Soft eyes looked up at me through a veil of welling tears. “But,” she asked slowly, fighting to find the words, “how do you know that it’s time?”
This is one of the most common and heart-wrenching questions that veterinarians face. It falls under the broad category of Quality of Life. It is complex. It is fraught with emotion. And there is never a perfect, right answer.
Before considering the end of life, we must look at the beginning. All of us are born with a certain amount of energy - like a fully charged battery fresh from the factory. In Chinese medicine terms this is known as “Essence”. In Western medical terms we call it the "mammalian target of rapamycin" (mTOR). Like a candle, when all the wick is used up, the flame goes out, and while disease and stress can certainly shorten the length of the wick, nothing can extend it.
mTOR is a protein associated with mitochondrial function and is associated with canine longevity. Mitochondria are organelles found in large numbers in most cells and are responsible for producing the energy currency of the body, ATP (adenosine triphosphate). Some of you may be familiar with this acronym either because you have been subjected to my spiel concerning cold laser therapy or because you were a fan of the Wrinkle in Time books growing up. When mTOR is not functioning correctly (i.e. poor nutrition, stress, medications) cellular energy falters and can eventually result in chronic diseases such as Type II diabetes, obesity, metabolic syndrome, several types of cancer, and chronic fatigue syndrome.
As holistic pet parents we would prefer to avoid chronic diseases and head off cellular energy loss as early as possible. We can do this by looking at a few subjective and objective biomarkers.
Subjective biomarkers can be illustrated with this acronym - BEAM → Behavior, Energy, Appetite, Mood.
Behavioral changes can include separation anxiety, fears, phobias, and aggression. Cellular energy is reflected by changes in activity, such as getting up to greet people or lengths of walks. Appetite symptoms may present as lower or pickier eating habits. Mood changes can include the pet spending more time alone or barking more frequently. These subjective biomarkers can indicate internal abnormalities before a specific diagnosis can be made.
Objective biomarkers are ones that can be measured and quantified. Decreases in Hematocrit (found on a Complete Blood Cell count, or CBC) and Albumin (found on most Chemistry blood panels) reflect a loss of cellular energy and are often accompanied by generalized muscle loss (sarcopenia). Specialized blood tests such as the C-Reactive Protein test from VDI Lab can measure the amount of generalized internal inflammation in your pet’s body before it manifests as outward physical symptoms.
Whether a pet is suffering from loss of cellular energy due to age or a chronic disease like cancer, a common thread running through them all is that nutrition is a key component in restoring and preserving cellular energy. Adequate, high-quality nutrition and supplementation have been shown to reverse sarcopenia (thus improving strength), improve memory, relieve chronic pain, and bolster the emotional state of mind - specifically, the provision of increased amounts of high-quality protein, amino acids, and omega-3 fatty acids.
Using both subjective and objective biomarkers together can help us assess physiologic function, disease progression, response to treatment, treatment efficacy, and can inform medical decisions. The BEAM acronym is a useful tool for caretakers to assess their pet’s quality of life and can guide conversations with their veterinarian. I personally recommend pet owners keep a “Good Day” and “Bad Day” mason jar on the kitchen counter with a supply of pennies. Each day the caretaker can assess the BEAM biomarkers with their pet and decide whether overall it was a “good day” or “bad day” for them. This act helps remove thoughts and fears from the emotional seat of our brain (the amygdala) to the more rational decision-making part (the frontal cortex).
Deciding when to say goodbye to our companions is never an easy or lighthearted decision. Always look for guidance from your holistic veterinarian and never be afraid to broach the subject. Your holistic veterinarian is on your team and would be honored to help you and your pet navigate this season of life.
“Significance of Signs, Symptoms, mTOR, and Quality of Life”. Feinman, Jeff. AHVMA Journal • Volume 56 Fall 2019