Facing End of Life Illnesses with Your Dog

by Jean Mansen

When you’re faced with the devastating news that your dog has a potentially life threatening illness, it is impossible to look at him the same again. Your tone of voice, posture, energy level can all speak of sadness and devastation. Animals blessedly do not worry about their health, but they can become anxious if the people around them act differently or if routines change. Now that you have the bad news, how can you best support your companion?

Data, data, data

Gather your thoughts, list questions for your vet, and seek input from other knowledgeable dog owners. Write down what the vet tells you so you can refer back to it later. Have a calm and practical friend or relative join you in meetings and on phone conversations to help gather and record information.

Richard Timmins, DVM, Director of the Center for Animals in Society at the UC Davis School of Veterinary Medicine, advises, “The pet owner should seek to obtain a specific diagnosis of the ailment. For example a diagnosis of cancer is not enough. In order to make appropriate therapeutic decisions, you have to know what type of cancer, and what stage it is in.”

Like a dog with a bone

Pet owners have to be persistent, urges Suzie Yokomizo, dog trainer, behavioral consultant, and owner of Positively Trained, a canine educational resource in Lafayette. Suzie’s dog Jack was diagnosed with osteosarcoma shortly before Thanksgiving. Jack had a pre-existing autoimmune disorder and earlier x-rays indicated nothing inconsistent with its progression. Jack, however, wasn’t his usual jolly self, so Suzie felt something was different this time. Suzie took Jack to two specialists, who confirmed the initial diagnosis. Still not convinced, Suzie agreed to have a biopsy performed, the results of which, along with a radiologist’s review, led to the osteosarcoma diagnosis.

Keep a log

Noting your pet’s condition and jotting down remarkable events may facilitate your dog’s care, suggests Laurie Kaplan in her book, Help Your Dog Fight Cancer. Veterinarians may ask you when you started giving your dog a particular medication or supplement, at what dose, and how he responded to it. Keep a log, and you’ll have the answers. Besides medications and supplements given, note any change in diet, eating, urination, and defecation habits or mood, names and dates of treatments (including holistic), side effects and reactions, who suggested the remedy, and secondary illnesses. File blood tests results, laboratory reports, surgery reports, and x-rays for easy reference.

Know what is acceptable

“It is very important for the pet’s owner to understand what it means for their pet to have a good quality of life,” according to Dr. Timmins. Timmins recommends four areas for consideration: Motivation, Mobility, Appetite, and Pain. Motivation means your dog’s eagerness to do his favorite things like going for a walk. Mobility is the ability or willingness to get up and move around. Appetite implies a change from the normal approach to eating. Pain, however, can be difficult to assess. Some breeds of dog don’t show pain until it is significant. Labradors are notorious for this. Other breeds will whimper at the suggestion of hurt. Try to learn your pet’s usual response to pain, so you can respond appropriately.

How do I rate?

Ideally the owner should be able to rate each one of these areas on a daily basis during the pet’s illness using a scale from 1–10, with 10 indicating highly motivated, very mobile, great appetite, no pain. Timmins suggests you rate on a daily basis in order to track your pet’s response to therapy. With this data, you and your vet can determine when the quality of life has slipped below an acceptable level and when euthanasia may be appropriate.

Testing for treatment

Initial diagnostic tests are usually required. Beyond that, however, be discriminating. Discuss with your veterinarian each test’s value in determining treatment. Ask about discomfort, pain level, trauma, and cost. If the benefits don’t outweigh the costs and potential distress and pain, you can say no. After all, you are your pet’s main advocate.

Once you have test results and your team of specialists, it will be time to discuss treatment. Treatment options may be clear-cut, or you may have to decide from several offered options. Think through each option, clarify your feelings and thoughts about each and list the reasons you might have for choosing or not choosing an option.

When considering each treatment option, ask your veterinarian: • How long do I have to make a treatment decision? • What’s the best possible outcome I can expect? • How often is this outcome achieved in a dog the age and breed of my dog? • How often is this outcome achieved in a dog with a medical condition as far advanced as my dog’s? • How invasive, traumatic, or painful will this treatment be for my dog? • What’s the worse possible outcome? (e.g., failure to work, side effects, death) • If the treatment isn’t successful, what is Plan B? • If I chose Plan A and it doesn’t work, have I foreclosed other options that may have been potentially beneficial for my dog? • What is the cost of Plan A, in the short run and, if longer-term therapy is required, for the longer term? • What would you do if this were your dog? • What questions am I not asking you or factors am I not considering?

Don’t automatically reject an option without understanding it fully. Some say that they won’t put their dog through chemotherapy because it might make their dog horrendously sick. In fact, dogs tend to have far fewer side effects from chemo than people do. Hear your vet out as she describes the various treatments, and ask how other dogs have handled those treatments.

Second opinions, finances, and your support team

If you would feel better getting a second opinion, do so. Your vet will understand your desire to get all the information you can about your dog’s prognosis. If financial considerations are a factor, ask your vet to work with you to find the lowest cost treatment.

Consider your dog’s age and health. Will you be substantially extending her life by having her undergo a treatment that might be painful or traumatic? A dog with a preexisting medical condition might not tolerate treatment well, and the preexisting condition may decrease the prospect of successful treatment.

Seek input from people whose advice you value or who have been through similar situations. Make the best decision you can. Then don’t look back. Remember, there’s no way of knowing what the outcome would have been had you chosen differently. Once you have made your decision, it is time to put together your support team.

You’ll need physical, emotional, and financial resources to care for your dog. Discuss your dog’s condition with family members, neighbors and friends, and elicit their help and emotional support. Be creative. Suzie hired her handyman to finish a household project while she was at work, so that he could carry Jack outside for his mid-day walk.

Keeping him comfortable

There are some simple, inexpensive ways to help your dog get around more easily. Carpet remnants laid over bare floors give dogs better traction and more stable footing. Stairs can be made out of Styrofoam blocks to help your dog onto his favorite sofa or into your car. If your dog has trouble climbing stairs use a bath towel as a sling under his lower abdomen, just in front of his hind legs, to support him as he climbs.

Alternative therapies include acupuncture, massage, synchronized breathing, and chiropractic treatments. Supplements, dietary changes, and Chinese herbs are also helpful for some dogs.

Acupuncture doesn’t cure cancer, but can alleviate treatment side effects, support organs in need of fortification, and generally balance body systems and energy flow. Andrea Sirott, an East Bay based dog behavioral consultant and trainer has taken her dogs for acupuncture since it was introduced in San Francisco. She credits acupuncture with keeping her agility dogs in top condition while in competition and also with keeping them comfortable through cancer treatments.

Chinese herbs can be powerful drugs that may interact poorly with other medications. Dr. Timmins cautions herbal remedies should be administered in consultation with your vet team.

Massage is something you can do for your dog at home. It may encourage circulation and healing and allow you to discover changes in his body early. Myofascial release, Tellington Touch, and other healing-touch techniques may also encourage healing, circulation, and relaxation.

Even if your dog’s breathing is labored, shallow, or uneven, lay next to him and synchronize your breathing to his. Very gradually shift your breathing to a deep, even pattern. You may hear your dog’s breathing shift as she tries to breathe in sync with you. When you hear a deep, slow breath, a heavy sigh, a cleansing breath, your mission is accomplished.

Hospice care

Until recently, the choices available to people with terminally ill pets were limited. Some veterinarians now offer hospice as an alternative to euthanasia for aging and ill animals. The Nikki Hospice Foundation (www.pethospice.org) provides links to Bay Area hospice veterinarians and other veterinarian hospice technician and service providers. The web site has information about hospice care for companion animals and the foundation is working to promote advancement of veterinary hospice care.

Hospice care for pets is similar to the long-term care available for terminally ill people. Hospice personnel teach pet owners how to administer pain medications, change bandages, provide fluid therapy, and perform general nursing duties at home along with the help and training of a veterinarian or trained vet tech or nurse.

Knowing when to say good-bye

One of the benefits of keeping a log using the 1-10 scale, as well as an early discussion with your vet team about what constitutes a quality life for your dog, is that you and your vet team will know when that quality has declined below acceptable levels.

“I knew this wasn’t a good life for Jack. Various vets we’d seen told me dogs didn’t show pain. I didn’t want Jack to be in pain. At the same time, I didn’t want Jack’s life to be shorter than he wanted it to be. Every single day, I had to ask myself what was the best thing to do for Jack. There were days when his quality of life was still good. He went outside and seemed to enjoy the sunshine,” recalls Suzie.

“But as the days went by, he seemed less interested in doing this. Finally, I decided things were getting to be too much for Jack. He had stopped acknowledging Rocky’s (my other dog and his best buddy) presence two days before. So I contacted Dr. A.J. Smith. On the morning of Christmas Eve, Dr. Smith came over. Although I really didn’t think I would need to call him so soon, I had spoken to Dr. Smith to find out what his services entailed and what to expect.

“Dr. Smith came over, did a quick exam of Jack and told me that he agreed that it was time to say goodbye. Dr. Smith was compassionate and allowed us to spend time with Jack. He sedated him before he put him to sleep. After Jack was gone, we hugged Jack and cried. Dr. Smith left the room and allowed us to have time with Jack. Dr. Smith waited until I told him we were ready to have him take Jack away. I am grateful that Jack was able to pass peacefully in his home, surrounded by loved ones. I feel very fortunate that we have such wonderful professionals here in the Bay Area. I feel Jack had the best possible care.”