Originally published in the August 2015 issue of Veterinary Practice News. Right along with baby boomers, the pet population is aging as well. According to the U.S. Pet Market Outlook for 2014-2015, approximately 45 percent of dog owners have a dog aged 7 or older, and 46 percent of cat owners have a cat in that age bracket. Life with a senior pet has many joys, but it also comes with age-related health problems and, eventually, the recognition that a pet's days are drawing to an end. Not that long ago, owners would find themselves contemplating euthanasia sooner than they might like, but veterinary hospice and palliative-care programs now offer them a chance for a greater quality time with a dog or cat before the need to say goodbye. A Growing Need for Hospice Care Hospice is a philosophy of care that emphasizes quality of life over quantity of life. The idea of hospice for pets was originated by veterinary oncologist Alice Villalobos, who refers to it as "pawspice." She says veterinary practices and communities can benefit from the emerging specialty. "Only five percent of veterinarians offer professional services for end-of-life care. There's a huge unmet need for more compassion and end-of-life veterinary medical services for companion animals diagnosed with life-limiting disease," Villalobos says. Veterinarians may recommend palliative care or hospice as a good choice for a pet in a number of situations. Sometimes, a pet resists or no longer responds to additional diagnostics or treatment. In other instances, family members may no longer wish for the pet to undergo treatments that are invasive or uncomfortable. They may have particular goals for the end of a life that are not met by the traditional approach of "cure, fix, extend life until the very end." Those people often seek a different approach as soon as a pet is diagnosed with a serious illness, says Katherine Goldberg, DVM, whose practice focuses on end-of-life care. "Palliative care and hospice are typically initiated when treating a condition aggressively is deemed no longer in the pet's best interest," says Robin Downing, DVM, a pain-management specialist, who serves on the American Animal Hospital Association (AAHA) task force, creating guidelines for palliative care and hospice for pets. "The true niche for palliative care and hospice is in that 'space' between withdrawing curative care and the time for euthanasia," Downing says. "Those of us who advocate palliative care are outspoken that we need to empower veterinary clients to assist their pets to 'live until they die.' " Choosing Between Hospice or Palliative Care While choosing hospice or palliative care is acknowledging that nothing more can be done to cure a condition, it does not necessarily mean that the end is near. Villalobos recalls one hospice patient, a dog, who lived three years with nasal cancer after receiving chemotherapy. "Every week, he did 10Ks with his owner," she says. The terms hospice and palliative care are often used interchangeably, but Dr. Goldberg describes them as distinct disciplines with a great deal of overlap in their philosophy of and approach to care. She describes hospice as specialized palliative care at the end of life, distinguishing it from palliative care for any disease at any time along the course of the disease. For instance, hypertension can't be cured, but it is treatable with medication, so it is technically palliative care. A Change in Vocabulary Often, clients are told, "There's nothing more that can be done." That's a phrase that Dr. Goldberg would like to eliminate from the profession's vocabulary. "There is always something that can be done, even if it is not cure-oriented," she says. "In addition to pain management, we need to be more specifically addressing symptom management, even if we may not know why a particular symptom is occurring." Treatments and pain-management techniques for pets in hospice run the gamut. They include thoracocentesis for pulmonary effusion; debulking surgery, when appropriate, to reduce the size of a tumor that can't be cured; providing medication to relieve nausea; using physiotherapy techniques and therapeutic laser treatments to promote comfort and mobility; and hygiene management. How to Get Your Clients Involved Clients can learn to monitor a pet's respirations and identify labored breathing. Some families are willing to provide oxygen therapy at home for ailing pets or to learn how to administer fluids for cats with kidney disease. Cats who have difficulty eating may do well with esophageal feeding tubes. Appetite stimulants or hand-feeding can help anorexic pets resume eating. Environmental enrichment might involve creating comfortable resting spots, taking pets for "walks" by pulling them in a child's wagon and ensuring that they stay engaged in family activities if they enjoy that type of contact. The dog with nasal cancer breathed easier at night after his owner taught him to sleep holding a tennis ball in his mouth. Villalobos says the technique helped to relieve the difficulty the dog had breathing. Another of her clients rode his dog around in a bike basket when he was no longer able to go for walks. With the client's consent, be willing to try treatments that may help improve a pet's comfort. A Focus on Comfort "Sometimes in the absence of a diagnosis, we need to trial-treat judiciously and see if there is a clinical response," Dr. Goldberg says. Hospice is always about providing comfort for pets and support for owners. Prevention and management of pain and other symptoms is the number-one priority, Dr. Downing says. Unlike hospice for humans, veterinarians and pet owners may relieve unmanageable suffering with the gift of gentle euthanasia. Pets should never be allowed to suffer until they die. Keep quality of life at the forefront when discussing end-of-life care for a patient. The use of the quality-of-life scale can help clients feel validated and justified as they make decisions. No formal training program exists for introducing palliative care and hospice into a practice, but information on the subject is readily available. The AAHA, American Association of Feline Practitioners (AAFP) and American Veterinary Medical Association (AVMA) all provide guidelines for pet hospice and palliative care. The guidelines address such issues as appropriate circumstances, family dynamics, recordkeeping, grief counseling, discussions about fees and more. The International Association for Animal Hospice and Palliative Care and the International Veterinary Association of Pain Management are also good resources. Seminars on the topic are available at more and more veterinary conferences, says Dr. Downing, who can frequently be found teaching the sessions. Adding palliative care and hospice to a veterinary practice calls primarily for a shift in attitude. It's a recognition that there is a space of time between withdrawing cure-focused care and delivering euthanasia. Providing these services is a compassionate gift to clients and patients. "This is the way for us to support families during the most difficult time of their relationship with their beloved pets," Downing says.
