Mobility concerns and end of life decisions

End-of-life decision-making in dogs with mobility concerns

Guest article by Mary Gardner, DVM 

Founder, Lap of Love 


End-of-life decisions for dogs with mobility concerns

When I changed my practice focus 10 years ago to exclusively help families with their pets’ in-home hospice and euthanasia, I thought I would be the cat lady! I would be the savior for the oodles of cats who don’t like traveling—especially not to the veterinary hospital—and help them at home.  Well, that was the furthest thing from reality. By a landslide, the most common types of patients I’ve helped at home have been dogs with mobility issues.  From 20-lb Shelties to 200-lb Mastiffs and all the 70-ish-lb Labradors in between.

The company I co-founded, Lap of Love Veterinary Hospice, now has more than 190 veterinarians around the United States who provide these special in-home patient services full-time. We help over 65,000 families a year, and mobility problems remain the leading ailment that clients request our help for across the country. Because of their pets’ compromised mobility, so many of our clients simply can no longer get their pets in and out of the car or carrier for a veterinary clinic visit, so they need our help in the home. And in our practice, mobility problems are also the biggest reason for pet euthanasia, with cancer as a close second.

The many facets of diminished mobility

A multitude of diseases and conditions cause or contribute to mobility issues, including arthritis, cancer,  intervertebral disc disease, neuropathies, sarcopenia, and obesity. Regardless of the cause, if you are managing a dog with mobility issues, you know how difficult and draining it can be. You may be strategically placing non-slip bath mats all over your house, baby-gating various rooms, building or buying special ramps or stairs, trying out a variety of support harnesses and booties, and investing in a wagon or wheelchair (or both). Lifting your pet in and out of their bed, helping them on and off the couch (or having to discourage them from sharing it with you), and hefting them into and out of your car become part of your own daily workout routine. You’re frequently reminding yourself to give your pet medications (and coaxing them to take them!) and to keep up with the refill schedule. You may also be scheduling and taking your pet to their physical therapy, laser therapy, or acupuncture appointments. Your daily walks with your less mobile pet wind down to a tortoise’s pace. Going out of town becomes wishful thinking because no one can care for your pet while you’re away as well as you can.

And yet, all of that pales in comparison to the hardest part of caring for a dog with mobility problems, and that is determining when it’s time to say goodbye. The decision is agonizing because oftentimes, the dog is still happy, eating well, and even joyously wagging their tail.  How can you euthanize your pet when they still have that sparkle in their eyes?

Experiences with jeopardized mobility in my own pets

I can speak to the difficulty of this decision with intense insight, not only because of my experiences as a hospice veterinarian, but because I am a pet owner who has had three dogs with severe mobility challenges, and a cat who was paralyzed.  My Samoyed Serissa had hip dysplasia; my Doberman Duncan had geriatric-onset laryngeal paralysis and polyneuropathy (GOLPP); my current dog Sam, an Anatolian Shepherd, is struggling with lymphoma that has crept into in her spine; and my cat Goldie had a spinal fracture. My dogs were (and are) medium- to large-size dogs who weighed 50 lb to 110 lb, and each one’s daily activities became difficult to manage.

Sam started to show signs of trouble about a year ago. It started with a simple, subtle leg tremor. Then I began hearing one of her toenails scrape the pavement on our walks – every twentieth step or so. Then she started to “sink” in front of her food bowl (she would start eating while standing, but would gradually lie down to finish)  and I knew something serious was going on. After a slew of diagnostic tests, we found cancer in her spine that was causing her neurological problems.

Since then Sam has had chemotherapy and radiation to slow the disease progression and she is receiving the best medications to manage pain. She goes to veterinary physical rehabilitation therapy three times a week, which she seems to love. There, they help Sam exercise (including on an underwater treadmill), and on different days she receives acupuncture treatments, laser therapy, and massage. In addition, I’m pretty sure I have product-tested every bootie, sock, and nail cap available for dogs. Next week Sam will begin training with her wheelchair.

And to add a cherry on top, Sam has frequent fecal incontinence. Often she doesn’t even notice it. Or she’ll struggle to get up in time, have an accident, and then plop down in it – smooshing it into the rug. I set my alarm to wake up an hour earlier every morning than I might otherwise, so I can care for Sam before others in my household wake up. I want to clean up any accidents before anyone else sees them because her elimination issues cause strife in my household.

Needless to say, palliating Sam’s disease and assisting with her mobility is a lot to manage. Not only physically, but emotionally!  Sam is a large breed, a 14-year-old dog with cancer and her mobility is worsening. I know the time to say goodbye is coming soon. So trust me when I say I know how hard this decision is.

The quality of life elements

As I manage Sam, I am able to put on my veterinary hat and do my best to evaluate her (and my) quality of life to make sure that I do not keep her going because I’m having a hard time saying goodbye.  And if I’m completely honest with myself, maybe I’m already grappling with that. But I am confident that Sam is not suffering. Is she happy? I think so. She barks at “threats” to the house, seeks love, eats well, and still adores going for walks (even though they are difficult).

When I guide owners through a quality of life assessment for their pet, I start with their pet’s ailments. Will the ailment lead to anxiety? Pain? Malaise? Suffering?  Mobility issues can be painful, create anxiety  (due to struggles to eliminate, perhaps has to be separated from the family because of elimination problems, resists assistance or becomes aggressive), and produce suffering (pain that isn’t or cannot be properly relieved).  To most pet owners, a pet’s appetite is a big indicator of quality of life. But in pets with mobility issues, appetite usually holds up, so we need to evaluate other quality of life indicators.

Next, I assess the pet’s personality. Are they tolerating their ailment and the necessary environmental adjustments and treatments well? Do they mind wearing the booties? Do they accept wearing their support harness or diapers? Do they readily use their ramp? Do they seem to enjoy their physical rehabilitation therapy? My dog Sam is a fantastic patient – nothing bothers her. But my other dog would have a big problem with all of those things. I would not want to force him to wear or do things that make him anxious and that he would be unable to adapt to. And sadly that may mean that given a similar situation, I would have to let him go sooner than Sam.

Also, evaluate the activities that make your dog unique and happy!  Are they still doing those things? They may no longer be able to run a mile on the beach – but do they enjoy sitting next to you on the sand, sniffing the salty breeze? Are there other non-mobile activities that still bring them happiness?

The family’s beliefs then come into play, and each family member may have different views on what to do and what not to do in caring for their pet. Some people shake their heads when they hear that Sam has had radiation therapy and goes to physical rehabilitation therapy and that I bought a wheelchair for her.  They say, “That is way too much for a dog.”  Or maybe they don’t believe in trying multiple treatments because they think the efforts are prolonging the inevitable.  Neither belief is right or wrong. But everyone’s views do play into the end-of-life decision-making.

The essential pet care budgets

Lastly, I evaluate the pet owner’s four budgets, each one crucial in ensuring their pet’s optimal care:

1) Monetary budget. Is it financially feasible for the owner to provide the care the pet needs? That amount could range from $100 for a harness, yoga mats to prevent slipping, and medications to manage pain, to $500 for a wheelchair, or to thousands of dollars for radiation treatments.

2) Physical budget. Can the pet owner lift the dog when needed, or put a harness on their pet, and help them into the car?  I am 6’ 1” and pretty strong, so I can manage Sam. But I remember one client who had severe rheumatoid arthritis. She had to say goodbye to her 20-lb Sheltie because she could no longer lift her dog.

3) Time budget. Dogs with mobility problems may need extensive care, and that care takes time. Owners with many other work or family commitments may not be able to devote adequate time to their pet’s care. I have to make sure I am home every four hours to take Sam outside and assist her. Fortunately, I  work from home, but that is a luxury that not everyone has.

4) Emotional budget. This is an extremely important component of caring for an ailing pet that many people forget to consider. Is the owner emotionally tapped out, or are they a powerhouse in dealing with all the struggles?  My emotional budget is still on the plus side, but dealing with the tension in my household over Sam’s condition often subtracts from it.

At any time, if one of these budgets is depleted for a family, then I support their decision to say goodbye.

When the time is right

Unless a pet is experiencing unretractable suffering, there is never an absolute “right” day to say goodbye. If your pet is struggling with mobility and having a hard time enjoying the things they love, or if one of your pet care budgets is nearly depleted, then you are in a widely subjective time period that I call The Roller Coaster.  You and your pet will have good days, bad days, and everything in between. The Roller Coaster may be an expected and acceptable ride, for a time, in many cases.

What I encourage pet owners to be attuned to and to avoid is a string of bad days with only a few good moments sprinkled in here and there. If at any time you are on The Roller Coaster and are ready to get off and say goodbye to your pet, I support that decision.

If you are thinking, “When my pet has more bad days than good days, then we will say goodbye,”  I suggest that you define what is a good day to you (and most importantly, to your dog) and document each one. And as I mentioned above, because appetite is not usually a problem with dogs that have mobility issues, try not to rely on appetite as your primary gauge of quality of life. The caveat here is that if your dog has a disease that also decreases their appetite, then taking their appetite into account is more helpful.

Keep a calendar in plain sight, where you monitor your pet’s good and bad days and can clearly count them, and see whether a trend has developed. What constitutes a good day is subjective, but when you do this exercise, it will help you with your pet’s quality-of-life evaluation process. And if there are disagreements among family members, this visual evaluation can help bridge the gap. Using a calendar like this one may be helpful.

When the day comes to say goodbye, I know that this will be the most difficult day. Your dog may still wag their tail, lick your face, or gobble up a big steak or bowl of ice cream. When I help families in this situation and visit their homes to euthanize their pets, I think it is a blessing. Their pet is still mentally happy! They are enjoying their family’s love and that big steak. And afterward, the families are grateful and they tell me the same things. I hope I am able to end my story here on Earth the same way.

For more resources on quality of life, please go to LapofLove.com and review the resources in the Quality of Life section.