Hospice Care in Dogs
Marlene Grass, RVT, CMT
Bringing a pet into our lives is a joyful and rewarding experience. As people continue to embrace the giving spirit of the animal, we take on ethical and moral considerations; they are a part of our family.
The concept that an animal is "property," "just a dog" is no longer accepted by many people. When a pet becomes chronically or terminally ill, whether with cancer, immune diseases, kidney disease, liver disease, diabetes or other ailments, some difficult decisions need to be made. Some people feel that euthanasia is the best alternative.
However, the number of people who prefer to help ease their pet through the remainder of their days is growing. These individuals feel that it is not their choice to end a life. Instead, they would rather care for their pet, provide support and allow their companion to gracefully pass away. This type of care, referred to as hospice, has been common in the human health field for many years. It is now becoming more and more accepted in our pets.
Caring for the terminally and critically ill can entail numerous tasks. The concept of hospice care has historically been thought of in connection with people. Many centers around the country and the world have been established through the human health care system to deliver hospice and palliative care. This care is done in conjunction with doctors and nurses in a facility for the aged, hospital or in a private residence. With the family acting as caregiver, the person is aided in the basics, grooming and appearance, exercise and physical therapy, nutrition and feeding, medication, fluid therapies, pain acknowledgement and remedy and general quality of life. This knowledge of hospice care is now being applied to our animal companions.
Once the decision is made not to immediately perform euthanasia, the owner of the pet is then responsible for providing care. The owner or caregiver is not alone in this activity. Their support is the veterinary community, friends and neighbors. The veterinarian is available for examination, consultation and to prescribe and administer medical treatment. They may or may not make house calls. The veterinary technician is available to continue medical protocols, and to assist in the recognition of changes in the patient. The veterinary technician (nurse) can assist the caregiver of the terminally ill in many facets. With hospice care the quality of the pet's life is carefully monitored.
The amount and timing of medications and/or fluid therapy is crucial to the pet. Is he/she receiving medical treatment and supportive care correctly? How are the treatments or medications applied? Does he/she need oxygen support? Might there have been a change in the condition of the patient, and the veterinarian needs to be notified? Has the caregiver introduced homeopathic care to the pet? Could the patient be having a reaction to treatment? The nurse assisting the caregiver with consistent visitation and care of their pet will be able to observe these changes, sometimes more rapidly than the caregiver or the owner. Although medication and fluid therapy is a great or major part of health care, relief from pain is always one of the most important aspects of hospice and palliative care.
Palliative care is concerned with relieving pain. In the terminally and chronically ill pain relief can make the difference as to whether the pet and the caregiver can manage. There are some pain relief medications that only the veterinarian or the nurse will be allowed to administer directly to the patient. The caregiver can give other medication alone. The quality of life not only involves medication, but other therapeutic needs.
The activity level and ability of the patient is also of great concern. If the pet is not active and cannot move, roll over or walk, assistance is needed. Different walkers and lifting slings, boots, harnesses and water therapies, aid the patient and the caregiver in movement. Movement of the pet helps to stop bedsores or pressure sores, fluid build up in the lungs and fluid accumulation in the limbs. Physical therapy that may include range of motion, passive joint movement, massage or aqua therapy, are most often more productive with a certified therapist or practitioner, than done alone by the caregiver. Playtime is also needed (no matter how delicate the pet is) in order to keep him alert. Changes in the routine can cause anxiety and behavior changes for all involved.
The patient needs to eat. Often, more calories are needed to maintain the body and mind of an ill pet than a healthy one. There are many ways to give nutrition to the terminally ill. Feeding tubes of various kinds, hand feeding and syringe feeding, take time and need cleaning frequently. Some pets may need to be fed elevated or in a standing position, to aid them in acquiring the food and for digestion. Often the caregivers cannot do this by themselves. Different types of diets, or liquids (manufactured or homemade), or a combination of them are given.
Grooming is an often overlooked aspect of hospice care. A bath, nail trimming, brushing the teeth and cleaning the ears, eye and nose can help the pet feel better. Removing hair mats and trimming long hair will improve their attitude. Many pets have a difficult time going outside to urinate and defecate. These pets need diligent cleaning and protection against urine scalding. These things do not sound extremely pressing in light of the circumstances, but they are to your loved one.
Your pet's sleeping or living area may need to be supported with cushions or pads. Elevated beds, beds on the floor, and beds that may have heat, water or air circulating can help them maintain a certain body temperature and increase their circulation. Certain types of padding will help control incontinence problems. The area in which the patient's bed is located is also important. A pet that has been active and spends the majority of his time in the midst of the family should continue to do so. A bed placed out of the way can tend to be detrimental to the pet's well-being. This will allow other family members to visit frequently. The interaction between pets in a multi animal home is still very important and should be somewhat supervised, just like with children.
This is a brief idea of some of the concerns that hospice care entails. Taking the responsibility to care for the terminally ill can take a toll on the caregiver as well. Build a support network and talk to them often. Find a veterinarian willing to assist in hospice care. Allow a hospice veterinary nurse (certified technician) to help you care for your pet. Watching for respiratory, digestive and neurologic concerns with your pet, as well as administering medications, exercising, grooming, feeding, etc., is overwhelming. But not impossible! You are not alone.