In this week’s issue here’s what we are sniffing out

• Does my dog have a good quality of life?

• Hospice Companies

The Hard Topic of Quality of Life

Tackling issues about quality of life is an intensely sensitive topic, and for good reason. It’s a very subjective conversation; different for each dog and each family, and even each situation. As pet parents, we know our dogs better than anyone, even our veterinarians. They know more about the medical implications of age and disease on our dogs, of course. But we know a lot more about our dogs’ day to day well being, the changes they’re going through, and if they’re happy.

A primary concern for evaluating quality of life is the dog’s personality type to begin with… The dog who has truly embraced a couch potato life has a different definition of quality than the dog who has continually chafed at the restraints caused by aging. Quality of life is different for any dog, and it doesn’t make sense to apply the same measures to all of them across the board.

Are we able to see the reality of our dog’s situation?

I would argue that we aren’t always able to see things clearly. We get so mired in day to day management of declining conditions that we don’t always see reality. Changes happen so minutely, so gradually, that if we look back 4 months ago, we might be shocked to see how much is different for our dogs’ health and care.

A few comments I hear frequently:

My dog is eating and pottying normally on her own. That in and of itself doesn’t always mean quality of life is good OR bad... It really depends on how many other quality of life issues the dog is facing. If the dog is eating and pottying on her own AND she still has other things she enjoys doing, then great. But if that’s all life boils down to in activities these days, perhaps quality of life is low. Our little Groot who died just before 16 years old, would not have considered that an acceptable life. She loved spending her days running around doing things everywhere, and wouldn’t have been happy with sleeping, pooping and eating as her primary activities.

I am really hoping my dog just falls asleep one night and doesn’t wake up. No one wants to make the tough choice about euthanasia, that’s just a fact. But I feel strongly that we do have an obligation to make sure our dogs are not suffering, or existing as shells of their former selves because we don’t want to say goodbye or we want nature to take its course. Quite often when a dog dies naturally (but not always!) it means they’ve lived some time longer than was necessary; maybe the last few weeks were more difficult than the dog needed to suffer through. This is a touchy subject, but I feel it’s a gift we can give them; relieving the suffering that we as humans don’t have the ability to do when it’s our time.

They’ll tell me when it’s time. This is certainly not always the case. Of the dogs I see regularly, I would say perhaps 50% show this to their pet parents. I’ve seen dogs who clearly looked tired - world weary - and seemed ready, and I’ve seen dogs who don’t show a thing. I’m of the opinion that many of our dogs hold on for us, because they feel we need them, or they are worried how we will do when they’re gone. I don’t know that this is true, of course. But we certainly know dogs have emotions, and can sense and respond to our emotions as well. This statement also applies to Groot. In my opinion, she had no discernible changes in her happiness in the end that I could attribute to being ready to go. And this brings up another important point on this matter… We may not always see, or recognize what our dog is saying to us, OR recognize the situation for what it is. Groot spent her last week very sick, in and out of the hospital. But the doctors felt she would recover, until the day they didn’t, and she was then in a critical situation.

To do your best for your dog’s well being and comfort, and in order to have peace if you do let them go, try to assess quality of life often, and as objectively as possible. I’m linking some quality-of-life scales below, but here are some specific things to think about for your geriatric dog as well:

Things that are great news:

• Your dog still has the drive to play, chase, or chew sometimes. Maybe not every day, but there is still definitely some sparkle in her personality for play.

• Maybe occasionally, she gets ancient dog zoomies. Many dogs get them after a bath, but ideally you see them other times as well, even if it only lasts a minute.

• She still gets a little excited for her walks or car rides, even if she can only go one house up the street, or for a 5 minute car ride before she tires out.

• If she can hear and/or see, she still gets excited at people who go past the house, come to the front door, or when she sees birds/wildlife outside in her yard. This is a good time to really bump up enrichment games such as food puzzles, walks in new areas, etc. It helps dogs with vision or hearing loss to remain engaged in daily life.

• She still greets family with an old lady brand of enthusiasm, although it may be with a lower, slower tail wag and a greeting so brief you miss it if you aren’t paying attention.

• Your dog’s pain is controlled. Diseases, while more serious, are stable or well managed.

• Weight is stable. Your dog is eating her dog food well almost all the time and drinking normally.

Indications of a moderate quality of life:

• Your dog is eating less at breakfast, or doesn’t want breakfast till later in the day. Maybe you’re having to offer enticements to eat… special foods, more treats, meal toppers, etc, but overall she’s still eating pretty consistently. Maybe a little less than normal, but the quantity of food is still around 70% of her daily intake.

• If your dog has vision or hearing impairment, this can affect her quality of life pretty quickly. It’s similar to a human: hearing loss and vision loss can really isolate people unless something is done to reengage them in the world around them. This isolation in turn can lead to increased incidence of dementia like symptoms.

• She is sleeping more, and some days your dog prefers to skip walks for a nap instead, but most days she shows enthusiasm for a short stroll.

• Pain is creeping in so that you see more indications of discomfort. This can manifest as a few days here and there with moderate pain, or more days with minor pain. But overall the pain is more often controlled than it isn’t.

• You’re visiting the vet more lately. She still has more good days than bad, but her medical conditions are becoming slightly more difficult to manage and keep stable.

Indications that quality of life is at risk:

• Mealtimes are a real challenge. Your dog is eating 0-50% of her meals in a day multiple times a week, or every day. Maybe you’re feeding things she has typically loved in life and sometimes she’s turning it all away.

• Drinking large quantities of water, OR drinking none at all.

• No longer sitting with everyone during cozy family time; choosing to be alone on a bed or the floor somewhere.

• Sleeping except when woken to eat, or when she smells food, or has to go potty.

• Refusing walks or car rides that she used to love.

• Your dog isn’t able to go potty outside consistently, either because she forgets, because she can’t make it outside fast enough, or because she doesn’t know she has to go and will go on her bed, either when awake or asleep. This is happening on a daily basis or even multiple times in a day.

• Your dog isn’t able to walk on her own. This can be due to pain - it isn’t always a matter of slipping on floors. That can be fixed for many dogs, although for very large dogs it is definitely more likely to be an indicator of poor quality of life for both dogs and their humans.

• Diseases are taking a toll. Medicines are maxed out, or not working. Symptoms are getting worse despite the medicines, and your dog is not as comfortable as she was a few months ago. And you’re spending a lot more time at the vet lately with either new concerns or issues with ongoing ones.

• If your dog’s primary issue is dementia, she may be: forgetting to chew food or dropping it, walking only in circles or pacing constantly, or crying when restrained for more than a few minutes. Advanced dementia can also present some of the other symptoms on this list as well.

Your dog won’t show all the changes above, and she won’t show them in a linear fashion. Some dogs will go through phases too, so that life becomes a bit of a rollercoaster. After a few good weeks your dog may have a few bad ones. Or perhaps she doesn’t recover quite as well after a setback as she used to… the baseline of her health gets a little lower after each challenge. We’ve had dogs who show some symptoms that I would list as being critical, but in some areas, they were still great. Each dog is so different, not every point I’ve made matters to all dogs, and my list isn’t all encompassing. But these are things I see and hear about most often from the hundreds and hundreds of pet parents and dogs I’ve seen over the years.

It’s also really important to remember that caregiver fatigue is real. If your quality of life is suffering: you aren’t sleeping, or your anxiety is increasing with your worry about your dog’s care or mental well being, chances are your dog is also declining in health and quality of life. I see many people who are at wit’s end with their elderly pups. In those cases, the dog is also not managing well. We all love our dogs so much. Thinking about losing them can make us feel like we can’t breathe, or that we’re going to break, or that we can’t live without them. But letting a dog go before every day is a bad day is truly a gift. I know people say it a lot, and it’s hard to reconcile. But I promise, it is true. Dying of medical issues that couldn’t be managed or controlled is not a blessing. Crisis comes very quickly for old dogs and that is far worse than the gentle ending that a hospice or euthanasia veterinarian can provide for a dog’s last day.

If you’re in this phase with your pup, or will be soon, hospice veterinarians are a wonderful, compassionate resource to help keep your dog as comfortable as possible with advanced medical diseases or at an advanced age. These veterinarians will come to your home and manage many aspects of your dog’s comfort. I would say that if you think your dog has 2-4 months left, a hospice veterinarian can become an integral part of that last time. Hospice vets are great to help make sure pain and anxiety medications are dialed in as well as possible for your dog’s last months. They can help with diet issues, encouraging appetite and eating, and managing nausea. They’re also a great resource to help you know when it’s time to say goodbye. That alone is worth the journey with a hospice veterinarian, as so many of us struggle to know when the time is right.

Doggie death doulas, like my friend Courtney who wrote the article for us on anticipatory grief, are becoming more common now too. This article explains the skill set and the training as well as what to expect if you’d like to work with one. A person in this space is a great emotional and tactical support person to have on your geriatric dog’s care team, and I highly encourage that option if you’re struggling with the end of life time for your dog.

Quality of life measurement tools:

Hospice Companies

The two companies I listed are all over the US, but there are many local companies as well, so be sure to google for best results near you. The doctors who work with these companies are extremely compassionate and can be a huge support to your family and your dog during her final months.

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Senior Dog Humor 🤣 

How did we do with this week’s newsletter?

• High Paws

• Pooped in the House