0214: Pet Hospice with Dr. Shea Cox

Dr. Shea Cox explains how pet hospice is so much more than facing the final days of a treasured relationship. It’s an opportunity and an obligation to make the best choices for a beloved pet long before that time comes.

Blue Pearl Pet Hospice provides senior care, pain management, hospice care and end-of-life services for your pet with in-person and virtual services available. Free access to their LearnPetHospice.com includes video modules on understanding quality of life, recognizing pain in dogs, recognizing pain in cats, and nationwide telehealth consults.

The In-home Pet Euthanasia Directory connects families to local providers who specialize in pet end-of-life care needs. Services offered will vary by provider, but can include hospice, palliative care, pain management, acupuncture & alternative medicine and euthanasia.

Dog Words guest Jesse Shroyer shared the touching story of her experience with hospice foster Huck on episode 0102.

Celebrate 5 years of Rosie Fund by supporting our campaign to sponsor 50 dogs. You can donate on our website or Facebook page. You can also contribute by making a purchase from the store on our website or buying a t-shirt at Bonfire.com.

Music for this episode is provided by alternative string duo, The Wires. Visit them at TheWires.info. Learn fiddle and cello-fiddle online — even if you've never played before — from Laurel Morgan Parks and Sascha Groshang at FiddleLife.com.

The transcript for this episode is available on the Dog Words Buzzsprout page: Buzzsprout.com/840565.

Make a donation at RosieFund.org or through our Facebook page. You can contribute by making a purchase from the store on our website or buying a t-shirt at Bonfire.com. Also check out our page on BarkYours, the online mall with gifts for people who love their dogs.

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Transcript

DR. COX  0:02 
Hospice is best started at the time of diagnosis or the first sign of decline, not the time of death. Because there is so much we can do to improve quality of life and extend really good life if we can get in with families early.

PHIL   0:25 
I'm Phil Hatterman and this is Dog Words presented by Rosie Fund.

Today Dr. Shea Cox explains how pet hospice is so much more than facing the final days of a treasured relationship. It's an opportunity and an obligation to make the best choices for a beloved pet long before that time comes. The episode description has links for more information to help you understand your options during the weeks and months when your pet may do most, including the In Home pet Euthanasia Directory.

If you're new to this podcast, in each episode we explore the world of dog care and companionship. "We save each other" is the motto of Rosie Fund, which simply means the more we do for dogs, the more they do for us. And they already do a lot. If you love dogs, you'll love Dog Words. We welcome your comments, questions and suggestions. Go to the podcast page at Rosie fund.org to share your thoughts. We welcome your input. Please download, follow, rate, and, most importantly, share Dog Words.

Celebrate five years of Rosie Fund by supporting our campaign to sponsor 50 dogs. You can donate on our website or Facebook page. You can also contribute by making a purchase from the store on our website or buying a t-shirt Bonfire.com. Your donations help fund Rosie Life Starter Kits that make sure the senior and harder-to-adopt dogs that we feature have some of the items that they'll need in their forever home.

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Next time on Dog Words cofounders of the canine stars Keri Caraher and Ethan Wilhelm tell us how they entertain and educate audiences with their team of shelter and rescue dogs.

The mission of Rosie Fund is to provide humans with the resources and education they need to give senior and harder to adopt dogs a better life. We thank you for joining our mission.

Today's guest on Dog Words is Dr. Shea Cox. Welcome to the show.

DR. COX  2:36 
Thank you! Excited to be here talking about hospice.

PHIL   2:40 
Which is a tough topic to talk about, I think for a lot of people, because you're confronting mortality in general, but specifically the mortality of a beloved pet. But it's an important conversation to have. Tell us a little bit about your background and what led you to becoming so involved in this important area.

DR. COX  3:04 
Well, there's the long version, but I'll give you as short a version as I as I can.

PHIL   3:09 
And if I — I can ask follow up questions if it's too short of aversion.

DR. COX  3:14 
Excellent. So you know, I always wanted to be a veterinarian ever since I was about eight years old and went to college to be a vet. And I failed chemistry. And so I thought, "Well, just try chemistry again." And I failed it again. And so I thought, "Okay, I'm going to get a tutor this time. And I'm going to pass it." Third time's a charm, right? Got a tutor. Ended up dating him and failed it again.

PHIL   3:40 
That's not — See, I used to work in higher ed. And I think there was a flaw in the system there. Maybe a lack of focus where it needed to be placed.

DR. COX  3:51 
Exactly. So I ended up switching gears. I went to art school instead to my degree in ceramics and decided that, "Gosh, there isn't a whole lot I can do with this'" as much as I loved it. So I did what any typical person would do. I got a one way ticket on a Greyhound bus to LA. And then I thought, "I didn't think that went through, either." First my degree I didn't think through. Now this big move I didn't think through. But eventually I ended up getting a job as a nurse's aide in a convalescent hospital. And that spurred just this connection to people and caring for people and at a really difficult time. And then I ended up going from a nurse's aide to going to school for a registered nurse. Although it was like, "Ah! I had to take chemistry."

PHIL   4:45 
I was gonna say my mother is a registered nurse. You will not escape chemistry by changing directions. For those listening out there who want to be a veterinarian and think, "Well, I can't do chemistry, I'll be an RN instead." Well, that's that's not the way out.

DR. COX  4:59 
Go to pottery school.

PHIL   5:04 
Yes!

DR. COX  5:04 
So chemistry raised its head again. I was so dirt poor, I scraped all my money together. I ended up buying this $5 book at a college used book sale that was a baby chemistry book. Started studying chemistry on my own. Something clicked. And I was like, "Oh! Okay, maybe I can do this," and ended up going to nursing school at Los Angeles Pierce College and spent the next, gosh, six years in the human side of healthcare and continued that path of home health, transitional care, hospice care. And during that time, having conquered my nemesis, chemistry, I was like, "Maybe I can do this vet school thing." So I started taking prerequisites for vet school as well. And did nursing school prerequisites for vet school. Got accepted to vet school and went immediately into emergency and critical care after graduation. And I spent 13 years in that area. And it was really close to my 10th year doing emergency that I was seeing this bigger and bigger disconnect between the time people needed with really difficult conversations and the time that veterinary people could actually give to the pet parents at that time. And I was like, "Boy, this is just like human medicine." It's a one way conversation, oftentimes. That the doctor's saying, "Here's your diagnosis. Here's your options. Here's what it costs to do that. any questions?"

PHIL   6:41 
And with pets, it's — as with many things, even not emergency medical care, but so many things with pets — is more compressed than it is with humans as far as time. Because with pets, oftentimes, we don't get them to medical care as soon as we should. And something becomes critical, becomes an emergency because animals are so good at hiding injuries. Pet owners are so good at deluding themselves that, "Oh, it's okay. It's okay. It's a limp. They'll walk it off. They'll be fine." Or, "It's just a little bump. That's probably just some swelling." And then you don't find out until it's too late to do anything about the cancer or the infection or any number of issues. With a human where you might have had them there and say, "Okay, this is a fast spreading cancer and they probably only have a year and a half to two years. And let's figure out what we're going to do." With a dog, "This is a fast spreading cancer. They have weeks." And then you've got tough decisions to make.

DR. COX  7:48 
That can certainly be definitely a scenario that unfolds. But even with either of those scenarios, whether you have two weeks, or you have two years, you still have that rate limiting step of that conversation, that connection, that understanding what your next steps are. And if you look at the time that an average person has with their veterinarian per year, it's 16 minutes.

PHIL   8:14 
Wow.

DR. COX  8:14 
How do you even begin to help a pet parent wrap their head around all of these nuanced conversations and goal setting and planning and explaining things in that short amount of time. And that's when I decided I was gonna to start offering three hour appointments to families focused on the most difficult part of our journey with our pets, which is that last end of life phase. Whether that's years, or whether that's days, that's still such a part of the continuum of pet care that just gets overlooked. So, you know, I was told I was pretty crazy that that's not a sustainable model. And it's not going to work and just it's foolery. And I just said, "Well, I'm gonna to try." Because, you know, if that's all I can do is try and if it doesn't work, then I readjust. And so in 2012, I started my hospice services. And so here we are 2021 and you know, getting ready to take this exact model nationwide to help more pet parents. So it does work because it's what people need. And if you can fulfill a need, then it will work.

PHIL   9:32 
I found it interesting when you're describing the pushback that you were getting. No one was saying, "This isn't necessary. No one needs this." They were talking about bottom line and practical issues. Sometimes those aren't the most important criteria.

DR. COX  9:50 
Exactly. And that was the approach to take is like you know, what do we have to — you know, not to get into the finances of things — but you know, what do we have to charge families to make this sustainable to continue to do this. And when you're offering something of such value to people, cost becomes less of an issue because you're delivering such a value, and fulfilling a gap, a big gap that's not being taken care of.

PHIL   10:22 
We've had to have tough conversations with veterinarians. And you can tell they're trying to give you as much time as they can. But you know in the next consult room is another family whose pet is just as important to them as yours is to you. The doctor is pushing them back so they can answer your questions and give you time. To be able to know that you have their undivided attention and remove some of the distractions from you as the pet owner, to really focus on that moment, I agree that you're not gonna to really probably be thinking about the money, and, "What's this appointment going to cost me?" If you're there in the first place, you're there because you care about your pet.

DR. COX  11:11 
Exactly. And I think a lot of hospice, end of life is so focused on end of life. Like when you have conversations about hospice care, it invariably goes to the conversation of death and euthanasia and such. And I think one of the things that I work so hard to educate our veterinary colleagues and pet parents is that hospice isn't just the last few days of life. There's a misconception that if a pet is in hospice quote unquote that death is imminent. And for me, it's hospice, if I can stress like one big takeaway for anyone listening, hospice is best started at the time of diagnosis, or the first sign of decline, not the time of death. Because there is so much we can do to improve quality of life and extend really good life if we can get in with families early. I can't tell you how many patients we have in pets that come to us that, "My doctor said, 'Gosh, we only have about a week or maybe two weeks,' and we just want these to be the best weeks that they can be. So we want to go into hospice." And we take them under our care. And then it's four months later, five months later, eight months later, because you're really focusing and being able to dedicate the time and treat the whole body, not just the disease. And we have an animal with cancer it's not just about treating cancer, but it's treating the whole body, treating the pain, treating the emotional aspects, treating the family. And when you can balance that whole unit, it's amazing the outcomes that happen. That's why it's so rewarding. People are like, "Man, isn't it just always sad what you do?" And it's like, "No, it's so wonderful. And it's so helpful." And, of course, any kind of death and loss is sad, but to be able to make that the best goodbye ever.

PHIL   13:21 
And know that that death was preceded by that pet living their best life and that you don't have to second guess your choices. You know you did everything you can to give them that life. Our regular listeners have heard me tell the abbreviated version of this story many times but I will link to the interview of when we had multi-guest Jesse Shroyer on who fostered a hospice dog for KC Pet Project, Kansas City's animal shelter. They told her that Huck who was a senior pit with kidney failure had three or four weeks to live. Just make him happy. Make him comfortable. Give him his meds. And let him hang out with your dog, Rosa. And not only did she do that, but she brought him to play at Bar K Dog Bar and brought him to play with our dog, Peaches, and some other dogs. Let him eat whatever he wanted 'cause he only has three or four weeks. So if he wants to have a brownie, if he wants to have a bag of hamburgers, whatever he wants. And Huck had the best four months any dog could have. And this is a stray dog who had been brought in with kidney failure. So it wasn't that this is early diagnosis. He'd been suffering with that for who knows how long and to overcome that and you could tell he was just loving life.

DR. COX  14:44 
Absolutely. And I think, you know, such an important piece of that of that time, that gift of time is not just for the pet, but just as equally for the family. Because so often, and I would see it all the time people would come into the ER with their pet, they got a, I call it a gutshot diagnosis, and you're not expecting a terminal diagnosis. And so oftentimes it's like, "Well, we can either do you know, surgery, or these aggressive things, or we can euthanize because he's doing poorly." And when you don't offer that third option of, "Let's just go home. Let's regroup. Let's think. Let's just, you know, hit the pause button for a second. You know, death is not necessarily an emergency. Let's go home and regroup." And if you can give families that time to process this diagnosis, understand this diagnosis, make sure that they feel like they've explored their options. where it's not just this on the spot, emotional decision rushed. Because when that happens, families walk away feeling guilty, that they let their pet down, that they let their family down. And if we can shift that to, you know, even if the outcome is the same, in a few days, at least, you give people the time to prepare, and the opportunity to say goodbye. And I just can't stress that enough how important that is,

PHIL   16:12 
For the emotional health of that family, certainly to have the time to feel like, "I've made a decision based on considering all my options and not on the pressure to make a decision now." When you expanded to the three hour sessions, I'm guessing you had some clients who had experienced end of life decisions before you were their veterinarian. So they had an A/B comparison — what's it like to be rushed and have no time at all to make a decision and what's it like to have this three hours. What was the feedback you were getting from clients?

DR. COX  16:50 
The unanimous feedback was, "Oh, my gosh, I wish I would have known about you sooner." Or, "I would have known about your services sooner. This is so much different than the previous experiences." And I just really want to stress, veterinarians want to do a good job. They want to give clients that time. We're empaths. We're caregivers. That's why we're in this profession. But the system set up where it doesn't work. It's broken. When appointments are 20 minutes in length you just can't do — it's like in human medicine, you just can't do the job you want to do in that time.

PHIL   17:31 
When you go to your vet clinic, and you're trying to take all of those resources for your pet, you're putting a veterinarian in a position to, well an awkward position to make tough choices about, "What other emergencies are happening? Am I making myself available to other people whose time is valuable?" Who may even have a pet which is in greater need than yours. They don't know until they see that pet. But to build in that cushion, that three hours, I can see how veterinarians would be sort of torn between that business model and how they can serve clients the way they probably really want to and, "How do I pay the bills?"

DR. COX  18:16 
Veterinarians are trained to fix and heal. They're not trained at these psycho-social conversations. And, you know, all of these these other soft parts of medicine. When I was in school, we had literally in four years of veterinary school, we had one hour of end of life training. And it was basically on the pharmacology of of euthanasia drugs. So you're not taught how to have conversations. You're not taught about how to prepare people for death and loss. You're not taught to think about family goals and what people need in those moments. You're only taught how to fix that pet. And so oftentimes, when you can't fix a pet, it's almost like there's a failure of medicine or...

PHIL   19:12 
They don't have something in their toolkit for that.

DR. COX  19:14 
Right. So it's this odd dichotomy that happens, I think, in medicine, and you know, coming from the human side of medicine, you know, you do get that kind of training because...

PHIL   19:26 
You were an RN. So, yeah, you know, there's a difference between a surgical nurse and a hospice nurse. You don't just, "Well, the hospice nurses on our lunch break, grab any other RN." No. It's a very specific skill set for the different areas that those nurses are working in.

DR. COX  19:42 
But even when you go to nursing school, no matter what nursing role you go into, you're still taught about the human communication and the human component because you're dealing with humans. In veterinary medicine, you're dealing with animals, but it's almost like that's forgotten that at the end of that leash is a human.

PHIL   20:03 
Yeah, and then you send the human a bill.

DR. COX  20:06 
Right.

PHIL   20:06 
Do everything you can for the animal and then you turn the paperwork over to the front desk.

DR. COX  20:11 
Exactly. So part of all of these things that we've been developing in our telehealth consults for clients that are focused on quality of life only, are really all started out as a tool for veterinarians. Offload these really difficult conversations that you don't have the time for or that you don't have the training for and let us take on that burden for you. And we can give families that hour, hour and a half to talk through all of these nuances. And then they can resume their care with you. But we're a tool to help the veterinarians who don't have the time to go through all of those complexities of end of life decision making.

PHIL   20:57 
Did you have to adjust some expectations for yourself when you shifted to that three hour model? Did you think, "I'm just gonna give it more time." But then did you realize, "Oh, there's other changes I need to make," that you weren't expecting until you actually stepped into it?

DR. COX  21:15 
I thought three hours was a safe kind of amount of time. And I thought, "Okay, that's what I'll lead with an adjust." And nine years later, we're still spending that two to three hour timeframe with people. What has adjusted for us was back in 2017, I was realizing that of our hospice consults set three hours, 75% of that time was non-medical. So it was about establishing goals and preparing children, "How do you plan for euthanasia?What do you want end of life to look like? What are your struggles? Who is your support system?" So really unpacking all of that information. And I was like, "Boy, you know, we don't need to be in the home to help families with this piece of it." And in veterinary medicine, in order to diagnose or prescribe you have to physically touch a pet to establish what's called a veterinary-client-patient-relationship, or VCPR. So to do anything medical, you need a VCPR, which means you need to be in a vicinity to touch a pet. With telehealth on, you know, the human side of medicine, you still need to have a VCPR in order to diagnose or prescribe. So there's limitations to that telehealth. But what I realized — this was back in 2017 — was that, "Boy, we don't need a VCPR to guide families with all of these end of life decision making." And now all of a sudden that just took away geography. So we were able to pivot our services to include a nationwide telehealth service focused on virtual quality of life consultations so that distance no longer mattered. The key thing that people were looking for was not for you to necessarily be in their living room. But that time component. That hour, hour and a half to work through all of those questions. What do I do? How do I know? So that was one big thing that how we changed as a business in order to serve more people and more veterinarians also, you know, helping reduce their burden of care.

PHIL   23:26 
How does someone access your services, or just in general, someone who wants to start having those conversations?

DR. COX  23:35 
Our PetHospice.com is our website. And you can make a virtual quality of life assessment directly online through our scheduler and it connects with all of our veterinarians or veterinary nurses. It also, I think, on on a not necessarily a better side but a different side is I've worked really hard to create learning modules and education resources that essentially walk through all the things that I walk through during our quality of life consult on video that people can watch these videos and just look at things from the perspective of quality of life or understanding if their pet's in pain or not. And that is a free resource that I created to help families who needed more education that could be trusted. You can read so much on the internet and such. I'm like, "How do I pull all of these vital things into one place? And use the conversations that I've had thousands and thousands of times with people like all the things that float up to the surface?" I wanted to capture that and put that into a format that anyone could access. I can't say is real high quality production but...

PHIL   24:53 
But if it gets the information out there, that's that's what they need.

DR. COX  24:57 
Exactly. Yes. So that's, that is A huge passion of mine is to educate pet parents. Because really education is empowerment. And you don't know what you don't know. And if you don't know what questions to ask your vet or know that you have choices, or that other alternatives are available, there's nothing worse than finding about that later when a really huge decision such as euthanasia has already been made. And so, you know, my mission is to, is to provide more for pet parents.

PHIL   25:34 
Is there a network of veterinarians that are affiliated with you who refer people to the website at the appropriate time, or people who meet with a vet and then somehow find you or just tell a vet on their own, "I need some time to think." And the vet says, "Okay, well go do your research, and then come back." How do they find you?

DR. COX  25:54 
Other websites refer to us. Other hospice veterinarians refer to us. Organic search online. It's one of those things where it's like, "Boy, I just wish everyone everyone knew." So podcasts like this, where you can share the knowledge of resources that are out there. So thank you for this platform and opportunity to share that.

PHIL   26:15 
You're very welcome. And I would hope most veterinarians, once they're aware of this, would — do you have brochures or posters that they can put up in their lobby that they can just point to or hand someone and say, "You have some decisions to make. And I'll answer all the questions you have. But you're probably not ready to even ask those questions right now. Take this brochure and go to this website." Knowing full well, they might never come back to the veterinarian. They might get all their questions answered. Or they might get their questions answered and realize the next step does involve our veterinarian. But regardless, pushing that client to do what's best for them and their pet.

DR. COX  26:58 
Yes. And you know, when veterinarians know of this or other people, then it is very openly shared, because you're doing what's best for the pet and the family. The crux is how do you get that mass awareness? Part of the decision to partner with Blue Pearl Emergency and Specialty Hospitals was they provide a really powerful platform for our model. And being able to integrate our services into their specialty hospitals nationwide, where care is still done in the home, but it really elevates that awareness component, being part of that Mars Petcare family, because with Blue Pearl comes VCA, comes Banfield. So we're hoping that this starts to catch on. I'm hoping it does, too.

PHIL   27:51 
In the few minutes we have left, I want to make sure we do touch on what is the most, I think, challenging part of this topic, which is euthanasia. And you mentioned earlier that when you start talking about hospice, people, typically even with talking about humans, leap to those final moments and ignore everything that leads up to it and making the most of that. Big picture, "What can we do to make the most of the time we have." But then eventually you have to make those tough decisions. How do you make that call? What resources for that specific part of it are available?

DR. COX  28:29 
The website, the LearnPetHospice.com will be the new website. But that has a video module, Understanding Quality of Life, and it's specifically focused on that alone. And that is 20 little videos that walk through all aspects of quality of life. So that is one resource. And the other is how we approach that when we're working with families, is we establish all of our goals upfront. Which is part of why that hospice appointment is so important. What are your goals? What do you want for your pet? What don't you want, more importantly? And we create a loose framework knowing that the end of life journey is incredibly organic, and emotions change. But it provides at least some anchor points that we can refer back to. And so we work with our families in that way. For our virtual families that have a virtual quality of life, where that's all we focus on is just that knowing when and how to plan. That is where we unpack all of that in, you know, a 60 to 90 minute conversation with veterinarians and veterinary nurses who this is all that they do. So very specialized in that way.

PHIL   29:51 
Quality of life, I think is a moving target for people. Because it's really easy when your dog is active and running around the yard and at the peak of its vibrancy, to say, "I know it's gonna be a tough decision, but I never want my dog to suffer. And if it really doesn't have the quality of life that makes it worth it waking up every day, I'll do what I need to do." But then you get into that moment, I think that's why it's so critical you talked about setting sort of those benchmarks and, and such that your dog has a bad day. And you tell yourself, "Well, maybe tomorrow will be a better day. I don't want to take this step too soon. Or I don't want to have to do this in a cold, sterile veterinary clinic, you know, could I do this in my yard? Or in our home or in our dog's favorite place?" I'm having trouble asking the question, because it's so hard, one, to figure that out and, two, when you get to those moments, even though you've said, "Here's what we're going to do." To say, "Are we there yet? Are we not there yet? This moment in time, is this that moment? Or if we wait for the next moment? Will it be better? Will that moment have passed?"

DR. COX  31:13 
Yeah. And that is I think, the most difficult question that there is no clear line for. There's no line that you cross it all of a sudden, something magically goes, "It's time."

PHIL   31:25 
A bells not gonna go off.

DR. COX  31:27 
Right.

PHIL   31:27 
There's not an app for that.

DR. COX  31:29 
There would be so nice if it were that simple. And I think that's what makes these decisions so hard. And not to mention the fact the emotional burden of an ending life. And this is a life and a being that I love with all my heart. And you know, how do you even begin to wrap your head around that? You know, the short answer is, I don't think you do. You can't. And that really goes to not choosing the right time but the best time. When you look at all of the complexities that go around it and knowing that it's not a bull's eye on a target, it's the target. And we know that it's the synergy of things that happen. And one of the loose frameworks that we work with families on is really understanding, creating a personalized quality of life scale for your pet. And one of the videos goes through that. "How do I create a quality of life scale that fits my pet and my pet circumstance?" And use that as a guide. And the first day that really becomes more bad than good is oftentimes when we say, "Okay, we have a shift here we have a shift in quality of life and the way a pets doing." The way we like to approach things are, "Let's two days from now set time aside to help your pet pass." And it's just a placeholder. We never call it an appointment. It's just setting time aside. It feels much less committal that way. And we give it another 24 hours. We adjust care. When the pet is not in crisis, we have time to make sure that we are really getting as close to that target as possible.

PHIL   33:21 
And if you set aside the time to euthanize and then that time comes and you don't, well, you've set aside time that you can spend with your pet.

DR. COX  33:29 
Exactly!

PHIL   33:30 
You still spend that time with them.

DR. COX  33:33 
We will see how the next 24 hours goes. And if it looks like the quality of life is still not where it should be we keep that appointment. If it looks like a pet's improving, they just had a down day and we've adjusted things or you know their veterinarian did and a pet has perked up, then we just cancel the appointment. But our philosophy is it's so much better to have a plan in place and not need it then to be in an urgent situation where you're like, "Oh, my gosh! Today's the day and no one's available."

PHIL   34:09 
for the family to understand. This is how we're approaching it. That this is a placeholder and we would love for you to cancel the appointment. It's not like we're closing on a house. "We have the notary public here and now you're not going to show up?" This is a team that understands, "We're going to do what we need to do if we have to do it. And if we don't, we're glad that you cancelled the appointment."

DR. COX  34:31 
We love cancellations. But there becomes this sense of, "Okay, we have a plan." And that in of itself alleviates a lot of stress. And ...

PHIL   34:44 
Yeah, you're spending all day wondering, "What's next? What's next?" You're spending all day loving that pet.

DR. COX  34:50 
Yeah, and seeing how the day goes. And there's so many, you know, things I've heard along the way from just other families and other people that it's true. People will always regret waiting a minute too long, but they'll never regret making a decision a week too early. And that really becomes that nuancing of trying to find just the right amount of time. But I would say, in general, if a pet isn't coming back up out of that little declining quality of life by day three, they're not going to in our experiences. And that's the sweet spot we try and find for for families and for pets. Where sometimes there's ups and downs through end of life, and good days, bad days. And sometimes they'll feel a little crummy one day, but great for another few weeks. So we try and take that into account. But if you get to that point where day one's pretty bad, day two is pretty bad. Looks like day three is going to be that way we know they're not likely going to get better. And decisions can confidently be made or more confidently be made that you know, we didn't wait too long. But we gave them a little window of a chance to make sure it wasn't just a dip in how they were feeling.

PHIL   36:05 
I'm so grateful for what you're doing for not just your clients, but for sparking this conversation beyond just your practice and that more veterinarians and more pet owners will take advantage of this perspective on end of life decisions for pets. Certainly, it's better for the pets. But I think it's also much better for the emotional health of a family. And that whole range of family members from the small children understanding, "This is how life works. That we have these moments. We have the decisions to make, but we do what's best." I think this is just so needed. I'm glad to get this out there on our podcast. Let us know anything else we can do to help promote what you're doing. And certainly come back if there's information you want to share any updates, any final thoughts for our audience, Shea?

DR. COX  37:03 
A parting thing that I would love to leave people with is to just trust your heart. Bceause so many times in hospice, people will say, "Gosh, you're just dragging out your pets life and you're being selfish." And one of the things that I come across so often is that when you are in a home and you see this pet and this family together, it's like, "Wow, no one's suffering. There's such happiness and love here." But so often, our perceptions can be persuaded by outside influences. But the thing with outside influences is they're seeing such a small little snapshot of that big picture. And they're making judgments on that picture instead of the whole picture. And, so, you know, trust what you feel. Trust your love. Do your own research. Be your pet's advocate. Don't hesitate to reach out to other providers or other people if you need answers for things. There's such a growing movement in hospice and the veterinary sphere. Especially over these past five years that there's a good chance there's someone in your area that can help with that. And that's one of the resources InHomePetEuthanasia.com. It's not just euthanasia, but hospice providers, also, that's a really good resource for people. That was a long, long way around to just really just be yourself and your pets advocate at all times. And because no one knows your pet better than you do. And that's so important.

PHIL   38:44 
I have no problem whatsoever with the length of your response because it was all important information that again, I thank you for sharing. You mentioned another website there. And you've mentioned several throughout this discussion. I'll make sure those are linked in the description for this episode, as well as a link to the interview that I referenced with Jesse Shroyer and her hospice foster with Huck. Dr. Shea Cox, thank you for joining us today.

DR. COX  39:11 
Thank you so much. Thank you for helping me spread this important message. I really, really appreciate it.

PHIL   39:22 
I'm Phil Hatterman and you've been listening to Dog Words presented by Rosie Fund. Thank you to Dr. Shea Cox for sharing her experience and insight. Links to her websites and the In Home Pet Euthanasia Directory are in the description. There's also a link to our interview with Jesse Shroyer where she shares the touching story of her hospice foster, Huck. Please share this episode of Dog Words and any other archived episodes you enjoy with your friends. This helps us grow our audience.

Next time on Dog Words we talk to the founders of the entertaining and educational Canine Stars.

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