This article answers requests about how to set up "pawspice" (hospice services) following the article, "Helping Clients With the Long Goodbye" (November 2006). It featured a thoughtful letter from Kimberly Fox sharing her feelings about Rennie, her Golden Retriever with terminal cancer. Rennie entered our pawspice program, which provides comfort care for both the family and the patient. Pawspice provides clients with end-of-life care and staff with a protocol that validates a mutual willingness to endure its special purpose. Pawspice is actually a philosophy which can be personalized to fit into your own practice. The human-animal bond is a celebrated, life-enriching relationship that an increasing number of pet caregivers want to nurture and cherish at home to the end. Our clients need and want us to facilitate and lengthen the process so they can spend as much quality time as possible with their beloved pets before the inevitable loss. A well-conceptualized, creative and palliative pawspice plan is often the very best medicine that our profession can offer a terminal patient. When pets approach their final days, their caregivers can be very emotional. They suffer from anticipatory grief, interruption of routine and financial outlay. Since pets are considered family members, it becomes the veterinarians' societal responsibility to console clients and provide comfort medical care for their pets. With all this in mind, you can set up your own pawspice service at your hospital. You can improve your end-of-life services and quality of life support for terminal patients. Maintain Quality of Life You can adopt my proposed HHHHMM Quality of Life (Q of L) Scale to measure seven special parameters. The acronym stands for Hurt, Hydration, Hunger, Hygiene, Happiness, Mobility and More good days than bad days. Each parameter is measured from zero to 10. Evaluate each parameter and try to alleviate each problem by at least 30 percent to 50 percent. This scale is a guideline to help clients determine for themselves when a pawspice plan is good for the pet or when it is time to make the final call for euthanasia. Using the Q of L guidelines, pawspice workers would give counsel and help pet owners face their issues of letting go. Pawspice also encourages clients to create and enjoy special moments and treasure the final days with their best friend. We all have preconceived notions, biases and ingrained feelings regarding terminal patients. The pawspice philosophy must overcome a profession-wide defeatist attitude about end-of-life supportive care. We need to change the old way of thinking and minimize the utilitarian knee-jerk impulse to rank euthanasia as the first, second or third best option for clients with terminal pets. Clients want advice. They don't expect us to prematurely terminate their pet without offering them reasonable options. Pawspice offers pet owners informative, supportive, palliative options and demonstrations that teach complete home care for the failing pet. Pawspice prioritizes the importance of multimodal pain control and helps family members understand, detect and respond to the signs of discomfort and pain in their pet. Animals think in present time, and if their pain is not controlled properly, they suffer needlessly with no hope. If pain is refractory, then it is kindest to elect euthanasia. Join the International Veterinary Academy of Pain Management (IVAPM), attend their lectures and review their list serve discussions for "true grit" pain control. Dr. Robin Downing, author of "Pets Living With Cancer," published by AAHA Press, is the president of IVAPM. Plan Ahead A pawspice plan commits staff to providing a comprehensive professional end-of-life care service. The program set up in your hospital should compassionately provide education, advice and meticulous home care instructions for caregivers. Staff must work with clients' unique inhibitions and concerns, teach them to give medications, SQ fluids, injections, and show them how to feed and clean their ailing pets. Home care for pets with incontinence or paresis is a task certain pet owners want to tackle. In pawspice, owners are taught to avoid decubital ulcers and how to use hoisting straps, harnesses, pet carts or wheels, ramps, soft bedding, egg crate mattresses and diapers. Pawspice teaches clients how to express the bladder and give hind-end baths as needed. Pets with compromised respiration may benefit from oxygen therapy using portable oxygen tanks. Pawspice would teach clients to use a stethoscope and listen for troubled breathing and fluid sounds. Some people react with fear or nervousness at the sight of a growing tumor, blood, oozing wounds or bandage changes. Others cringe at the sight of needles. The pawspice team is accessible to comfort clients about their concerns. For example, one client called last night because his cat's tongue tumor would not stop bleeding. I advised him to apply digital pressure in the sublingual space and use cornstarch mixed with water under the tongue to help coagulation. Veterinarians and staff can kindly and respectfully enter terminal pets into pawspice care programs at their hospitals with the goal of sustaining quality of life for patients during the last days. Reaching Out Pawspice doctors reach out to validate the human-animal bond and help support the emotional needs of all family members, especially young children, teenagers and upset clients who must say goodbye to their pets. Many pet owners don't realize that they are cheating themselves out of quality time with their pet when they become so upset. They don't know how to deal with their anticipatory grief over the pending loss and may respond with a wide range of emotions from panic to a complete shutdown based upon their personality type, their marital and family situations and other issues that are going on in their life. Be sure to have a professional counselor in mind to recommend to clients who may need help. Pawspice consultations instruct clients to create joyful moments each day for the ailing pet. It encourages clients to grasp the value of good moments and present-time thinking and helps clients enjoy their pet for the moment. Nurture Human Bond Many pet caregivers also bond with their veterinarian and staff members because of the routine hospital visits and intimate interactions. They have social contact and purpose, which will end abruptly when the pet dies. "I know that when Mitzie dies, I will fall into that dark pit," said Roberta Karsch, a pet owner whose beagle was diagnosed with liver cancer. Pawspice is more than an extended farewell to the pet, it is a farewell to connections and supportive relationships with you and your staff. Pawspice consultations help family members identify and deal with their feelings of guilt, sense of duty and remorse as their pet encounters problems as the disease progresses. If There's a Will, There's a Way The most important ingredient to look for in oneself, in the hospital staff and in the pet owner is willingness. When you hold a pawspice staff meeting, ask, "Do we want to be a compassionate veterinary care facility with a pawspice program? Would our nursing and reception team be supportive of pawspice families?" Appoint one special staff member as the "pawspice support person" for a certain pet and its owner or for a specific time period. Ask clients to direct phone calls and concerns to their designated staff member or to members of the clinic nursing team. Nursing staff can handle most of the phone calls regarding home care problems. Appointments should be made weekly or bimonthly for the doctor to recheck each patient. The doctor needs to monitor disease progression, answer major questions, adjust or add medications, discuss client and patient well being, and make Q of L assessments. Pawspice is about more care at the end, not less. Dr. Villalobos is a member of the American Assn. of Human-Animal Bond Veterinarians and is on the editorial review board of the Society for Veterinary Medical Ethics. She may be contacted at dralicev@aol.com. <HOME>
