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


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