Dear Kin, K9 Parents, and Desert Wanderers,

As we left VCA Tiara Rado and headed home on October 2nd, I had my answers. My head was spinning. Cimarron was palliative. How could I make the most of her remaining time? My Facebook post for the day sounds shocked, but optimistic for some quality time with my Little Cim. The shift from recovery to palliative was a huge one for me, because Cimarron was a soul dog.

My initial attitude was that I would make her palliative weeks the best I could. The next morning, I made dog cake, froze goat milk treats and cream cheese daps. She was still sleeping in my bed as I put up baby gates on the stairs and made signs to remind myself to close them each time. The last thing she needed was a tumble down the stairs. I texted Animal ER of the Western Slope in response to their follow-up text from her visit on October 1st to ask about euthanasia services – they called back quickly. I cried but still wanted a plan to get her through the holidays, if possible. I would get a solid plan in the next few days so it would be safe to give her as much time as possible. I would ask the specialist vet for his recommendations for a liquid lasix dose if I had to drive her to ER in Grand Junction urgently. I looked on Chewy to see how much liquid vetmedin cost. I almost put in an order for it – but I could do that tomorrow.

I was also procrastinating waking her up to get her meds down. There could be no pilling, no fight from here out. I eventually woke her up with gentle head kisses(our summer routine) and carried her outside for a short potty stop. As I carried her out, I would say “kiss” and she always happily gave me one. And, when I went to let the dogs in, there she was waiting – I had trained her to go in her dog house and wait while the other dogs took their turns coming in – and she did that. But, she wouldn’t take the pills no matter what I put them in – so I ordered Arby’s and it worked. Whew.

That day was when I started noticing the signs, though. Her respiratory rate had climbed to close to 30 and she was working harder to breathe. As a doctor of nursing practice, I knew what respiratory effort looked like in newborns. Shortly after breakfast, I saw her prancing or stomping on the rug – I couldn’t figure out what she was doing. When I got up, there was a spot of urine there – that isn’t how she normally urinated. Then, sometime in the afternoon, I noticed a small (1-2 inch diameter) brownish spot on her potty pad. It wasn’t urine. Closer to bedtime, she had a small, mucusy stool right in front of me – also not her norm. Then, I found a small puddle of mucusy fluid on the floor of the bedroom right after she came out of there. While IDK for sure, these are likely signs of decreased cardiac output and her body systems starting to shut down. As an experienced clinician, I knew these were signs that she was dying sooner rather than later.

Despite the ominous signs, she had a good day. She slept on my clothes (on the bathroom floor) when I took my bath, as always. She walked about 1 block with the other dogs that afternoon, then enjoyed a stroller ride. And while her night pills took a little coaxing with some human food, she got hungry and ate a full container of her food. Maybe, I thought, she was reacting to the hydrocodone and she still had time. My Facebook post that night talks of picking a time – is it better to avoid any risk of suffering from a rapid cardiac event or allow her to live as long as her quality of life is good? While I was masking my fears in the post, I did say she could have high QOL in the morning and be dead by afternoon. I was in denial, but not.

The next day, I woke up hoping for a miracle – and there was one! She was in bed with sister, Kachina, waiting for me to wake-up, as usual. Staring at me with her bright eyes. I put her and sis on my bed. She wanted to burrow, as usual, so I tented the covers so her airway was safe. Maybe today would be better. I got up and made mini meatballs with lean ground beef to help with morning pills. But, inside I knew – I called my friend, the vet tech at the new local Pioneer ER to talk about euthanasia services. I told them I would send records when I got them on Monday and just wanted to know their routine. Then, I kissed her awake, got my morning kiss, and put her outside for a couple minutes. She waited in her dog house, again. It was bittersweet – her trying so hard to keep her routines.

She would not take her pills even with mini meatballs (although she ate them plain). I tried leftover Arby’s – nope. She gobbled up some of my cream cheese at lunch, but still no pills. Her respiratory rate was above 30 for the first time and there was obvious increased effort to breathe. This was the day I decided I needed some art therapy – so I took her downstairs and worked on painting pumpkins for my business, Art from the Hartt. She slept peacefully in her little purple bed near me for a couple hours. I was watching her breathing, I didn’t count but my clinical wisdom knew it was over 30. AI said rush her to ER.

Instead I tried Tiara Rado, but they directed calls to the Animal ER of the Western Slope. They wouldn’t be able to advise. So, I called Pioneer ER back to ask my friend – but she wasn’t available. A little while later, Cimarron was sitting in front of a window – with the backlighting – I could see her respiratory effort as her head bobbed up and down a bit with each breath. I called Pioneer ER back (about 30 minutes after my last call) and the vet advised me to bring her in for a rate over 45. We weren’t there yet.

Look, I knew there was no treatment for a rupturing heart valve. Rushing to ER meant saying goodbye, and she was still engaged and walking around. So, I decided on a hospice stroller ride. This time, no walking with her sisters. But she watched me out of the back of the stroller and even enjoyed sniffing the air. It makes me smile that I made that decision to savor her last hours.

There was only a gradual change over the next few hours. She eventually took her pills with the left over Arby’s but her interest in meat and food was clearly diminishing. At one point, while she was next to me on the couch, she pawed at the keyboard so I would give her pets, as usual. I was so confused by this – I was like, Cimarron, the mixed messages are killing me. Finally, she drifted into a peaceful slumber next to me on the couch. I could see her breathing out of the corner of my eye – it was not going to be too long, but she was comfy.

Then came bedtime. I let the other dogs out; she didn’t budge – just kept sleeping. I hated to disturb her but she had to be near me so I could watch her for distress. I wasn’t sure if I should take her then or see if she could make it through the night. I was emotionally and physically exhausted. I needed sleep but I would not let her suffer. I decided to move her to her bed in my room and watch her closely – if I needed to drive to Grand Junction during the night, maybe we could both sleep a little first.

When I picked her up to lay her in her bed, she yelped a little. IDK if it was just awkward positioning or if that was the final rupture of her chordae tendineae – I’ll never know. I do know she initially laid her head down on the edge of her bed and watched me. She wasn’t in distress at that moment. She looked peaceful.

I let the other dogs in for bed. We do this treat thing in my room before they go to bed, and I had treats in my hand ready to go. But when I returned to my room moments later for treat time, I saw her sitting up, struggling to breathe. I knew it was time – like someone flipped a switch from her peace 5 minutes before. I felt the weight of an exhausted drive to Grand Junction with her in distress. Then I looked at my watch, and Pioneer ER (5 minutes away) was open for another 70 minutes. I called them and let them know I was headed in. I grabbed my fleece jacket from the chair, wrapped her up and drove to ER.

I went into super protective mode. Some of the routines, like vitals, seemed so unnecessary to me. But, I understand they have protocols. I did get her some blow-by oxygen. She sat on my lap, supported by my arm. She was restless and anxious, but clearly still engaging with noises and not coughing. I tried to calm her with my voice. The vet came in and said her respirations were about 80 at that point. They gave her the shot to relax her. I felt her anxiety melt as she drifted into her final sleep in my arms. I told her stories of our adventures during the 10-15 minutes they waited for full effect. The vet felt that the first medicine might be enough, but she needed the final injection. I felt her go limp. I took 5 minutes to tell her goodbye. Somehow, I was numb and exhausted enough that there weren’t many tears. That surprised me.

I got home just after midnight and gave my other pups their treats. Then I wrote her RIP post on Facebook – it is like the words just wrote themselves from my exhausted brain. Finally, about 2 AM, I drifted to sleep. When I woke up, I was hoping it was all a dream. Maybe she would be in Kachina’s bed, looking up for me. She wasn’t. I put Kachina on my bed and the tears flowed. Kachina immediately offered her comfort. I was glad she was there. I had lost my little soul dog and she had lost her BFF.

Peace, Doc Cathy

Cimarron’s Final Journey (Part 1): What My Dog’s Summer Taught Me About Subtle Respiratory and Cardiac Decline

Cimarron’s Final Journey (Part 2): The Trip, the Morning Collapse, the 2 AM Honking Cough, and the Long Road to Urgent Care

Cimarron’s Final Journey (Part 3): The Good Days, a Missed Diagnosis, and the Cough Returns

Cimarron’s Final Journey (Part 4): The Second Collapse, the Diagnosis, the Stunning Prognosis

This is a series of blog posts discribing my 6 pound soul dog, Cimarron’s, final life journey. I am sharing this to help other dog owners recognize early signs of tracheal collapse and mitral valve disease (with or without congesting heart failure). I may be Doc Cathy (Doctor of Nursing Practice), but I had a lot to learn during these final weeks, including navagating rural veterinary systems. The series starts with her summer red flags, goes through her first collapse and a recovery week where her quality of life returned to nearly normal. I then talk about the second collapse, her hospice days, and euthanasia. The final post covers the grief process when one says goodbye to a soul dog.