Molly, our Cockapoo rescue here at Perpetual Care, recently passed away at the age of 15. Truth be told, I primarily feel relief and I think the other dogs residing here have less stress and tension as well. The feeling of relief is normal when caring for a person or pet with dementia once they pass, but it causes us to feel guilty and adds to our grief.
Living with a dog with dementia affects everyone in the household and it creates a new normal that sometimes we don’t realize is an intense pressure until that pressure is released by their passing. In retrospection, I see the stages that we all passed through together that brought us to this time of relief.
The Beginning Stages
It started when Molly began to walk into things and she seemed unsure of how to get out of them. It was sometimes funny to see and she enjoyed a little snuggle when I picked her up and held her to get her out of it, but I knew it was a warning sign. Then, she began to stumble around the house trying to find her way to the doggie door. This also required just a little intervention because she would eventually find the door and get outside, but then the accidents began.
Escalation and Accommodation
Molly’s struggles eventually affected everyone when she was no longer able to find her way to the doggie door before she had to pee and she began to have accidents in the house. She was so disoriented that she stumbled over the other dogs laying on their pillows. They would growl, bark and sometimes nip at her to try to warn her off when they saw her coming, but she just kept going unless I could catch her before she reached them. This required me to be ever vigilant about her wanderings to head her off and help her to go outside or else I would be cleaning up behind her (this is why we have tile floors) or pulling her off the other dogs in their doggie beds. If placed in her crate, she bounced against the walls and yelped because of her need to wander. It clearly stressed the other dogs and demanded more time on my part that could not be spent with the others, but it was still manageable.
Then Molly developed Sundowners, which is basically increased levels of wandering, nighttime activity and disorientation. It helped to prop the doggie door open and keep a night light on outside because her vision worsened and she needed to walk for long periods of time until she exhausted herself and finally made her way back inside and fell asleep. Ironically, despite access to the outside, the pee accidents increased and the other dogs were always vigilant when she was up and walking, waiting to bark, growl and nip to force Molly to change her direction of wandering.
Eventually, she was no longer able to hold her pee and sometimes she was so exhausted that she peed in her bed which was in her crate before she even woke up although the door to the crate was open. I purchased six new inexpensive doggie beds and put down pee pads in her crate so that I could change her pads and wash her bedding 2-3 times a day, and always at least once in the middle of the night. When I was up, of course everyone was up and we all became tired from lack of sleep and the tension she stirred up in the other dogs.
In her last days, Molly began to have difficulty staying up and often fell over where she would stay until she gained strength to get up and walk again, often leaving a trail of pee or poop as she walked. Cleaning her bedding became a significant activity each day, usually also requiring a bath for Molly too.
Still, through all this time, Molly let me pick her up, hold her like a baby, rub her belly and talk to her. It seemed to relax her and relieve her anxiety. This routine became my gauge for quality of life. I thought, if she still lets me give her affection and recognizes my voice, she is able to enjoy those moments of time. In the back of my mind, I knew there would be a day of decision ahead of me when she no longer allowed me to hold her or when she no longer knew she was being held.
The decision to let them Go
I use the quality of life criteria for our pets at Perpetual Care and it works well when it comes to pain and disease, but it still gets blurry when you are dealing with dementia. We all have a tendency to put our feelings onto our pets and it can be difficult to assess the quality of life from their perspective and not our own. What is a quality of life for our pets? We tend to think that if they are eating and drinking, they are fine. It certainly works in the opposite view. If they are not eating and drinking it is definitely a sign that they will quickly deteriorate and may require euthanasia to save them a painful death. On the other hand, if they are eating and drinking, from the dog’s perspective, does it mean they have a quality of life or that they are a happy dog? If they are eating and drinking but laying in their pee or poop, are they happy? If they are wandering without knowing where they are and getting stuck between furniture, whining or yelping for help because they don’t know how to get out of it, are they happy?
With dementia, if you wait until they have reached the point of not eating or drinking, it can be months or even a year. In the meantime, their daily activities are nothing like the life they are used to experiencing and more often than not, they also no longer enjoy being touched or held by a person. In fact, being touched or held may cause them to panic, pull away or thrash around, perhaps even nip at you.
Each person must make a decision when the quality of life for their dog has deteriorated to the point that they are compelled to alleviate their suffering (and ours) and it is not an easy decision, especially when we are willing to do anything to accommodate them. The trouble is, sometimes we are accommodating them to avoid the pain and hurt of losing them and the responsibility or guilt of making the decision to euthanize them.
Some people believe their pet should pass on naturally absolutely will not euthanize them. They may even reach the point where they are feeding them and giving them water using eye droppers and cleaning up after them when they pee and poop in place because they can no longer get up and walk. I’m not able to subscribe to that belief because I want to save them from suffering if it is within my power to do so. Unfortunately, there is no one right answer and so it is left to us as pet owners to make the decision.
For Molly, I thought it would be the time when she could not walk or perhaps not eat, but as I watched her struggle more and more with finding her way around, stumbling into things and walking in circles in the front yard endlessly unless I picked her up and brought her inside, I worried that she was no longer enjoying life. Then, I would pick her up, hold her like a baby, rub her belly and she would relax and become peaceful. Then I would say, “Give me a kiss Molly” and she would stick out her tongue to lick my face and I believe she still found joy in that moment.
The last weeks of Molly’s life, she stopped eating her regular food because her sense of smell was gone. I played with more smelly foods and it worked for a while. Then one day Molly stopped eating at all and a couple of days after that, I found Molly wandering endlessly in the front yard at 3 am. I picked her up, held her like a baby and rubbed her belly. She seemed to relax, but when I said, “Give me a kiss Molly” she stared blankly breathing heavily.
It was then that I called the vet, told her it was time, and she said she would come to the house the next day to help her pass. As if to confirm her time, the next morning, Molly stopped drinking and by the end of the day, she could no longer walk. That evening, we helped Molly to pass, and I was able to hold her to give her comfort and peace in her final moments.
I was at peace with my decision and the next morning I felt relief when I realized that I could go back to normal activities and I could feel the relief and lack of tension in the other dogs because they no longer had to be vigilant for the wanderer. Overall, I feel that everything worked out as it should and that the timing was just right, but there are times I have wondered if I should have made the decision sooner.
I have talked with many pet owners and I have helped five dogs with dementia pass over the years, and I always question the timing of the decision to euthanize. That’s why, whenever you make the decision, it’s important to trust that you did your best and forgive yourself if you think you decided too soon or too late.
If you are struggling with the decision for your pet, my advice is to do the following:
1. Use a quality of life criteria checklist to help your make the decision from , your pets perspective, not your own. For a quality of life checklist, visit our website at www.perpetualcare.org .
2. You may want to write down the 2 or 3 things that you watch for that you consider the tipping point. For me it was being able to walk, still eating and our ritual of her letting me hold her and get her to give me a kiss.
3. You may hesitate, perhaps even make an initial appointment with the vet and cancel or your dog may rebound. That is okay. There will be a time when you make the appointment and follow through with it.
4. If at all possible, have the vet come to your home to minimize the stress on your pet and let them pass in the place where they are most comfortable and peaceful.
5. My final recommendation is to be there when your pet passes, so that they can feel the comfort of your touch and hear your voice in order to pass peacefully.