Palliative care is medical care for patients with a terminal illness, with one main goal: to keep them as comfortable as possible for as long as we can.
For dogs, this usually involves active monitoring, regular veterinary check-ups, adjusting treatment as their needs change, and a great deal of day-to-day nursing care at home.
The medical side is important, but so is the care the family provides — helping their dog eat, move, rest comfortably and feel safe. Good palliative care is very involved, and it works best when the veterinary team and family are closely working together.
We start by looking at how comfortable the dog is
When I see a dog for palliative care, I start by looking at the whole patient.
I look at whether they can stand and walk, whether they are able to get up by themselves, and whether they look comfortable when they are resting.
I also look at body condition and weight, because weight loss can be an important sign that a dog is not coping as well as they were before.
I pay attention to how alert and aware they are too. A dog who is settled and interacting normally is very different from one who is restless, withdrawn, pacing or confused.
Then I ask the family what has been happening at home.
Appetite is always important. I want to know whether the dog is still eating well, whether they have lost weight, whether there has been vomiting or diarrhoea, and whether their toileting habits have changed.
All of this helps me work out how well the dog is coping and which parts of the care plan may need adjusting.
A lot of palliative care is about controlling symptoms
The symptoms I spend the most time managing are pain, nausea and inflammation.
Pain in dogs is not always obvious.
They do not have to cry out to be uncomfortable. Sometimes the clues are much more subtle: reluctance to move, difficulty settling, sleeping in one position all day or avoiding normal movements they would usually make without thinking.
In the clinic, I will palpate areas that may be painful and watch how the dog stands and moves.
At home, I often ask owners to look at whether their dog can still sleep comfortably, change position easily and carry out normal little movements such as stretching or scratching.
Nausea can also be easy to miss.
Vomiting is only one sign.
If a dog starts walking away from food, eating smaller amounts, losing weight or frequently lip smacking around food, nausea becomes more likely.
These are the kinds of changes that may prompt me to adjust medication.
What happens at home is just as important as what happens in the clinic
Owners see their dog for far more hours than we do, so what they notice at home is extremely useful.
I usually ask them to keep an eye on appetite, water intake, weight, sleep, toileting, mobility and any vomiting or diarrhoea.
For some patients, breathing rate at rest is also important.
For example, in dogs receiving fluids or dogs with heart or lung disease, I may ask the family to monitor resting respiratory rate. In many dogs, I like this to be below around 25 to 30 breaths per minute when they are asleep or resting comfortably, although the target depends on the individual patient.
What I am looking for is not one isolated bad day.
I am looking for a change in pattern.
If a dog is gradually eating less, sleeping less comfortably, becoming weaker or breathing faster over several days, that tells me much more than one unusual afternoon.
How often I need to review a palliative patient depends on how stable they are.
Some stable dogs may only need a review every few months.
A dog with advanced disease may need to be seen every week or two.
If a patient is deteriorating quickly or not eating, I may need to see them much more often.
Nursing care becomes increasingly important as dogs become weaker
As mobility declines, nursing care at home becomes a much bigger part of palliative care.
A weak dog may need help getting up, walking, eating, drinking and toileting.
For dogs who are becoming unsteady, non-slip flooring and a supportive harness or sling can help.
For dogs who cannot move themselves, comfortable bedding, regular repositioning and good hygiene become very important.
A fully paralysed dog may need to be repositioned every two to three hours during the day to reduce pressure on the same areas.
Dogs who pass urine or stool where they are lying also need to be cleaned and dried quickly, otherwise urine scald, faecal scald and skin problems can develop.
This kind of care can be intensive.
That is why I also think about whether the family can realistically provide it.
If one person is doing everything, they can become exhausted very quickly. Where possible, I prefer care to be shared between several people.
I do not usually expect families to wake every two to three hours through the night for days on end. A nursing plan has to be sustainable for the people providing it as well.
When do we need to hospitalise palliative care patients?
I hospitalise palliative-care patients when they need treatment or monitoring that cannot be provided safely at home.
A dog with uncontrolled cluster seizures may need intravenous medication and close monitoring.
A dog struggling to breathe may need oxygen and urgent treatment.
A sudden deterioration may also be a reason to hospitalise if we think there is something reversible that we can treat.
The decision is different when a dog is in very advanced palliative care and the decline is expected.
At that stage, I think carefully about what hospitalisation is actually going to achieve.
If a dog has limited time left, I do not necessarily want them spending a large part of that time away from their family unless there is a clear medical benefit.
Sometimes day hospitalisation can be a useful compromise. The dog can come in during the day for treatment and monitoring, then return home in the evening to rest in their own environment.
Palliative care plans change with the patient
Palliative care is not a plan that we make once and then leave unchanged.
Symptoms change. Appetite changes. Mobility changes. Nursing needs change.
Sometimes all that is needed is a small medication adjustment.
At other times, the whole focus of care needs to change.
The important thing is that we keep reassessing the dog and responding to what they need at that stage.
Good palliative care is about protecting comfort and time together
Good palliative care is not only about medication.
It is about recognising discomfort early, treating symptoms properly, providing good nursing care and continuing to adjust the plan as the dog changes.
It can be a demanding period for families, but it is also a very precious one.
Once we know that our dog has limited time left, the ordinary things become more important — helping them eat, making sure they are comfortable, sitting with them, letting them rest somewhere familiar, and simply being there.
We cannot get this period back later.
For me, good palliative care is about keeping a dog as comfortable as we reasonably can, while helping the family protect the time they still have together.
Vet-built education. Practical and evidence-led. For informational purposes only; not a substitute for veterinary care. Not for emergencies.