- Lap of love and dog of love and animal lover and friend of love
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
diarrhea
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
know
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
eating
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
quickly
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
Eddie
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
