End of Life Decisions

From: The Whole Dog Journal

By Nancy Kerns  –Published:September 7, 2022

I will trust someone whose practice is mostly animals at the end of their lives to help me with this decision.

Three years ago I wrote a blog post about “how to know when the time is right for euthanasia.” A the time, I had three friends and family members who were facing this decision. One dog, Beau, was euthanized not long after I wrote the post. Lena lasted another year before her owner decided that the dog was too disabled to go on. Chaco, the third dog is still living, the last I heard (I don’t hear from that friend very often anymore). But as I said in the post. I hoped it would be at least several years before I was mulling this topic again.

Well, here we are, almost exactly three years later. Guys, I’m having to think hard about this right now, with my nearly 15-year-old heart dog, Otto.

He had surgery on his liver about four years ago, and we keep an eye on that organ with annual abdominal ultrasounds, to make sure that the benign growth that was removed hasn’t grown back. He’s had a handful of teeth extracted for various reasons, including one broken and several cracked. And he’s been receiving an increasing amount and variety of medications for arthritis pain for a couple of years now.

But until recently, he honestly looked pretty darn good for his age. This last year, though, as the arthritis pain has ramped up, he’s moving less, and has lost a lot of muscle tone, especially in his rear legs. His weight is a few pounds less than his ideal “high school weight” and he’s a little on the ribby side – but I’m trying to keep him on the light side, to reduce the burden on his arthritic joints. His worst arthritis is in his elbows and front paws, and the pain seems to be altering his stance – which is probably causing more pain in his shoulders and back. In the past few weeks, all of a sudden (it seems), he just looks awful when he stands around, swaybacked and panting, and with his ears back and face tense.

We’re having a really hideous heat wave in California right now, so that’s not helping as I try to figure out how much of his panting is due to pain and how much is the heat. He’s always hated being hot. Now it’s even too hot for him to find relief, as he’s always done, by digging a hole in his dampened sandbox, in the shade of an umbrella under an oak tree. For the past few days, it’s been over 100 degrees in the shade! I’ve had to make him come in my office and stay with me and the other dogs where it’s cooler – but he hates this, too. He lays down for a few minutes, then gets up, pacing and panting. He scratches at the door, wanting out. I open the door and he gets only halfway through when the wall of heat makes him stop and remember why he’s not already out there. He turns around, stiffly, and stands for long minutes in the middle of my office, panting and with that awful, painful-looking posture, before laying down again. This just breaks my heart! I don’t want him to be in pain.

Is it the dementia that makes him forget it’s too hot to go outside? Absent-mindedness? Stubbornness? Why can’t he seem to get comfortable in my cool office? There are three beds, of varying heights and softness, and he gets first dibs on any of them. But he just doesn’t want to be in here, he wants the heat to go away and he wants to be in his sandbox. I know the heat is temporary, but his arthritis pain is not.

I don’t want him to suffer.

I use several different assessment tools, developed by various experts on hospice and end-of-life issues for dogs, in an attempt to find some objective data points to help me decide whether “it’s time.”

On one, the result translates to, “Quality of life is a definite concern. Changes will likely become more progressive and more severe in the near future. Veterinary guidance will help you better understand the end stages of your pet’s disease process in order to make a more informed decision of whether to continue hospice care or elect peaceful euthanasia.”

On another, the score indicates, “Everything is okay.”

On a third, the score suggests that Otto has “acceptable life quality to continue with pet hospice.”

Assessment Tools for Deciding End of Life Care

Lap of Love Pet Quality of Life Scale

Lap of Love Daily Assessment

The HHHHHMM Quality of Life Scale

I discuss Otto’s condition with close friends who know him. My trainer friend Sarah suggests a consultation with a veterinarian who has a housecall practice and specializes in hospice care for animal companions. Well, why and how the heck did I not think of that on my own? I called and made an appointment for next week. For now, a load has been taken off of my mind. I will trust someone whose practice is mostly animals at the end of their lives to help me with this decision.

And in the meantime, of course, the goal is to give Otto the best possible daily experience I am capable of delivering to him. I’m trying to make up for his unhappiness with the heat and the unaccustomed confinement in my (cool) office by taking him and my other dogs to the lake every evening. There’s a place that has a sandy, gravelly (but not sharp) bottom and with water that gets only very, very gradually deeper. It’s where I like to bring small dogs, novice swimmers, and now, my old guy, too.

As shallow as it is close to shore, the water is refreshing but not cold. We can linger at dusk, when the other lake-visitors are all gone, and not get a chill. Woody asks me to throw his ball, and he bounds through the shallow water, happily fetching. Boone looks for opportunities to steal the ball from Woody and then play “catch me if you can!” Otto wades back and forth, back and forth – not like his nighttime dementia pacing, but like a happy water buffalo. Every so often he wades into the deeper water and swims a bit, and then comes back, tail wagging slowly on the surface of the water, looking extremely content. When he’s like this, the end feels far away from now, and I find a little bit of hope that it truly is.