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
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.
If only I had a lake in my backyard! But 5 or so miles is not too far to drive every day, if it keeps him happy. © Nancy Kerns | Whole Dog Journal
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.
This South Bay veterinarian is leading the pack to provide hospice care for cats and dogs who are terminally ill
From The Beach Reporter By Melissa Heckscher Feb 5, 2020
So when emergency vets recommended hospitalizing the 12-year-old dog to give her, maybe, a few extra weeks in her six-year battle against cancer, Russell knew what needed to be done:
“I just looked at them and said, ‘I’m taking her home,” she said. “We sat in the chair until about midnight, then I put her in the bed and laid there holding her until 4:30 in the morning.”
Cricket died the next day with the help of in-home euthanasia.
“She was tired,” Russell said. “She had gone through a lot.”
But she wasn’t alone. For the past six years, Cricket has had the help of veterinary oncologist Alice Villalobos, a Torrance-based veterinarian who specializes in palliative and end-of-life hospice care for dogs and cats.
For Cricket, palliative care meant treating the cancer—the dog underwent four surgeries and four chemotherapy sessions for her recurrent tumors—and getting a slew of supplements and medications to keep the champion agility dog active and comfortable.
Hospice care meant preparing Russell for the days when nature would take its inevitable course—and guiding her about how to recognize her dog was “ready to cross the rainbow bridge.”
“In human medicine, physicians don’t generally refer to hospice until patients are about three days before death,” said Villalobos, who in January received the Shomer Ethics Award from the Society of Veterinary Medical Ethics for her contributions to both cancer and palliative care for pets.
“When we use the word ‘hospice,’ we want to make sure people know that we are going to support the pet and provide comfort care whenever they get the diagnosis of a life-limiting disease,” said the Hermosa Beach resident.
While palliative care is a growing niche in the world of pet care, it isn’t all that different for dogs and cats than it is for humans. The goal is to make patients comfortable so they can live out their days in peace, even in spite of incurable conditions. The only difference for pets is the added option of euthanasia when suffering becomes intolerable.
“Many times people say, ‘Let nature take its course,’” said Villalobos, who has been called the”Mother of Veterinary Hospice” by the SVME. “And then I’m contacted to help with that end-of-life decision. People want to know, ‘When is the right time to put my pet down?’”
To aid in this decision-making, Villalobos developed a Quality of Life Scale to help people determine if their pet has “acceptable life quality to continue with pet hospice.” Her guidelines have been shared and used by veterinarians and pet-owners worldwide.
“In the old days some doctors would just recommend euthanasia right away,” Villalobos said. “People would take a limping dog into the vet and they would come home without a dog. [Doctors] would choose to do euthanasia upon diagnosis.”
Veterinarians, she said, would often give patients two options when presented with a seriously sick pet: Euthanize the pet or opt for surgery, the latter of which is expensive and may not necessarily extend the animal’s life significantly.
“I’m trying to give people a third option—and that is hospice,” Villalobos said. “Hospice embraces the whole beginning right up to the end. It allows people time to grieve and gives me time to counsel the family members.”
For Ari Dane of Playa del Rey, Villalobos helped his 17-year-old chihuahua, Roxy, stay comfortable despite a trio of grim diagnoses including a chest tumor, heart problems and kidney disease.
“(Roxy) keeps bouncing back and she’s still here,” said Dane, who sees Villalobos about every six weeks. “She will perk up around mealtime, but most of the time she sleeps. It’s fading time.”
Under Villalobos’ direction, Dane adds more than 15 different medicines and supplements to Roxy’s food every day, all of which are meant to treat the tiny dog’s myriad health issues. It’s a tedious, expensive process, but one that Dane wouldn’t give up.
“It’s a sad thing to watch her decline, but that’s the price of admission,” he said. “Roxy has been a part of the family for 17 and a half years. I wouldn’t want her to be treated any differently.”
Pets As family
In a society where people consider pets part of the family—and where half of all dogs that reach the age of 10 will be diagnosed with cancer, according to the American Veterinary Medical Association—it only makes sense that palliative care would become a part of the deal.
As of 2020, there were more than 800 members in the International Association for Animal Hospice & Palliative Care (IAAHPC), an organization dedicated to developing guidelines for comfort-oriented care to pets as they approach the end of life. The organization was founded in 2009.
“Veterinarians have been offering some measure of comfort care for animals as long as they have been caring for them, but the shift has come with families embracing pets as members of the family,” said IAAHPC President Tyler Carmack, a Virginia-based veterinarian. “They now wish their pets to have the same level of compassionate care at end of life as our human family members.”
Carmack said many providers and pet-owners shy away from discussing hospice and palliative care until their pets are already very sick. She hopes this will change as people become more aware of their options.
“As we open the communication about caring for pets as they enter their end-of-life stage, we allow more and more families to make the best possible decision for their pet and their family,” Carmack said.
Costs of care
Of course, caring for sick and dying pets isn’t cheap.
According to the Veterinary Cancer Society, cancer care costs for dogs ranges between $150 and $600 per dose of chemotherapy and between $1,000 and $6,000 for radiation. Pet insurance can help pay some of these costs, but many companies have a cap on annual or per-illness expenses.
On top of that, in-home euthanasia, the option most palliative care specialists prefer, costs about $250.
For many pet-owners, it’s a price that must be paid.
“You get them as a pup and you know that you’re probably going to outlive them,” Russell said. “It’s part of the package.”
For more information about Dr. Alice Villalobos and to get information on palliative care for pets, visit www.pawspice.com. Villalobos operates out of Harbor Animal Hospital. She plans to move her services to Redwood Animal Hospital in Redondo Beach in the coming months.