Providing the Best Care for Senior Dogs | Dr. Mary Gardner

[00:00:00] >> Dr. Mary Gardner: Palliation should be everywhere in veterinary medicine. Palliative care is everywhere, right? So we always wanna do palliative care. Hospice has a component of palliative care. You can’t have hospice without palliation, but you can have palliation without hospice.

[00:00:17] >> Announcer: Welcome to Dog Cancer Answers, where we help you help your dog with cancer.

[00:00:24] >> Molly Jacobson: Hello friend. Today on Dog Cancer Answers, we have a very interesting conversation. We just finished up an interview with Dr. Mary Gardner of Lap of Love. She is a specialist in geriatric and palliative care, hospice care, and she has a lot to say about the real nuances that all of us are going to face at the end of life with our dogs and how sometimes the symptoms of old age might show up and look like the symptoms of cancer and vice versa, just kind of how to think about that last stage of life. I personally found it very stimulating. So I’m hoping that this conversation will serve you well in your life with your dog, and hopefully take a little bit of the edge off of your fear about the end of life. Dr. Mary Gardner, thanks so much for joining us today.

[00:01:18] >> Dr. Mary Gardner: Yeah, no, I’m, I’m glad to be here. Thank you.

[00:01:21] >> Molly Jacobson: So my first question for you is how do we know that we have an old dog? Because I look at my 14 and a half year old Maltese and I see the puppy.

[00:01:33] >> Dr. Mary Gardner: Right. And it does change depending on the breed, right? So technically there’s some ranges of ages for senior dogs that are dependant on the size, so a Great Dane is senior at six, where a Maltese might not be senior until 10 or 11. But, you know what, it’s just a number Molly. So, you know, are we senior citizens? You know, who’s to say, and-

[00:01:58] >> Molly Jacobson: I don’t know.

[00:01:58] >> Dr. Mary Gardner: Right? Like, what’s that, I don’t know. What is the number that humans become senior citizens. And that could vary ’cause some people say it’s 65. Some people say it’s 60. The AARP, at 47, sent me stuff, like they were ready to talk to me and I’m like, ugh.

[00:02:13] >> Molly Jacobson: A hundred percent.

[00:02:14] >> Dr. Mary Gardner: So my focus is not necessarily how old they are, but how they are. And so you and I could be maybe 70 years old, right, and we are still, we’re technically seniors, but we’re not geriatric. We’re not fragile. We don’t have all these problems. And so the senior is really just a number. To me it’s geriatric and, and how fragile they are, and all the aging problems that come with it.

So a Maltese, you know, typically the smaller dogs, they do live longer and that’s a whole other topic right, of why, why the Great Dane does not live as long. And we wish they would, but you know, you’re, yes, definitely senior. Don’t know if your Maltese is geriatric yet though.

[00:02:52] >> Molly Jacobson: Great. That’s a really great distinction. So what is geriatric then?

[00:02:57] >> Dr. Mary Gardner: Right. So when I was learning about geriatrics, I actually went to a human geriatric conference. So it was for like geriatricians and I’m like, what is a geriatrician?

You know, we have pediatricians and geriatricians. And so like, what is that? What is that in humans? So I went to one of their conferences and they, uh, it was just very interesting because I learned so much from them. And we’re not gonna do the same thing in our world, but it was just kind of cool.

So family doctor, when a human is of a certain age, but having multiple issues like slowed walking, memory, you know, issues, uh, weakness, sleep disturbances, things like that, they will send them to a geriatrician. And they consider them, it’s more like a, it’s called a fragility syndrome. And they’ll send them to a geriatrician to work with. And the geriatricians deal with polypharmacy, so all the specialists and all the doctors are giving them meds, which happens to us too. They’re dealing a lot with cognitive dysfunction, so Alzheimer’s in humans, and caregiver burden.

They help families manage this aging person. What can we do to the house to make sure they’re safe? How can we help them at the store and get them what they need? And so I thought of that with our dogs and cats, and I’m like, okay, what makes a geriatric dog, because you can have Molly a 12 year old Lab that’s wagging his tail and everything is great, but he’s not doing well.

You know, he’s not eating, you know, he’s cognitive dysfunction at night panting and pacing. But three years earlier, he’s a senior at nine and he’s totally fine, chasing balls and running around like crazy. So the concept of geriatric is really about fragility and adverse outcomes. So a stumble to an older dog is way harder on them than a stumble if they’re six. Right?

So we wanna make sure that they’re kept safe, and a lot has to do with cognitive dysfunction and some other impairments that they start to have.

[00:04:47] >> Molly Jacobson: Okay.

So what would you call normal aging versus like signs of illness that we start to see?

[00:04:54] >> Dr. Mary Gardner: Great question. So a lot of people say that old age is not a disease, and I always say, well, disease means dis-ease. They’re not doing well. And there’s a lot of natural quote "aging processes" that make us not well. So for instance, here’s an easy one, we’re all getting wrinkles, right? So we all get wrinkles as we get older because the collagen isn’t there as much.

And it stresses us out when we see it in our forties and fifties and maybe in our sixties, right? But is that really a problem that we have wrinkles? Well guess what, when we’re in our eighties and we don’t have that oil production and our collagen, our skin becomes fragile. Right? And if you’ve ever seen an elderly person it’s, it’s bruised and it’s fragile and they get, you know, bumps. So is that a disease, Molly? Right.

[00:05:36] >> Molly Jacobson: Okay.

[00:05:37] >> Dr. Mary Gardner: Is your skin being fragile a disease? So I think there are absolutely diseases, but just as we age and get older, like nuclear sclerosis, a, a problem with our eyes. That is a disease, technically, but it’s usually not gonna cause complete blindness, but it can bring a lot of struggles. And so in the human world, they actually would like to make aging a disease, because then there’s better insurance programs behind it, more research.

[00:06:06] >> Molly Jacobson: You can code for it.

[00:06:07] >> Dr. Mary Gardner: You can code for it. Exactly. You can’t code for something that people say is not a disease. But lemme tell you when my Grandma Gardner, when she was, when she was in her eighties, she had a lot of struggles, but did not have a diagnosed disease.

[00:06:19] >> Molly Jacobson: Right.

[00:06:19] >> Dr. Mary Gardner: Besides arthritis. Like that was about it.

[00:06:21] >> Molly Jacobson: Yep.

[00:06:22] >> Dr. Mary Gardner: Which, you know, so many of our pets have.

[00:06:23] >> Molly Jacobson: Well, that’s really interesting. Okay. So, at what point, Dr. Gardner, do you feel that a dog has gone from being a senior who’s doing well to geriatric? Like as a clinician, what are you looking at when dogs come in, is it that fragility, is the skin problems?

[00:06:45] >> Dr. Mary Gardner: Well, it’s a fragility ’cause – and they may not have skin problems, right. So I think it’s usually when we have three ailments. And also we start to tax the caregiver. So the caregiver can’t leave them for eight hours, right?

[00:06:57] >> Molly Jacobson: Oh.

[00:06:57] >> Dr. Mary Gardner: They have to come home in four to let them out. They have to wake up at night, you know, they’re starting to struggle. They have to entice them to eat more. So when you have that caregiver burden on them, that, it becomes a serious issue. So it usually starts when there’s about three things, ’cause you know, a dog that’s losing his vision, we set the house up a little bit for them and it’s not so bad.

Now you add incontinence. Hmm, Uh-oh. Then you add cognitive dysfunction or mobility issues. And it’s really hard. And you know, I was talking to this woman yesterday about her dog, Louie, and Louie has a bad disease. He’s got osteosarcoma. But she, she can’t leave for a trip that she needs to go on because you know, he’s got some mobility issues now.

And if that, if that fractures, it’s not good. And I said, well, he’s geriatric. He has other problems. And he’s got a bad disease. He’s in hospice. So as a clinician, usually all the ones that we see at end of life, they’re geriatrics, they’re, you know, they’re up there, they’re the weak and the wobbly and the crusty and the lumpy and the most beautiful ones of all.

[00:07:56] >> Molly Jacobson: For sure.

[00:07:57] >> Dr. Mary Gardner: Yeah.

[00:07:57] >> Molly Jacobson: Because they’re so loved.

[00:07:58] >> Dr. Mary Gardner: Oh yeah. And they’ve got like a whole history of story behind them. The sad thing that, Molly, that really upsets me is, you know, doing end of life, everybody thinks that we must be crazy and sad. Right? And so, going to somebody’s home to euthanize their dog or cat that’s old and it’s got problems, is, it doesn’t make me sad. I mean, I’m sad for the family.

[00:08:18] >> Molly Jacobson: Of course.

[00:08:18] >> Dr. Mary Gardner: But it doesn’t break my heart. Right?

[00:08:20] >> Molly Jacobson: Right.

[00:08:20] >> Dr. Mary Gardner: What breaks my heart is that so many have not been to their doctor in the year before. And I did research and we, I looked at 817,000 families that euthanized their pets in the United States across the whole country, and 50% of pets had not been to their doctor the year before they died.

And that is when they’re really geriatric. In humans, it’s usually, to be a broad categorization is the last 10% of a lifespan. So if the average lifespan is, let’s say 12 years old, right? That’s a year and a half, you know, a year and a half. And it’s so sad that 44% have not been to their doctor a year and a half before.

And it’s not just about the blood work and x-rays, and you know, it’s, it’s, what’s the best harness to give them? What’s the best, you know, should they, do they need a halo ’cause they can’t see anymore, how do we protect them? How, what about enrichment to keep their minds going? What, you know what they do smell because their skin isn’t so good like I was talking about, right? So now we’ve got some crusties and stinkies or dandruffy and oily like it’s in between. And we could help those families so much at that last stage even if it’s not about chasing Cushings and chasing some bad stuff. Just caring for these guys that, you know, I lovingly call them jalopies. Right? Like they they’ve got a lot going on.

[00:09:36] >> Molly Jacobson: Aww, little doggie jalopies.

[00:09:38] >> Dr. Mary Gardner: Little doggy jalopies and-

[00:09:40] >> Molly Jacobson: Yeah.

[00:09:40] >> Dr. Mary Gardner: And so that’s what makes me sad is that so many have not, have not seeked care. And, and a lot of people ask me, well, why do you think that is? And I think it’s a myriad of reasons. I think there, you know, denial is a, is a wonderful place to be in sometimes, right? Like I don’t even wanna know.

Finances are another, listen, he’s a 14 year old Lab that’s got a lot of issues. What is Dr. Mary gonna say, right. Like, she’s just gonna give me the list of issues and charge me $500 to do blood work and x-rays to find that issue, like-

[00:10:08] >> Molly Jacobson: Right.

[00:10:08] >> Dr. Mary Gardner: So I, I see that. And they also sometimes think, well, how much time do I have left?

And they’re waiting and they’re waiting and it’s a waiting game ’cause they think they’re gonna die in a month or two. And then they keep living ’cause they don’t. So I, you know, I don’t know for sure, these are just anecdotally when I hear families and they’re talking to me, they’re like, I know we haven’t brought them in and this is why.

[00:10:27] >> Molly Jacobson: Yeah. It’s hard. Remind me of the title of your book. Your book is called?

[00:10:31] >> Dr. Mary Gardner: So It’s Never Long Enough.

[00:10:33] >> Molly Jacobson: Never Long Enough.

[00:10:34] >> Dr. Mary Gardner: Because Molly, no matter how old they are, when your, you know, little one is 18, it’s still never long enough, right. We want them like a turtle. 40 years would be great.

[00:10:44] >> Molly Jacobson: A hundred percent.

[00:10:45] >> Dr. Mary Gardner: And it used to, it kind of drives me nuts when somebody will say "a really good old age," like, you know, oh, he’s a 16 year old Lab and people will say, oh, that’s really good, isn’t that really good? And you know what, when my grandmother died, nobody said, oh, that’s really good for her, you know, for an Irish American, that’s really good.

Like, no, I wanted her more. So I mean, that’s the name of the book. And my cat book is coming out later, Nine Lives Are Never Enough.

[00:11:12] >> Molly Jacobson: Fantastic.

That’s great. So should – obviously this is Dog Cancer Answers. So this is always something that people who are coping with dog cancer, you know they’re constantly, I think almost every day, people are looking at their dog and saying, where are we? You know, there’s a continuum, there’s a spectrum, and I wanna balance it. So what do you see when it comes to cancer? What’s your best advice for someone whose dog has cancer?

[00:11:40] >> Dr. Mary Gardner: Oh, this is so interesting. And you’re spot on Molly, because it’s a rainbow of choices that we have. And I always, I like to understand the goals, the goals that somebody has and the goals of care. You know, some people have so much guilt with cancer because if they, if they can’t afford certain treatment options or, you know, they themselves have gone through chemo so they’re kind of anthropomorphizing what they went through and they, they, you know – and you know, some people will say, well, it’s just a dog, why would you do chemo, and why would you do this or that. So, and funny, I had my, my own dog, Sam, she had, I thought she had degenerative myelopathy. About two years ago she started doing some wonky stuff. Long story short, she had spinal lymphoma. So just very, you know, rare, but it was like a DM dog. So that was her symptoms, was, you know, toe dragging, uh weakness, whatever, incontinence. Everyone was, you know, they’re like, okay, we’re – I went for chemo and radiation.

I went for it. ‘Cause I’m like, you know what? If I can get some more time, and I will manage her symptoms well, I could take her to chemo every week. I could take her to physical therapy three times a week. Thankfully we were in COVID. We were shut down. I could actually take her and I wasn’t traveling. So this was a beautiful time.

[00:12:51] >> Molly Jacobson: You had the time.

[00:12:52] >> Dr. Mary Gardner: I had the time. But let me tell you, in normal circumstances, her dad, he wouldn’t take her. No way. I love quality of life discussions and, and quality of life scales, and having everybody do them and, you know, and respecting what everybody’s decisions are and what their thoughts are.

[00:13:10] >> Molly Jacobson: Right.

That seems like a good place to pause and take a break. And then when we come back with Dr. Mary Gardner, I wanna talk about those tools that you use, your pet hospice journal and your Grey Muzzle app.

And we’re back with Dr. Mary Gardner. And, you know, I said I wanted to talk about your apps, but before we do that, let’s talk about mobility. You were talking a little bit about not being able to get up. Is there anything that you would recommend people think about when their dog starts moving, like limping or not able to get up so well, like, are there things that they can do or things to look for, signs to really take seriously and take to the vet?

[00:13:53] >> Dr. Mary Gardner: Yeah. I dedicated a whole chapter to that in the book because we see so much mobility issues in our older dogs. It’s the number one, besides cancer as a disease, it’s the number one ailment that we see in, in older dogs that we manage and whatever the reason is, it could be a disc issue, um, muscle wasting, arthritis, neuropathy, or things like that.

So, whatever the issue is we still have a mobility issue and, you know, whatever the, the cause of it is rather.

[00:14:19] >> Molly Jacobson: Okay.

[00:14:19] >> Dr. Mary Gardner: And the other thing that – I know a lot of people can understand limping and they can understand slow getting up and down. The one thing that surprises families is the toe dragging. They’re like, oh, it’s just getting slow, so he is dragging his toes, or, you know, flipping of the feet. But the toe drag, I, this scuffing of the toe, I hear it, and I’m like, uh-oh. That’s what triggered me with Sam. I was like, I heard it on the walk. I heard a scuff. And I’m like, that’s not good. They should not be scuffing. And we see that a lot with, um, you know, polyneuropathies and even some disc issues too, the, the messages aren’t going correctly.

So these are early signs and the sooner we catch mobility issues and manage them, the better. What I don’t like for people to do is, is just say, well, he’s hurting, so let’s not let him move. We got to move, right? Like we gotta keep moving. We gotta keep our muscles strong. We could learn from this. We gotta keep muscles strong.

We gotta keep lymph flowing. We’ve gotta keep all of the juices cooking and I want them walking. We do, we have to alter what we do, for sure. You know, we’re not gonna be running around playing as much, but absolutely walking. I, I walk four miles every morning with my dog. So if you’ve got a dog with some ailment of mobility, break up their walks to three or four times a day, shorter walks, but absolutely do them and they love it.

They love walking, right? That’s their jam.

[00:15:37] >> Molly Jacobson: Smaller walks, more often.

[00:15:39] >> Dr. Mary Gardner: Smaller walks, more often. And I don’t get paid by this harness company, but my favorite harness of all times is Help ‘Em Up harness.

[00:15:47] >> Molly Jacobson: Help ‘Em Up. Okay.

[00:15:48] >> Dr. Mary Gardner: Help ‘Em Up. Right. And so it’s just got great support in the front and the back. And so that way you could help lift their hind end, and they’ve got tons of accessories, and – it is my favorite. It’s maybe a hundred dollars for a large dog, so it’s not that bad. You can buy cheaper stuff and it’s, that’s what it is, it’s cheaper. But you’ve got to set your house up for success. And if there is a hardwood floor or a tile, that’s not good, and they’re gonna find that spot.

So you have to cover your floor in rugs and in bath mats and yoga mats, stuff like that. They need traction, ’cause when they have traction, they’re gonna use their muscles, they’re gonna be safe. And there’s a ton of other products that I, that I talk about that, you know, the toe grips and, and what kind of booties are best, ’cause not every bootie’s the best for, you know, certain diseases, and just making sure that, that they can move.

But we have to address pain if they are in any pain too. ‘Cause we don’t wanna force movement if they do have pain.

[00:16:40] >> Molly Jacobson: Okay. So let’s talk a little bit about pain. The things that people always wanna know is, is my dog in pain? And oftentimes I’m looking at the description, I’m thinking, well, it seems to me like that’s pain that you’re describing. But how do we know?

[00:16:53] >> Dr. Mary Gardner: Right. And chronic pain is the harder one. The acute pain is, is easy to see, right? So if they’ve, you know, broken leg or a ligament or something like that, you know, they’re limping and their leg is up and they’re like crying and whining, that that’s so obvious, right? But-

[00:17:07] >> Molly Jacobson: Right.

[00:17:07] >> Dr. Mary Gardner: -the chronic pain, we kind of get used to seeing them do certain things we, so we don’t notice it as much, right? And so we just, it’s their, oh, they’re just getting slow. It could be so minor, just like the saw horse stance of their legs. They just look like they’ve got, you know, something going on where they’re just sitting like a saw horse. Of course getting up a little slower, getting down a little slower, things like that, but that is signs of pain. But they also could just be panting more.

That’s a huge sign of pain. They could be, you know, pacing more. They could look anxious more. They could also show no signs. Just because a pet does not show outward signs of pain does not mean they don’t have it, right. Like nobody would say right now I have pain. And I absolutely do. I’ve got a really bad shoulder and it hurts so bad.

But nobody knows ’cause, ’cause we manage it, right? Why would I complain also. Dogs and cats don’t love to complain, right? Except certain breeds, certain breeds maybe are a little bit more sensitive to stuff. The other thing, you know, a lot of people don’t realize is something called allodynia, which means things, sensations and things that should not normally hurt, because a pet is so wound up in pain, they’re already in a state of pain, that these other things start to hurt.

So a great example is the Golden Retriever with really bad arthritis or, you know, even osteosarcoma or something like that. He’s got pain and nobody’s noticing it, but he doesn’t like to get pet anymore.

[00:18:29] >> Molly Jacobson: Ah.

[00:18:30] >> Dr. Mary Gardner: And somewhere else. It could be his head, right? So allodynia lowers the threshold of where pain is so things that normally shouldn’t hurt – even like a vaccine, you give a little teeny weeny needle and they’re like Ahh! And it normally doesn’t hurt, but because they’re already in pain, their threshold is down. I get migraines and you know, the light hurts me, right. Somebody touching me hurts me. So-

[00:18:52] >> Molly Jacobson: Right.

[00:18:53] >> Dr. Mary Gardner: So even just signs of things that are starting to aggravate them that probably shouldn’t.

[00:18:57] >> Molly Jacobson: Okay. Well, that’s a really helpful thing. So when – my dog Roo had pretty severe arthritis at the end and she had it for the last couple years of her life and she started to get really aggressive with us. And she’d always been like the most cuddly, lovely, you know, kisses kisses kisses dog, and she just was getting so aggressive. And that was definitely a sign for us that she was in a lot of pain a lot of the time.

[00:19:21] >> Dr. Mary Gardner: Yes.

[00:19:22] >> Molly Jacobson: And so it sounds like that’s what you’re talking about here. Could be.

[00:19:25] >> Dr. Mary Gardner: Yes. A hundred percent. And so many people would say, well, it could be, right. They could be, you know, some people would say, well, they’re just getting ornery in her old age, right? Well, no, it’s probably something else. They just don’t get curmudgeons. Right? Like we, not like-

[00:19:39] >> Molly Jacobson: That’s not actually a sign of aging, to get ornery?

[00:19:43] >> Dr. Mary Gardner: No, like for us, yes, right. But not for them. Like, they’re, they’re just awesome. And it’s either pain or anxiety. And let me tell you something, anxiety is a form of pain.

[00:19:53] >> Molly Jacobson: Aha.

[00:19:54] >> Dr. Mary Gardner: And so the definition of pain is – that is really important. Yeah. Let’s touch on that. So, so really pain is not just a sensory, you know like a physical biological thing, like arthritis. It is also an emotional and social component. Anxiety is, dare I say, more painful than pain. If any of your listeners have ever had, been anxious over something, right, whatever it may be, like that is, oh, it can make you sick and you stress about it and you can’t even think about anything. Right? So-

[00:20:22] >> Molly Jacobson: Yeah.

[00:20:23] >> Dr. Mary Gardner: Separation anxiety. When pets get older and they have separation anxiety. Even, dare I say, sometimes going to the clinic, if that brings them more anxiety as they get older, ’cause they have cognitive dysfunction and things like that, we got to address this.

So it’s, it’s not about gorking a dog out on meds, you know? It is about making sure that they’re comfortable. And that’s what palliative care is, is making sure they’re as pain free and anxiety free as possible.

[00:20:47] >> Molly Jacobson: So when a dog has cancer, for example, where do you start to offer, in your expert opinion, where should someone start thinking about palliative treatments as opposed to curative treatments? Where do we cross that line?

[00:21:01] >> Dr. Mary Gardner: Oh, Molly, this is good. Okay. So there’s a difference though, because palliation should be everywhere in veterinary medicine. Palliative care is, is everywhere. Right? So we always wanna do palliative care.

[00:21:14] >> Molly Jacobson: Right.

[00:21:14] >> Dr. Mary Gardner: Hospice has a component of palliative care, right? So you can’t have hospice without palliation, but you can have palliation without hospice.

[00:21:22] >> Molly Jacobson: We should probably define palliation and palliative for our listeners just to make sure they know what we’re talking about, now that I think about it.

[00:21:29] >> Dr. Mary Gardner: Yeah. It really is very simple.

It’s, it’s keeping a pet comfortable, as pain free as possible, whether that is a short period of time, so maybe after a surgery that we know they’re gonna recover from and we wanna give them medication to make sure that they can sleep at night, they can not have pain. That’s palliative care. You’re taking away, you’re trying to keep away pain and anxiety. So it could happen for a short period of time. And it could also be for the rest of their life, ’cause they have to deal with something, right. So-

[00:21:59] >> Molly Jacobson: Okay. So if a dog has chemo or has a surgery and then they’re prescribed Cerenia, for example, as just one, right, to try to keep nausea at bay and keep them comfortable. And they’re prescribed pain medications after a surgery to give routinely for a few days after the surgery. Those are palliative care steps, ’cause you don’t need the pain medication in order to heal from the surgery.

[00:22:24] >> Dr. Mary Gardner: Right.

[00:22:25] >> Molly Jacobson: Okay.

[00:22:25] >> Dr. Mary Gardner: But there’s a lot of studies though that show when you are painful, you actually heal slower.

[00:22:31] >> Molly Jacobson: Aha.

[00:22:32] >> Dr. Mary Gardner: Yeah.

So, and that’s in human medicine too.

[00:22:34] >> Molly Jacobson: Right.

[00:22:34] >> Dr. Mary Gardner: And it drives me nuts when people don’t give the meds. And let me tell you, nausea, oh, that’s the worst. I don’t want ever to be nauseous.

[00:22:42] >> Molly Jacobson: I agree.

[00:22:43] >> Dr. Mary Gardner: Right? Like, I’ll take a broken toe over nausea any day.

[00:22:46] >> Molly Jacobson: Same.

[00:22:47] >> Dr. Mary Gardner: So I love Cerenia and I, and I prophylactically give it right. Like, just give it, ’cause you know they may have it, because it’s much easier to keep pain away than chase it away.

[00:22:57] >> Molly Jacobson: Okay.

[00:22:57] >> Dr. Mary Gardner: Right? Like once you start having it, it is really hard. So some people say, well, he’s having a good day, so I’m not gonna give it. Please just, please just give it, right, because he’s not telling you.

[00:23:07] >> Molly Jacobson: Okay. I think that’s really important advice. I’m just gonna highlight and repeat what you just said.

[00:23:12] >> Dr. Mary Gardner: Okay.

[00:23:12] >> Molly Jacobson: Which is that sometimes we think, oh, I don’t wanna give too many drugs. I’m not gonna give the anti nausea or the pain medication today. But your advice is to give it because it’s better to give it when he doesn’t need it as much, but still needs it a little, than to not give it at all.

[00:23:27] >> Dr. Mary Gardner: Right.

[00:23:28] >> Molly Jacobson: And isn’t there a cycle that can start, like pain begets pain in the body, like-

[00:23:33] >> Dr. Mary Gardner: Yep. That’s like the wind up comment I made earlier. So pain begets pain and, and you also then have a harder time getting it down. So like, sometimes we have to give multiple drugs. Once they’re in such a state of pain, we have to give so much more to get them to lower that threshold so that way they feel a little bit better.

And it is true when I start to feel, you know, sick and nauseous, then everything starts to escalate. And I know so many people are scared of giving some drugs, but, but if it was you, you’d probably take them. The dog or cat’s just not complaining. And, and some people don’t take drugs, they’re like, no, I’m not gonna take the Tylenol even though I’ve got, you know, a bone sticking out of my leg and, and they need more than a Tylenol, but they don’t even wanna take that, right? And I’m like, ugh, don’t be tough. This isn’t the time to be tough. Sometimes we may not be doing curative treatment, and that will shorten their lifespan, they won’t live as long, but what I wanna make sure is that when they do live, they live well. I don’t wanna extend life if it’s not well, and that’s not the goal of hospice. That’s not the goal of what I do. It is about, even if I’ve got four days left, I want them to be good.

[00:24:41] >> Molly Jacobson: Yeah, I think everybody wants that for their dog. I think they want them to be happy and healthy and vibrant and vital.

[00:24:48] >> Dr. Mary Gardner: Exactly.

[00:24:48] >> Molly Jacobson: Right up until the day that they, for some crazy reason, have to leave us. And why do they have to do that?

[00:24:54] >> Dr. Mary Gardner: I know. I always say we just borrow them for a little bit. We gotta give them back.

[00:24:58] >> Molly Jacobson: Yeah.

Right?

So you have some tools that you recommend, the Pet Hospice Journal is one.

[00:25:05] >> Dr. Mary Gardner: Yes.

[00:25:05] >> Molly Jacobson: And the Grey Muzzle app.

[00:25:07] >> Dr. Mary Gardner: Yeah. So about maybe back in 2013, I, we have a number of quality of life scales available on our website, Lap of Love. And you could just search, Google quality of life scale, and you’ll have tons of, the Ohio State has one-

[00:25:20] >> Molly Jacobson: Right.

[00:25:21] >> Dr. Mary Gardner: Dr. Villalobos has one. Anyway, I’m a bit of a nerd. So I was, I worked actually in software for 10 years before I become a vet. And so I, I’ve got this little techy background.

[00:25:30] >> Molly Jacobson: Okay.

[00:25:31] >> Dr. Mary Gardner: So I built a little website called the Pet Hospice Journal and, and it just help – it’s just a digital way to monitor your pet. We also built an app a few years ago and that’s just simply good day, bad day, neutral day, and tracking this. ‘Cause everybody, Molly, will say, when he has more bad days than good it’s time.

Right? Well, guess what, what you do is, is they have three bad days in a row and then they have one good day and you forget all those three bad days ’cause you had one good day, right.

[00:25:57] >> Molly Jacobson: I’m so glad the bad days are over.

[00:25:59] >> Dr. Mary Gardner: Woo, we’re over that. And they’re like, forget about it.

[00:26:02] >> Molly Jacobson: Yeah.

[00:26:02] >> Dr. Mary Gardner: Right? So you’ve got to monitor what you’re measuring. And so whether it’s my app, whether, I have a journal that I also made that’s a companion to my book that’s got symptom tracking, cognitive questions, mobility things, quality of life, bucket list, all these tools that just can be so helpful. And it’s not for everybody, but I think it is actually really helpful to write things down, diary, journal, and, and create goals of care and things like that.

So, I got a whole bunch of tools in my toolbox. What anybody wants, I got.

[00:26:36] >> Molly Jacobson: Well, we’ll put links to all of them in the show notes.

[00:26:39] >> Dr. Mary Gardner: Okay, perfect.

[00:26:40] >> Molly Jacobson: Well, is there any last thing you want to impart to our listeners about – if you could sort of wave a magic wand, what’s the mindset that you would implant in their brains when it comes to dogs, hospice, end of life, geriatric care?

[00:26:57] >> Dr. Mary Gardner: Mm gosh. I know. My thing is, say I love you every day. That is the prescription I prescribe to every pet family, right? Like say, literally say it. Because we will, when the time comes, we will always wish we had one more time to say that. We’ll always wish we had one more picture, one more video, like go nuts, use up your phone, like go through all the memory you’ve got, and say I love you. Because if you are not present and they die on their own, you have not said it.

And I think it is really important to verbalize that every single day. And a lot of people say, I do that all the time. Make time. 15 minutes with nothing else, you just sit there and lay with them and say how much they meant, just hold their paw and just say how much that you love them.

[00:27:42] >> Molly Jacobson: Beautiful. Thank you so much for joining us today, Dr. Mary Gardner.

[00:27:47] >> Dr. Mary Gardner: Oh, thank you. I hope this is helpful for everyone.

[00:27:50] >> Molly Jacobson: Oh, I know it is. And the beauty of podcasts, right, is that they live on forever so it’ll be helping people for many, many years in the future.

[00:27:58] >> Dr. Mary Gardner: Yeah. Perfect. Thank you.

[00:28:03] >> Molly Jacobson: Well, that was a wonderful conversation with Dr. Mary Gardner.

Kate Basedow, thanks for joining me to debrief and think it through and wrap it up a little bit because my mind is, my wheels are turning around hospice, geriatric, and, uh, end of life. I feel like I learned a lot and I had like a, I don’t know, like a, a huge insight about just where life ends and begins. It was a very cosmic conversation for me inside my head.

[00:28:33] >> Kate Basedow: Yeah, for sure. I love that Dr. Gardner brought up that grumpiness isn’t a normal part of old age. Because as well as the potential that the dog is painful, also that can be a sign of cognitive dysfunction. And canine cognitive dysfunction, which is kind of like doggie Alzheimer’s, is very much treatable in most cases.

My senior dog that I just lost last December, when she was around 12, she started doing kind of the sundowners behaviors with the whining and pacing at night. And it was like, oh my gosh, what are we gonna do? And we tried medication for it. And within a week, not only had the pacing stopped, but she was brighter and more cheerful.

And I hadn’t realized how grumpy she had gotten until we fixed it. And it was like, wow, I’ve got my dog back. And she went on another almost five years.

[00:29:30] >> Molly Jacobson: Wow.

[00:29:31] >> Kate Basedow: Much brighter and happier.

[00:29:33] >> Molly Jacobson: And I imagine that if you hadn’t fixed it, she would’ve gotten grumpy, like that pain cycle and that anxiety cycle, like we know these things can spiral and they get worse as they get worse.

So if you interrupt these things, then you can sometimes really reverse them, stop them or arrest them or stabilize them so that it doesn’t get worse over time. Sounds like that’s what happened with Queezle.

[00:29:56] >> Kate Basedow: Yeah. And for sure if we had let it go, also my husband and I weren’t getting to sleep and-

[00:30:02] >> Molly Jacobson: Right.

[00:30:03] >> Kate Basedow: That was taking its toll.

[00:30:04] >> Molly Jacobson: Right.

[00:30:05] >> Kate Basedow: And the medication that she was put on is called selegiline and it’s not the cheapest, but oh boy, was it worth every penny for both her quality of life and ours. For all of us to get the sleep we needed and to be ourselves and be happy and enjoy our lives together.

[00:30:22] >> Molly Jacobson: Which I’m sure is what Queezle wanted.

[00:30:24] >> Kate Basedow: Oh, yeah.

[00:30:25] >> Molly Jacobson: Queezle didn’t wanna be grumpy. She didn’t wanna be pacing. She didn’t wanna be sundowning. She wanted to have her beautiful life.

[00:30:32] >> Kate Basedow: She wanted her comfy beds and her food delivered on time. The other thing that really resonated with me from what Mary Gardner was saying was about just give the pain meds.

And if your vet is concerned about nausea and has given you anti nausea meds, just give them. And, at the very end for Q, she had been on pain meds pretty regularly for a while due to arthritis issues. And she was having kind of ongoing issues with appetite the last six to eight months of her life, and then started having a lot of problems with nausea.

And those last two weeks of her life, where I was, at first, it was a, all right, we’re gonna try Cerenia to resolve the nausea and see if we can fix this and bounce back. And then to when we realized that this was it, she got the Cerenia every day for t hose last two weeks of her life ’cause it was like, you know what, even though she felt good and ate today, I don’t wanna stop it and have tomorrow be another pukey day.

[00:31:36] >> Molly Jacobson: Right.

[00:31:37] >> Kate Basedow: And so she got that medication every day whether she ate or not for those last two weeks, ’cause I wanted those last two weeks to be as good as we could possibly have them be.

[00:31:46] >> Molly Jacobson: Yeah. Sometimes people really worry about how potent a pharmaceutical can be. And I often, in my mind, think that’s true, and, life is very potent. And the end of life is potent as well.

[00:32:02] >> Kate Basedow: And pain is potent.

[00:32:04] >> Molly Jacobson: And pain is potent. Dr. Gardner mentioned that she gets migraines. I get migraines too, and I would do everything. I have given up all the foods, I gave up, you know, any like little taste of anything delicious for years to prevent pain.

So pain is a potent foe. And it’s absolutely worth treating even when you just suspect it’s there.

Yeah.

There was a lot of food for thought. We’re gonna put all of the links in the show notes, right, to all of Dr. Gardner’s books and tools and the harness that she mentioned that sounds like is a really great tool for mobility.

[00:32:43] >> Kate Basedow: Yes.

[00:32:43] >> Molly Jacobson: And of course our support group. Kate, is there any last word of wisdom you have as a licensed vet tech and the daughter of a veterinarian about this subject that you wanna drop in the podcast?

[00:32:56] >> Kate Basedow: Love your dog, and especially with these senior dogs, if something seems off make that call and make that appointment with your vet to get it checked out. Because sometimes it’s just a bad day and sometimes it’s a sign of a problem that hopefully we can fix if we catch it early.

[00:33:12] >> Molly Jacobson: Love it.

Thanks again for joining us today and I’ll see you on the socials and in our Facebook group. Join us on dogcancersupport.com, it’ll redirect you to our Facebook Dog Cancer Support Group. And dogcancernews.com is where you can sign up for our newsletter. We send it out three times a week with all sorts of things about dog cancer, but also lots of light and happy things, ’cause it is about love, right? It’s about connecting with our dogs and giving them those glorious last days so we get them too.

I’m Molly Jacobson. And from all of us here at Dog Podcast Network, I’m wishing you and your dog a warm Aloha.

[00:33:54] >> Announcer: Thank you for listening to Dog Cancer Answers. If you’d like to connect, please visit our website at dogcanceranswers.com or call our Listener Line at (808) 868-3200. And here’s a friendly reminder that you probably already know: this podcast is provided for informational and educational purposes only. It’s not meant to take the place of the advice you receive from your dog’s veterinarian.

Only veterinarians who examine your dog can give you veterinary advice or diagnose your dog’s medical condition. Your reliance on the information you hear on this podcast is solely at your own risk. If your dog has a specific health problem, contact your veterinarian. Also, please keep in mind that veterinary information can change rapidly, therefore, some information may be out of date.

Dog Cancer Answers is a presentation of Maui Media in association with Dog Podcast Network.