster in the

middle of the living room that everybody

can see and that's what I want you to do

is have everybody involved and

everybody's seen what's going on because

if you're the primary caregiver and

nobody understands that the struggles

that you are facing every day then when

it comes time to make that decision they

may not be in agreement with you so get

the whole family involved we also have a

tool called the Pet hospice journal and

what this allows you to do is create a

profile for your pet and you're gonna

pick the disease that your pet is

struggling with and based on that

disease we're going to monitor the

different symptoms that that happen

because of this disease so for instance

if your dog has mobility issues we know

they're probably still gonna have an

appetite so we really want to focus on

the things they struggle with with

mobility issues and so the Pet hospice

journal is a little bit more advanced

than the grey muzzle app but it may be a

really good tool for your family now one

of the things I love about that Pet

hospice journal is it allows you to post

pictures or attach pictures every day

and looking at pictures is so important

because how your pet looked maybe just

even a year ago could be very different

than how they look now and so every day

is you see your pet every day you don't

always notice the changes as they're

occurring and so just looking back and

and seeing how they looked when they

were healthier may give you clarity on

how they look now and so I really love

and encourage you to go look at pictures

of your pet another thing that I adore

are bucket lists so these are a list of

all the favorite things that your pet

enjoys that you want to make sure they

do before you say goodbye and here's

Eddie's bucket list and there's things

on here like you know going to the park

and having a steak dinner even attending

a birthday party and not inviting Emily

for some reason and I love Eddie's bonus

which is writing in a firetruck and so

they were able to check off everything

that they did for Eddie before they had

to say goodbye and I tell you when when

the day came for them to say goodbye to


they had no

rats because they did everything on his

bucket list so think about your pet and

their personality and what what's

important to them now and make that list

and check off all those favourite things

there's a place called denial island and

I've been there myself with my own pets

and it's just really hard when you're

when you're dealing dealing with these

things yourself

when it's your pet and you don't want to

say goodbye that we could maybe let

things go a little bit too long and and

I understand now a smaller version would

just be denial goggles and this is Darby

Darby was a patient of mine many years

ago and Darby's mom was the one who told

me about denial denial Island and so she

did some quality of life scales but she

kept giving Darby excellent and

everything is fine but she knew to her

be was not well so she asked me if I

would do the quality of life scale for

her because she was on denial island and

maybe that would be helpful to you is

getting advice from from friends or

family that know you that know your pet

better than then maybe you do at this

time because you've got those denial

goggles on and they can help you now

going back to Duncan and is it time for

him and so I want you to think about

everything that that that we learned

about the budgets of the family and his

personality and the ailment that he's

got with that heart failure and how his

how his disease is gonna progress and

and how how his goodbyes will be so

Duncan's family had a previous

experience with their last Doberman Neos

so they loved Dobermans now neo had

cancer and his medications were making

him drink a lot and pee a lot and so

they had to when they left for the day

had to had a blockade um in in a hallway

well unfortunately they came home one

afternoon and neo had passed on his own

and although like I mentioned earlier

many of us want our pets to die on their

own they actually weren't ready for that

especially in the middle of the day and

they didn't get to say goodbye they

didn't get to say I love you and so when

they came home and neo was already gone

it was very traumatic for them and they

knew they didn't

wanted to not be present again and so

they thought about that when when

evaluating quality of life was was

happening with Duncan so now with his

mobility issues and his heart issues his

pharmacy got to be a little bit a little

bit big and so he had to take many pills

multiple times a day and the family is

willing to do that they would have done

anything for Duncan but Duncan started

to not want to take his pills now one

day when mom was traveling Duncan's dad

sent her a text message and it said

Duncan is not eaten in a day and a half

now and I'm really tired of trying to

figure out what to do cat food meat

cubes pill pockets I've killed him the

last nine times and now today it looks

like I'll have to do it all again so I

want you to think about the budgets what

budget is is about for dad and that

would be the emotional budget he can't

handle this anymore his dog his Duncan

is not the warrior that he that he was

and so dad is ready to say goodbye the

problem was is that Duncan's mom was me

and I wanted to make sure that I did

everything I could as a veterinarian but

you know what I'm still a mom and I

wanted to also make sure that his

quality of life was good and that I

don't I don't keep holding on just for

my own reasons and so you know what I

agreed with dad is that I wanted him to

go like a warrior too and so I wanted to

make sure that I was home and present

and did his bucket list so we made a

bucket list for Duncan and what's

important to him and it was everything

from a slumber party to an in-and-out

party visits from his human girlfriends

and even one last pee on the neighbors

plants and maybe a chase into the mail

truck and it was was not his normal

chase into the mail truck

but a few good barks he got in and so I

made sure that we did everything on his

bucket list

it's that way when it came time to say

goodbye I would still have grief but I

would not have regret and so a year ago

I had to say see you later

to my boy

and you know I tell you this story

because I want you to know that you're

not alone in this difficult decision

you're not alone on denial Island you

have a support system here at lap of

love our veterinarians will help you

with assessing quality of life and

guiding you through this important time

and important decisions well I hope this

gave you some information and tips on on

how to best assess quality of life for

your pet in your family and I hope it is

going to help you in in deciding when is

time to say goodbye and if we can say

goodbye surrounded by friends and family

and give your pet the love that they

deserve then even though it will still

be sad you'll know that you've made the

best decision