11 Essential End of Life Care Steps for Your Dog

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I am in a somber sort of mood today, as it is the anniversary of a very sad event in my life. I’ve been talking quite a bit about my Boxers, Janice and Leroy, lately. Today, however, I want to tell you about Gloria, another Boxer. This is the tenth anniversary of her death.

I’ll never forget the day, 19 years ago, that I brought Gloria home. She was your typical puppy, I suppose, playful and curious, and sometimes a bit of a challenge. Of course, the furthest thing from my mind on that day was the idea that, at some point, I would have to guide her toward a peaceful death. I always hope that my dogs will just go easily and instantly in their sleep after a completely healthy life, but it hardly ever happens. Gloria needed quite a bit of care in her old age, and toward the end, I was taking something of a “hospice” approach.

What Is Hospice for Dogs?

Hospice care for dogs is much the same as it is for humans, except that humans can receive hospice care either with in-home support, or in a special facility. Your dog’s hospice care will be at home, supported by your veterinarian. It is a means of assessing and managing your dog’s quality of life as he approaches the end of his time with you, and it could last for a matter of days, or it could go on for months. Your dog needs hospice care when there is no hope that he is going to get better, but is still enjoying a certain quality of life.

With Gloria, I chose hospice care because I simply wasn’t ready to let her go. She wasn’t terminally ill, but she was chronically ill, with arthritis, digestive issues, and frequent abscesses. She also had a recurrence of the mammary cancer that had led me to have her spayed at a young age. My vet at the time, Dr. Kim, said that the cancer was not terribly invasive, and given Gloria’s age (she was 9, which is old for a Boxer), she was likely to die with it, but not of it.

So from my perspective, Gloria deserved a little more time, and so did I. We put her on a special diet, and Dr. Kim prescribed medication for the arthritis pain. Gloria still had good days, although they were becoming fewer and farther between. I’d know when it was time to let her go.

Gloria’s Journey

Gloria’s journey through hospice care began around age eight-and-a-half. I knew she wasn’t getting around as well as she once had, and it seemed as though she was vomiting more than usual. A few months later, during x-rays that were taken after she fell on the stairs, the mammary cancer recurrence was identified. I found myself having to administer medications on a daily basis, and under Dr. Kim’s tutelage, I even learned in the later stages how to deliver fluids subcutaneously when Gloria didn’t seem to feel like drinking water. I still walked her regularly, although we weren’t going as far as we once did, because she tired easily. I also kept plenty of detergent on hand, because her indoor messes were becoming more frequent. Mostly, I just enjoyed spending time with her, cuddled up together watching TV, or sitting outside in the garden. I also took pictures of her and made a memory album.

Finally, the day came when there was no sparkle left in her eyes. That’s how I knew it was time. So I called Dr. Kim, who had already assured me that when the time came, she would take Gloria out gently at home. It was a warm day for this time of year, so I carried Gloria out to the garden (no small feat, as she was still a sizeable dog), and placed her on the grass. I stroked her ears and told her what a wonderful, amazing girl she was. Then, I held her head in my lap while Dr. Kim pushed the injection.

I still miss Gloria, and I suppose I always will. But I will never regret the way I handled her end of life care.

What to Do for Your Dog

If you have received the sad news that your dog has little time left, you’ll probably feel overwhelmed. The first thing you should do is try to get a really good handle on your dog’s condition, and that will mean doing some research. You can find any number of reliable websites that will give you all the information you need so that you can work effectively with your veterinarian to design a treatment plan.

Of course, in addition to veterinary support, you’re also going to need emotional support through this difficult time. If you have family or friends to lean on, that’s great! If you don’t, though, you can find support online. One of the best websites is Petloss.com – you’ll find tons of resources, and there’s also a message board and chat room, so in the days leading up to that final one, you’ll have no shortage of support.

There are also 11 essential things you’ll need to do.

1. Recognize Pain

We’re often not all that good at identifying pain in our dogs – it’s easy to build a case of denial, for one thing, and for another, dogs are really good at hiding pain.Don’t expect to hear whimpering and yelping unless your dog is in extreme distress. Higher blood pressure is the most reliable indicator of pain, but it’s probably a safe bet that you don’t have a blood pressure monitor at home. Loss of appetite, lethargy, a reluctance to stand or walk, irritability and other changes in your dog’s behavior are likely signs that he is in pain.

Rapid breathing and a change in pulse rate are also signs of pain. A small or medium-size dog should have a pulse of about 70-100 beats per minute. 60-90 beats per minute is normal for a large dog. The pulse should be strong and regular. The more relaxed your dog is, the lower the pulse rate will be. As to respiration, 10-30 breaths per minute is normal, regardless of the dog’s size.

2. Manage Pain

A veterinarian may not be able to confirm that your dog is experiencing pain, and will most likely prescribe medication if pain is even suspected. The most common drugs are analgesics (Buprenorphine, Tramadol, etc.) and anti-inflammatories (Deramaxx, Previcoxx, Metacam, Etogesic, Rimadyl, etc.).

You can use herbal analgesics and anti-inflammatories in conjunction with prescription medication. Acupuncture and massage can also be helpful.

3. Keep Your Dog Well-Hydrated

In humans, dehydration is believed to cause an increased sensitivity to pain, and this is likely also the case for our canine friends. In addition, dehydration can cause loss of appetite, sluggishness, and constipation. By monitoring your dog’s hydration, you can also get a better idea of when it’s time to let go. If your dog feels better after fluid is administered, then that’s good. However, if the dog is retaining fluid, edema can be the result, and this can create difficulty with breathing.

If your dog is properly hydrated, then when you pinch a fold of skin, it should immediately snap back. If it takes a few seconds, then the dog is likely dehydrated. In old dogs, though, there is usually some loss of skin elasticity, so this can vary a bit. Another test for dehydration is done by opening your dog’s mouth – if the gums are wet, the dog is properly hydrated. If the saliva is sticky, you should suspect dehydration.

4. Observe Your Dog’s Mood

Does your dog seem to be happy? Is he responsive to his environment? We know that dogs can get bored, the same as humans. It’s also reasonable to think that if a dog is ill, he might be prone to depression. So what you want to do is try to keep your dog engaged – if he likes going for drives, take him for one. If he’s always enjoyed grooming, keep on doing it. The end stages should still be as enjoyable as possible – don’t think of hospice care as a “death watch.” It’s extra time with your dog, so enjoy it.

If you can, try to keep a lid on your own anxiety. Your dog is going to pick up on your mood, and right now he shouldn’t be worrying about you.

5. Modify Your Home

You may not have to do this in every case, but in some instances you will have to adapt your home environment to accommodate your dog’s limitations. If he’s having trouble getting around, non-slip surfaces and ramps can go a long way to ensure his safety.

If your dog typically sleeps in a crate or on a dog bed, locate it where you spend the most time. It’s more important now than ever that he knows you’re with him.

6. Keep Your Dog Moving

Lack of mobility can be a huge problem in the ailing dog. Keep him moving as much as possible. If he needs assistance, you might try a body harness for a bit of extra support. As the condition progresses, you might need a rear end sling or a whole body sling.

7. Don’t Neglect Hygiene

Be sure to keep up your grooming routine. If your dog is incontinent, check his skin for urine and feces regularly to be sure that infection doesn’t develop. Wipe his nose, mouth and eyes with a damp cloth from time to time, as well.

8. Consider Nutrition Changes

A sick dog may no longer be interested in food. At the point where a dog has been refusing food for days, some distraught owners will ask the vet to install a feeding tube. This is a bad idea. A feeding tube should only be used to administer medication, not to force-feed your dog. Persistent refusing of food is a very strong indication that it’s time to say goodbye.

If your dog just seems to be picky, you might try warming his food. You can also try a different type of food – anything that smells really good, and tastes great. I’ve talked about foods that are really bad for dogs in Your Dog is Not a Human, So Don’t Feed Him Like One, but you can throw most of those rules out now. You still need to avoid highly toxic foods like chocolate, and of course you can’t give him alcohol, but if he’d like a piece of pizza, it’s not likely that a bit of tomato sauce is going to kill him. If he loves bacon, give it to him. Buy him a Big Mac. Let him have some ice cream. You get the idea.

Your veterinarian might also suggest an appetite stimulant like prednisone or mirtazapine. Acupuncture can also help to stimulate the appetite. Ideally, your dog should be consuming about 100-130 calories per day for each pound of body weight. If you measure out food carefully, you’ll have a good idea as to whether your dog is getting enough nutrition.

9. Think About Quality of Life

In humans, our quality of life depends on feelings that are present continually. Those feelings can be pleasant or unpleasant, and physical or emotional. Feelings that are unpleasant physically can include pain, being too hot or too cold, hunger, thirst, nausea, weakness and constipation. Feelings that are unpleasant emotionally would include fear or anxiety, frustration, boredom, depression, helplessness and loneliness.

Dogs have all the same feelings that we do, so try to encourage positive emotional feelings in your dog by keeping him stimulated mentally and ensuring that he has plenty of companionship. Negative physical feelings would include pain, of course, and blindness. Partial hearing loss, though, is not likely to trouble your dog.

Consider the feelings your dog may be experiencing. If the negative feelings are outweighing the positive, and there is no way to correct the deficit in positive feelings, then the dog is not having a good quality of life. Keep in mind, too, that if even one unpleasant feeling is especially strong, it can make for a very low quality of life.

You know your dog better than anyone. So identify his feelings, both positive and negative, and consider whether there’s enough on the positive end of the scale to allow you to say, “His quality of life is still pretty good.”

10. Know When It’s Time

Some dog owners use hospice care the same way that they would for humans – to keep the patient as comfortable as possible until death occurs naturally. Most of us, though, see it as a way of extending life until allowing it to continue would be cruel, at which point we euthanize. That’s because we want our dog to not just have a good quality of life – we want a good quality of death as well.

Knowing when it’s time can be hard. So ask yourself some questions, and answer them honestly. How do you envision a good death? Would you rather say goodbye at the point where your dog is suffering, or when he is reasonably relaxed? Are you hesitating to euthanize because of the cost, and just hoping that your dog will go peacefully without assistance? If you do not euthanize now, will you regret not having done it sooner, or at all?

As I stated previously, we would all love to see our dogs pass calmly in their sleep, but the reality is that most of us are going to have to euthanize at some point.

11. Allow Yourself To Grieve

It seems as though we have no trouble at all grieving for the humans in our lives. We take bereavement leave from work, have a funeral, and let the tears come as needed. And yet we somehow feel as though when it comes to our dogs, we have to “man up” and move on. A friend once confided to me, slightly shame-faced, that when his dog died, he cried like a baby. I told him that I’d consider him to be a pathetic excuse for a human being if he hadn’t.

Some people are going to tell you, “Be thankful the death was in the kennel and not in the house.” If you’re like me, you’ll find that cold comfort. And if you’re like me, you might only resist the completely natural impulse to punch the jerk in the nose because you really can’t afford bail money – after all, you’ve just dropped a huge chunk of change on your dog’s hospice care and euthanasia.

Well-meaning idiots are probably also going to suggest at some point that you’ve grieved long enough and should get over it. Grief doesn’t have a set timeline. Take all the time you need. Seek support. Check out Petloss.com. If the grief seems overwhelming, you might even consider counselling. I’m not ashamed to admit that I’ve done it, and it’s helped a lot.

Keep in mind, too, even though it’s difficult in the raw aftermath of a dog’s death, that it really is true that things get better with time. When I had Gloria put to sleep, I cried for weeks, and I was a long time recovering. But now I’m able to remember her on this anniversary without tears. Still a bit of sadness, to be sure, but with far more smiles when I think of the joy that she brought to my life.

Making the Final Decision

Whose decision should it be when a dog is in the end stages? I’ve seen people subject their dog to horrible suffering on the theory that “Only God should decide when to end a life.” Well I’m sorry, but my take on that is that if God isn’t taking that dog in a timely fashion, then He’s messing up, and someone is going to have to step up and do the right thing.

Animals, under the law, are still considered property. So you can let your dog die in pain if you want to, as long as you’re not inflicting that pain. Stephen tells me that he often wishes that he could say to some dog owners, “It’s time, and the decision is out of your hands.” Of course he can’t do that, no matter how much the dog is suffering. He does try, though, to guide the owner gently to the right decision. He says he doesn’t tell them, “You really should…” Instead, he acknowledges their point of view, and explains to them that he knows of several people who suffered horrible guilt after allowing the situation to go on for too long. Sometimes he can bring them around to doing the right thing. Other times he has no choice and asks himself why the hell he ever wanted to be a vet in the first place.

Conclusion

Your dog’s end of life is always going to be a sad time. But it can be filled with much happiness as well. You know what’s coming, so you can prepare for the end as opposed to having it forced on you suddenly, as it would be if your dog, for example, were run over by a car. You can make adaptations to your home, and to the way that you care for your dog, that will ensure that he still enjoys a good quality of life for just a bit longer. By following the 11 essential end of life care steps, you’ll be able to keep a close eye on your dog’s condition, and know when it’s time to take him for that last drive, or have the vet out to your home.

I was so grateful to have all those wonderful years with Gloria, and when I knew she was in the end stages of her life, Dr. Kim and I worked to make sure that her final months were good ones. I wish she could have lived forever, but I have no regrets about her last days or the manner of her passing.

We have them for so little time. So show your dog every day how much you love him. If hospice care is possible as an alternative to immediate euthanasia, I urge you to consider it. In the final analysis, the time and nature of your dog’s passing will be up to you. I hope this post will help you to make the right decision at