End of life decisions

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.”

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.

dog swimming in lake
Much more comfortable in the lake. 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.


  1. Anyone else crying as they read this? I have faced this decision many times with many species. It is never easy. Sometimes the decision is made for us and sometimes we have to make the decision. So hard. Not much anyone can say except follow your heart.
    Please update on what the hospice vet says.
    Otto is lucky to have a pet parent like you.

      • You absolute will know.

        My Ramses died two days before our last appointment at the vet, thus relieving me of having to follow through with that decision. A gentleman to the end. He gave me the gift of knowing when and then not having to act on it.

    • Absolutely crying… I have followed Nancy and Otto in the Whole Dog Journal for a long time; and, having lost my senior dog to bone cancer a few months ago, I totally understand the questions you have… when is it time? No one can answer that for you.. It is so sad… Just give them all the love you can while you can, and then help them cross with as little pain as possible. Nancy, we Love you and Otto. Our prayers and thoughts are with you.

    • I put down my best friend on September 1, 2022. Tica, in the last 14+ years had not spent more than 20 nights outside my bed. She was a rescue. I took her to Europe 8 times (Belgium, Germany, France, Holland); across Canada twice, and down into Florida. My wife was placed in a home earlier this year and I am helping to raise a granddaughter whose mother (my daughter) has ADHD and is a single parent. I am not coping well. But, as Will Rogers purportedly stated, ‘If there are no dogs in Heaven, I want to go where they go.’ Now, back to my tears knowing I have a family of friends (like you) who share my sorrow.

  2. My heart goes out to you. A vet once told me that it’s a fog, not a finish line. I consider myself pretty practical and knowledgeable and thought that was good advice. Even experts need experts – take care.

  3. Have you tried homeopathic arnica to help with pain and or some MSM coarse flakes from a company like Kala health. Soaking in an epsom salt bath helps people. Haven’t researched that for dogs but listed here since it came to me while typing. These things usually don’t interfere with meds you may already be giving. Sounds like your taking him to the lake did good for both of you. He enjoyed himself and you were able to see a bit of “the old himself” or at least felt like he was happy. Making these decisions has always seemed to me to be the hardest things I have ever done. I’ll keep you both in my thoughts and prayers and hope that you’ll find your right answers.

  4. I am so sorry that you are having to even think about this with your Otto.

    My husband and I both agree that we don’t want our pets to suffer as they age. Our schnauzer was 16 when we made the tough decision. His hearing was gone and his back legs were no longer able to hold him up for long. He did have some fatty lumps as well. Our vet came to our house so that our other two dogs and cat were there.

    There’s rarely ever an “easy” decision to make when it comes to end of life. When our Westie girl turned 14, she was perfectly healthy and active. Then she started walking in circles and other neurological issues. She finally had a horrible seizure and the ER vet said that she was no longer cognitive and recommended that we euthanize her. We were thankful to essentially have our girl make the decision for us.

  5. you are a good dog mom. I would think that the water therapy is good for him. I know you have heard what I am about to say before. But here goes. You will know when the right time comes. So as of today, it is not.

  6. We have all been there and know how difficult this is. It’s horrible but dogs are worth it. I used to think I would ask God – when I get to heaven – why do parrots and elephants and other animals live so much longer than dogs but now I realize there will be a lot more dogs in heaven because of their shorter lifespan. They are worth the pain when you lose them. Bless all of you who take such excellent care of your companions and make their time on earth full and happy. When you lose one to illness or old age, the best thing you can do is get another one.

  7. I went through this with my Buddy, and ended up having a mobile euthanasia service on Father’s Day. I’ve always heard that it is better to be a week early than a minute late. What finally made the decision for me was when he began falling and being unable to get up without help. He also wanted to go and lie in the sun, which he’d never done before because he would overheat so quickly. I did not want that to happen when I wasn’t home. The home euthanasia was such a great idea. Buddy had a disease which required regular, multi-hour blood tests to treat, and developed an extreme fear of going to the vet. When I made the decision, it was about 10 AM on Fathers Day Sunday, and I didn’t want him to suffer another day before I helped him. A vet and tech were here by 5 PM, and it was such a relaxed, easy passage, with no fear at all. I recommend it highly. All my other pets were euthanized at the vet’s office, which involved a lot of stress at a time when I wanted them to be relaxed and at peace.

    • Just two days ago my 18 year and 4 day old Cocoa passed at home with a mobile vet euthanasia. The vet specialized in hospice and I will be eternally grateful for her wisdom and the thoughtful way which she guided us through the process. I highly recommend using a mobile vet who specializes in this process.

  8. Breaks my heart to read about Otto but I knew it was coming. I am so sorry. The question that got me was “what are you waiting for?” Lap of Love is awesome and is helping me with the grieving process as well. I had to put my sweet Cooper down a few months ago and I’m devastated. She was a shepherd rot who lived to be 13 1/2. She had degenerative myelopathy. It was a very difficult year. Thank you for your journal. Ive been reading it since Cooper was a pup. I always look forward to it every month! Always awesome information. Thank you so much and I am so sorry about Otto.

  9. Nancy, I am so sorry that you are facing this difficult decision. Otto is indeed a very lucky boy to have someone who loves him and wants what is best for him. Have you tried Lubrisyn for his arthritis? I’ve used it for my horse who had severe arthritis and had great results! I’ve also given it to my dogs as they’ve gotten older and it has helped. My thoughts and prayers are with you and Otto.

  10. I just read your thoughts about Otto and making the ultimate final decision, one that is really final. I also have a 15 year old dog and I am always thinking and assessing each day and each activity how he feels and how the day is going. He is definitely not as mobile as he once was, but he goes for one good walk a day with my other two dogs and me and what I call his mini-walk every evening where we don’t go far, he has all my attention, and he can SNIFF to his heart’s content. We also do fitness work (having learned the exercises from a rehab vet) three days a week. There are days when he says NO to the first walk with the other two dogs, but so far he has never said no to the mini-walk. But, i find myself wondering if his standing around is beginning dementia or something else. Wondering if i should not do his fitness exercises, etc. I have never seen any of the assessment tools you put in the article, i am trying so hard to make sure his last months and maybe years are as pain free as possible, as enjoyable as possible, and as stimulating as he seems to tolerate. I think the assessment tools will help. I felt real connection to you reading your thoughts about Otto, so similar to mine about my boy, Pan. Thank you for both the assessment tools and writing such an important blog note.

  11. Oh Nancy, my heart goes out to you. The roller coaster of emotions that come with this time of their lives. I am so glad you have the assistance of the coming vet appointment.
    The image of Otto wading contentedly in the water, tail wagging slowly, is a treasure.

  12. I’ve had several old pooches with arthritis pain, and as an arthritis sufferer myself I can tell you that your cool office (air conditioning) is a source of pain in itself. It’s a conundrum for sure. I’ve found that a cool pad helps in the heat (not in your office) and have even put them on top of orthopedic beds.

    I’m so sorry that you and Otto are going through this. Hugs to you both.

  13. I remember when you adopted Otto, and the adjustment time he needed…Time flies and we loose our best friends too quick. I’ve rescued a good number throughout the years (close to 50 at last count) and I remember each life, and each farewell. Now my Red, the sweetest pitbull ever, is 13 and nearing her own end, but she still wags her tail, slowly but surely, so it won’t be today.

  14. Thank you for writing about this. Having lost my heart dog this summer, it made me cry, and I’m sure many other readers as well. Otto is “our” dog 🐕 too.
    Otto and Nancy,
    We love you, we’re with you, we understand.

  15. This next week is supposed to be cooler and you should be able to get a better idea of what part of his discomfort is heat-related.
    I always listen, read the info and go with my gut feeling. To me, the worst case scenario is making them live with pain. How is it that letting them go a little sooner, be pain-free sooner, always what we as a society worry about?
    Just my opinion.
    Fake email address in case of hate mail.

    • I agree. In many articles I’ve read, usually by vets, they say people regret not letting their pets go earlier than they had. I am guilty of that myself – I let 2 of my dogs wait too long. I will always regret it. Though it is very difficult to sometimes see when to let them go. Perhaps one needs an objective outsider to tap you on the shoulder and tell you to start thinking about letting them go. They are too close to us and we love them too much to sometimes make that decision at the right time. My heart goes out to Otto, Nancy and her other dogs.