Palliative care and animal hospice

If your pet has been diagnosed with a long term condition that can’t be cured or have been told by your veterinarian that the end of your pet’s life is approaching, it is time to begin talking about palliative care and hospice support. It is really important to focus on keeping your pet comfortable and for them to be able to enjoy a normal daily routine throughout this time. Your veterinary team can help provide medications and therapies tailored for your pet and make sure that everyday is the best it can be. Quality of life is very important in palliative and hospice care so now is the time to begin talking about next steps.

Palliative care is a form of medical care intended to improve the quality of life for your pet without actually curing the disease or illness itself. These therapies may be the sole method of treatment or they may be used in conjunction with more treatments aimed against the disease process itself. Some examples of palliative care include medications for pain, nausea, anxiety, breathing trouble, organ disease but there are many others. There are many types of palliative therapy including acupuncture, massage, minor surgery and laser treatments. The focus should be on identifying what it is that is causing your pet most distress and setting a care plan to minimize or alleviate this. The better your pet feels the more they will want to engage in normal activities.

Quality-of-life refers to the ability to do the things we love to do, and for our pets this is also true. Quality-of-life for our pets may include playing with a ball, following you around the house, doing tricks for food, riding in the car or just sitting in the sun in their favorite spot. Palliative care is used to improve and/or maintain a pet’s quality-of-life. Your own quality-of-life when nursing a chronically ill pet is also an important consideration. It is essential that you can talk openly and honestly with your veterinarian about how your pet is. In most cases, quality-of-life discussions are best had early on in the disease process to develop an appropriate care plan. Successful implementation of palliative therapies can significantly extend a pet’s life and keep them comfortable for much longer than expected.

Animal hospice is a philosophy of care that provides comfort at the end of a pet’s life. It begins when a terminal disease is diagnosed or in aged animals where natural death is approaching. Palliative comfort care is provided for the dying pet and emotional support and education is provided for the family of caregivers.  Animal hospice is about keeping options open throughout the end-of-life journey and preparing for death.  Death itself can happen naturally with hospice support or via euthanasia if suffering becomes too great.  Animal hospice requires close monitoring of the pet to minimize suffering from pain, anxiety, and other medical problems and a team approach to care is helpful. Talk to your veterinary team and ask if hospice care is right for you and your pet.

As a care giver it can be very hard to see your pet in pain or to be worrying about whether you can recognize pain in your pet. It is hard to know how many cats and dogs with chronic or terminal illnesses do suffer with pain. Pain can stem from sore muscles, bad teeth, lingering wounds, cancers, and just about anywhere in the body where inflammation or toxin build-up is present. Understanding which behaviors in your pet are normal, abnormal, or new will help you pinpoint sources of pain. Pain score assessment tools can also be used. Signs of pain in pets include:

Lameness                     Licking sore spots
Panting                          Loss of appetite
Dilated pupils               Reclusive behavior
Tucked tail                    Aggressive behavior
Reluctance to jump     Tender to touch
Poor grooming             Muscle loss

Once pain is identified, a pain-management plan should be established to minimize it. Palliative care for pain can come from combinations of therapies including:

Medications
Nutritional support
Physical rehabilitation
Acupuncture/acupressure
Elimination of environmental stressors
Weight management
Thermal modification

Comfort comes from minimizing physical and emotional pain and distress. In palliative and hospice care, it is important to take each day as it comes and ask yourself “What does my pet need to be comfortable today?” If they are painful they need pain relief; if they are nauseous, we give medications to minimize it; if they are feeling stressed and anxious, we find ways to calm them. If a time comes when, no matter what is tried, we cannot relieve suffering, there is always the option for euthanasia to humanely and gently end life.

Decisions are best made taking into account opinions from everyone caring for the pet. Open, honest communication with all involved will help keep the goals of care at the forefront. Before choosing palliative care, a decision has to be made whether to attempt to cure the pet’s disease. If cure is not possible, palliative care can be started to maintain comfort for as long as possible. For hospice care, decisions around end-of-life and euthanasia need to be made. Who will the primary caregivers be? Are there any financial or time limitations to providing care? When death comes, what are the wishes for aftercare such as burial or cremation? Talking about these things early on is important and will make for a better experience for everyone.

Pet loss support is an important part of palliative care and animal hospice. The love we feel for our pets is very strong and sadness over their loss can be overwhelming. Even before death, it is natural to experience anticipatory grief as you anticipate the loss. This form of grief can make it hard to function in our daily routines similar to the grief we feel around actual death. Stages of grief include anger, depression, denial, bargaining, and acceptance. Many counsellors and therapists specialize in pet loss and numerous books have been written on the subject. Ask your veterinarian about resources you can access.

Palliative care can help keep your pet comfortable even in the face of illness. Animal hospice is a combination of both physical and emotional support during the dying process and is designed to maintain the human-animal bond right up until the end. Through education and daily support, the dying process, while a sad time, can be very enriching and filled with joy. By taking each day as it comes, comfort care can be given and quality-of-life maintained for as long as possible. If a time should come when euthanasia is needed, it’s an option to relieve suffering. Talk with your family about the goals of care and things that may affect your ability to provide it. Together with your veterinary team, you can establish the right palliative care or hospice program for you.