eight month writeup on at-home hospice for our 14 year old golden mix from the congestive heart failure diagnosis through the end last week, because the practical day to day picture of what at-home hospice actually looks like is almost impossible to find when you are trying to decide between hospice and earlier euthanasia and we needed it badly last october

Riley was a 62lb golden retriever / golden mix we adopted from our county shelter at age 4 in 2016. she made it almost ten years with us and she died at home in her bed on june 9 at age 14 and three months, eight months after her stage B2 congestive heart failure diagnosis. im writing this two weeks out from the loss because when we got her diagnosis in october of last year i could not find a single honest writeup of what the at-home hospice timeline actually looks like day to day, and i had to make some of the hardest decisions of my adult life with almost no information that was both specific and not catastrophizing. if this writeup helps one family understand what they are actually signing up for when they choose hospice over early euthanasia for a cardiac senior, it was worth writing.

the diagnosis. Riley started coughing in late september, a soft kind of throat clearing cough that we initially thought was kennel cough. by mid october it was waking her up at night and her energy had dropped noticeably. her regular vet did the chest rads and the cardiac auscultation in the room and then referred us to a veterinary cardiologist (DACVIM-Cardiology, this is a real subspecialty and the consult was $480 with the echocardiogram included). the diagnosis was advanced mitral valve disease with congestive heart failure stage B2 progressing to stage C, which in plain terms means her heart was already struggling and would continue to decline. the cardiologist gave us a candid prognosis of 6 to 14 months with optimal management. we ended up at eight, which was in the middle of that range and which i think is roughly typical based on what she told us.

the daily picture, which is the part i could not find. pimobendan (Vetmedin) 2.5mg twice a day from diagnosis until end, this is the drug that does the actual work of keeping the heart pumping effectively and the difference in her energy 72 hours after starting it was the most dramatic clinical change i have ever seen in any of our dogs. furosemide (Lasix) started at 12.5mg twice a day in october, increased to 25mg twice a day in february, increased to 25mg three times a day in may, this is the diuretic that keeps fluid out of her lungs and the dosage going up over time is how you can see the disease progressing. enalapril 5mg twice a day from january onward. spironolactone added in march at 25mg once a day. total monthly medication cost in october was about $85, by may it was about $215. the cardiology rechecks were $180 each, we did them at diagnosis, then at three months, then six months, then a final phone consult instead of an in-person near the end.

the things nobody warned us about that i wish someone had. one, the nighttime coughing is the marker, not the daytime energy. Riley would have a "good day" with us in the yard and then cough for two hours at 3am, and the cough frequency at night is what the cardiologist actually asks about at recheck. start a phone notes log on day one and write down nighttime cough counts, do not try to remember them at the appointment, you will underestimate. two, the appetite is the second marker and the more sensitive one. when Riley stopped eating her morning kibble in week 28 i panicked and called the cardiologist and she said we were entering the last phase, which we did, riley had about three weeks left from that point. the appetite drop precedes the breathing crisis by 2 to 4 weeks in cardiac dogs and it is the actual early warning. three, you will need a plan for the breathing crisis BEFORE it happens, not when it happens. we had a written page taped to the fridge with the after hours emergency vet number, the address, an alternate route in case the highway was closed, and a pre-packed bag with her medication record. we used that plan twice in eight months and both times in the middle of the night.

the decisions about end of life specifically. we used an in-home euthanasia service (Lap of Love in our region, $475 for the home visit and the cremation arrangement, well worth it) and we made the call ourselves the morning of june 9 when Riley refused her morning food for the third day in a row and could not get up from her bed on her own. she had a peaceful end at home in the room she had slept in for nine years and i would make that choice the same way a hundred times. the part i want to put in the record for the next family. the question of "are we waiting too long" haunted us for the last six weeks and i now believe we got the timing roughly right because riley was clearly comfortable until the last three days and clearly not comfortable for the last 48 hours. the framework our cardiologist gave us for the timing decision was three questions, is she eating, is she drinking, is she able to get up to relieve herself. when two of those three become hard, you have days to weeks. when all three become hard, you have hours to days. it gave us a structure to make the call without spiraling and i pass it along.

total cost across the 8 months, about $3,200 for medications, $720 for the cardiology rechecks, $475 for the in-home euthanasia, and probably another $400 in vet pharmacy fees and follow up labs. roughly $4,800 total which is real money and which we were grateful to be able to spend. if you cannot do the cardiology specialty route the next best version is your regular vet managing the pimobendan and furosemide directly which is more accessible than the specialty community talks about, ask your vet whether they are comfortable managing congestive heart failure without referral and most of them will say yes. the most important thing for anyone reading this who is in the october-of-last-year position we were in, the at-home hospice timeline is real and it gave us eight months that were largely good for riley and that we will be grateful for the rest of our lives