Peace of Mind for Pet Parents Episode 073: Reading What They Can’t Say: Pain, Comfort, and the End-of-Life Journal

RESOURCES MENTIONED & RELATED LISTENING

• PEACEFUL PDF - Free Download
• LIVING Quality of Life Care Assessment Tool — Free download
• BrightHaven Animals YouTube Channel — Search: BrightHaven Animals | @brighthaven_animals
• Animal Hospice Group (animalhospicegroup.com) — professional certification organization in animal hospice and palliative care

You might also find helpful:

• Episode 056: Someone in Your Corner — What a Veterinary Social Worker Can Do for You and Your Pet
• Episode 069: Preparing for Your Pet's Death — Physical, Emotional, and Spiritual Ways to Make Every Moment Count
• Episode 053: From Pet Parent to Caregiver: The Quiet Shift Nobody Warns You About
• Episode 006: When Pet Care Gets Hard: Supporting a Pet with a Difficult-to-Manage Diagnosis

Related reading:

• What Is Animal Hospice Care for Pets?
• Life-Changing Diagnoses in Pets: A Comprehensive Guide
• Emotional Support for Pet Owners Facing a Difficult Diagnosis: Coping with Guilt, Fear, and Grief
• Monitoring Your Pet's Health at Home: A Palliative Care Guide for Chronic and Difficult Conditions

---

Episode Transcript: 

Introduction: A Question Many Pet Parents Never Say Out Loud

Karen Wylie: Hello and welcome back to Peace of Mind for Pet Parents. I'm Karen Wylie here as always with my wonderful friend Gail Pope. If you've ever sat next to a pet that's in decline and you're thinking to yourself, "I don't know if this is actually pain or maybe it's just old age," then know you're not alone and this episode is probably just right for you.

Gail and I follow a hospice nurse named Barbara Karnes and she has spent decades teaching families how to care for their dying loved ones at home. Honestly, so much of what she writes can be included in what we teach pet parents; except our patients can't tell us how they feel, which is just a small difference there between caring for humans at end of life and our pets.

Barbara wrote a blog post recently about morphine and the use of it at human end of life and how it's a very misunderstood medication. She makes the point that dying itself is usually not painful but that disease can be because disease is what causes pain. So not every disease and not every death but she says that when there is pain, that the goal of medication is always comfort and never to hasten death.

That distinction matters just as much for our pets as it does for people. So there's this piece missing when we try to bring these ideas into the animal world and that's what Gail and I are going to dig into today. How do you know if your pet is in pain when they can't tell you?

That question and how you answer it really changes everything you do downstream of that. Because it changes whether you feel confident managing pain at home, it changes whether hospice-supported natural death feels like a real possibility or a very scary gamble, and it changes how euthanasia feels too. Whether you feel like a judge scheduling an execution or whether you feel you're responding with clarity to what your pet's body is telling you.

So we really want to talk about reframing pain and dying in our pets. Gail, I just mentioned that we've both been following Barbara Karnes' work for a long time. You, longer than me because you came to this hospice work and animal hospice earlier than me.

So does that distinction that disease causes pain, not dying causing the pain, match with what you've seen firsthand across all the animals that you've cared for at BrightHaven?

Discomfort vs. Pain: A Distinction Gail Learned from Barbara Karnes

Gail Pope: Golly, what an interesting topic this is. Absolutely, because this takes me back years to when I first discovered Barbara's work and I read her little blue book that has in more recent years become even more popular. But when I read that book, it changed my life because that's what I had found in the animals that I'd worked with. That's what I taught, what I preached.

But finding that parallel with humans suddenly made it all so much easier to talk about. It gave me not a different perspective, but the perspective matched my own. I think it was from then forward that I really started reading more books about human hospice care and people's experiences and how their journey to end of life grew and morphed, and how some had pain meds, some didn't.

It was just like, I don't know, like a flower opening because I realized that my path was exactly the same. I'd become very well used to the way we cared for our animals, the different types of medical approaches that we took, the way we brought pain meds in if and when. 

I think there's a difference between discomfort and pain. It's a slippery slope. I think when you encounter discomfort, you have to address it because that's pretty much always there before. If pain is an acute thing that suddenly hits, then obviously it's an acute thing and you're going to treat it— probably more acutely. If discomfort starts, then that doesn't have to be treated like with morphine, as the article was talking about, you can begin with different ways.

I think maybe that's where my journey started because I would obviously be treating holistically in various ways by starting with maybe different bedding, somewhere more comfortable to lie. Maybe, the way the bed supported the body as it were, you see that again in human care. Then going on to all the other areas of daily life where I could make comfort more of a priority for that animal, generally more in dogs than cats. I think in my experience, dogs have shown discomfort earlier in life maybe than cats.

I think cats perhaps are just more nimble overall. They're built a little differently. Who knows? But I think that taking baby steps is important. For us it would be getting the right diet, working with homeopathic veterinarians, bringing herbal tinctures into the mix. Just watching and allowing the animal to interact with us so that we could understand if they were comfortable or if there was something missing.

Then gradually, that journey moved along to learning about slightly stronger products maybe, like CBD products. Wow, and did that make a difference. So you reach a point where you're familiar or I was familiar with what needed and what didn't need to be treated. I don't know if that goes anywhere to open the conversation, does it?

Karen Wylie: Oh, I think it beautifully opens it up because there's so much about pain and suffering and comfort that we can talk about that is so essential for any of us caring for a pet from the moment we receive a diagnosis. Our mind starts racing with what we'll need to do, what we might need to change, how to keep our pet comfortable.

I think you're making the distinction between discomfort and pain being different but that it's important to begin engaging when you do see that discomfort, not waiting for pain to increase. As you said if it's acute pain, we're going to see that. It's going to be a dramatic observation that we can make.

Whereas day-to-day discomfort could be more subtle. So I thought that was wonderful. Now, why do you think pet parents always assume pain is coming even when it might not be? Why are they assuming that pain is going to come as their pet continues to decline toward the end of their life?

Why Pet Parents Assume Pain Is Coming

Gail Pope: I think it's for two reasons. The first may be that we understand more and more in time about various illnesses and the pain that they cause. So that really brings the second part into light, which is an assumption with some illnesses or out of balance illnesses for the body, we just assume pain. 

Do our animals tell us they're painful?

There's your big question mark. I know my animals well enough to spot something that looks like discomfort. They're just a little out of balance. It just doesn't seem quite right, so yes, I treat it. If it continues or gets worse then obviously I treat it a little more strongly until I actually really get a sense of what I'm dealing with here. Is it to do with the illness? Did they just pull a muscle?

It was unrelated to that illness. There are so many different nuances with the word pain, with dis-comfort. And because we're human and because we love our animals and so we fear, not only that they may be in pain but this may be something to do with them going to die. So I think rather than worry so much about pain, we need to actually perhaps do something about it sooner.

That doesn't necessarily mean give a strong drug but find a better balance. And if you can't, then obviously your veterinarian needs to be consulted and you need to take more action. But I think understanding the process of dying, such as Barbara has been teaching for years too, dying itself is a process.

It was designed by Mother Nature and we know it isn't painful. However, we also know that chronic illness can often be painful. So if we've been treating our animals for pain all the way through the process, we understand that dying isn't painful. It separates. We've got two lanes. We're focusing on pain because we know that they had it before, so we keep on treating. Now we can put that to one side. Now we can focus on what's normal and what's not in the actual process of dying. If we see something that doesn't appear normal, then let's focus on that. That's not pain.

We've already got that under our umbrella. So there are so many nuances in dying. If you put 10 humans in a room who are all in a dying process, say, in the next week, they're all going to be experiencing different things. Their body is winding down towards the end of life, and each of those people or animals lined up are experiencing it in a different way.

Their body is dealing with a physical ailment perhaps at the same time. But then the gentleman in the next bed may have been perfectly healthy, he's just 100 years old. So it's the same thing. You can't talk about the dying process as “set in stone”, this is what happens to everybody. You can do that. We can say that but then we have to bring in all the nuanced pieces for that individual. God, I enjoy talking about this. 

Karen Wylie: I told you it was going to be a nice surprise today. We're going to talk about something you love to talk about. But it's also so important to talk about. Because you've just described how to approach it if a pet has had a condition that was painful and was being treated in an ongoing way throughout perhaps years of their life for that chronic condition and any pain that was involved.

But if pain is not a given, let's look at some scenarios where pain is not a given. To expect pain, it depends entirely on the specific disease that they've been diagnosed with. Then that raises another real question underneath all of this, who isn't a veterinarian and doesn't have a 24/7 hospice nurse at home with them or in a hospital, how does a pet parent actually figure out whether their own pet is hurting?

Sitting with Fear: The Peaceful Checklist and the Birthing Parallel

Gail Pope: I would say if you love them, if you've shared your life with them for years, or sometimes for some animals it can almost be just days. Now, whether you label it as pain, discomfort, or as something else, when the going gets tough, the tough get going.

That's your job. One of the things that I always do say to people because I think one of the biggest things that comes up here is the word fear. 

As an animal or a human is approaching the end of life, we are fearful. We don't know what to expect. It's like as children when we learn to swim or we've gone to the swimming pool for the first time, we've got to jump off the edge and into the water. It's almost that same kind of simile. 

Here we are on the edge, not really knowing quite what to expect, knowing it's normal, reassuring ourselves, "I can do this." But inside of us, we can't. Inside of us we're like, "Oh my God, what if something terrible happens?" And I think that's normal, so one of the things that I always say to people is here's our “PEACEFUL” checklist that we developed years ago.

These are the things that are normal in the dying process to just help you." Oh, if his breathing is changing, if he doesn't want to eat, if he's not drinking, " Oh, okay. That's on the list. Okay, I've got that." But if you're in doubt, and the list isn't helping, then what you do need is to have already spoken to your veterinarian and had them prescribe strong, fast-acting pain meds that don't have to be swallowed because we know that during the dying process the swallowing mechanism ceases to work.

Strong, fast-acting pain meds that don't have to be swallowed can be rubbed into the gum, even into the ear, however they're applied. Then you have your cushion, "I've got meds. They're in the fridge. They're in the cupboard," wherever they are. If I start to panic, "Okay, I've got something that I can use," that makes such a difference because the caregiver, again, whether human or animal, has to deal with the emotional journey as well as the physical journey.

So there is so much emotionally that sits on one side, and then so much physically to care for and make sure we've got everything prepared. It really is a hell of a journey unless you're experienced, and most people, we don't experience it that often. Maybe more so with our animals since they live shorter lives than we as humans do. But again, then I turn it upside down. Now let's look at the other experience, Birthing is another experience that brings up fear. The mother's having the baby, whether, again, whether it be cat, dog, or a human and it's not the easiest of processes.

Anyone who's listening to this that has actually had a baby will be going, "Oh my God, no, I remember when I gave birth." It was, it was an experience, and it was pretty painful generally. 

But again, at the end of life it's a similar passage but there's no actual pain, perhaps it's an easier transition than coming in. I think it's easy to understand that, you start off with this, traveling down to that. So the body is making all those natural changes to allow the baby to get out, so it's physically a little different that way.

Karen Wylie: But as you were saying earlier, the body knows how to die. So the body as it is naturally declining toward death, the body is making changes in-

Gail Pope: Absolutely.

Karen Wylie: In so many different ways so that it is easier, the actual physical death is easier when you come to that end.

Mother Nature as "The Other Doctor in the Room"

Gail Pope: I think so. Again, it's trusting Mother Nature. Mother Nature is the other doctor in the room that I love to talk about because Mother Nature has designed this process. As in birthing, in dying, we are there as the midwife, if you like, to actually assist in whatever way we need to make the process easier. I think that at this point we're now bringing in the spiritual component to the journey, and I think that makes a huge difference too, don't you?

Karen Wylie: Oh, very much it doesn't take away the worry throughout the whole decline of trying to make sure that you're handling everything that you can handle as well as possible for your pet, and it doesn't take away the grief of losing them physically. But it then does transform how you will feel when they have physically left their houses, as you said.

Gail Pope: Yes, to me, it's so important the spiritual aspect. I think when I was young, I didn't even think of the word. It didn't mean anything to me. But as I've trodden the path of the last several decades, my whole world has opened to a much wider understanding of life, living, birthing, dying, transition. I think when you say the word transition, that's where it opens the door.

Transition? How can death be a transition? 

We talk about it as a transition. Where does it go? Once you start being curious about that and you start looking back in history, and looking into various religious understandings and cultural beliefs, all of a sudden we are now looking at death a little bit differently. And actually, that brings a little bit more comfort to the experience.

Then you hear a friend say that their Cocker Spaniel, Wendy, who died last year, came to visit them yesterday and sat on their bed and talked to them. Those kinds of conversations open your eyes when you're treading into that world. But then the more you read, the more you learn, the more it just touches your heart and you realize that love doesn't end.

Karen Wylie: Once we start talking in terms of transition, we then start talking about the end of our pet's physical life instead of just end of life. Because we're making that distinction between what is a physical end, what is a spiritual continuation and a non-physical beginning.

Gail Pope: And I think that helps a lot during the transition of dying because if you have that understanding then you can look at the "body house" that they're still living in, and yet you can also now separate that spiritual being and the home they're living in. So somehow you can almost feel that separation. You view the two different aspects. The "body house", you want to make that as comfortable as possible, so that the spirit, the soul, whatever name you choose to use, can actually have an easier transition out of that body. Then into the next part of that transition.

Behavior as Vocabulary: Reading What Your Pet Can't Say

Karen Wylie: Well, one of the things that you're saying, Gail, is that there are the spiritual aspects to the pet's journey before the pet physically dies. That's something we've described in our e-book, "Soul-Centered Care: Seeing Pet Death Differently". You may or may not have had that in mind as you were describing that but that is something we try to actually look at the phases of what our pets go through as they're preparing to leave their bodies.

I'd like to go back a little bit, back to the physical if we can. Because if pain isn't a given as you said, and it depends entirely on the specific disease that they've been diagnosed with, then the burden is on the pet parent trying to monitor and figure out whether their pet is hurting.

And unlike a hospice patient, our pet can't say "I'd give my pain a 7 out of 10 today." Our pets don't have that language. They can't report anything in words. What have you learned to watch for instead? What are a few perhaps specific things that you have looked for as your indicators?

Gail Pope: Well, as I was saying I think for me, it's knowing what is normal in the dying process. So if you know what kinds of symptoms, what kinds of things you're normally going to see in the process, if you see something that isn't on that list, as it were then that's the time to take action. That would generally be with pain meds.

Again, I think one thing that we haven't talked about today is the fact that dying, the dying process, isn't a few hours. It isn't a few days. It's a process over sometimes weeks and longer. A being can be winding down physically towards the end of life for a few years. We all get gradually older. We all get maybe gradually  sicker in some way or another. Some of us don't and some of us do.

As our bodies age due to whichever it is, then very gradually Mother Nature, again that other doctor in the room, is orchestrating things for organs that aren't working very well anymore, for the heart that isn't as strong, for the lungs that just don't breathe so well. 

So everything is a process. So it's very difficult, I think, to actually pinpoint, "Aha! The dying process started now and it's going to last for a month", or "It's going to last three days because something is happening fairly quickly." You know , we can't know.

The Case for Keeping a Written Record

Karen Wylie: No. And as you're saying the Peaceful Checklist is looking at what's normal in the dying process but because we have a lot more lead time for the most part for most pets who are aging and declining. We also then know what's normal for them. So if they begin behaving differently, their behavior becomes the vocabulary for us to capture.

So they might not be able to say, "My pain's a 7 out of 10." But when their behavior takes a drastic turn and is very much changed, you would see that and you would know it. I think that, once again, makes the case for keeping a written record of your observations.

Gail Pope: I was just going to say something slightly different but it really hones in on what you were saying. One of the things I would be doing would be keeping in touch with my veterinarian. My veterinarian is obviously a homeopath. Would I like to talk more about that? Maybe another time.

But your veterinarian, I believe, should be, in this kind of instance, preferably a holistically-minded veterinarian but certainly a veterinarian who is somewhat familiar or educated in the process of dying. So they actually will know and be able to help comfort you and support you. I think it's important that you work with someone who can walk the path with you. Who can be available at 9:00 at night or 3:00 in the morning when you're human and you're seeing something a little bit different, and you're not sure if it's right or not. You need someone you can talk to because we're human. Don't you think that's important?

Karen Wylie: I do think it's important but I also think that the first thing they're going to be asking you for is the consult or why you've come for the appointment. This is where you're describing the behavior that is concerning to you, that there's been a change in behavior and you've begun to think that it could be caused by pain.

So I've just found for myself that keeping a good record of what I've been observing over time allows my vet to be of greater help to me. Otherwise, they're only going to see your pet for five minutes. That's not a good time for them to assess whether your pet is in pain.

Your adrenaline's going to be pumping for your pet and your pet may not be showing anything to the vet. 

But they will be showing how they feel at home because you're able to see what's normal for them, what's normal for that pet. Creating that baseline for yourself and your pet is what I try to do before I ask for my vet's help. Because otherwise, I don't really know what help I'm hoping to get from them.

From Observation to Decision: Euthanasia and Natural Death

Gail Pope: I think you've just opened up another little kind of corner of that conversation. Yes, I would certainly recommend working with a veterinarian who is familiar with choices at the end of life because we are obviously all thinking about the choice here and if it should be euthanasia?

Should the choice be natural death? And if you actually are geared towards wanting to do one or the other. We're all different. We support each other's choices. But I think it best if you are working with somebody preferably your veterinarian who is hospice trained.

However, if your veterinarian who you have a wonderful relationship with isn't familiar with end of life, then having another practitioner by your side who is experienced in end of life matters can help you when you reach that “choices” area. To help you make the right choice for you but particularly for your animal. They need to be part of this discussion too.

Karen Wylie: What you're saying to me validates, keeping track of your observations in a written way.

Gail Pope: Yeah Because you need to. Let's face it, veterinarians for the most part don't have enough time for every single client, for every single need, for every single one, for every single hour of the day. We can only do our best to help our clients, and the journey through end of life is a little different. It does require a little more contact.

If your veterinarian can't be available at odd times when you might need them, then having another consultant available to be able to help you as and when you might need it. We know it's important. You have to have someone to talk to. "Is this normal? Is it not normal? " Then if you're talking to various people at different times for help in different directions, if you haven't been writing things down as they change, what you gave, whether it worked or not, you can get into a complete muddle.

So without doubt, yes, I have files for my animals. Do I write them down as much as I should do and as often as I should? Probably not but I do try to. I must say, when I had many more animals than I have now and I had a huge bookcase of files at the ready, I was very much more consistent. In fact, at that time, I would carry a pad around with me in my pocket.

Every time I happened to notice something on one of the animals that to other people might be normal, a cat particularly doing this with his ear, ooh, I need to check that to see if I need to clean his ears again, or it may be part of his chronic illness and it's a sign I need to notice. 

But as a loving mother, those are the kinds of things we take in but two weeks later when it might have been an important thing to remember, "Yes, I actually saw him coughing two weeks ago. I saw something. Yes, I wrote it down. It was 3:00 in the afternoon on Wednesday." It can be very helpful to look at when a behavior started or a symptom of some sort. But it wasn't that much, and you just made a mental note.

Karen Wylie: 'Cause you never know when something that happened that one time becomes a pattern over time. Which then changes how you approach it, changes how you describe it to your vet, and probably changes their recommendation for you. At some point when we have been making regular observations where we are that has become a routine of our day.

As we monitor the decline of a pet, at some point the observations become useful in making decisions and also important to your emotional experience of the end-of-life care that you're providing to your pet. Because your observations almost become like you've been collecting evidence of what's possible or what's not, what's happening or what's not. That can really change the whole end-of-life experience for a pet parent.

Gail Pope: Exactly. And it's not only physical observations, it's mental, emotional, the whole being. Everything is relevant.

Karen Wylie: Yes. And I'm going to be a broken record on this but we do have "The Living Quality Of Life Care Assessment Tool" as a free download on the Bright Path for Pets website. That particular tool is looking at the connection time between you and your pet, or between your pet and other members of the animal family. And really that's you're being able to establish what's normal in those kind of interactions as well and how that can change at end of life.

If they're wanting more contact or less contact. That's just one dimension you could be monitoring as you go. For a pet parent who does ultimately choose euthanasia and some say they feel like they're scheduling their pet's death like a judge signing an order, Gail, how do you see having real observations, real evidence of suffering, how would that change that feeling about the choice of euthanasia?

Gail Pope: You've just opened a huge topic probably for another conversation which is that word "Suffering" because yes, it obviously has to be part of a final decision but it really is an emotional component. The biggest question there is who's suffering? Is it you? Is it the animal? What's the suffering related to? What does the word suffering mean?

Karen Wylie: I hear you. Let's take it from the other perspective. How does good pain management and close observation in a journal where you're keeping your notes, does that ever make the option of natural death feel like a stronger, safer option for a family than they may have initially thought?

Gail Pope: Yes, in a word, definitely. Of course that takes you to one of my other very favorite topics is Education. The more you know, the more you actually are qualified to make a decision. And as parents we don't trust ourselves in these kinds of matters. We panic very quickly and very easily. And so again, the more we know, the less we fear.

It's never going to be easy. It's never going to be easy. But I think when euthanasia becomes the choice— sometimes it's an acute choice. You're not really given a choice because maybe something acute has happened, and you see it's the obvious answer. Maybe it's something less acute but really worrying, and that's obviously the time to reach out for help, for understanding, for people who are qualified in this matter to say, "Actually, it's normal. It's okay, and here's what we can do." Or to say, "I really think you need to consider euthanasia."

My clients come from all different directions, some who are focused on euthanasia but want to make the journey as beautiful as possible to get to that point where they do make the decision. Others who are focused on a natural end of life, and that can be a really difficult journey. Exactly the same but with a different ending.

Then there are those who haven't made a choice. They know that choice is there and they're treading the path knowing that's there but they're making each day the best it can be. Those are the people who I find have an easier journey. If you're focused on, "Is today going to be the day I need to make the choice?" That's so hard on the heart.

Karen Wylie: Every day. To live every day like that.

Gail Pope: To live with that fear. Especially if you don't have a lot of education and you see something that you don't think is normal, you don't know. You end up making a decision that haunts you. It may have been completely the right decision but you didn't know.

Again, we come back to education. The more you know and the more you trust. And let's face it, very often people make a decision for euthanasia, and it is totally the appropriate choice. Maybe they've got a 110-pound dog who is needing really advanced hospice care. They simply can't do it. Maybe they have a full-time job, and they can't take time off. They can't care properly for the animal.

We don't have choices like we do as much with humans. When we have humans who are in hospice care, we have nurses visiting at home. We have so many more options available to us. But it's much more of a lonely road when we're a pet’s mother or father and we're on our own. We don't have the support.

Closing: Observation, Education, and Love

Karen Wylie: Yeah, we have so many additional factors to consider in both making our observations over time, and then making any decisions that need to be made. 

With what Barbara Karnes has taught human hospice families and what you've walked us through in this conversation for pet families, it really comes down to the same basic idea which is that comfort is always the goal throughout the process. 

Good information is what gets you there without fear.

So the real difference for us as pet owners is that our information doesn't come from what our pets say, it comes from what we notice in our pet's behavior. That can provide us with the information we need to have more confidence in what our understanding is, and any decisions that may need to be made overall.

So I think in bringing this conversation to a close, Gail, I guess I think I would be saying to everyone is if you could take one thing from today, let it be that you start watching your pet and start writing down what’s important. Because capturing what is normal is going to be your best bet in identifying what is not normal when changes occur.

To start writing these things down, not because you need to be a nurse overnight, but because your own daily notes are really what will tell you the difference between is this just old age or is this a pain that needs attention? And that clarity is a true gift for your pet and for yourself. How would you like to bring this conversation to a close?

Gail Pope: You've just done it really with two words: observation and education. The more you know, the easier it will become. The bottom line is it really is all about love. It really is all about love. I know I'm a broken record but let's face it, we love our animals with such intensity.

If they have a hurt paw, we have a hurt heart. It's as simple as that. It really is all about love. It's about trusting yourself and them to share what's going on with you, because they do. We just have to attune ourselves to listen when they need our help. So it's trusting us, trusting them, living in the moment, and loving. That's it really. It's our anchor, isn't it, love?

Karen Wylie: It is. It all begins and ends with love, someone has said.

Gail Pope: Thank you.

Karen Wylie: And we thank you for being with us this week on Peace of Mind for Pet Parents. Hope you'll check us out again next week. Thanks. Bye-bye.

Gail Pope: Thank you. Bye-bye.