Yesterday I saw one of my favorite patients, a 14 year old lab mix with arthritis named Ribbit. Ribbit’s original name was Scout, but his owners changed it when they discovered his passion for the frogs, turtles, and (unfortunately) koi in their backyard pond. On good days, Ribbit does still track the occasional turtle, but for the most part, he is now living a life of indoor pampering.

His owners have rearranged their lives around Ribbit’s needs. They never leave him alone in the house because they don’t want him to fall and get stuck somewhere. They sleep in the living room with him because he can no longer make it up the stairs to the bedroom. They cook his meals and run out for sushi-grade salmon when he needs a special treat.

I see Ribbit weekly for acupuncture which, in combination with his conventional pain medications and supplements, keeps him comfortable and as mobile as possible. Performing treatments in his house feels like working in a spa. We sit on a very comfy orthopedic dog bed, the lights are soothingly low, and there is gentle music playing in the background. Ribbit always greets me then makes himself comfortable in the den. During the 20 minutes that his needles are in place, he either falls asleep or places a persistent paw on my arm to indicate that I should continuously massage his belly.

The whole experience is very relaxing for both of us. This, however, is not the norm.

For one thing, the environment is not always peaceful and quiet. I used to practice in a traditional veterinary clinic, and it was hard to get patients, particularly cats, to relax with other animals barking in the lobby and machines beeping and buzzing in the back. It is generally easier in the pet’s home, but not always. I have performed acupuncture with toddlers chattering away and builders stepping over us with supplies for the bathroom cabinets. I have played ball with the exuberant housemate of a patient with one hand while trying to calm my patient with the other. And I have come to dread landscapers. I can’t tell you how many times an otherwise peaceful treatment has been interrupted by the arrival of the “lawn guy”.

Another challenge is keeping my patients still. I have one patient, a feisty 16 year old, who allows me to place her needles and then walks a circuit around her house for 20 minutes. When my 15 year old chihuahua patient has to go to the bathroom, there is no stopping him. His mom and I follow him around the yard and watch for any needles that fall out along the way. The needles I use are designed for moving patients. They have brightly colored handles that show-up well on most flooring surfaces. Finding them in grass, however, is challenging.

Lastly, not all of my patients love their treatments. To be fair, these are typically pets that do not like being handled by anybody but their owners; I respect that. When I was studying acupuncture and somebody asked my teacher how to place needles in an aggressive cat, he answered, “Use the flying needle technique. Just place it as fast as you can and get out of the way!” I believe that stress mitigates the benefits of acupuncture, so if a pet really seems uncomfortable with the treatments, I recommend discontinuing them. Most of my skeptical patients can, however, be won over by a sufficient amount of attention and treats. I see a Bernese Mountain Dog named Vuitton who has never liked veterinarians. His dad and I have figured out that I can do his treatments as long as he gets one treat per needle. Vuitton has gotten used to this arrangement and now seems genuinely happy to see me when I come over!

It might seem like I am complaining about my job; I am not. I love what I do. It is a challenge to learn the idiosyncrasies of each patient and to find the best way to get them the treatments they need. It’s rewarding when the treatments go well and the owners see results. And it’s good for me physically. Who needs yoga class when your job requires you to contort between 100 mastiffs and recliners on a regular basis? Not me! Well, I could probably use some yoga - but you get the idea!

Quality of life. I talk about this topic almost daily. Defining what quality of life means for a pet and understanding how to monitor it are two of the most important aspects of hospice care.

I usually tell owners to try to think of three to four things that their pet loves to do or behaviors that indicate that their pet is happy and engaged. I offer ideas of what these might be - greeting people when they come to the door, barking at squirrels, or getting excited over a midday snack. I then ask my clients to keep a calendar. If their pet exhibits two or more of the selected signs in a given day, they mark the day as good. If their pet shows few or none of the signs, they mark the day as bad. If they reach a point at which there are more bad than good days in a given week, we start talking about the next steps.

People sometimes find it hard to pick three or four things, but I do not have this problem with my own dog, Madeleine. I know exactly what her quality of life markers are. For one thing, she loves to torment the Dachshund that lives above us. She watches for him from our windows and barks ferociously when she sees him. I have even seen the Dachshund’s owner hide behind a bush with him to avoid encountering us on a poorly-timed walk. Madeleine also likes to play with her stuffed weasel. It is a hand-me-down weasel toy that she has had for years, and she has rejected many brighter and squeakier toys in favor of its well-worn floppiness. But above all, Madeleine loves her morning toast.

She prefers white bread. She likes it freshly toasted and liberally buttered. She won’t eat it if it is burned. And she abhors rye. On the rare occasion that rye bread crosses her lips, she spits it out melodramatically and goes back to bed. But when the toast is just right, there is almost nothing more satisfying than watching her eat it. She chomps away at it with a look of utter joy.

A diabolical Dachshund, a stuffed weasel, and toast. I wish the things that make me happy could be so simple. But why aren’t they?

I have been thinking about this a lot. In our busy modern lives, it is easy to get caught-up in the perception that the more we have, or the more successful we are, the happier we will be. It takes effort to stop and appreciate the little things that have meaning and that make our lives worth living. I believe that, if we can identify these things - our quality of life markers - and put our energy into them, many of the societal ideas of what we need to be happy will fall away, and we will be able to enjoy every day just a little bit more. So, with this in mind, I began making a list. My entries include (but are not limited to) the first sip of coffee in the morning, hearing my husband’s voice when I come home after a long day, hearing a great story, and falling asleep with my cat, Virginia, leaning against me and purring.

This exercise has been really helpful. As you can probably imagine, my days can be emotional and can take a toll. But remembering my list and acknowledging the importance of these everyday pleasures seems to boost my spirits and keep me going. I highly recommend it!

This morning, Madeleine and I shared toast. I’ve been buying a healthy sprouted-grain variety lately. Madeleine doesn’t love it, but she tolerates it as long as it has adequate butter. I tore off part of the crust and offered it to her. She ate it with gusto. As I watched her, I could feel my heart lighten a little. “Toast really is wonderful,” I thought. And the two of us sat chewing in contented tandem.

The Heart Meridian

Adventures in Animal Acupuncture!

The Joy of Toast & Other Thoughts on Quality of Life