When it comes to end-of-life care for our beloved pets, decision making is often met with anxiety and despair. What many do not realize is that there is often time prior to euthanasia or death when hospice or palliative care can provide support, comfort, and improve the quality of life for the time a pet has left. When we think of “hospice care” in human terms we think of the days leading up to death. In the pet world, that term has become associated with the comfort care given in the days/weeks/months before death, with the goal to provide relief and improve the quality of life. This in fact is more accurately termed “palliative care”, where we are palliating, or relieving symptoms related to disease. I am personally drawn to the all-encompassing term “end-of-life care” to include the final chapter of a pet’s life from the time of a terminal diagnosis to maximizing quality of life and keeping the pet comfortable, up until the decision is made to say good-bye. We have veterinarians and technicians who seek out advanced training in hospice and palliative care to help guide and support families through this end-of-life journey. How do you know when it is time to reach out for this help?
Terminal Diagnosis
Learning that your beloved pet has a terminal condition can be confusing and bring up a multitude of questions… “What do I do now?”, “Will she suffer?”, “How much time does he have left?”, “What do I do if there is an emergency?”. Seeking out veterinarians with advanced training in hospice/palliative care shortly after the diagnosis not only answers initial questions and helps to formulate a plan but lays the foundation for support and guidance moving forward. The end-of-life chapter is a very dynamic journey and conditions can change quickly often necessitating a plan b, plan c etc. Having an established veterinary hospice team who has been with you since the initial diagnosis allows for a close, supportive relationship that can best navigate changes as they occur.
Declining Quality of Life
What if your pet does not have a “terminal diagnosis” like cancer, or organ failure, but instead is tired, struggling, just doesn’t seem like themself? Or seems uncomfortable but maybe isn’t quite to the point of euthanasia? This is a wonderful time to bring in a hospice/palliative care team to focus on pain management, environmental changes and mental enrichment and subsequently help you determine when the quality of life is no longer where it should be for your pet. A good quality of life for their pet should be at the forefront of every owner’s mind, whether the pet has terminal diagnosis or not. For those pets who are ailing, a knowledgeable veterinary hospice team can offer input on quality of life parameters, and support a family when a declining quality of life warrants euthanasia.
No Longer Responding to Treatment
Advances in modern medicine have not only helped humans, but also our animal friends. Because of this, pets are living longer, and with more complex diseases and conditions. Unfortunately, no matter how hard we try, the disease will always surpass our medical treatments. Owners may feel lost at this point, with no place to go, having already tried everything. While there may not be anything more medically to do in terms of the disease, the hospice/palliative care team can still be quite helpful as we move from ‘cure to comfort’. Comfort care within the home, along with education, support and guidance will help you navigate this final chapter.
Symptoms and Potential for a Crisis
Understanding the trajectory of your pet’s illness or condition is extremely important. Knowing what to look for that indicates progression of disease is extremely valuable as cues can be very subtle. Does the pet have a disease with a fast progression, such as some types of cancers? Or is it a condition such as kidney failure that may continue with a slower, longer decline? How might a pet look who is reaching the next stage in the disease? A thorough education on disease trajectory and symptoms is an important part of the hospice/palliative care support. One of the greatest fears of a pet owner is the thought of an emergency in the middle of the night, or at a time when they don’t have access to their regular veterinarian or end-of-life care veterinarian. Part of the hospice/palliative care plan involves planning for those “what if” scenarios. If appropriate for the pet’s condition, many hospice veterinarians will discuss “comfort kits” with owners. These are kits of medication (often injections) to be given by the owner in case the pet goes into distress. Examples that may warrant comfort kits are pets in congestive heart failure who may suddenly have difficulty breathing, or dogs with bone cancer who may break their leg. I have found most of my hospice families do not need to use the comfort kit, but they are all grateful they had something on hand just in case of emergency. For those who have used it, they have been thankful they could provide relief until we could arrive for the final good-bye.
Pain
Having a beloved pet in pain is a worry for everyone. Knowing how to tell if a pet is painful is a tool that needs to be taught to families early in the end-of-life journey. Animals are inherently protective of themselves when it comes to pain and discomfort and are adept at hiding cues. Pets may have significant pain without whining or crying… body language, routines/habits and interactions with family members often give plenty of information. A benefit of having an in-home hospice/palliative care consultation is that it allows the veterinary team to see the pet in their home surroundings which often gives a more accurate picture of pain than attempting to tease away pain signals from anxiety or fear of being in a clinic. Empowering a family to not only recognize the subtle signs of pain, but also provide a stepwise plan on how to manage each step of pain is a critical piece of the hospice/palliative care plan.
Recognizing when your pet is ready for hospice/palliative care may seem like an acknowledgement that the end is near. And for some, it may even feel like a failure, or an act of giving up. I firmly believe it is the complete opposite! It is giving your pet the best chance possible at increased comfort for the time they have left. And it is giving you access to guidance and support during this final journey, to empower you to make the best decisions possible, on behalf of your loving companion.